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Immune derangement occurs in patients with H7N9 avian influenza

Wei Wu, Yu Shi, Hainv Gao, Weifeng Liang, Jifang Sheng and Lanjuan Li*

  • * Corresponding author: Lanjuan Li

  • † Equal contributors

Author Affiliations

Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China

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Critical Care 2014, 18:R43  doi:10.1186/cc13788

Published: 24 March 2014



Currently, little is known about the immunological characteristics of patients with avian influenza A (H7N9) virus infection.


The numbers and percentages of peripheral blood immune cells were measured in 27 patients with laboratory-confirmed H7N9 virus infection and 30 healthy controls (HCs). The functional phenotypes of T cells and monocytes, as well as serum cytokine levels, were analyzed by flow cytometry.


There were 19 patients (70.4%) with acute respiratory distress syndrome, 13 (48.1%) with secondary respiratory infection, 20 (74%) with systemic inflammatory response syndrome (SIRS; defined as having at least two concurrent SIRS components), 18 (66.7%) with lymphocytopenia and 11 (40.7%) with reduced numbers of monocytes. In comparison with levels in the HCs, the levels of serum interleukin 6 (IL-6), IL-8 and IL-10 and the percentages of CD38+ or Tim-3+ T cells were significantly increased. However, the percentages of human leukocyte antigen-DR + and Tim-3+ monocytes were significantly decreased in patients compared with HCs.


Patients with avian H7N9 virus infection display profound SIRS concomitantly with an anti-inflammatory response, which may be associated with the rapid progression of and high mortality associated with this novel viral disease.