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 H7N9 influenza: the laboratory presentations
Viroj Wiwanitkit
Visiting Professor, Hainan Medical University, China; visiting professor, Faculty of Medicine, University of Nis, Serbia; adjunct professor, Joseph Ayobabalola University, Nigeria; special lecturer, Chulalongkorn University, Thailand
Correspondence
Professor Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok Thailand 10160
Email: wviroj@yahoo.com
Phone: 6624132436

Abstract
Emerging influenza becomes a present public health threat. H7N9 influenza has just been reported since early 2013. This knowledge on this emerging disease is still limited. Here, the author will discuss on the reported laboratory presentations of this new emerging influenza.

Key words: H7N9, influenza, bird, emerging, laboratory

Introduction to new H7N9 bird flu
Influenza virus infection is an important group of respiratory infectious disease. Several groups of influenza viruses can cause human infections. However, in the recent years, there are many new emerging influenza infections, which have never been previously seen in human. Crossing species from animal to human leads to new emerging zoonosis. Those new influenza infections are considered atypical influenza infections and have the trend of worldwide expansion [1 - 2].
H5N1 bird fu [3] and H1N1 swine flu [4] are the good examples of new emerging influenza infections. However, the present hottest concern is on the new H7N9 bird flu [5 – 7]. In fact, H7N9 influenza is the known virus causing avian disease [8 – 9]. However, the observation of the human infection in China is the first description in human, hence, it is mentioned as the newest emerging infection of the world [5 - 6]. Due to the nature of a new emerging infection, lack of knowledge on H7N9 influenza can be expected and this is the point for further study.  In this specific article, the author discusses on the laboratory presentations of new H7N9 influenza infection, which has just been described for a few months (first observed in February 2013) [5 - 6]. Firstly, the pathogen was not identified. However, the pathogenic agent was finally detected as a newly identified human influenza virus, H7N9 [10 - 12].

Laboratory presentations of new H7N9 influenza infection
The signs and symptoms of swine flu are difficult to differentiate from other influenza virus infections. The main clinical signs and symptoms include high fever, coughing and myalgia can be seen [5 – 6].  Additional atypical clinical manifestations can also be seen.
Based on present clinical practice, diagnosis of specific new H7N9 bird flu is totally based on molecular laboratory diagnosis [13 – 15].  However, there are also many interesting observation on the routine clinical laboratory investigations.
Focusing on the routine hematology laboratory testing, complete blood count (CBC), the important observation is on the platelet [5 – 6, 16]. Thrombocytopenia is the main platelet disorder [17]. Alteration of thrombohemostasis should be the focus for further hematological study. The other observations on CBC results include leukopenia and lymphopenic [16 - 17].
Focusing on clinical chemistry tests, there are several observations. First, the renal function test can be seen. The impaired renal function reflects the nephrological concern due to H7N9 influenza [16 - 17]. Second, the liver function test abnormalities can be seen [16 - 17]. The increased level of aminotransferase can be seen and this implies the hepatitis due to the infection [16 - 17]. Finally, the increased myocardial enzymes showing cardiac problem can also be seen [16 - 17].

What we can learn from laboratory presentations in new H7N9 influneza?
       As already mentioned, there are several clinical laboratory aberrations in new emerging H7N9 influenza. This can confirm the observation on multiple organ failure seen in several cases of new H7N9 influenza [5 – 6]. The clinical pathology findings can support the clinical anatomical pathology. Due to the nature of new emerging infections, the nature of atypical laboratory findings can confirm the nature of atypical influenza infections. This might be helpful to presumptive diagnosis of this new infection in the period of outbreak. Any case with clinical feature of classical influenza plus atypical laboratory presentations can lead to the presumptive diagnosis of new H7N9 influenza infection.
Apart from diagnosis usefulness, the basic laboratory investigation can be useful in following up management. Due to the fact that there are many laboratory abnormalities, the investigation can be useful to detect the early problems that help physician in charge plan for proper case management.
Nevertheless, further accumulated data is needed. The detected laboratory presentations might be due to other factors, which can be confounding to the presence of H7N9 influenza. Also, the concurrent of other underlying disease such as underlying cardiac diseases, underlying viral hepatitis and underlying blood cytopenia can modify the laboratory finding and severity of the H7N9 influenza infection.

References

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  1. Lu SH, Xi XH, Zheng YF, Cao Y, Liu XN, Lu HZ. Analysis of the clinical characteristics and treatment of two patients with avian influenza virus (H7N9). Biosci Trends. 2013 Apr;7(2):109-12.
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