We report here the first case of H7N9 infection outside mainland China.
A 53-year-old male patient was admitted because of fever for 3 days after returning from Suchow, Jiangsu Province, China on April 9, 2013. He had been otherwise well except for a history of hypertension and chronic hepatitis B virus infection. The patient did not report a history of contact with sick persons or animals during the travel.
He began to get fever and general malaise on April 12. He had no respiratory symptoms, gastrointestinal symptoms, or myalgias. The patient sought medical attention on April 16 when fevers continued. Two throat-swab specimens tested negative for H7N9 with real-time PCR on April 17 and April 20, respectively. The first chest radiograph was normal.
Treatment with oseltamivir was started at a dose of 75 mg twice daily. A follow-up chest radiograph on April 18 revealed interstitial pneumonia at the right lower lung, for which moxifloxacin was added. Progressive dyspnoea developed on April 19. Follow-up chest radiographs showed progressive bilateral lower-lung consolidation.
He was transferred to National Taiwan University Hospital on April 20. The dose of oseltamivir was increased to 150 mg twice daily. Endotracheal intubation and mechanical ventilator support was given on arrival because of respiratory failure. Ceftazidime and levofloxacin were started, although microbiological investigations were negative.
Desaturation worsened despite use of supplemental O2 at O2 fraction of 100%. Inhalational NO was added on April 21 without benefit. Chest radiography and sonography did not reveal pneumothorax. He was put on extracorporeal membrane oxygenation on April 22.
This patient's sputum specimen was subtyped as H7N9 with the protocol provided by WHO Collaborating Centre in Beijing. Very high H7N9 viral loads (4·5-51·4 × 107 copies per mL) were found in the two sputum specimens and one throat-swab specimen (collected on April 20 and April 22, respectively) while the viral load was undetectable in the blood specimens collected daily between 20 and 23 April.