| Avian
Flu |
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Introduction
Dear Visitors,
Thank you for visiting our webpage on "avian flu". Through
this webpage, we hope to share the clinical and radiographic features
of this novo disease with the rest of the medical community.
Our first encounter with this new viral disease was in 1997 when
there was a limited outbreak of the infection in Hong Kong. No
major human outbreaks have since occurred until last winter. This
time, however, the disease is more widespread and not limited
to Asia or a single strain of the virus. With the help of our
colleages in Hong Kong and Vietnam, we have gathered a collection
of serial radiographs of this disease and the associated clinical
findings.
We would like to thank all the medical staff who have contributed
and helped with providing information for this webpage. We would
also like to acknowledge the efforts of the public, health-care
workers and health authorities in limiting the spread of this
disease.
Department of Diagnostic Radiology and Organ Imaging,
The Chinese University of Hong Kong.
16th April, 2004.
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Case
One: 13-year-old
symptomatic female
Admitted
to Paediatric ward 26/11/97 (Day 1) from the Emergency department.
Previously
healthy. Sore throat, rhinorrhoea, and dry cough one week prior
to admission. Fever four days prior to admission.
Examination - Alert, febrile, no respiratory distress. Lung auscultation
- decreased breath sounds and crepitations in R lung base.
Complete
blood count - WCC 4700/microL, Platelets 62 000/microL
Blood culture - negative
Sputum culture - nil of note
Viral titre - nil of note
Diagnosis
of atypical pneumonia - Clarythromycin orally.
Following
day - haemoptysis. Cefotaxime added.
In evening cough, increasing respiratory rate and distress and
hypoxia despite oxygen therapy.
Admitted
to ICU on 27/11/97 (Day 2).
Mechanical
ventilation for hypoxia 6 h after admission. Clinical R lower
and middle lobe crepitations and audible "rub". Rapid deterioration
over next 3 days with ARDS, multiple organ dysfunction.
29/11/03:
Upper gastrointestinal bleeding. Worsening ARDS requiring prone
position ventilation - until the 5th or 6th Dec.
Died
21/12/97. cause of death intractable respiratory failure (hypoxia).
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| Day 2 |
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| Day 3 |
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| Day 4 |
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| Day 5 |
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| Day 9 |
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| Day 14 |
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| Day 20 |
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| Day 23 (1) |
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| Day 23 (2) |
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| Day 26 |
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Case
Two: M
31 yrs: exposed to dead chicken 5 days before illness (onset 3/1/04).
Fever 40C, malaise, dry cough, SOB, headache for 2 days. His 2 sisters
died of confirmed H5N1 2 weeks later. |
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| 5/1/2004 |
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| 6/1/2004 -
1 |
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| 6/1/2004 -
2 |
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| 9/1/2004 |
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Case
Three:
M/52 yrs old: poultry farm worker, contact with dead chicken. Fever
5 days/ dry cough, runny nose & SOB for 2 days. CPK 15820. Rx:
Fortum & Amikacin. |
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| 9/2/2004 |
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| 10/2/2004 |
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Case
Four:
M/19 yrs: poultry farm worker with contact of dead chicken. Fever,
productive cough, SOB since 5/12/03. WBC 2.1, L=0.6, Plt 30, normal
fibrinogen & APTT. Urea 15.4, Cr 238, ALT 49, AST 397. Rx: cefotaxime,
gentamicin. |
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| 8/12/2003 |
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| 9/12/2003 |
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| 10/12/2003 |
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Case
Five:
M/23 yrs: farmer. Contact with dead chicken 3 days prior to illness.
T38.7C, Productive cough, SOB, diarrhoea. Admitted to HCM Hosp for
Tropical Dis 7 days after onset. SpO2 90% on 40% oxygen. Hb 17.6,
WBC 3.9, Lym 0.7, Plt 102, Cr 121, ALT 89, AST 110. RTPCR positive
for H5N1. |
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| Critically
ill - 1 |
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| Critically
ill - 2 |
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| Critically
ill - 3 |
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Case
Six: M
33 yrs/Princess Margaret Hospital, Hong Kong: returned from Fujian with fever, chills, cough since
7/2/03. Lymphopenia, increased ALT. ARDS & MODS on 14/2/03.
Died on 17/2/03 |
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| 11/2/2003 |
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| 13/2/2003 |
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| 14/2/2003 |
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Case
Seven:
- F/6
yr, fever for 8 days, developed acute respiratory distress
- Adm
WBC 2.4 x 109/L, L 0.5 x 109/L, plt 127 x 109/L, ALT 246 IU/L,
AST 1379 IU/L, nasal swab H5 Ag +ve
- Given
Methylpred 5 mg/kg/day and Tamiflu. Died 3 days after admission
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| CXR on admission |
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| CXR 6 hours
after admission |
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| CXR on day
2 |
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| CXR on day
3 |
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,
Gavin M Joynt
, KT
Wong
, Gregory E Antonio
