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- Title
Clinical Features of Human Influenza A (H5N1) Infection in Vietnam: 2004-2006.
- Authors
Nguyen Thanh Liem; Cao Viet Tung; Nguyen Duc Hien; Tran Tinh Hien; Ngo Quy Chau; Hoang Thuy Long; Nguyen Tran Hien; Le Quynh Mai; Taylor, Walter R. J.; Wertheim, Heiman; arrar, Jerem; Dinh Duy Khang; Horby, Peter
- Abstract
Background. The first cases of avian influenza A (H5N1) in humans in Vietnam were detected in early 2004, and Vietnam has reported the second highest number of cases globally. Methods. We obtained retrospective clinical data through review of medical records for laboratory confirmed cases of influenza A (H5N1) infection diagnosed in Vietnam from January 2004 through December 2006. Standard data was abstracted regarding clinical and laboratory features, treatment, and outcome. Results. Data were obtained for 67 (72%) of 93 cases diagnosed in Vietnam over the study period. Patients presented to the hospital after a median duration of illness of 6 days with fever (75%), cough (89%), and dyspnea (81%). Diarrhea and mucosal bleeding at presentation were more common in fatal than in nonfatal cases. Common findings were bilateral pulmonary infiltrates on chest radiograph (72%), lymphopenia (73%), and increased serum transaminase levels (aspartate aminotransferase, 69%; alanine aminotransferase, 61%). Twenty-six patients died (case fatality rate, 39%; 95% confidence interval, 27%-51%) and the most reliable predictor of a fatal outcome was the presence of both neutropenia and raised alanine aminotransferase level at admission, which correctly predicted 91% of deaths and 82% of survivals. The risk of death was higher among persons aged ⩽16 years, compared with older persons ( ), P <! .001 and the risk of death was higher among patients who did not receive oseltamivir treatment (P = .048). The benefit of oseltamivir treatment remained after controlling for potential confounding by 1 measure of severity (odds ratio, 0.15; 95% confidence interval, 0.026-0.893; P = .034). Conclusion. In cases of infection with Influenza A (H5N1), the presence of both neutropenia and raised serum transaminase levels predicts a poor outcome. Oseltamivir treatment shows benefit, but treatment with corticosteroids is associated with an increased risk of death.
- Subjects
VIETNAM; AVIAN influenza; NEUTROPENIA; ASPARTATE aminotransferase; DISEASE risk factors; DEATH rate; PUBLIC health; MEDICAL care; MEDICAL research
- Publication
Clinical Infectious Diseases, 2009, Vol 48, Issue 12, p1639
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1086/599031