🆕 In @nejm.org "Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection" Highlights of the article in a 🧵 👇 www.nejm.org/doi/full/10.... - ThreadSky

krutikakuppalli.bsky.social • 68 days ago

🆕 In @nejm.org "Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection"

Highlights of the article in a 🧵 👇

https://www.nejm.org/doi/full/10.1056/NEJMc2415890

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krutikakuppalli.bsky.social•68 days ago

(1/) Patient Profile: A 13-year-old girl in Canada with history of asthma was infected with H5N1 avian influenza, a strain commonly associated with wild poultry (D1.1). The source of infection remains unknown.

melodyschreiber.com•68 days ago

Wild birds. Not wild poultry

krutikakuppalli.bsky.social•67 days ago

Genotype D1.1 has been detected in wild birds and poultry across various states. Should have mentioned both.

melodyschreiber.com•67 days ago

And the NEJM piece said it was most closely related to wild birds

krutikakuppalli.bsky.social•67 days ago

They have not identified how the patient got infected - the particular strain D1.1 this far has been found in both wild birds and poultry

Even CDC says the same

melodyschreiber.com•67 days ago

Right but in this case sequencing was closest to wild birds in BC

krutikakuppalli.bsky.social•68 days ago

(2/) Initial Symptoms: The patient initially presented with 2 days of conjunctivitis and 1 day of fever, suggesting early localized infection. They were discharged home with no treatment

krutikakuppalli.bsky.social•68 days ago

(3/) Progression: She developed cough, vomiting, diarrhea and returned three days later with respiratory distress and required intensive care.

She had resp failure, pneumonia, AKI, thrombocytopenia, and leukopenia.

krutikakuppalli.bsky.social•68 days ago

(4/) Testing: NP swab from admission was positive for influenza A but negative for A(H1) and A(H3) by the BioFire Respiratory Panel.

Reflex testing with the Xpert Xpress CoV-2/Flu/RSV plus assay revealed an influenza A cycle threshold (Ct) value of 27.1.

krutikakuppalli.bsky.social•68 days ago

(5/) Treatment: Initially received oseltamivir. Amantadine added on hospital day #2 and baloxavir on hospital day #4.

Due to cytokine mediated instability received plasma exchange hospital day 7-9.

krutikakuppalli.bsky.social•68 days ago

(6/) Supportive care: Hospital day #2 patient intubated and started on ECMO. Continuous renal replacement therapy (CRRT) initiated on hospital day #3.

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