The retiree became ill March 27, with a fever that soared as high as 40.6 degrees Celsius (105.1 Fahrenheit), doctors at Huashan Hospital in Shanghai wrote in a report on the case in the journal Emerging Microbes & Infections. Treatment with intravenous antibiotics, steroids, antibody therapy, and mechanical ventilation failed to help, and she died April 3.
Her illness, the first H7N9 avian influenza case to be described in a medical journal, highlights the seriousness of the new strain, which has sickened at least 38 people in eastern China, killing 10, in the past two months. Hospital doctors didn’t know the cause of the woman’s illness when she was admitted. Tests identified the H7N9 virus after she died.
“What they had here was a seriously ill patient and they didn’t know what was going on,” said Dominic Dwyer, director of the Institute of Clinical Pathology and Medical Research at Sydney’s Westmead Hospital, who reviewed the case report. “This person was so ill, they just threw everything” at her.
Three new infections were confirmed in Shanghai yesterday, along with another two in the neighboring province of Jiangsu. More than two dozen cases have been reported since the woman’s death, spurring heightened vigilance for the new strain, which the World Health Organization said doesn’t appear to be spreading from person to person.
“All fatal cases in Shanghai, including this patient, were admitted to hospital very late until the symptom of shortness of breath developed,” Feifei Yang and colleagues at Huashan Hospital wrote in the journal.
Without knowing the cause of their disease, the patients weren’t offered anti-flu drugs, such as Roche Holding AG’s (ROG) Tamiflu, which might have helped them fight the virus, especially if taken early, the authors said.
The woman’s early high fever, the late onset of respiratory problems and quick deterioration are reminiscent of the deadly H5N1 strain of bird flu, said Nikki Shindo, a doctor and flu expert at the WHO, commenting on the report.
The woman began experiencing fevers and chills on March 27. After several days, she developed a cough, tightness in her chest and difficulty breathing. A chest X-ray showed severe pneumonitis and she was given antibiotics. Her condition worsened and a week after her symptoms began, she was hospitalized for acute respiratory distress syndrome and died the next day.
Blood tests showed cardiac enzymes that suggest the patient had a heart attack, Dwyer said, referring to the published case report. Her heart complications may have been caused by the virus directly or the effects of “trying to push blood through a very heavily congested lung,” he said.
“This is what happens with severe influenza, even if it doesn’t go outside the lung,” Dwyer said. “The big question here is, are these severe cases the tip of a very big iceberg or do most cases get really ill like this?’
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