[Clinical investigation of the clinical management and therapeutic strategies to the first human case infected by influenza A/H5N1 in Guizhou Province].

Objective: To explore the optimized clinical management and therapeutic strategies for the survived human case infected by influenza A (A/H5N1).

Methods: All the data of the first human case infected by A/H5N1 in Guizhou province was collected and analyzed.

Results: The first case infected by A/H5N1 in Guizhou Province was confirmed by laboratory findings with reverse-transcription polymerase chain reaction (RT-PCR) and A/H5N1 isolation. Patient was healthy in the past and exposed in the environment of living poultry. The initial symptoms was high fever without influenza-like presentation, but with extremity hyperspasmia and conscious disturbance sometimes. A productive cough with a large mount of pink foaming sputum then appeared. The clinical situation was rapidly deteriorated with dyspnea, acute respiratory distress syndrome and atrial fibrillation. Multiple infiltration in bilateral lungs was progressively developed with moderate bilateral pleural effusion. Invasive ventilation was intervened since ARDS on day 8 after sickness. Oseltamivir was kicked off since day 9 after sickness. However, the clinical condition was still exacerbated. High titering antibody of A/H5N1 vaccinated plasma was administrated on day 10 after sickness. The clinical condition (including oxygen saturation, respiratory symptoms, etc.) was improved rapidly. The weaning of ventilation was carried out in two days. Atrial fibrillation was back to normal. The patient was clinical recovery and was discharged from hospital on day 23 after sickness.

Conclusions: The prognosis was poor if A/H5N1 infected human cases developed as acute respiratory distress syndrome with heart injury. However, it could be ameliorated if the plasma of A/H5N1 vaccinated neutralizing antibody was administrated in time or within two weeks after sickness.