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Clin Infect Dis. Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus

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  • Clin Infect Dis. Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus

    [Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]


    Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus


    Liang Yu 1,2,*, Zhaoming Wang 3,*, Yu Chen 1,2,*, Wei Ding 3, Hongyu Jia 1,2, Jasper Fuk-Woo Chan 4, Kelvin Kai-Wang To 4, Honglin Chen 2,4, Yida Yang 1,2, Weifeng Liang 1,2, Shufa Zheng 1, Hangping Yao 1,2, Shigui Yang 1,2, Hongcui Cao 1,2, Xiahong Dai 1, Hong Zhao 1, Ju Li 5, Qiongling Bao 1,2, Ping Chen 1,2, Xiaoli Hou 6, Lanjuan Li 1,2, and Kwok-Yung Yuen 2,4

    Author Affiliations: <SUP>1</SUP>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China <SUP>2</SUP>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, China <SUP>3</SUP>Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China <SUP>4</SUP>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China <SUP>5</SUP>Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China <SUP>6</SUP>Center of Analysis and Testing, Zhejiang Chinese Medical University, Hangzhou. 310003, China

    Correspondence: Lanjuan Li. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, 79 Qingchun Road, Hangzhou, 310003, China. Phone: 86-571-87236458. Fax: 86-571-87236459. E-mail: ljli@zju.edu.cn, Kwok-Yung Yuen. Carol Yu Centre for Infection, Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China. Phone: 852-22554892. Fax: 852-28551241. Email: kyyuen@hkucc.hku.hk

    * These authors contributed equally to this work.


    Abstract

    Background.

    Systematic analysis of histopathological and serial virological changes of fatal influenza A(H7N9) cases is lacking.


    Methods.

    Patients with A(H7N9) infection admitted to our intensive care unit between April 10-23, 2013, were included. Viral loads in the respiratory tract, as inferred from the Ct value of RT-PCR, and the serum hemagglutination inhibition antibody titer, were analyzed. Postmortem biopsies of the lung, liver, kidney, spleen, bone marrow and heart were examined.


    Results.

    Twelve patients (six fatal cases, six survivors) were included. Median viral load was higher in sputa than the nasopharyngeal swabs for fatal cases (median Ct, 23 vs 30.5; P=0.08). RT-PCR for A(H7N9) was positive in stool samples (67%, 4/6) of fatal cases and (33%, 2/6) of survivors, but was negative in the cerebrospinal fluid, urine or blood of all patients. Nosocomial bacterial infections were more common in fatal cases than survivors (83% vs 50%). HI titer increased by ≥4-fold in those with convalescent sera. Postmortem biopsy for three patients showed acute diffuse alveolar damage. Patient 1, who died eight days after symptom onset, had intra-alveolar hemorrhage. Patient 2 and 3, who died 11 days after symptom onset, had pulmonary fibroproliferative changes. Reactive hemophagocytosis in the bone marrow and lymphoid atrophy in splenic tissues were compatible with laboratory findings of leukopenia, lymphopenia and thrombocytopenia. Hypoxic and fatty changes of kidney and liver tissues are compatible with impaired renal or liver function.


    Conclusion.

    Fatal A(H7N9) infection was characterized by viral and secondary bacterial pneumonia with 67% having positive RT-PCR in stool.


    Received June 9, 2013. Accepted August 4, 2013.

    The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

    For Permissions, please e-mail: journals.permissions@oup.com.


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  • #2
    Re: Clin Infect Dis. Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus

    H7N9 bird flu may be spread through human faeces, research suggests

    Thursday, 15 August, 2013, 8:15am
    Emily Tsang

    The H7N9 bird flu that emerged on the mainland in March may be spreading through human faeces, as university researchers found the virus in the stools of four out of six people killed by the bug in Zhejiang .

    Theoretically, the virus could spread in the same way as severe acute respiratory syndrome (Sars) did during the 2003 outbreak in Amoy Gardens, Kowloon Bay - through sewage pipes - University of Hong Kong microbiologist Yuen Kwok-yung, a top researcher behind the cross-border study, told the South China Morning Post.

    "This has important implications on the infection control strategies for H7N9 virus infection, as the influenza virus in stools may contaminate the surrounding environment," Yuen and his team reported.

    But the team also suggested that the fact the virus may be transmitted via faeces was the reason why, so far, few cases of human-to-human infection had been recorded, Yuen said.

    HKU conducted the joint study with Zhejiang University's First Affiliated Hospital in Hangzhou and published the results in the Clinical Infectious Diseases journal on Tuesday. They tested 12 patients who were admitted to the intensive care unit between April 10 and 23. Half of them have died.
    During post-mortem tests, stool samples collected from four of the six fatalities returned positive results for the H7N9 strain.

    The rate - 67 per cent - was much higher compared with those found for human flu or H5N1 bird flu, which ranged from 5 per cent to 33 per cent, the report said.

    More...
    http://www.scmp.com/news/hong-kong/a...earch-suggests
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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    • #3
      Re: Clin Infect Dis. Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus

      Translation Google

      Faecal H7N9 bird flu virus is no evidence

      Published: 2013-08-16

      The first case of H7N9 bird flu in Guangdong of transmission remains uncertain, the 15th Hong Kong media reports, the Hong Kong Secretary for Food and Health Ko Wing-man pointed out, H7N9 avian influenza virus, or spread through the feces. In this regard Guangdong CDC chief expert Jianfeng believe that this can not exclude the possibility of transmission, but currently there is no clear evidence yet academia.
        
      According to Hong Kong radio news, Hong Kong Secretary for Food and Health Ko Wing-man, said he noticed Zhejiang University of Hong Kong and infectious disease specialist research shows, H7N9 bird flu virus could spread through the feces. He stressed that the virus in the earlier risk assessment and prevention and control of the process, the Hong Kong government has made this into account.
        
      Guangdong, the first case of H7N9 bird flu will not be infected with this approach? Beijing to attend the 15th International Symposium of H7N9 avian influenza Guangdong CDC chief expert, He Jianfeng, director of infectious disease prevention and control, said the seminar experts have raised this issue, but have not found a clear academic evidence proof of avian influenza viruses can spread among humans through feces.
        
      Jianfeng said that in studies on birds, a conclusion already clear that the bird flu virus can be excreted through the feces, and has reminded the public avoid contact with bird droppings; currently in the H7N9 avian influenza has also been shown in patients with secretory things there will be a virus, "Even the ordinary seasonal flu, the patient will have the virus in faeces, but the performance is far below the droplets spread other ways."
        
      Jianfeng said the bird flu virus is transmitted through the varied, manure is also one way. But as a kind of influenza virus, avian influenza virus is spread primarily through the upper respiratory tract or pathway; regards the spread of gastrointestinal route performance, and viral shedding time, after detoxification, the amount of viral load and so on. "The present study only shows that there is this phenomenon and the situation, but some infections are so specific and how infections, but also a fuller investigation, research and demonstration."
      ...
      http://news.china.com.cn/live/2013-0...t_21745104.htm
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

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