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      Influenza (H7N9) leads to persistent encephalitic infection in an HIV-infected patient

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          Abstract

          We present a case co-infected with HIV and H7N9, which resulted in a persistent encephalitic and respiratory infection, and indicated that an immune compromised individual may present a very different clinical symptoms from H7N9 infection alone and experience a chronic clinical infection.

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          Clinical findings in 111 cases of influenza A (H7N9) virus infection.

          During the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread among humans in China. Data were lacking on the clinical characteristics of the infections caused by this virus. Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013. Of the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of 61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed in 88.3% of patients, and thrombocytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108 patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptase-polymerase-chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95% confidence interval, 1.21 to 9.70; P=0.02). During the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia and ARDS, with high rates of ICU admission and death. (Funded by the National Natural Science Foundation of China and others.).
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            Emerging H7N9 influenza A (novel reassortant avian-origin) pneumonia: radiologic findings.

            To determine the radiologic findings of human infection with a novel reassortant avian-origin influenza A H7N9 virus in March 2013, the first outbreak in humans. The institutional review board approved this retrospective study. Twelve patients (nine men and three women) with novel avian-origin influenza A H7N9 virus infection were enrolled. All patients underwent chest radiography and thin-section computed tomography (CT). Lesion patterns, distributions, and changes at follow-up CT were investigated. Two chest radiologists reviewed the images and clinical data together and reached decisions concerning findings by consensus. At presentation, all patients had progressing infection of the lower respiratory tract, with fever, cough, and shortness of breath, which rapidly progressed to acute respiratory distress syndrome. The imaging findings included ground-glass opacities (GGOs) (in 12 of 12 patients), consolidations (in 11 patients), air bronchograms (in 11 patients), interlobular septal thickening (in 11 patients), centrilobular nodules (in seven patients), reticulations (in seven patients), cystic changes (in four patients), bronchial dilatation (in three patients), and subpleural linear opacities (in three patients). The lung lesions involved three or more lobes in all cases and were mostly detected in the right lower lobe (in 11 patients). Follow-up CT in 10 patients showed interval improvement (in three patients) or worsening (in seven patients) of the lesions. Imaging findings closely mirrored the overall clinical severity of the disease. Rapidly progressive GGOs and consolidations with air bronchograms and interlobular septal thickening, with right lower lobe predominance, are the main imaging findings in H7N9 pneumonia. The severity of these findings is associated with the severity of the clinical presentation.
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              Safe Pseudovirus-based Assay for Neutralization Antibodies against Influenza A(H7N9) Virus

              Serologic studies are urgently needed to assist in understanding an outbreak of influenza A(H7N9) virus. However, a biosafety level 3 laboratory is required for conventional serologic assays with live lethal virus. We describe a safe pseudovirus–based neutralization assay with preliminary assessment using subtype H7N9–infected samples and controls.
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                Author and article information

                Contributors
                Journal
                Infectious Diseases and Translational Medicine
                Infect. Dis. Transl. Med.
                Infect. Dis. Transl. Med.
                International Biological and Medical Journals Publishing House Co., Limited (Room E16, 3/f, Yongda Commercial Building, No.97, Bonham Stand (Sheung Wan), HongKong )
                2411-2917
                30 June 2015
                30 March 2015
                : 1
                : 1
                : 9-11
                Affiliations
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China
                School of Public Health, the University of Hong Kong, Hong Kong, China
                From Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Key Laboratory of Medical Molecular Virology of Ministry of Education/Health, Shanghai Medical College, Fudan University, Shanghai, China; State Key Laboratory for Infectious Disease Prevention and Control, China CDC, Beijing, China
                Author notes
                Correspondence to: Jianqing Xu, Email: xujianqing@ 123456shaphc.org ; Tel: +86-21-37990333-7335; Fax: +86-21-57247094.

                †: These authors contributed equally to this work.

                Article
                10.11979/idtm.201501004
                9ec58f20-f72a-4b19-a5e9-2602cf1c5bb7

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Page count
                Figures: 1, Tables: 0, References: 8, Pages: 3
                Product
                Funding
                This work was supported by the National Grand Program on Key Infectious Disease Control (2013ZX10001-002), the China Ministry of Health, the 973 National Key Basic Research Project (2014CB542502), the Ministry of Science and Technology of the People’s Republic of China, the Shanghai Municipal Commission of Health and Family Planning (2013QLG003), and the 985 program at Fudan University (EZF101606/018-019).
                Categories
                Case Report

                Medicine,Infectious disease & Microbiology
                Persistent infection,Encephalitic infection,Influenza,HIV,H7N9,Co-infection

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