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Article: Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection
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TitleDelayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection
 
AuthorsTo, KKW4
Hung, IFN4
Li, IWS4
Lee, KL9
Koo, CK6
Yan, WW8
Liu, R10
Ho, KY5
Chu, KH5
Watt, CL1
Luk, WK2
Lai, KY7
Chow, FL12
Mok, T11
Buckley, T3
Chan, JFW4
Wong, SSY4
Zheng, B4
Chen, H4
Lau, CCY4
Tse, H4
Cheng, VCC4
Chan, KH4
Yuen, KY4
 
Issue Date2010
 
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
 
CitationClinical Infectious Diseases, 2010, v. 50 n. 6, p. 850-859 [How to Cite?]
DOI: http://dx.doi.org/10.1086/650581
 
AbstractBackground: Infections caused by the pandemic H1N1 2009 influenza virus range from mild upper respiratory tract syndromes to fatal diseases. However, studies comparing virological and immunological profile of different clinical severity are lacking. Methods: We conducted a retrospective cohort study of 74 patients with pandemic H1N1 infection, including 23 patients who either developed acute respiratory distress syndrome (ARDS) or died (ARDS-death group), 14 patients with desaturation requiring oxygen supplementation and who survived without ARDS (survived-withoutARDS group), and 37 patients with mild disease without desaturation (mild-disease group). We compared their pattern of clinical disease, viral load, and immunological profile. Results: Patients with severe disease were older, more likely to be obese or having underlying diseases, and had lower respiratory tract symptoms, especially dyspnea at presentation. The ARDS-death group had a slower decline in nasopharyngeal viral loads, had higher plasma levels of proinflammatory cytokines and chemokines, and were more likely to have bacterial coinfections (30.4%), myocarditis (21.7%), or viremia (13.0%) than patients in the survived-without-ARDS or the mild-disease groups. Reactive hemophagocytosis, thrombotic phenomena, lymphoid atrophy, diffuse alveolar damage, and multiorgan dysfunction similar to fatal avian influenza A H5N1 infection were found at postmortem examinations. Conclusions: The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death. © 2010 by the Infectious Diseases Society of America. All rights reserved.
 
ISSN1058-4838
2013 Impact Factor: 9.416
 
DOIhttp://dx.doi.org/10.1086/650581
 
ISI Accession Number IDWOS:000274656000009
Funding AgencyGrant Number
Providence Foundation Limited
University Grant Council
Research Fund for the Control of Infectious Diseases (RFCID)
Food and Health Bureau of the Hong Kong SAR Government
Funding Information:

The Providence Foundation Limited in memory of the late Dr Lui Hac Minh, the University Grant Council, and the Research Fund for the Control of Infectious Diseases (RFCID) of the Food and Health Bureau of the Hong Kong SAR Government.

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorTo, KKW
 
dc.contributor.authorHung, IFN
 
dc.contributor.authorLi, IWS
 
dc.contributor.authorLee, KL
 
dc.contributor.authorKoo, CK
 
dc.contributor.authorYan, WW
 
dc.contributor.authorLiu, R
 
dc.contributor.authorHo, KY
 
dc.contributor.authorChu, KH
 
dc.contributor.authorWatt, CL
 
dc.contributor.authorLuk, WK
 
dc.contributor.authorLai, KY
 
dc.contributor.authorChow, FL
 
dc.contributor.authorMok, T
 
dc.contributor.authorBuckley, T
 
dc.contributor.authorChan, JFW
 
dc.contributor.authorWong, SSY
 
dc.contributor.authorZheng, B
 
dc.contributor.authorChen, H
 
dc.contributor.authorLau, CCY
 
dc.contributor.authorTse, H
 
dc.contributor.authorCheng, VCC
 
dc.contributor.authorChan, KH
 
dc.contributor.authorYuen, KY
 
dc.date.accessioned2010-10-31T11:09:59Z
 
dc.date.available2010-10-31T11:09:59Z
 
dc.date.issued2010
 
dc.description.abstractBackground: Infections caused by the pandemic H1N1 2009 influenza virus range from mild upper respiratory tract syndromes to fatal diseases. However, studies comparing virological and immunological profile of different clinical severity are lacking. Methods: We conducted a retrospective cohort study of 74 patients with pandemic H1N1 infection, including 23 patients who either developed acute respiratory distress syndrome (ARDS) or died (ARDS-death group), 14 patients with desaturation requiring oxygen supplementation and who survived without ARDS (survived-withoutARDS group), and 37 patients with mild disease without desaturation (mild-disease group). We compared their pattern of clinical disease, viral load, and immunological profile. Results: Patients with severe disease were older, more likely to be obese or having underlying diseases, and had lower respiratory tract symptoms, especially dyspnea at presentation. The ARDS-death group had a slower decline in nasopharyngeal viral loads, had higher plasma levels of proinflammatory cytokines and chemokines, and were more likely to have bacterial coinfections (30.4%), myocarditis (21.7%), or viremia (13.0%) than patients in the survived-without-ARDS or the mild-disease groups. Reactive hemophagocytosis, thrombotic phenomena, lymphoid atrophy, diffuse alveolar damage, and multiorgan dysfunction similar to fatal avian influenza A H5N1 infection were found at postmortem examinations. Conclusions: The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death. © 2010 by the Infectious Diseases Society of America. All rights reserved.
 
dc.description.naturepublished_or_final_version
 
dc.identifier.citationClinical Infectious Diseases, 2010, v. 50 n. 6, p. 850-859 [How to Cite?]
DOI: http://dx.doi.org/10.1086/650581
 
dc.identifier.citeulike6649981
 
dc.identifier.doihttp://dx.doi.org/10.1086/650581
 
dc.identifier.eissn1537-6591
 
dc.identifier.epage859
 
dc.identifier.hkuros173891
 
dc.identifier.isiWOS:000274656000009
Funding AgencyGrant Number
Providence Foundation Limited
University Grant Council
Research Fund for the Control of Infectious Diseases (RFCID)
Food and Health Bureau of the Hong Kong SAR Government
Funding Information:

The Providence Foundation Limited in memory of the late Dr Lui Hac Minh, the University Grant Council, and the Research Fund for the Control of Infectious Diseases (RFCID) of the Food and Health Bureau of the Hong Kong SAR Government.

 
dc.identifier.issn1058-4838
2013 Impact Factor: 9.416
 
dc.identifier.issue6
 
dc.identifier.openurl
 
dc.identifier.pmid20136415
 
dc.identifier.scopuseid_2-s2.0-77749282915
 
dc.identifier.spage850
 
dc.identifier.urihttp://hdl.handle.net/10722/125075
 
dc.identifier.volume50
 
dc.languageeng
 
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
 
dc.publisher.placeUnited States
 
dc.relation.ispartofClinical Infectious Diseases
 
dc.relation.referencesReferences in Scopus
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshCohort Studies
 
dc.subject.meshCytokines - blood
 
dc.subject.meshInfluenza A Virus, H1N1 Subtype - isolation and purification
 
dc.subject.meshInfluenza, Human - immunology - pathology - virology
 
dc.subject.meshViral Load
 
dc.titleDelayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection
 
dc.typeArticle
 
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Author Affiliations
  1. Kwong Wah Hospital
  2. Tseung Kwan O Hospital
  3. Yan Chai Hospital - Hong Kong
  4. The University of Hong Kong
  5. Princess Margaret Hospital Hong Kong
  6. Tuen Mun Hospital
  7. Queen Elizabeth Hospital Hong Kong
  8. Pamela Youde Nethersole Eastern Hospital
  9. United Christian Hospital Hong Kong
  10. Ruttonjee Hospital and Tang Shiu Kin Hospitals
  11. Kowloon Hospital
  12. Caritas Medical Centre Hong Kong