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Eur J Clin Microbiol Infect Dis. Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) vi

Giuseppe

Giuseppe

Emeritus
[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]


Eur J Clin Microbiol Infect Dis. 2013 Aug 30. [Epub ahead of print]

Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China.

Xie L, Ding H, Kao QJ, Yang XH, Wen YY, Lv HK, Chen ZP, Chen EF, Sun Z, Pan JC, Pu XY, Li J, Wang FJ, Xu XP.

Source: Hangzhou Center for Disease Control and Prevention, Hangzhou City, 310021, Zhejiang Province, China.


Abstract

To investigate and report on the clinical and epidemiological characteristics of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China. A field epidemiological survey was used to study the first case in Hangzhou. The patient was a 39-year-old male chef with a history of exposure to a farm product market and to poultry prior to the onset of disease on 15 March 2013. He had diarrhea, chills, pyrexia, and intermittent cough with freshly red foamy bloody sputum early in his disease. His fever > 39 ?C continued for a week with rapid progression. Computed tomography findings showed extensive bilateral consolidation, followed by multiorgan failure. The patient died on the morning of 27 March. His infection was eventually confirmed 1 week later on 3 April. Flu-like symptoms including fever and cough were found in 46 of his 138 close contacts. This was the first case of human infection with avian influenza A(H7N9) virus in Hangzhou. None of the close contacts had onset of the disease. The case patient's condition progressed rapidly. The source of infection might be his exposure to the farm product market, but the mode of exposure remains unclear.


PMID: 23990172 [PubMed - as supplied by publisher]


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Re: Eur J Clin Microbiol Infect Dis. Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China.

We have several other references on FT regarding this case:


Here the patient is reported, in an interview with his wife, to have experienced the first symptom of diarrhea on March 10, and then a fever on March 15.

In this paper the patient the disease onset is identified as March 7. This is impossible since he had not yet bought the contaminated chicken (March 8). This paper states the flu-like symptoms started on March 14.

So we have 2 dates for disease onset: diarrhea on March 10 and then additional symptoms, including fever, on March 15. The paper in post 1 above uses the March 15th date. The date stated in the WHO report (March 7) is apparently totally incorrect as the patient had not yet bought the contaminated chicken.

So which date to use? I think for our purposes the date of March 10 is important because I think diarrhea should be recognized as the first symptom. This patient was too ill to work by March 13 because the symptoms of "tiredness" and "poor appetite" had presented.
 
Re: Eur J Clin Microbiol Infect Dis. Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China.

From #1 this thread:

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[FONT=AdvTT50a2f13e.I][FONT=AdvTT50a2f13e.I][FONT=AdvTT50a2f13e.I]
Epidemiological history
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''The patient was a chef residing in Taicang City, Jiangsu Province.

''He had bought two chickens at a farm product market on the morning of 8 March, cooked them by braising, and ate the meat the next day.

''He went to the Headquarters of his work affiliation in Xiaoshan, Hangzhou, Zhejiang Province by company car for a 2-day service training course and returned to Taicang by company car on the afternoon of 10 March.

''He walked 2 km to a farm product market to buy food ingredients on 11 and 12 March, where his exposure to poultry or vendor booths and mode of exposure were unclear.

''He had no visitors, travel history or contact with similar patients during the 2 weeks before disease onset.


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[FONT=AdvTT50a2f13e.I][FONT=AdvTT50a2f13e.I][FONT=AdvTT50a2f13e.I]Dwelling environment[/FONT][/FONT][/FONT]

''The patient lived with his wife and son in two intercommunicating rooms (30 m2) in the building where he worked.

''The rooms were well illuminated and ventilated.

''The dwellers had good hygienic habits, and aired and cleaned the rooms every day.

''The building was surrounded by farmlands with no poultry farm or living garbage dump within a 2-km radius.

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Re: Eur J Clin Microbiol Infect Dis. Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China.

Was also described here

The first avian influenza A (H7N9) viral infection in humans in Zhejiang, Frontiers of Medicine September 2013, Volume 7, Issue 3, pp 333-344 Province, China: a death report - Springer
Enfu Chen and 17 others

http://link.springer.com/article/10.1007/s11684-013-0275-1#page-1


Frontiers of Medicine (Icon to look inside) I noted initial onset date 7 March and 14th respectively!

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In http://press.thelancet.com/H7N9.pdf (Yu Chen et al.)

Table 1: Epidemiological and clinical features of patients with avian influenza A H7N9 virus infection

To note this 39yo (Table 1: Epidemiological and clinical features of patients with avian influenza A H7N9 virus infection "pt 1") didn't receive oseltamivir but received Piperacillin–tazobactam, moxifl oxacin, imipenem–cilastatin, linezolid, sulfamethoxazole; intravenous methylprednisolone given Days 15–18 (80 mg every 24 h)

H/T Sharon
 
Re: Eur J Clin Microbiol Infect Dis. Clinical and epidemiological survey and analysis of the first case of human infection with avian influenza A(H7N9) virus in Hangzhou, China.

It may be convenient for the Chinese researchers to adjust the date of onset to include prior poultry exposure as an explanation for infection. Symptom onset on March 7 would open the possibility of infection from another human rather than infected poultry.
 
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