Treatment with Convalescent Plasma for Influenza A (H5N1) Infection

Abstract

A previously healthy 31-year-old male van driver presented to a local clinic in Shenzhen, in southern China, on June 7, 2006, with a 4-day history of a high fever (temperature, 39.9°C), chills, and a cough with clear sputum. A chest radiograph obtained on June 9 revealed large opacities in the lower lobe of the left lung. A reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay and an isolate from a tracheal aspirate were positive for influenza A (H5N1) virus. Treatment with 150 mg of oseltamivir twice daily was started at 2 a.m. on June 12 ( Figure 1 ). After 2 days, there was increased consolidation in the right lung and only slight improvement in the left lung. Quantitative RT-PCR revealed a high viral load (1.31×10⁵ copies per milliliter) when it was first measured (at 4 a.m. on June 13), 26 hours after the patient began to receive oseltamivir. The viral load continued to increase and was 1.68×10⁵ copies per milliliter by 10 a.m. on June 14, despite the continuation of oseltamivir treatment. Although oseltamivir resistance during the treatment of influenza A (H5N1) virus infection has been reported,¹ no genetic evidence of resistance to oseltamivir was observed in our patient.