Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection

This correspondence documents a severe case of H5N1 influenza in a 13-year-old girl in British Columbia, Canada. Initially presenting with conjunctivitis and fever, the patient rapidly deteriorated into respiratory failure, thrombocytopenia, and acute kidney injury. She required venovenous extracorporeal membrane oxygenation (ECMO), renal replacement therapy, and combination antiviral therapy including oseltamivir, amantadine, and baloxavir. Serial RT-PCR tests demonstrated declining viral load; sequencing of the H5N1 virus revealed markers for potential human adaptation, such as PB2 E627K and mutations in the HA gene that enhance binding to human airway receptors. Despite the severity of her condition, the patient recovered respiratory function and was weaned off ECMO and mechanical ventilation. The case underscores the risk of severe zoonotic influenza in North America and the importance of genomic surveillance for mutations facilitating human infectivity.

This correspondence documents a severe case of H5N1 influenza in a 13-year-old girl in British Columbia, Canada. Initially presenting with conjunctivitis and fever, the patient rapidly deteriorated into respiratory failure, thrombocytopenia, and acute kidney injury. She required venovenous extracorporeal membrane oxygenation (ECMO), renal replacement therapy, and combination antiviral therapy including oseltamivir, amantadine, and baloxavir. Serial RT-PCR tests demonstrated declining viral load; sequencing of the H5N1 virus revealed markers for potential human adaptation, such as PB2 E627K and mutations in the HA gene that enhance binding to human airway receptors. Despite the severity of her condition, the patient recovered respiratory function and was weaned off ECMO and mechanical ventilation. The case underscores the risk of severe zoonotic influenza in North America and the importance of genomic surveillance for mutations facilitating human infectivity.