A case report of avian influenza H7N9 killing a young doctor in Shanghai, China
Journal
BMC Infectious Diseases
Journal Volume
15
Journal Issue
1
Date Issued
2015
Abstract
Background: The novel avian influenza H7N9 virus has caused severe diseases in humans in eastern China since the spring of 2013. On January 18th 2014, a doctor working in the emergency department of a hospital in Shanghai died of H7N9 virus infection. To understand possible reasons to explain this world's first fatal H7N9 case of a health care worker (HCW), we summarize the clinical presentation, epidemiological investigations, laboratory results, and prevention and control policies and make important recommendations to hospital-related workers. Case presentation: The patient was a 31-year-old male Chinese surgeon who was obese and had a five-year history of hypertension and suspected diabetes. On January 11th 2014, he showed symptoms of an influenza-like illness. Four days later, his illness rapidly progressed with bilateral pulmonary infiltration, hypoxia and lymphopenia. On January 17th, the case had a high fever, productive cough, chest tightness and shortness of breath, so that he was administered with oseltamivir, glucocorticoid, immunoglobulin, and broad-spectrum antibiotic therapy. The case died in the early morning of next day after invasive ventilation. He had no contact with poultry nor had he visited live-poultry markets (LPMs), where positive rates of H7N9 were 14.6 % and 18.5 %. Before his illness, he cared for three febrile patients and had indirect contact with one severe pneumonia patient. Follow-up with 35 close contacts identified two HCWs who had worked also in emergency department but had not worn masks were anti-H7N9-positive. Viral sequence identity percentages between the patient and two LPM-H7N9 isolates were fewer than between the patient and another human case in shanghai in January of 2014. Conclusions: Important reasons for the patient's death might include late treatment with oseltamivir, and the infected H7N9 virus carrying both mammalian-adapted signature (HA-Q226L) and aerosol transmissibility (PB2-D701N). The LPM he passed every day was an unlikely source of his infection, but a contaminated environment, or an unidentified mild/asymptomatic H7N9 carrier were more probable. We advocate rigorous standard operating procedures for infection control practices in hospital settings and evaluations thereafter. ? 2015 Pan et al.
Subjects
Avian influenza H7N9; Healthcare workers; Live-poultry market; Preventive measures; Public health policies
SDGs
Other Subjects
glucocorticoid; imipenem; immunoglobulin; oseltamivir; vancomycin; antiinfective agent; oseltamivir; virus RNA; adult; antibiotic therapy; Article; artificial ventilation; case report; chest tightness; China; clinical feature; contact examination; disease association; disease duration; disease severity; drug effect; dyspnea; fatality; flu like syndrome; human; hypoxia; influenza A; influenza A (H7N9); Influenza virus A H7N9; lung infiltrate; lymphocytopenia; male; nonhuman; obesity; surgeon; virus detection; virus isolation; classification; genetics; Influenza A virus (H7N9); Influenza, Human; isolation and purification; lung; phylogeny; physician; pneumonia; radiography; reverse transcription polymerase chain reaction; virology; Adult; Anti-Bacterial Agents; China; Glucocorticoids; Humans; Immunoglobulins; Influenza A Virus, H7N9 Subtype; Influenza, Human; Lung; Male; Oseltamivir; Phylogeny; Physicians; Pneumonia; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral
Type
journal article