Shenzhen man in critical condition with H7N9

A 38-year-old man has been hospitalized in the Chinese city of Shenzhen with H7N9 avian flu, the fourth such case from Guangdong province in the last several days, authorities announced today.

The man got sick with a fever and cough on Dec 9 and was seen at a local clinic and hospital, according to a statement today from Hong Kong's Centre for Health Protection (CHP). His respiratory samples tested positive for the virus at the Shenzhen Center for Disease Control on Dec 17, and Guangdong health officials confirmed the findings the next day.

He is hospitalized in critical condition. The man is the first known H7N9 case from Shenzhen, though two patients from the city were recently diagnosed and treated for H7N9 infections after arriving in Hong Kong. The detection of the virus in three environmental samples led to the temporary closure of live-poultry markets in one of Shenzhen's districts.

Over the past week or so, three other H7N9 patients have been confirmed in Guangdong province: a 63-year-old man and 65-year-old woman from Yangjiang and a 36-year-old man from Dongguan.

The new case from China would lift the global total from the novel virus to 146 cases, which includes 45 deaths.

Meanwhile, two new reports in the medical literature describe the work-up and treatment of some of the first patients who were infected in China during the first wave of infections in early spring. One of the reports described H7N9 screening results in patients who sought treatment at a hospital for fever and other flu symptoms, while the other described the treatment course in a pregnant woman.

Screening identifies one patient

In the first study, a research team based at Nanjing University Medical School reported the results of throat swab testing in 200 consecutive patients with fever and flulike symptoms who lived in Jiangsu province, one of the regions that was hardest hit during the outbreak. The findings were published yesterday in Public Library of Science (PLoS) One.

The patients were evaluated in the emergency department at Nanjing Drum Tower Hospital, located in the province's capital, from Apr 15 through Apr 25. Researchers collected throat swabs from the patients and performed polymerase chain reaction (PCR) tests.

Of the 200 tested, only one patient was positive for the H7N9 virus, a 36-year-old man from Xinhi city who sold live poultry and transported them to Hangzhou, the capital of Zhejiang province. He was hospitalized on Apr 22 with pneumonia and treated with oseltamivir (Tamiflu). The man recovered and was discharged from the hospital on May 15.

None of his close contacts showed any symptoms.

The authors noted that the report shows that screening in patients with fever and flulike symptoms is useful for rapid diagnosis in areas where confirmed outbreak cases have been detected.

H7N9 in pregnancy

The second report describes H7N9 illness in a 25-year-old pregnant woman who was seen in an outpatient clinic for flulike symptoms in Jiangsu province on Mar 30. Researchers from the Jiangsu Province Center for Disease Control and Prevention described her clinical course in a letter published yesterday in Emerging Infectious Diseases.

The woman lived with her husband and his parents, who were pork butchers at a live-animal market where several types of poultry were sold. She had visited the market once during the 2 weeks before she got sick.

She was 17 weeks pregnant when she got sick and was hospitalized on Apr 5. Her condition worsened, and she was placed on a mechanical ventilator and received several treatments, including oseltamivir.

Her condition stabilized and she was discharged from the hospital on May 14, with no known fetal abnormalities. She delivered a healthy baby by cesarean section Jul 17.

Researchers said the case suggests that pregnancy might be a risk factor for severe flu in women infected with the H7N9 virus.

See also:

Dec 19 CHP report

Dec 18 PLoS One report

Dec 18 Emerg Infect Dis letter

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