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China –Zhejiang - Emergent H7N9 Clinical Progression to a Fatal Outcome in a 38 Year Old Male

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  • China –Zhejiang - Emergent H7N9 Clinical Progression to a Fatal Outcome in a 38 Year Old Male

    Reconstruction of Disease Progression in Fatal H7N9 Case

    The case described below is case #8. He was only 38 years old. Our condolences to his family and friends.

    Italics are my edits

    March 8 - Patient goes to market and buys suspected H7N9 contaminated chicken.

    March 9 - Patient (presumably in his job as cook) prepares and cooks chicken but he does not eat any. His wife also prepares some this chicken but not become sick. Their sons eat some of this chicken and do not become sick.

    March 10 - Patient begins to experience diarrhea.

    March 11 - Patient still experiencing diarrhea, onset of tiredness & poor appetite.

    March 13 - Too tired to work.

    March 15 - Onset of fever. Goes to clinic and they refer him to hospital. He describes his symptoms as "no appetite, diarrhea, fever".

    March 16 - Patient goes to Chinese traditional medicine hospital in 40 degrees celsius (104 F). He is referred to clinical hospital but he does not go.

    March 18 - Patient goes to clinical hospital.

    March 19 - Patient reports feeling "more comfortable".

    March 20 - Patient is vomiting blood. Diagnosed with pneumonia. Standard pneumonia protocol is started.

    March 21 - Patient put on ventilator. CT scan reveals right side of the bottom of a lobe infection. Patient not responding to pneumonia protocol.

    March 23 - CT scan reveals both lungs were infected

    March 24 & 25 - Experts consult and can not diagnose problem.

    March 25 - Kidneys fail. Patient put in dialysis. Regional CDC advises that patient tests positive for Flu Type A but does not match to known sub-types.

    March 26 - Patient gravely ill but lucid.

    March 27 - Clinically dead from multi-organ failure. Family takes him home and disconnects respirator.


    Source:

    Zhejiang is the first case of the H7N9 virus patients: death from "buy back two chickens"2013 04 11, 2011 15:44
    Source: Newsweek, Author: Wei Chen Xiaoyan Zhao

    Original title: Zhejiang first case of H7N9 virus patients: a hindsight death

    Until his death, Hongming do not know the real cause of their own. He has four times for medical treatment by doctors that the organs of the problem are the liver, gall bladder, and lung. Eventually, he died of respiratory failure and multiple organ failure

    Articles the reporter /陈薇Xiaoyan Zhao (from the bottom of Zhejiang Hangzhou )

    Until his death, Jiande, Zhejiang Hongming not know the real cause of their own.

    He has four times for medical treatment by doctors that the organs of the problem are the liver, gall bladder, and lung. In the early morning of March 27, 2013, due to multiple organ failure, and he died in the intensive care ward of a hospital in Xiaoshan District, Hangzhou.

    April 1, Hongming funeral does not end at home just to please people figured out what a day, intend next day funeral home to the uninvited guest. Qiu Jing, Hongming, Hangzhou Center for Disease Control, several staff members told of Hongming the wife died of H7N9, a new avian influenza virus. Then, inside and out hongjialou spray disinfectant.

    Qiu Jing dazed very. Farm women who graduated from junior high school, the first time I heard the term. Two days later, she was released by the Zhejiang Provincial Health Department communications found in her husband's case: "The patient province first case of human infection of H7N9 avian influenza.

    April 6, home in Jiande, Qiu King accepted an exclusive interview with "Newsweek". She was a black clothing, the corner next to the remnants of paper towels to wipe the tears after the debris, redness of the eyes revealed sadness and despair.

    "I threw up two bowls of blood"

    From Jiande urban area towards the southwest, along the provincial highway straight, they can go to the Da Hongming a village living. This afternoon, the sun as summer-like strong, laid out the mahjong stall next door neighbor, the old man with the the children bask funny puppy, only **** doorstep doldrums.

    This is a four-story house of one side of the road, pull down the shutter doors, the door has posted two brand new red spell lobby put a square table, empty.

    Eight years ago, from the neighboring village, a Hongming moved here. However, they are usually at home is not much time. Hongming of Jiande local farmers, played odd jobs after graduating from junior high school to enter until 1998, Zhejiang earth Steel Co., Ltd. stabilized. At first, he did a welder and some chores. In 2010, he relocated to with the branch Jiangsu Taicang, because the dish is burned and his wife, Chiu King began working in the canteen.

    Hongming slightly fat meter seven heads, about one hundred fifty-six of ten pounds, nicknamed "Fat Man". Taicang employees of the company have thirty or forty and Hongming buy food to cook, Qiu Jing odd jobs. Their 3-year-old son with you, the 13-year-old daughter to stay home in Jiande started reading, and grandparents live together.

    Early in the morning of March 8, Hongming riding a bike, go to the Taicang company near the vegetable market to buy back two slaughtered chicken, and intend to add in the next day's canteen food. The company cafeteria food in general, and also miss a meal a week once chickens and ducks. Hongming prefer to eat pork, interest nothing chickens and ducks.

    The next day, (March 9) Qiu Jing to do a braised chicken is very popular, and her small son also ate three chicken wings. But Hongming did not eat.

    The day before, (March 10) he along with some of the staff to participate Corporation in Xiaoshan crane operator training. In the the Xiaoshan car, the driver, Hongming begin diarrhea.

    Hongming infrequently to the head office, guard Guo Jun saw him at the door, simple greeted, as usual, did not think his body, what is wrong ". Guo Jun said, "The Fat Man" and all kindness, be popular in the company, Guo Jun go Taicang company until three or four o'clock in the afternoon, the fat also specifically hot lunch waiting for him.

    Back to Taicang, March 11, is of Hongming also diarrhea, but the couple did not got the idea too. May eat the bad stuff. "Hongming said to his wife. His appetite poor, and to sweep a while, I felt tired,

    two days later,(March 13) not even ride a bike effort to go out and buy vegetables, but to let the vegetable vendors to send food over.

    March 15, Hongming fever, general cold shook Qiujing Qing Chu remember. "Go to the hospital to take a look and see," King said Qiu.
    Hongming to go to the company's nearby health clinic. Health center without any instrument, hear his complaints "no appetite, diarrhea, fever symptoms, suggested he go to a large hospital to do B to check liver function.

    The next day,(March 16) a Chinese medicine hospital Taicang B-concluded that the thickening of the gallbladder. Hongming still fever, body temperature up to 40 degrees Celsius in the hospital for examination. The doctor told him to hospital, he did not want to worry about his wife has to go to work and take care of themselves, too busy to.

    But burning has not been back. And his wife, sister discuss after the March 18, Hongming a person to sit more than three hours drive back to his sister where Jiande ready hospitalization.

    The next night, (March 19) Qiu Jing calls from him, said the hospital himself hanging brine, fever is a man more comfortable.

    The Qiu King or do not care about. A few times to see a doctor, are her husband own a go; husband gave her the information she had cholecystitis, the problem is not too much.

    This day until March 20, Qiu Jing husband received phone again. Hongming told her, they have to go to the People's Hospital of Xiaoshan a, she had come to take care of the job also said something surprising: "The son of school back."

    Qiu the King very strange: Why?

    At this time, Hongming only told her that there may be some serious disease, "I spit bowls of blood".

    Until Hongming vomiting blood, the hospital took his chest X-ray, the conclusion as pneumonia. From the 11th to diarrhea, fever, vomiting blood, Hongming 19 has four times for medical treatment, doctors believe that the organs of the problem are the liver, gallbladder, and finally lung. But it turned out that these are not his real cause.

    "Moving too fast."

    10 pm on March 21, 2011, Qiu Jing, pull back the son of the school, to see her husband in the People's Hospital of Xiaoshan a respiratory department. Hongming the outermost a bed trio ward, put on a ventilator. Also clear his mind, to see Nianger Liang, did not speak, just held out his hand, shook hard and youngest son a grip.

    That night, Hongming not how to sleep well. Now and then he raised his head, listening to the beeps emitted by the heart rate detector, or look at the values ​​of oxygen saturation. Displayed on the instrument, the oxygen saturation at 90 floating up and down - normal value should be between 90-120.

    However, as long as the the Hongming win the masks a word, or eat a dish, this figure will rapidly decline to about seventy to eighty, he had to immediately re-wear due to hypoxia. Therefore, Hongming rarely speak or actions, just lying quietly in bed. The couple are still optimistic that, eat, sleep, and the situation is not so bad.

    In this case, the People's Hospital Respiratory gradually find that and Hongming illness extraordinary. Under normal circumstances, the approach to treatment of pneumonia is the rational use of antibiotics, anti-pathogen treatment; combined with oxygen, expectoration, sufficient rest. However, these approaches in Hongming who did not work.

    "Moving too fast, bad treatment." Hospital respiratory department director of the "Newsweek" memories. March 20 hospitalized CT slice Hongming, only the right side of the bottom of a lobe infection;

    March 23, have both lungs were infected, chest radiograph showed a large white-like "white lung". Formation of white lung, generally indicates that 9 percent of lung inflammation invasion.

    This day, Qiu Jing hospital medical staff increased protective measures Hongming also be classified as "severe pneumonia, the hospital began to consider is not a special kind of virus, Xiaoshan District CDC reported the next day.

    On this day, Hongming be transferred to the single ward intubation. A doctor after the end of the "cruel truth" of Qiu King said: "This man is useless! Lungs are bloody!"

    The Qiu King was crying on the ground. In this case, the referral is no longer possible. She knelt down and begged doctors to think of a way. That afternoon, the hospital under the first critical condition.

    Hongming not speak. In order to let him tamper intubation, his hands are fixed beds on both sides, plus tranquilizers role, the whole person is unconscious.

    "Why is he"

    The next two days,(March 24 & 25) the hospital has hired two expert consultation of the First Affiliated Hospital, Zhejiang University School of Medicine. Adjust ventilator settings, then the beds slightly elevated point outside the the expert conclusions hospital consistent.

    March 25, the results of the chest X-ray seems a little a lot better, but another bad news at the same time came, Hongming has no urine - which means that his kidneys began failure. In the afternoon, he was transferred to a hospital intensive care unit, a dialysis.

    Xiaoshan District CDC preliminary conclusions, the three types of influenza viruses "(Universal) nucleic acid testing positive for influenza virus, influenza B virus, a type of influenza virus A H1N1 influenza virus nucleic acid were negative, This means that this is a flu virus, but it is not a common known types of influenza. However, in the end is still no from knowing what kind of virus?

    Daily from 14:00 to 3:00, the visiting hours for the Intensive Care Unit. March 26, Qiu Jing once again saw the husband in the bed. Doctor Qiu Jing psychologically prepared for, repeated illness or deterioration, no one can control. Chiu King to see her husband, and his face did not poor, the body no edema seems there is still hope.

    However, this is Qiu Jing husband last seen alive.

    At 6:00 on the March 27 and more, living in a hotel near the hospital Qiu King was awakened by the phone. Hospital informed her, on the evening of the previous day, Hongming's condition worsened, and nothing worked until the early hours, the rescue. Although the hospital has no formal declaration of death, but the fact, Hongming the life, rely on a ventilator to maintain.

    The family eventually decided Hongming brought back Jiande home. The hospital agreed to help them find a van, has been sent home, along the way, relying on a simple breathing machine, Hongming also "symbolic" to maintain breathing, has been home.

    Death - March 27

    Parking. Lift to go to bed. Take off the ventilator. People go.

    zhttp://www.ce.cn/xwzx/gnsz/gdxw/201304/13/t20130413_24286508.shtml
    Last edited by sharon sanders; April 15th, 2013, 02:34 PM. Reason: added linik
    "May the long time sun
    Shine upon you,
    All love surround you,
    And the pure light within you
    Guide your way on."

    "Where your talents and the needs of the world cross, lies your calling."
    Aristotle

    “In a gentle way, you can shake the world.”
    Mohandas Gandhi

    Be the light that is within.

  • #2
    Re: China - Reconstruction of Disease Progression in Fatal H7N9 Case

    If he didn't eat the chicken, what did he eat instead?
    Was the individual not feeling well to begin with, hence the reason he did not eat the food he prepared?
    Alot of information is missing that would be critical knowledge for a case investigation.
    The data provided is narrow and is based on the assumption the only link was chicken or the chicken market.

    Comment


    • #3
      Re: China - Reconstruction of Disease Progression in Fatal H7N9 Case

      I agree. A lot of questions are raised about the patient's exposure.

      Apparently he experienced symptoms 2 days after exposure and it was not respiratory. Diarrhea started 2 days after probable exposure and fever started after 4 days.
      "May the long time sun
      Shine upon you,
      All love surround you,
      And the pure light within you
      Guide your way on."

      "Where your talents and the needs of the world cross, lies your calling."
      Aristotle

      “In a gentle way, you can shake the world.”
      Mohandas Gandhi

      Be the light that is within.

      Comment


      • #4
        Re: China - Reconstruction of Disease Progression in Fatal H7N9 Case

        Tends to suggest an ingestion of virus leading to a GI route of infection.

        Comment


        • #5
          Re: China - Reconstruction of Disease Progression in Fatal H7N9 Case

          Originally posted by Vibrant62 View Post
          Tends to suggest an ingestion of virus leading to a GI route of infection.
          I agree with the higher probability the source was ingestion. I do not think what was ingested, however, is reasonably clear. Particularly since the case did not ingest the assumed infectious agent - chicken.

          The exposure may or may not be chickens.
          The ingestion may or may not have occured two days before symptom onset.
          The GI distress may have even been a coincidental illness, leading the patient to seek assistance where another virus lingered in the waiting room?

          There is just not enough information to assume any particular exposure point.

          Comment


          • #6
            Re: China - Reconstruction of Disease Progression in Fatal H7N9 Case

            This is not meant to be the definitive case description. It is a look into what happened to this man. Some of the description is self reported.

            It is meant to give us an idea of what is going on since so little is being released.

            The WHO has listed the onset of his H7N9 disease as March 7 which is earlier than the date on this report. But apparently diarrhea is part of the H7N9 experience which is reported to have started on March 10.

            On March 13th he was too tired to work and by March 15 he had a fever.

            On March 27th he died.

            So he died somewhere between 17 & 20 days after initial symptoms.
            "May the long time sun
            Shine upon you,
            All love surround you,
            And the pure light within you
            Guide your way on."

            "Where your talents and the needs of the world cross, lies your calling."
            Aristotle

            “In a gentle way, you can shake the world.”
            Mohandas Gandhi

            Be the light that is within.

            Comment


            • #7
              Re: China – Emergent H7N9 Clinical Progression to a Fatal Outcome in a 38 Year Old Male

              In the aftermath of loss, during this time of grieving, two questions are often asked:
              1. "Why did this happen?"
              2. "How did this happen?"
              Those questions are paramount in importance to each family that has lost someone and who may, indeed, be treating other members also in the throes of this same illness. Any honest endeavour to answer these questions for those families requires exploration, a revisiting of difficult moments.

              If you have lost someone to this disease, seeing this discussion may be more than you can bear at the moment. Please accept our condolences . . . and our promise to seek the answers that you need, then to make those answers understandable.

              And in doing so, perhaps we at FluTrackers will answer another cause: to prevent the next family from suffering the loss you are feeling now.

              Some answers are available today; others are forming and will be presented and debated here in the coming weeks. At the moment, details concerning the genetics of the offending pathogen, including the Novel H7N9 HA Q226I adaptation arising at a critical Receptor Binding Site potentially from human H3N2, are available in the GeneWurx Cross Serotype Homology Analysis (Open-Access, Full-Text version). The genetics comparatives are under comprehensive discussion on the wider thread, entitled "China - H7N9 Human Isolates on Deposit at GISAID".

              Comment

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