安徽省阜阳市首例H5N1型人禽流感临床报告

目的了解人感染高致病性H5N1型禽流感流行病学和临床学特征及防治手段。方法对本院收治的1例人感染高致病性H5N1型禽流感病例的相关资料进行回顾性分析。结果患者为26岁年轻孕妇,有病、死家禽接触史,临床表现为以急性呼吸窘迫综合征为主的全身多器官功能障碍,治疗上采取了以机械通气为主的综合性措施,治愈出院。结果提高对人感染高致病性H5N1型禽流感诊断的警惕性,及早干预是降低病死率的关键环节。     

江西省首例高致病性H5N1人禽流感临床特点分析

目的了解高致病性H5N1人禽流感病例的临床表现、实验室检查、影像学特征、治疗及其预后。方法对2005年12月在江西省遂川县人民医院收治的1例高致病性H5N1人禽流感的临床表现、实验室检查、心电图、影像学改变、病理变化和治疗等多方面的资料进行总结。结果患者经逆转录-聚合酶链反应（RT-PCR）、实时荧光定量PCR（real-time PCR）方法和病毒分离确诊为高致病性H5N1人禽流感病例。患者发病前有禽流感环境暴露史，以发热、畏寒起病，伴流感样症状，继之出现咳嗽、咳脓痰和脓血痰，病情进行性加重，出现腹泻和呼吸困难，伴外周血白细胞和淋巴细胞明显降低、大量尿蛋白、肝功能和心肌酶谱明显异常及血清白蛋白明显降低。发病第6天后痰培养多次发现耐苯唑西林肺炎球菌，在病情明显加重后，痰培养出现其他细菌和真菌。发病初期（第5天）胸部影像学可见右肺中下高密度病灶，继之迅速发展至双肺，出现急性呼吸窘迫综合征（ARDS）样肺部表现。经抗病毒、抗细菌、抗真菌、糖皮质激素和对症治疗未见好转，于发病后第27天死于感染性休克和多器官功能衰竭。病理表现为双肺弥漫性肺泡损伤合并感染，继发弥漫性血管内凝血（DIC）；淋巴组织中淋巴细胞明显减少，组织细胞增生；心肌水肿、空泡变性；肾小管广泛坏死。结论高致病性H5N1人禽流感患者病变进展为ARDS合并多器官功能损害时。预后不佳。     

湖北省鄂州市首例孕妇患H5N1型人禽流感的临床报告

2010年6月4日卫生部公布湖北省鄂州市陈某为人感染高致病性禽流感H5N1确诊病例。为提高对本病的认识,现将诊治过程中的经验与教训总结如下。     

H5N1型人禽流感一例并文献复习

患者女，26岁，妊娠2个月余。2006年2月11日患者出现发热38.5℃以上，最高达40℃，伴咳嗽，痰不多，腹泻2次。发病后4d初次就诊于某县人民医院，血白细胞6.1×10^9/L，中性0.75，淋巴0.16。听诊闻及右下肺呼吸音低。     

H5N1人禽流感的临床诊治

1959年首次分离到A群H5N1亚型禽流感病毒,1997年5月中国香港首次发生人禽流感流行,发病18例、死亡6例,说明A群H5N1亚型病毒是强致病性,并证明其为致禽、兽及人共患的病毒。事隔7年,2004年再次在东北亚、东南亚禽流感疫点频繁暴发,既有大批家禽、野禽（如青海湖野鸟）死亡。也有人感染禽流感、兽类（如泰国虎）死亡的报道。进人2005年流行季节H5N1亚型在土耳其禽流感多点暴发,已发生人禽流感11例,死亡4例,并同时在欧洲波兰、罗马尼亚、伊朗、希腊以及非洲尼日利亚等国家出现禽流感疫点,引起全球重视。这是进入21世纪以来,     

山西省首例高致病性禽流感A/H5N1病毒感染患者的救治体会

目的 探索高致病性禽流感A/H5N1病毒感染(简称人禽流感)病例的临床特点及治疗体会.方法 对2009年1月17口山西省太原市第四人民医院收治的1例人禽流感患者的临床表现、实验室检查、影像学改变及治疗方法等进行总结.结果 患者鼻咽抽取物A/H5N1病毒经逆转录聚合酶链反应(RT-PCR)、实时PCR榆测A/H5N1病毒核酸阳性,确诊为人禽流感病例.患儿女,2岁11个月,体重11 kg.患儿平素体健,发病的有活禽屠宰市场环境暴露史.以发热、咳嗽、呼吸困难为主要症状;肺部病灶进展快,病程第8天肺部病变迅速进展,x线胸片呈"白肺",病情迅速进展为ARDS,静脉应用甲泼尼龙165 mg(15 mg·kg-1·d-1)及无创通气治疗,病程第9天病情有所好转,肺部病灶明显吸收;病程第11天开始给予奥司他韦及100 ml高滴度A/H5N1病毒疫苗免疫血浆,后患者病情日见好转,氧合指数及各种酶学指标恢复正常,肺内病灶明显吸收;病程第28大患者好转出院.结论 人禽流感发现晚、病情重、进展快,临床主要表现为严重的ARDS;有效的氧疗及呼吸支持是治疗的基础;糖皮质激素对肺部病灶的吸收有一定疗效,使用剂量有待进一步探讨;A/H5N1病毒疫苗免疫血浆治疗可能对改善患者的预后有一定帮助.     

贵州省首例高致病性禽流感A/H5N1病毒感染患者的救治体会

目的 探讨成功救治高致病性禽流感A/H5N1病毒感染(简称人禽流感)患者的诊断流程和临床管理措施.方法 对2009年1月16日贵州省人民医院收治的1例人禽流感患者的临床表现、实验室检查、心电图、影像学改变和临床管理等资料进行总结.结果 经逆转录-聚合酶链反应(RT-PCR)方法和病毒分离确诊为人禽流感病例.患者男,29岁,平素体健,发病前有活禽市场环境暴露史,以发热、畏寒起病,尤明显流感样症状,高热时伴有肢体抽搐和意识障碍,继之出现咳嗽,咳大量粉红色泡沫样痰,病情进行性加重,先后出现呼吸困难、急性呼吸窘迫综合征和心房颤动,影像学显示双侧肺炎进行性加重,并伴双侧胸腔积液.病程第8大给予有创呼吸机治疗,并给予奥司他韦,但病情仍进一步加重.病程第10天给予高滴度A/H5N1病毒疫苗免疫血浆后,患者病情日见好转,呼吸道症状逐渐减少甚至消失,心房纤颤转为窦性心率,病程第23天肺内病灶明显吸收后好转出院.结论 人禽流感患者发病可无典型的流行病学史,病变进展为急性呼吸窘迫综合征合并心脏损害时病情危重,预后不佳;如能在2周内及时给予适当的病毒免疫血浆治疗,则可能迅速改善患者的预后.     

安徽省人感染禽流感A(H5N1)两例

目的 分析安徽省2例确诊的人感染禽流感病毒A（H5N1）临床和流行病学特点，并对治疗方法进行探讨。方法 对安徽省枞阳县和休宁县2例患者的临床、流行病学资料、实验室检查、影像学资料进行回顾性分析。结果 2例患者为健康青年女性，都有明确的病死禽（鸡）接触史，从暴露到发病的时间均为5d，均以发热为首发症状，早期出现咳嗽、胸闷、呼吸困难，无明显的上呼吸道症状；实验室检查：白细胞、淋巴细胞正常或降低，血小板减少；胸部X线显示为双肺下叶和右下肺的实变阴影，具有短期内病灶进展快的特点；都发展为急性呼吸窘迫综合征（ARDS）并伴有多脏器功能衰竭综合征（MODS）。结论 人感染禽流感病毒A（H5N1）临床以发热伴有下呼吸道症状的流感样表现为特点，是以肺损伤为主的多脏器受损的疾病，与直接接触病死禽有关。     

H5N1高致病性禽流感病毒研究进展

流行性感冒病毒属正粘病毒科,根据内部核蛋白（NP）和基质蛋白（MP）抗原性的不同,将流感病毒分为A型、B型和c型3型。A型流感病毒的基因组是由8个分节段的单负链RNA组成,编码11种蛋白质,表面糖蛋白为HA和NA,根据HA和NA的抗原差异分为16种HA亚型（H1一H16）和9种NA亚型（N1～N9）。     

湖北省首例人感染H5N6禽流感病例实验室检测结果分析

目的分析湖北省首例人感染H5N6禽流感病例的实验室检测结果,为更好地检测人禽流感疑似病例标本提供参考。方法对患者的不同病程、不同种类的标本进行实验室检测并进行分析。结果我省首例人感染H5N6禽流感确诊病例只有前期的痰液标本检测到H5N6核酸,其它时间未检测到。结论疑似人感染H5N6禽流感病例标本采集一定多样化,而且一定采集到初期的痰液标本。     

Intensive care management of life-threatening avian influenza A (H5N1)

A large proportion of patients with avian influenza A (H5N1) develop life-threatening manifestations, often including ARDS, acute renal failure and multiple organ failure that requires aggressive intensive care management. The pace of development of respiratory failure is often rapid and can occur in previously healthy hosts, mandating close observation and timely intervention of infected individuals. Use of standard, contact, droplet and airborne isolation precautions is recommended to protect healthcare workers. Key components of ARDS management encompass appropriate mechanical ventilation including limiting tidal volume to ≤6 mL/kg of predicted body weight, maintaining transpulmonary pressures ≤30 cm H₂O, and utilizing positive end–expiratory pressure to limit alveolar deflation and to improve oxygenation. Additional strategies include conservative fluid management and using nutrition supplemented with antioxidants. Use of corticosteroids is controversial for both early and late ARDS and although often used for avian influenza, beneficial effects on outcomes have not been demonstrated for corticosteroids. Prone positioning can improve oxygenation temporarily and might be useful as rescue therapy for severe hypoxemia. Administration of inhaled nitric oxide and high frequency oscillatory ventilation can improve oxygenation but have not been demonstrated to improve survival in ARDS—their role in avian influenza is uncertain and availability limited. Management of multiple organ failure may include vasopressor support for septic shock and renal replacement therapy for acute renal failure.     

A case of avian influenza A(H5N1) in England,January 2022

On 5 January 2022, high pathogenicity avian influenza A(H5N1) was confirmed in an individual who kept a large flock of ducks at their home in England. The individual remained asymptomatic. H5N1 was confirmed in 19/20 sampled live birds on 22 December 2021. Comprehensive contact tracing (n = 11) revealed no additional primary cases or secondary transmissions. Active surveillance of exposed individuals is essential for case identification. Asymptomatic swabbing helped refine public health risk assessment and facilitated case management given changes in avian influenza epidemiology.     

Global epidemiology of human infections with highly pathogenic avian influenza A (H5N1) viruses

Abstract:   From 1997 through 2007, human infections with highly pathogenic avian influenza A (H5N1) viruses resulted in rare, sporadic, severe and fatal cases among persons in 14 countries in Asia, the Middle East, Eastern Europe and Africa. Of 369 reported human H5N1 cases that occurred from 1997 through 2007, overall mortality was 60%. Ten antigenically and genetically distinct clades of H5N1 viruses have been identified to date, and strains from four clades have infected humans. Surveillance has focused upon hospitalized cases of febrile acute lower respiratory tract disease among persons with exposure to sick or dead poultry, or to a human H5N1 case. Detection of H5N1 virus infection is based primarily upon collection of respiratory tract specimens from suspected cases for RT-PCR testing. Most human H5N1 cases were previously healthy children or young adults who developed severe acute pulmonary or multi-organ disease following direct or close contact with sick or dead H5N1 virus–infected poultry. Occasional clusters of H5N1 cases have occurred, predominantly among blood-related family members. Limited human-to-human H5N1 virus transmission has been reported or could not be excluded in some clusters. The frequency of asymptomatic or clinically mild H5N1 virus infection is unknown, but limited investigations suggest that such infections have been rare since 2003. There is no evidence of sustained human-to-human H5N1 virus spread. However, H5N1 viruses continue to circulate and evolve among poultry in many countries, and there are many unanswered questions about human infection with H5N1 viruses. Thus, the pandemic influenza threat presented by H5N1 viruses persists.     

H5N1禽流感病毒感染孕鼠的研究

目的用H5N1禽流感病毒感染昆明孕鼠,检测病毒在感染孕鼠各组织脏器中的复制及分布情况,并证明病毒能否通过孕鼠的胎盘垂直传染给胎鼠。方法用虎源H5N1亚型禽流感病毒滴鼻感染妊娠10-12 d的昆明孕鼠,观察孕鼠感染后的临床症状。接种病毒后第3、4、5、6和7 d分别处死3只孕鼠,取孕鼠的肺、脑、脾、肾、子宫、胎盘及胎鼠,利用RT-PCR、Real-time PCR和病毒分离方法检测各组织中的病毒核酸和病毒滴度,并进行病理组织学与免疫组织化学检测。结果昆明孕鼠接种病毒后第3 d,即可在肺、脑、脾、肾、子宫及胎盘组织中检测出H5N1禽流感病毒核酸,并从子宫、胎盘分离出H5N1禽流感病毒;感染后第6 d,从胎鼠体内检测到病毒核酸并分离出H5N1禽流感病毒。结论H5N1亚型禽流感病毒可以感染孕鼠,在孕鼠子宫和胎盘复制,感染后期可通过胎盘屏障传给胎鼠。     

云南省首例人感染H5N6禽流感病例调查与分析

目的 分析省内首例既全球第3例人感染H5N6禽流感病例的流行病学调查结果,总结人感染H5N6禽流感病例的流行病学特征,为今后人感染H5N6禽流感病例的排查及流行病学调查提供参考。方法 回顾性描述、分析云南省首例人感染H5N6病例流行病学调查过程、疫点及密切接触人员采样检测结果,总结人感染H5N6禽流感病例的流行病学特征。结果 我省首例人感染 H5N6 禽流感确诊病例为单个病例,未出现人传人,发病前有野禽接触史及菜市场活动史,住地菜市场部分禽类摊档标本H5N6禽流感病毒核酸检测阳性。结论 我省首例人感染 H5N6 禽流感病例为本地感染非人传人病例,传播途径可能为禽-环境-人或禽-人。