Low Pathogenic Avian Influenza A (H7N2) Virus Infection in Immunocompromised Adult, New York, USA, 2003

Belinda Ostrowsky¹

, Ada Huang, William Terry², Diane Anton, Barbara Brunagel, Lorraine Traynor, Syed Abid, Geraldine Johnson, Marilyn Kacica, Jacqueline Katz, Lindsay Edwards³, Stephen Lindstrom, Alexander Klimov, and Timothy M. Uyeki

Author affiliations: Westchester County Department of Health, New Rochelle, New York, USA (B. Ostrowsky, A. Huang, W. Terry); Westchester County Department of Laboratories and Research, Valhalla, New York, USA (D. Anton, B. Brunagel, L. Traynor, S. Abid); New York State Department of Health, Albany, New York, USA (G. Johnson, M. Kacica); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J. Katz, L. Edwards, S. Lindstrom, A. Klimov, T.M. Uyeki)

Abstract

In 2003, infection with low pathogenic avian influenza A (H7N2) virus was identified in an immunocompromised man with fever and community-acquired pneumonia in New York, USA. The patient recovered. Although the source of the virus was not identified, this case indicates the usefulness of virus culture for detecting novel influenza A viruses.

Limited numbers of human infections with low pathogenic avian influenza A, subtype H7, viruses have been reported and attributed to recent exposure to infected poultry (1–6). Such infections generally resulted in clinically mild illness. We report a case of low pathogenic avian influenza (LPAI) A (H7N2) virus infection in an immunocompromised adult.

The Study

On November 3, 2003, a 48-year-old man from the Caribbean sought care at an emergency department in Westchester County, New York, USA, after an episode of near syncopy; a 2–4 week history of feverishness, cough, fatigue, and myalgia; and a 10-pound weight loss over 2 months. He had lived in the United States since 1987 and had no known medical conditions. A month earlier, he had been evaluated at a clinic, and an oral antimicrobial drug was prescribed for possible pneumonia. Eight days before the emergency department admission reported here, he had sought emergency care for unilateral conjunctivitis, eye pain, and blurred vision; the diagnosis was corneal abrasion.
Physical examination on November 3, 2003, found that the patient was afebrile, weak, and mildly tachypneic (respiratory rate 18–26 breaths/minute, room air oxygenation saturation 98%) with bibasilar inspiratory rales. Pertinent laboratory findings included mild anemia and thrombocytopenia (hemoglobin 11.9 g/dL, platelets 107 × 10⁹/L, leukocytes 8.0 × 10⁹ cells/L [52% lymphocytes]), mildly elevated hepatic transaminases (aspartate aminotransferase 116 U/L, alanine aminotransferase 87 U/L), and elevated creatine kinase (1,844 U/L). A chest radiograph showed a right hilar density and left lower lobe infiltrates; computed tomographic scan of the chest and abdomen showed bilateral micronodular opacities with right perihilar infiltrates and lymphadenopathy. The patient was admitted for community-acquired pneumonia and received intravenous gatifloxicin.

Medscape CME articles
Volume 18, Number 7–July 2012

Low Pathogenic Avian Influenza A (H7N2) Virus Infection in Immunocompromised Adult, New York, USA, 2003

MEDSCAPE CME

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid ; (4) view/print certificate.
Release date: June 14, 2012; Expiration date: June 14, 2013

Learning Objectives

Upon completion of this activity, participants will be able to:
• Distinguish the usual severity of infections with LPAI
• Analyze the differential diagnosis for patients presenting with LPAI infection
• Evaluate the epidemiology of LPAI
• Assess other clinical characteristics of LPAI infection

CME Editor

P. Lynne Stockton, VMD, MS, ELS(D), Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: P. Lynne Stockton, VMD, MS, ELS(D), has disclosed no relevant financial relationships.

CME AUTHOR

Charles P. Vega, MD, Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

AUTHORS

Disclosures: Belinda Ostrowsky, MD, MPH; William Terry, MD, MPH; Diane Anton, MS, M(ASCP); Barbara Brunagel, MS; Lorraine Traynor, BS; Syed Abid, PhD; Geraldine Johnson, MS; Marilyn Kacica, MD, MPH; Stephen Lindstrom, PhD; Alexander Klimov, PhD; and Timothy M. Uyeki, MD, MPH, MPP, have disclosed no relevant financial relationships. Ada Huang, MD, has disclosed the following relevant financial relationships: owns stock, stock options, or bonds from Merck, Pfizer. Jacqueline Katz, PhD, has disclosed the following relevant financial relationships: received grants for clinical research from GlaxoSmithKline for research not related to the current study; received grants for preclinical research from Colby Pharmaceuticals (formerly Juvaris Bio Therapeutics) for research not related to the current study. Lindsay Edwards has disclosed the following relevant financial relationships: spouse owns GlaxoSmithKline stock.