The re-emergence of highly pathogenic #avian #influenza #H7N9 viruses in #human[s] in mainland #China, 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

The re-emergence of highly pathogenic avian influenza H7N9 viruses in humans in mainland China, 2019

Deshan Yu1,2, Guofeng Xiang1,3, Wenfei Zhu1,4, Xia Lei1,5, Baodi Li2, Yao Meng4, Lei Yang4, Hongyan Jiao6,Xiyan Li4, Weijuan Huang4, Hejiang Wei4, Yanping Zhang7, Yan Hai5, Hui Zhang2, Hua Yue5, Shumei Zou4, Xiang Zhao4, Chao Li7, Deng Ao6,Ye Zhang4, Minju Tan4, Jia Liu4, Xuemei Zhang6, George F. Gao4,7, Lei Meng2,8, Dayan Wang4,8

Affiliations: 1 These authors contributed equally in this study as first authors; 2 Gansu Provincial Center for Disease Control and Prevention, Lanzhou China; 3 Jiuquan Center for Disease Control and Prevention, Jiuquan, China; 4 National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention; WHO Collaborating Center for Reference and Research on Influenza; Key Laboratory for Medical Virology, National Health Commission, Beijing, China; 5 Inner Mongolia Center for Disease Control and Prevention, Hohehot, China; 6 Alasan League Center for Disease Control and Prevention, Alasan, China; 7 Chinese Center for Disease Control and Prevention, Beijing, China; 8 These authors contributed equally as last authors in this study

Correspondence:  Dayan Wang

Citation style for this article: Yu Deshan, Xiang Guofeng, Zhu Wenfei, Lei Xia, Li Baodi, Meng Yao, Yang Lei, Jiao Hongyan, Li Xiyan, Huang Weijuan, Wei Hejiang,Zhang Yanping, Hai Yan, Zhang Hui, Yue Hua, Zou Shumei, Zhao Xiang, Li Chao, Ao Deng, Zhang Ye, Tan Minju, Liu Jia, Zhang Xuemei, Gao George F., Meng Lei,Wang Dayan. The re-emergence of highly pathogenic avian influenza H7N9 viruses in humans in mainland China, 2019. Euro Surveill. 2019;24(21):pii=1900273. https://doi.org/10.2807/1560-7917.ES.2019.24.21.1900273

Received: 06 May 2019;   Accepted: 23 May 2019

 

Abstract

After no reported human cases of highly pathogenic avian influenza (HPAI) H7N9 for over a year, a case with severe disease occurred in late March 2019. Among HPAI H7N9 viral sequences, those recovered from the case and from environmental samples of a poultry slaughtering stall near their home formed a distinct clade from 2017 viral sequences. Several mutations possibly associated to antigenic drift occurred in the haemagglutinin gene, potentially warranting update of H7N9 vaccine strains.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Avian Influenza; H7N9; Human; Poultry; Gansu; Inner Mongolia; China.

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First successful combination of #ECMO with video-assisted thoracic surgery (#VATS) of pulmonary bullae #resection in the management of refractory #pneumothorax in a critically ill patient with #H7N9 #pneumonia and #ARDS: A case report (Medicine (Baltimore), abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Medicine (Baltimore). 2019 May;98(20):e15661. doi: 10.1097/MD.0000000000015661.

First successful combination of extracorporeal membrane oxygenation (ECMO) with video-assisted thoracic surgery (VATS) of pulmonary bullae resection in the management of refractory pneumothorax in a critically ill patient with H7N9 pneumonia and acute respiratory distress syndrome: A case report.

Huang J1, Li H1, Chen S2, Lan C3, Lin Q4, Weng H1.

Author information: 1 Department of Respiratory and Critical Care Medicine. 2 Department of Thoracic Surgery. 3 Department of Radiology. 4 Department of Pathology, Fuzhou Pulmonary Hospital of Fu Jian, Educational Hospital of Fujian Medical University, Fuzhou, China.

 

Abstract

RATIONALE:

At present, data regarding refractory pneumothorax treated with video-assisted thoracic surgery (VATS) in combination with extracorporeal membrane oxygenation (ECMO) in critically ill patients with H7N9 pneumonia have never been reported.

PATIENT CONCERNS:

A laboratory-confirmed case of human infection with avian influenza A (H7N9) virus was treated in our hospital. Acute respiratory distress syndrome (ARDS) developed and the patient was oxygenated via veno-venous ECMO due to the failure of mechanical ventilation. Unfortunately, a right refractory pneumothorax occurred. Despite treatment with pleural drainage and select bronchial occlusion, the patient still failed to improve.

DIAGNOSIS:

Fatal H7N9 pneumonia complicated with severe ARDS, pulmonary bullae, and refractory pneumothorax.

INTERVENTIONS:

Successful combination of ECMO with VATS of pulmonary bullae resection was performed and pneumothorax was cured.

OUTCOMES:

One week after the operation, ECMO was removed. However, the patient finally developed multiorgan failure (MOF) complicated by refractory hypoxemia due to progressive lung fibrosis and died 36 days after admission.

LESSONS:

Although the patient died of MOF triggered by severe lung fibrosis at last, the successful treatment of refractory pneumothorax by combination of ECMO with VATS is encouraging. Thus, when refractory pneumothorax in a patient with severe pulmonary dysfunction fails to improve through routine therapy, the treatment of pneumothorax by VATS based on ECMO support can be considered as a feasible selection.

PMID: 31096495 DOI: 10.1097/MD.0000000000015661

Keywords: Avian Influenza; H7N9; ECMO; ARDS; Pneumonia; Pneumothorax; China.

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A #hospital #cluster combined with a #family cluster of #avian #influenza #H7N9 #infection in #Anhui Province, #China (J Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect. 2019 May 14. pii: S0163-4453(19)30152-5. doi: 10.1016/j.jinf.2019.05.008. [Epub ahead of print]

A hospital cluster combined with a family cluster of avian influenza H7N9 infection in Anhui Province, China.

Zhang W1, Zhao K1, Jin J1, He J2, Zhou W1, Wu J1, Tang R1, Ma W3, Ding C4, Liu W1, Zhang L1, Gao R5.

Author information: 1 Hefei Center for Disease Control and Prevention, Heifei, Anhui Province, China, 230061. 2 Anhui Provincial Center for Disease Control and Prevention, Heifei, Anhui Province, China, 230601. 3 Lujiang County People’s Hospital, Heifei, Anhui Province, China, 231501. 4 The Second Hospital of Anhui Medical University, Heifei, Anhui Province, China, 230601. 5 National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory of Medical Virology and Viral Diseases, National Health Commission of People’s Republic of China, Beijing, China, 102206. Electronic address: gaorongbao@cnic.org.cn.

 

Abstract

OBJECTIVES:

To identify human-to-human transmission of H7N9 avian influenza virus, we investigated a hospital cluster combined with family cluster in this study.

METHODS:

We obtained and analyzed clinical, epidemiological and virological data from the three patients. RT-PCR, viral culture and sequencing were conducted for determination of causative pathogen.

RESULTS:

The index case presented developed pneumonia with fever after exposure to chicken in a poultry farm. Case A presented pneumonia with high fever on day 3 after she shared a hospital room with the index case. Case B, the father of the index case, presented pneumonia with high fever on day 15 after he took care of the index case. H7N9 virus circulated in the local farm to which the index case was exposed. Full genomic sequence of virus showed 99.8 to 100% identity shared between the index case and case A or case B. Compared to the earliest virus of Anhui, a total of 29 amino acid variation sites were observed in the 8 segments.

CONCLUSIONS:

A hospital cluster combined with family cluster of H7N9 avian influenza infection was identified. Air transmission resulted in the hospital cluster possibly. A poultry farm was the initially infectious source of the cluster.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Air transmission; Avian influenza virus; Family cluster; H7N9; Hospital cluster; Human-to-human transmission

PMID: 31100362 DOI: 10.1016/j.jinf.2019.05.008

Keywords: Avian Influenza; H7N9; Human; Poultry; Nosocomial Outbreaks; Anhui; China.

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Concomitant #severe #influenza and #cryptococcal #infections: A case report and literature review (Medicine (Baltimore), abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Medicine (Baltimore). 2019 May;98(19):e15544. doi: 10.1097/MD.0000000000015544.

Concomitant severe influenza and cryptococcal infections: A case report and literature review.

Huang J1, Li H1, Lan C2, Zou S3, Zhang H1, Wang X1, Weng H1.

Author information: 1 Department of Respiratory and Critical Care Medicine. 2 Department of Radiology. 3 Department of Clinical Laboratory, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China.

 

Abstract

Concomitant influenza and cryptococcal infections are rare. Herein, we describe an unusual case of an avian influenza A (H7N9) infection with several severe mixed bacterial infections and systemic super-infection with Cryptococcus neoformans presenting as ventilator-associated pneumonia (VAP) and bloodstream infection in a previously immunocompetent man during hospitalization.A 58-year-old man was admitted to our hospital complaining of hyperpyrexia, dyspnoea, cough, and phlegm with blood. A chest computed tomography scan revealed multiple ground-glass opacities and consolidation in both lungs with right pleural effusion. An initial sputum test was positive for influenza A (H7N9) virus. After antiviral treatment and other supportive measures, the patient’s condition improved. However, the patient’s condition deteriorated again approximately 2 weeks after admission, and bronchoalveolar lavage fluid (BALF) and blood cultures were positive for C. neoformans. Therapy with intravenous liposomal amphotericin B and fluconazole was started. After a 2-week antifungal treatment, BALF and blood cultures were negative for C. neoformans. However, the patient had persistent lung infiltrates with severe pulmonary fibrosis with a prolonged course of disease. On hospital day 40, BALF and blood cultures were both positive for multidrug-resistant Stenotrophomonas maltophilia. Finally, the patient developed septic shock, disseminated intravascular coagulation and multi-organ failure and succumbed to treatment failure.Cryptococcal infection can occur in patients with severe influenza during hospitalization with a more severe condition, and the clinician should be aware of this infection.

PMID: 31083210 DOI: 10.1097/MD.0000000000015544

Keywords: Avian Influenza; H7N9; Human; Cryptococcus neoformans.

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#Pathogen #Colonization #Resistance in the #Gut and Its Manipulation for Improved Health (Am J Pathol., abstract)

[Source: American Journal of Pathology, full page: (LINK). Abstract, edited.]

Pathogen Colonization Resistance in the Gut and Its Manipulation for Improved Health

Joseph M. Pickard, Gabriel Núñez∗

Department of Pathology and the Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan

DOI: https://doi.org/10.1016/j.ajpath.2019.03.003

 

Abstract

Mammals have coevolved with a large community of symbiotic, commensal, and some potentially pathogenic microbes. The trillions of bacteria and hundreds of species in our guts form a relatively stable community that resists invasion by outsiders, including pathogens. This powerful protective force is referred to as colonization resistance. We discuss the variety of proposed or demonstrated mechanisms that can mediate colonization resistance and some potential ways to manipulate them for improved human health. Instances in which certain bacterial pathogens can overcome colonization resistance are also discussed.

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Supported by NIH grants F32DK118800 (J.M.P.), DK091191 (G.N.), and DK095782 (G.N.).

Disclosures: None declared.

The Rous-Whipple Award is given by the American Society for Investigative Pathology (ASIP) to a senior pathologist with a distinguished career in experimental pathology research and continued productivity at the time of the award. Gabriel Núñez, M.D., recipient of the 2019 ASIP Rous-Whipple Award, delivered a lecture entitled “Role of the Microbiota in Host Defense and Inflammatory Disease” on October 21, 2018, at the PISA 2018 Annual Meeting in Ann Arbor, MI.

© 2019 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Keywords: Human; Microbiome.

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IncI1 ST3 and IncI1 ST7 #plasmids from CTX-M-1-producing #Escherichia coli obtained from #patients with #bloodstream infections are closely related to plasmids from E. coli of #animal origin (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

IncI1 ST3 and IncI1 ST7 plasmids from CTX-M-1-producing Escherichia coli obtained from patients with bloodstream infections are closely related to plasmids from E. coli of animal origin

Adam Valcek, Louise Roer, Søren Overballe-Petersen, Frank Hansen, Valeria Bortolaia, Pimlapas Leekitcharoenphon, Helle B Korsgaard, Anne Mette Seyfarth, Rene S Hendriksen, Henrik Hasman, Anette M Hammerum

Journal of Antimicrobial Chemotherapy, dkz199, https://doi.org/10.1093/jac/dkz199

Published: 14 May 2019

 

Abstract

Objectives

Fully sequenced IncI1 plasmids obtained from CTX-M-1-producing Escherichia coli of human and animal origin were compared.

Methods

Twelve E. coli isolates sharing identical ESBL genes and plasmid multilocus STs sequenced on Illumina and MinION platforms were obtained from the Danish antimicrobial resistance surveillance programme, DANMAP. After de novoassembly, the sequences of plasmids harbouring blaCTX-M-1 were manually curated and ORFs annotated. Within-group comparisons were performed separately for the IncI1 ST3 plasmid type and the IncI1 ST7 plasmid type. The IncI1 ST3 plasmid group was obtained from 10 E. coli isolates (2 from patients with bloodstream infections, 6 from food and 2 from animals). The IncI1 ST7 plasmids originated from E. coli isolates obtained from a patient with bloodstream infection and from a pig. Sequences of IncI1 ST3 and IncI1 ST7 plasmids harbouring blaCTX-M-1 with determined origin were retrieved from GenBank and used for comparison within the respective group.

Results

The 10 IncI1 ST3 blaCTX-M-1 plasmids were highly similar in structure and organization with only minor plasmid rearrangements and differences in the variable region. The IncI1 ST7 blaCTX-M-1 plasmids also showed high similarity in structure and organization. The high level of similarity was also observed when including plasmids from E. coli of animal origin from Australia, Switzerland, the Netherlands and France.

Conclusions

This study shows broad spread of a very successful CTX-M-1-producing IncI1 type plasmid among E. coli of both human and animal origin.

Topic: plasmids – drug resistance, microbial – food – genes – ichthyosis, x-linked – sequence tagged sites – escherichia coli – sodium thiosulfate – bloodstream infections – genbank

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; E. Coli; Bacteremia; Pigs; Human; Plasmids.

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Close #Relationship between cIAP2 and #Human #ARDS Induced by Severe #H7N9 #Infection (Biomed Res Int., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Biomed Res Int. 2019 Apr 7;2019:2121357. doi: 10.1155/2019/2121357. eCollection 2019.

Close Relationship between cIAP2 and Human ARDS Induced by Severe H7N9 Infection.

Qin C1, Sai XY1, Qian XF1, Wu Y1, Zou LF1, Wang HM1, Bian T1, Yan Z2.

Author information: 1 Department of Respiratory Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi 214000, Jiangsu, China. 2 Department of Critical Care, Wuxi People’s Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi 214000, Jiangsu, China.

 

Abstract

BACKGROUND:

cIAP2 is involved in necroptosis as a key upstream regulation factor. We aimed to investigate the role of cIAP2 in ARDS/ALI induced by H7N9 virus through regulating the RIPK1/3 necroptosis pathway.

METHODS:

Lung tissues of 11 patients who died from ARDS-complicated H7N9 infection between 2013 and 2016 were obtained as the H7N9-ARDS group. Lung tissues near benign lung nodules were acquired as the control group. Histological changes were evaluated by H&E staining. Protein levels of cIAP2, RIPK1, RIPK3, p-RIPK3, MLKL, and p-MLKL in the lung tissues were detected by Western Blot. The mRNA levels of cIAP2, RIPK1, and RIPK3 were detected by real-time PCR.

RESULTS:

H7N9 virus infection had a high mortality, with ARDS being the leading cause of death. The protein level of cIAP2 in the experimental group was lower than that in the control group (P<0.05). However, the experimental group showed higher RIPK1, RIPK3, and p-RIPK3 protein levels than the control group (P<0.05), as well as the expression level of MLKL and p-MLKL protein, which is a key downstream protein in necroptosis (P<0.05).

CONCLUSION:

In tissues from patients with fatal H7N9, downregulation of cIAP2 and induction of necroptosis was observed. We could speculate that necroptosis of the pulmonary epithelium is associated with severe H7N9 infection leading to ARDS. Thus, necroptosis inhibition may be a novel therapy for H7N9 influenza virus.

PMID: 31080811 PMCID: PMC6475567 DOI: 10.1155/2019/2121357

Keywords: Avian Influenza; H7N9; Human; Immunopathology.

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