Complications

Complications table
ComplicationTimeframeLikelihood

primary influenza pneumonia

short termhigh

Common complication of highly pathogenic avian influenza (HPAI) H5N1 virus infection.

Treatment is with antivirals as soon as possible, supplemental oxygen, and supportive therapy. Respiratory status should be monitored, and early ventilatory support considered.

respiratory failure

short termhigh

This is a common complication of highly pathogenic avian influenza (HPAI) H5N1 virus infection, usually due to ARDS. Has been documented among all affected age groups.

Antiviral and supportive therapy is necessary.

acute respiratory distress syndrome

short termhigh

The most common cause of respiratory failure.

Evidence-based, lung protective ventilation strategies are recommended.

multiorgan failure

short termhigh

Multiorgan failure, including renal or cardiac compromise, is a common complication of severely ill highly pathogenic avian influenza (HPAI) H5N1 patients.

Supportive therapy is crucial, as is targeted therapy where applicable. Management should follow evidence-based management guidelines.

sepsis

short termmedium

Septic shock requiring vasopressor support is a common complication of highly pathogenic avian influenza (HPAI) H5N1 virus infection.

Treatment is supportive and should follow existing evidence-based guidelines for the management of septic shock.

encephalitis

short termlow

Patients have headaches, behavioral disturbances, and altered mental status, and may have seizures and coma, as a direct result of virus infection. Encephalitis is an uncommon complication of highly pathogenic avian influenza (HPAI) H5N1 virus infection, but cases of CNS infection and detection of virus in CSF have been described.

The underlying infection should be treated with antivirals as soon as possible, and supportive care provided as indicated.

death

variablehigh

Occurs in about 53% of patients with highly pathogenic avian influenza (HPAI) H5N1 virus infection reported to WHO.[26]

community-acquired pneumonia

variablelow

While superinfection with bacterial pneumonia pathogens (Staphylococcus aureus, Streptococcus pneumoniae, group A streptococcus) is well described with seasonal influenza A or B virus infections, as well as with influenza A (H1N1)pdm09 virus infection, concurrent bacterial pneumonia with highly pathogenic avian influenza (HPAI) H5N1 virus infection has rarely been reported.

In most cases, empiric therapies for bacterial pneumonia and influenza virus infection are initiated before the HPAI H5N1 diagnosis is confirmed. Antibacterial therapy should follow evidence-based treatment guidelines, conform to regional standards of care, and target common community-acquired pneumonia pathogens from the region where infection occurred.

hospital-acquired pneumonia

variablelow

Common complication of mechanical ventilation and one of the most frequent of all healthcare-associated infections. However, it has been rarely reported in highly pathogenic avian influenza (HPAI) H5N1 patients.[17]

Evaluation and treatment should follow evidence-based guidelines.

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