Elsevier

Respiratory Investigation

Volume 50, Issue 4, December 2012, Pages 140-150
Respiratory Investigation

Original article
Clinical preparedness for severe pneumonia with highly pathogenic avian influenza A (H5N1): Experiences with cases in Vietnam

https://doi.org/10.1016/j.resinv.2012.08.005Get rights and content
Under a Creative Commons license
open access

Abstract

Background

Avian influenza A (H5N1) in human presents a global pandemic threat, and preparedness is urgently required in high-risk countries.

Methods

A retrospective chart review was conducted on 8 patients with H5N1 infection (aged 2–30 years; 3 fatal) who were hospitalized in Bach Mai Hospital (BMH), Vietnam, or in affiliated hospitals with consultation by physicians in BMH between 2007 and 2010. Demographic background, chest radiographs, and clinical and laboratory data were evaluated to determine the critical issues in relation to clinical outcomes. Treatment of 4 patients with acute respiratory distress syndrome (ARDS) (2 fatal) was assessed for renal replacement therapy using continuous hemodiafiltration (CHDF), polymyxin B-immobilized (PMX) hemoperfusion, or their combination.

Results

Patients had direct contact with dead/sick poultry infected with H5N1 virus or lived in areas where H5N1 poultry outbreaks had been reported at the same time as their illness. Time to initiation of oseltamivir from symptom onset was 2–6 days for survivors and 7–9 days for non-survivors. All patients except one had infiltrative shadows on chest radiographs on admission. Patients with delayed treatment developed ARDS. Renal replacement therapy contributed to patient survival, with improvement of oxygenation and a dramatic decrease in serum cytokine levels if initiated earlier.

Conclusions

Understanding local H5N1 poultry outbreaks and chest radiography assist early diagnosis and initiation of antiviral treatment. Developing a network among local and tertiary care hospitals can reduce the time to initiation of treatment. CHDF and PMX hemoperfusion are possible candidates for effective treatment of ARDS with H5N1 if applied earlier.

Abbreviations

ARDS
acute respiratory distress syndrome
ALI
acute lung injury
CHDF
continuous hemodiafiltration
PMX
polymyxin B-immobilized
IFN
interferon
IL
interleukin
TNF
tumor necrosis factor
FiO2
fraction of inspired oxygen
PaO2
partial pressure of oxygen in arterial blood
P/F
PaO2/FiO2
SOFA
Sequential Organ Failure Assessment

Keywords

Early intervention
Acute respiratory distress syndrome
Avian influenza
H5N1
Polymyxin B-immobilized hemoperfusion

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