Bedside chest radiography of novel influenza A (H7N9) virus infections and follow-up findings after short-time treatment.
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BACKGROUND: Influenza A (H7N9) virus infections were first observed in China in March 2013. This type virus can cause severe illness and deaths, the situation raises many urgent questions and global public health concerns. Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A (H7N9) virus infections and the followup appearances after short-time treatment. METHODS: Eight hospitalized patients infected with the novel influenza A (H7N9) virus were included in our study. All of the patients underwent bedside chest radiography after admission, and all had follow-up bedside chest radiography during their first ten days, using AXIOM Aristos MX and/or AMX-IV portable X-ray units. The exposure dose was generally 90 kV and 5 mAs, and was slightly adjusted according to the weight of the patients. The initial radiography data were evaluated for radiological patterns (ground glass opacity, consolidation, and reticulation), distribution type (focal, multifocal, and diffuse), lung zones involved, and appearance at follow-up while the patients underwent therapy. RESULTS: All patients presented with bilateral multiple lung involvement. Two patients had bilateral diffuse lesions, three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe, and the remaining three had bilateral multifocal lung lesions. The lesions were present throughout bilateral lung zones in three patients, the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone(s), both lower and middle lung zones in one patient, and the right middle and lower in combination with the left lower lung zones in one patient. The most common abnormal radiographic patterns were ground glass opacity (8/8), and consolidation (8/8). In three cases examined by CT we also found the pattern of reticulation in combination with CT images. Four patients had bilateral and four had unilateral pleural effusion. After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression. In four cases the severity of the pneumonia fluctuated. CONCLUSIONS: In patients with influenza A (H7N9) virus infection, the distribution of the lung lesions are extensive, and the disease usually involves both lung zones. The most common imaging findings are a mixture of ground glass opacity and consolidation. Pleural effusion is common. Most cases have a poor short-time treatment response, and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes. Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation. (+info)
Spatial and temporal analysis of human infection with avian influenza A(H7N9) virus in China, 2013.
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Descriptive and geographic information system methods were used to depict the spatial and temporal characteristics of the outbreak of human infection with a novel avian influenza A(H7N9) virus in mainland China, the peak of which appeared between 28 March and 18 April 2013. As of 31 May 2013, there was a total of 131 reported human infections in China, with a cumulative mortality of 29% (38/131). The outbreak affected 10 provinces, with 106 of the cases being concentrated in the eastern coastal provinces of Zhejiang, Shanghai and Jiangsu. Statistically significant spatial clustering of cumulative human cases was identified by the Cuzick-Edwards' k-nearest neighbour method. Three spatio-temporal clusters of cases were detected by space-time scan analysis. The principal cluster covered 18 counties in Zhejiang during 3 to 18 April (relative risk (RR): 26.39;p<0.0001), while two secondary clusters in March and April covered 21 counties along the provincial boundary between Shanghai and Jiangsu (RR: 6.35;p<0.0001) and two counties in Jiangsu (RR: 72.48;p=0.0025). The peak of the outbreak was in the eastern coastal provinces of Zhejiang, Shanghai and Jiangsu that was characterised by statistically significant spatio-temporal aggregation, with a particularly high incidence in March and April 2013. (+info)