Pneumonia in a 64 year old man

A 64 year old man was admitted to the intensive care unit with cough and dyspnea since 4 days. He reported fever and upper respiratory symptoms lasting 2 days prior to onset of his symptoms. At admission patient was severely tachypneic and hypoxemic. The chest radiograph revealed consolidation in the left lower lobe. Endotracheal intubation was performed and mechanical ventilation was started. Piperacillin tazobactam, azithromycin and oseltamivir were started.

1 week prior to the onset of illness, the patient had travelled to Beijing, China to attend a conference. Fever and upper respiratory symptoms had started while patient was in Singapore. At the time of patient’s travel, cases of H7N9 influenza were reported from Beijing and other Chinese cities.

Total leucocyte count was 5600 cells/μl. Liver function tests showed mild transaminitis. Cultures of endotracheal aspirates were sterile. Blood cultures were sterile. PCR for H1N1 influenza was negative. H7N9 PCR of nasal swab was positive.

The patient recovered over the hospital stay, was extubated on D4 of ICU stay. Stay in the hospital was otherwise uneventful.

Pneumonia caused by H7N9 Influenza virus acquired while travel to Beijing, China