Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus
Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus
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DOI：
10.1016/s0140-6736(98)01182-9
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发表时间：
1998-02-14
期刊：
影响因子：
168.9
通讯作者：
Cheng, AFB
中科院分区：
文献类型：
--
作者：
Yuen, KY;Chan, PKS;Cheng, AFB
最近在香港报道了禽流感病毒（亚型H5N1）的背景人类感染。我们描述了前12例患者的临床表现和快速病毒诊断的选择。分析了12例病毒养殖证实的流感病毒的病例注释H5N1感染。定义了与严重疾病相关的临床表现和危险因素，并比较了快速病毒诊断方法的结果。调查患者的年龄范围为1至60岁。临床表现是一种流感样疾病，有7例患者的肺炎证据。所有七名13岁以上的患者均患有严重疾病（四例死亡），而5岁以下的儿童患有轻度症状，除了与阿司匹林摄入有关的Reye综合征死亡的一名患者。胃肠道表现，升高的肝脏酶，与横纹肌溶解无关的肾衰竭和全年症异常突出。与严重疾病相关的因素包括年龄较大，住院延迟，呼吸剂的参与以及入院时总的白色血细胞数量或淋巴细胞减少症。 H5特异性的逆转录PCR分析（RT-PCR）可用于直接在呼吸标本中快速检测病毒。在快速病毒诊断中，市售的酶免疫测定比直接免疫荧光更敏感。具有H5特异性单克隆抗体池的直接免疫荧光可用于快速排除H5-囊型感染。解释AVIAN流感A H5N1病毒会导致类似人流感的疾病，其成人被送往医院的并发症很高。可以通过直接应用于临床标本的RT-PCR进行快速的H5-亚型特异性实验室诊断。
Background Human infection with an avian influenza A virus (subtype H5N1) was reported recently in Hong Kong. We describe the clinical presentation of the first 12 patients and options for rapid viral diagnosis.Methods Case notes of 12 patients with virus-culture-confirmed influenza A H5N1 infection were analysed. The clinical presentation and risk factors associated with severe disease were defined and the results of methods for rapid virus diagnosis were compared.Findings Patients ranged from 1 to 60 years of age. Clinical presentation was that of an influenza-like illness with evidence of pneumonia in seven patients. All seven patients older than 13 years had severe disease (four deaths), whereas children 5 years or younger had mild symptoms with the exception of one who died with Reye's syndrome associated with intake of aspirin. Gastrointestinal manifestations, raised liver enzymes, renal failure unrelated to rhabdomyolysis, and pancytopenia were unusually prominent. Factors associated with severe disease included older age, delay in hospitalisation, lower-respiratory-tract involvement, and a low total peripheral white blood cell count or lymphopenia at admission. An H5-specific reverse-transcription PCR assay (RT-PCR) was useful for rapid detection of virus directly in respiratory specimens. A commercially available enzyme immunoassay was more sensitive than direct immunofluorescence for rapid viral diagnosis. Direct immunofluorescence with an H5-specific monoclonal antibody pool was useful for rapid exclusion of H5-subtype infection.Interpretation Avian Influenza A H5N1 virus causes human influenza-like illness with a high rate of complications in adults admitted to hospital. Rapid H5-subtype-specific laboratory diagnosis can be made by RT-PCR applied directly to clinical specimens.