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Chinese University of Hong Kong - Clinical and Radiographic Features of Avian Flu

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  • Chinese University of Hong Kong - Clinical and Radiographic Features of Avian Flu

    <center> http://www.droid.cuhk.edu.hk/web/spe.../avian_flu.htm


    <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td colspan="3" align="center" bgcolor="#000000" height="30">Avian Flu</td> </tr> <tr> <td colspan="3">
    <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>

    <table border="0" cellpadding="0" cellspacing="0" width="620"> <tbody><tr> <td colspan="2">Prepared by Drs. David SC Hui, Gavin M Joynt, KT Wong, Gregory E Antonio, Anil T Ahuja and Mr. Terence Lam.</td> </tr> <tr> <td width="15"> </td> <td width="590"> </td> </tr> <tr> <td width="15">1 </td> <td width="590">Department of Medicine and Therapeutics</td> </tr> <tr> <td width="15">2 </td> <td width="590">Department of Anaesthesia</td> </tr> <tr> <td width="15">3 </td> <td width="590">Department of Diagnostic Radiology and Organ Imaging,</td> </tr> <tr> <td colspan="2" height="20">The Chinese University of Hong Kong.</td> </tr> </tbody></table>
    <!-- <table width="625" border="0" cellspacing="0" cellpadding="0"> <tr align="center"> <td width=625>No. of visits: 8864</td> </tr> </table>
    --> <table border="0" cellpadding="0" cellspacing="0" width="625"> <tbody><tr align="center"> <td width="320"></td> <td width="320"></td> </tr> </tbody></table>
    </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>
    Introduction
    Dear Visitors,

    Thank you for visiting our webpage on "avian flu". Through this webpage, we hope to share the clinical and radiographic features of this novo disease with the rest of the medical community.

    Our first encounter with this new viral disease was in 1997 when there was a limited outbreak of the infection in Hong Kong. No major human outbreaks have since occurred until last winter. This time, however, the disease is more widespread and not limited to Asia or a single strain of the virus. With the help of our colleages in Hong Kong and Vietnam, we have gathered a collection of serial radiographs of this disease and the associated clinical findings.

    We would like to thank all the medical staff who have contributed and helped with providing information for this webpage. We would also like to acknowledge the efforts of the public, health-care workers and health authorities in limiting the spread of this disease.

    Department of Diagnostic Radiology and Organ Imaging,
    The Chinese University of Hong Kong.
    16th April, 2004.

    </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case One: 13-year-old symptomatic female Admitted to Paediatric ward 26/11/97 (Day 1) from the Emergency department.
    Previously healthy. Sore throat, rhinorrhoea, and dry cough one week prior to admission. Fever four days prior to admission.

    Examination - Alert, febrile, no respiratory distress. Lung auscultation - decreased breath sounds and crepitations in R lung base.

    Complete blood count - WCC 4700/microL, Platelets 62 000/microL
    Blood culture - negative
    Sputum culture - nil of note
    Viral titre - nil of note

    Diagnosis of atypical pneumonia - Clarythromycin orally.
    Following day - haemoptysis. Cefotaxime added.
    In evening cough, increasing respiratory rate and distress and hypoxia despite oxygen therapy.

    Admitted to ICU on 27/11/97 (Day 2).
    Mechanical ventilation for hypoxia 6 h after admission. Clinical R lower and middle lobe crepitations and audible "rub". Rapid deterioration over next 3 days with ARDS, multiple organ dysfunction.
    29/11/03: Upper gastrointestinal bleeding. Worsening ARDS requiring prone position ventilation - until the 5th or 6th Dec.
    Died 21/12/97. cause of death intractable respiratory failure (hypoxia).
    </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 2</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 3</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 4</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 5</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 9</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 14</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="300"></td> </tr> <tr> <td>Day 20</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="300"></td> </tr> <tr> <td>Day 23 (1)</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="300"></td> </tr> <tr> <td>Day 23 (2)</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="245"></td> </tr> <tr> <td>Day 26</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> </td> <td align="center" valign="top" width="214"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case Two: M 31 yrs: exposed to dead chicken 5 days before illness (onset 3/1/04). Fever 40C, malaise, dry cough, SOB, headache for 2 days. His 2 sisters died of confirmed H5N1 2 weeks later.</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="200"></td> </tr> <tr> <td>5/1/2004</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="200"></td> </tr> <tr> <td>6/1/2004 - 1 </td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="200"></td> </tr> <tr> <td>6/1/2004 - 2 </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="210"></td> </tr> <tr> <td>9/1/2004</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> </td> <td align="center" valign="top" width="214"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case Three: M/52 yrs old: poultry farm worker, contact with dead chicken. Fever 5 days/ dry cough, runny nose & SOB for 2 days. CPK 15820. Rx: Fortum & Amikacin.</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="230"></td> </tr> <tr> <td>9/2/2004</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="230"></td> </tr> <tr> <td>10/2/2004</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case Four: M/19 yrs: poultry farm worker with contact of dead chicken. Fever, productive cough, SOB since 5/12/03. WBC 2.1, L=0.6, Plt 30, normal fibrinogen & APTT. Urea 15.4, Cr 238, ALT 49, AST 397. Rx: cefotaxime, gentamicin.</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="230"></td> </tr> <tr> <td>8/12/2003</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="230"></td> </tr> <tr> <td>9/12/2003</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="230"></td> </tr> <tr> <td>10/12/2003</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case Five: M/23 yrs: farmer. Contact with dead chicken 3 days prior to illness. T38.7C, Productive cough, SOB, diarrhoea. Admitted to HCM Hosp for Tropical Dis 7 days after onset. SpO2 90% on 40% oxygen. Hb 17.6, WBC 3.9, Lym 0.7, Plt 102, Cr 121, ALT 89, AST 110. RTPCR positive for H5N1. </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="150"></td> </tr> <tr> <td>Critically ill - 1</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="150"></td> </tr> <tr> <td>Critically ill - 2</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="150"></td> </tr> <tr> <td>Critically ill - 3</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td>Case Six: M 33 yrs/Princess Margaret Hospital, Hong Kong: returned from Fujian with fever, chills, cough since 7/2/03. Lymphopenia, increased ALT. ARDS & MODS on 14/2/03. Died on 17/2/03</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="180"></td> </tr> <tr> <td>11/2/2003</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="180"></td> </tr> <tr> <td>13/2/2003</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="180"></td> </tr> <tr> <td>14/2/2003</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3" align="center"> <table border="0" cellpadding="0" cellspacing="0" width="640"> <tbody><tr> <td width="5"> </td> <td> Case Seven:
    • F/6 yr, fever for 8 days, developed acute respiratory distress
    • Adm WBC 2.4 x 109/L, L 0.5 x 109/L, plt 127 x 109/L, ALT 246 IU/L, AST 1379 IU/L, nasal swab H5 Ag +ve
    • Given Methylpred 5 mg/kg/day and Tamiflu. Died 3 days after admission
    </td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="170"></td> </tr> <tr> <td>CXR on admission</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="170"></td> </tr> <tr> <td>CXR 6 hours after admission</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="214"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="170"></td> </tr> <tr> <td>CXR on day 2</td> </tr> </tbody></table> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td align="center" valign="top" width="213"> <table border="0" cellpadding="0" cellspacing="0" width="200"> <tbody><tr> <td align="center" bgcolor="#000000" height="170"></td> </tr> <tr> <td>CXR on day 3</td> </tr> </tbody></table> </td> <td align="center" valign="top" width="213"> </td> <td align="center" valign="top" width="214"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> <tr> <td colspan="3"> </td> </tr> </tbody></table>

    <table border="0" cellpadding="0" cellspacing="0"> <tbody><tr><td align="center"> Prepared on behalf of Faculty of Medicine, CUHK
    Copyright ? 2002-2006. Department of Diagnostic Radiology and Organ Imaging. All rights reserved. </td></tr> </tbody></table> </center>
    "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

  • #2
    Re: Chinese University of Hong Kong - Clinical and Radiographic Features of Avian Flu

    Sorry, the x-rays showed on my screen when I first posted this, now they don't.



    Edit: If you want to see the x-rays click on the link at the top of the page.
    Last edited by MHSC; August 18, 2006, 09:34 AM.
    "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

    Comment


    • #3
      Re: Chinese University of Hong Kong - Clinical and Radiographic Features of Avian Flu

      Chilling account of the 13 year-olds disease progression nonetheless. Alert when admitted with a steady downhill progression ending in death despite attentive hospital care.
      Please do not ask me for medical advice, I am not a medical doctor.

      Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
      Thank you,
      Shannon Bennett

      Comment

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