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In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and increased levels of protein (0.81 g per liter). The diagnosis of avian influenza A (H5N1) was established by isolation of the virus from cerebrospinal fluid, fecal, throat, and serum specimens. The patient's nine-year-old sister had died from a similar syndrome two weeks earlier. In both siblings, the clinical diagnosis was acute encephalitis. Neither patient had respiratory symptoms at presentation. These cases suggest that the spectrum of influenza H5N1 is wider than previously thought.

Original publication

DOI

10.1056/NEJMoa044307

Type

Journal article

Journal

N Engl J Med

Publication Date

17/02/2005

Volume

352

Pages

686 - 691

Keywords

Acute Disease, Child, Child, Preschool, Coma, Diarrhea, Encephalitis, Viral, Fatal Outcome, Female, Humans, Influenza A Virus, H5N1 Subtype, Influenza A virus, Influenza, Human, Lung, Male, Radiography, Seizures