Hemophagocytic Lymphohistiocytosis Induced by Severe Pandemic Influenza A (H1N1) 2009 Virus Infection: A Case Report.

After early outbreaks in North America in April 2009, the pandemic influenza A (H1N1) virus spread rapidly around the world, and even some patients developed certain severe complications. We reported one case of hemophagocytic lymphohistiocytosis (HLH) induced by severe pandemic influenza A (H1N1) virus infection. A 17-year-old girl had acute onset of fever, dry cough, rhinorrhea, and sore throat Her family members and close friends also had the similar symptoms. Anti-infection treatment with penicillin was given after 8 days of the onset of symptoms in the local hospital, and her chest radiograph showed consolidation of the left lung. Then, she was sent to the People's Hospital of Guizhou Province in China and endotracheal intubation were underwent on the ninth day for acute hypoxic respiratory failure. She was diagnosed with HLH induced by severe pandemic influenza A (H1N1) 2009 virus. Oseltamivir, steroids, immunoglobulin, and plasmapheresis were given immediately after admission. After being treated in the People's Hospital of Guizhou Province for 16 days, she was discharged. This experience shows that HLH may be a life-threatening complication for severe pandemic influenza A (H1N1) 2009 virus infection and responds well to therapy.

[Clinical investigation of the clinical management and therapeutic strategies to the first human case infected by influenza A/H5N1 in Guizhou Province].

OBJECTIVE: To explore the optimized clinical management and therapeutic strategies for the survived human case infected by influenza A (A/H5N1). METHODS: All the data of the first human case infected by A/H5N1 in Guizhou province was collected and analyzed. RESULTS: The first case infected by A/H5N1 in Guizhou Province was confirmed by laboratory findings with reverse-transcription polymerase chain reaction (RT-PCR) and A/H5N1 isolation. Patient was healthy in the past and exposed in the environment of living poultry. The initial symptoms was high fever without influenza-like presentation, but with extremity hyperspasmia and conscious disturbance sometimes. A productive cough with a large mount of pink foaming sputum then appeared. The clinical situation was rapidly deteriorated with dyspnea, acute respiratory distress syndrome and atrial fibrillation. Multiple infiltration in bilateral lungs was progressively developed with moderate bilateral pleural effusion. Invasive ventilation was intervened since ARDS on day 8 after sickness. Oseltamivir was kicked off since day 9 after sickness. However, the clinical condition was still exacerbated. High titering antibody of A/H5N1 vaccinated plasma was administrated on day 10 after sickness. The clinical condition (including oxygen saturation, respiratory symptoms, etc.) was improved rapidly. The weaning of ventilation was carried out in two days. Atrial fibrillation was back to normal. The patient was clinical recovery and was discharged from hospital on day 23 after sickness. CONCLUSIONS: The prognosis was poor if A/H5N1 infected human cases developed as acute respiratory distress syndrome with heart injury. However, it could be ameliorated if the plasma of A/H5N1 vaccinated neutralizing antibody was administrated in time or within two weeks after sickness.

[A discussion about the tactics of mechanical ventilation for acute respiratory distress occurring in the first case of influenza A (H5N1) in Guizhou Province].

OBJECTIVE: To discuss the tactics of mechanical ventilation in a human severe case of influenza A (H5N1) complicated with acute respiratory distress syndrome (ARDS). METHODS: The data of the patient infected by the influenza A (H5N1) admitted to People's Hospital of Guizhou Province on January 15, 2009, were analyzed and summarized. RESULTS: The patient, a 29-year-old man, had been healthy in the past, but had exposed to the environment of bird flu before illness. The initial symptom was unremitting high fever, and then the clinical situation deteriorated progressively with occurrence of dyspnea. Pulmonary infiltrates were evident in the left lower lobe on January 19, and rapidly progressed to involve bilateral lungs presenting ARDS-like changes. Mechanical ventilation became the most important treatment among others. The ventilation mode was synchronized intermittent mandatory ventilation (SIMV)+ pressure support (PS) + positive end expiratory pressure (PEEP), following lung protective ventilatory strategies, with low tidal volume. The patient's condition improved day by day without developing multiple organ dysfunction. The patient fully recovered and was discharged on February 6. CONCLUSION: Early detection, early diagnosis, and finely effective intervention are to improve oxygenation by mechanical ventilation with low tidal volume and adequate PEEP are critical to reducing the mortality.