PMID- 35402590
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220413
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 10
IP  - 5
DP  - 2022 Mar
TI  - Successful combinatorial therapy of sirolimus and neuraminidase inhibitors in a 
      patient with highly pathogenic avian influenza A (H5N6) virus: a case report.
PG  - 265
LID - 10.21037/atm-22-704 [doi]
LID - 265
AB  - BACKGROUND: Highly pathogenic avian influenza A (H5N6) virus poses a continuous 
      threat to human health since 2014. Although neuraminidase inhibitors (NAIs) are 
      prescribed in most patients infected with the H5N6 virus, the fatality remains 
      high, indicating the need for an improved treatment regimen. Sirolimus, an 
      inhibitor of the mammalian target of rapamycin (mTOR), has been reported to 
      reduce viral replication and improve clinical outcomes in severe H1N1 infections 
      when combined with oseltamivir. Here, we report the first case of severe H5N6 
      pneumonia successfully treated by sirolimus and NAIs. CASE DESCRIPTION: A 
      22-year-old man developed high fever and chills on September 24, 2018 (Day-0) and 
      was hospitalized on Day-3. Influenza A (H5N6) was identified on Day-6 from a 
      throat swab specimen. Despite the administration of NAIs and other supportive 
      measures, the patient's clinical conditions and lung images showed continued 
      deterioration, accompanied by persistently high viral titers. Consequently, 
      sirolimus administration (rapamycin; 2 mg per day for 14 days) was started on 
      Day-12. His PaO(2)/FiO(2) values and Sequential Organ Failure Assessment (SOFA) 
      score gradually improved, and imaging outcomes revealed the resolution of 
      bilateral lung infiltrations. The viral titer gradually decreased and turned 
      negative on Day-25. Sirolimus and NAIs were stopped on the same day. The patient 
      was discharged on Day-65. Based on observations from a 2-year follow-up, the 
      patient was found to be in a good condition without complications. CONCLUSIONS: 
      In conclusion, sirolimus might be a novel and practical therapeutic approach to 
      severe H5N6-associated pneumonia in humans.
CI  - 2022 Annals of Translational Medicine. All rights reserved.
FAU - Zeng, Qiaojun
AU  - Zeng Q
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Wang, Jiwen
AU  - Wang J
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Zhang, Xiang
AU  - Zhang X
AD  - Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 
      Guangzhou, China.
FAU - Chen, Liang
AU  - Chen L
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Zhou, Lin
AU  - Zhou L
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Kuang, Fang
AU  - Kuang F
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Huang, Linjie
AU  - Huang L
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
FAU - Xu, Fengqin
AU  - Xu F
AD  - Department of Nosocomial Infections Management, Sun Yat-sen Memorial Hospital, 
      Sun Yat-sen University, Guangzhou, China.
FAU - Zhu, Xun
AU  - Zhu X
AD  - Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, 
      Guangzhou, China.
FAU - Shen, Jun
AU  - Shen J
AD  - Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 
      Guangzhou, China.
FAU - Jiang, Shanping
AU  - Jiang S
AD  - Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial 
      Hospital, Sun Yat-sen University, Guangzhou, China.
LA  - eng
PT  - Case Reports
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC8987867
OTO - NOTNLM
OT  - H5N6
OT  - Sirolimus
OT  - case report
OT  - neuraminidase inhibitors
OT  - severe pneumonia
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://atm.amegroups.com/article/view/10.21037/atm-22-704/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2022/04/12 06:00
MHDA- 2022/04/12 06:01
PMCR- 2022/03/01
CRDT- 2022/04/11 05:32
PHST- 2022/01/11 00:00 [received]
PHST- 2022/03/04 00:00 [accepted]
PHST- 2022/04/11 05:32 [entrez]
PHST- 2022/04/12 06:00 [pubmed]
PHST- 2022/04/12 06:01 [medline]
PHST- 2022/03/01 00:00 [pmc-release]
AID - atm-10-05-265 [pii]
AID - 10.21037/atm-22-704 [doi]
PST - ppublish
SO  - Ann Transl Med. 2022 Mar;10(5):265. doi: 10.21037/atm-22-704.