Swine Flu Mystery in Healthy Young Spurs Search for a Cause By Jason Gale
http://www.bloomberg.com/apps/news?pid=20601087&sid=aMMBiJ78eqfo Sept. 14 (Bloomberg) -- After being infected with swine flu, Brent Robb, a 34-year-old New Zealander with no pre- existing medical conditions, spent 11 days in a coma induced by doctors in a last-ditch effort to save his life. A printer who liked to bike 12 miles a week for exercise, Robb lost two months of work while sick, and a sixth of his body weight. He survives as an example of a mystery hovering over the fast-moving pandemic that has spread to <http://gamapserver.who.int/h1n1/cases-deaths/h1n1_casesdeaths.html>177 countries in four months, yet causes little more than a fever and a cough in all but a select few. Seasonal flu kills predominantly the <http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html>frail elderly. Researchers are trying to determine why the <http://www.who.int/csr/disease/swineflu/en/index.html>H1N1 swine flu virus, much like the <http://www.who.int/mediacentre/factsheets/2003/fs211/en/>Spanish Flu of 1918, is lethal to a portion of <http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html>young people in good health. The reason may involve a person's genetics, or simply taking a deep breath just as a nearby infected person sneezes. "That's a question we have to find the answer to," said <http://search.bloomberg.com/search?q=Nikki+Shindo&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>Nikki Shindo, a Geneva-based doctor who has led the World Health Organization's investigation of swine flu patients since the virus was discovered in Mexico in April. Underlying conditions that can intensify the effects of flu include respiratory illnesses, especially asthma, cardiovascular disease, diabetes, a suppressed immune system, and even pregnancy. About <http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_20090611.pdf>25 percent to 50 percent of severe cases worldwide involve healthy young and middle-aged people like Robb, according to WHO Director-General <http://search.bloomberg.com/search?q=Margaret+Chan&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>Margaret Chan. Unpredictable Disease It is a statistic that highlights how unpredictable the disease has turned out to be, said <http://search.bloomberg.com/search?q=Ian+Barr&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>Ian Barr, deputy director of the WHO's Collaborating Center for Influenza in Melbourne. "People are happy to dismiss serious cases among people with underlying conditions," Barr said in an interview. "It's a wake-up call when healthy people are struck down." As many as 2 billion people, or 30 percent of the world's population, may become infected by the new virus as it spreads globally, according to the WHO. Identifying those likely to recover without medical help, and those who may become severely ill will help prioritize vaccination and drug treatment. In Australia, the median age of people dying from seasonal flu is 83. With the H1N1 swine flu, it is <http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/751B88F9D1BA64E4CA2576090005C2DD/$File/ozflu-no16-2009.pdf>54 years, according to the government's Aug. 28 influenza surveillance summary report. In New South Wales, Australia's most-populous state, the majority of H1N1 patients in intensive-care units are <http://www.emergency.health.nsw.gov.au/swineflu/resources/pdf/case_statistics_090909.pdf>30 to 59 years old, the state government's Sept. 9 weekly report notes. Host Factors Global health experts are gathering this week in San Francisco at the<http://www.icaac.org/>Interscience Conference on Antimicrobial Agents and Chemotherapy, the world's biggest meeting of infectious disease specialists. Scientists at the conference are set to report on a study that sifted through blood test results from dozens of patients with complications in search of a common genetic cause. Bad luck may also play a role, Shindo said. Taking a deep breath or yawning immediately after an infected person nearby coughs or sneezes may enable large amounts of airborne viral particles to penetrate the lower lung, he said. "There have got to be some host factors that are involved in terms of explaining why there are these rare, lethal pneumonias and why some folks don't handle the virus at all well and the vast majority have an uncomplicated illness," said<http://search.bloomberg.com/search?q=Frederick+Hayden&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>Frederick Hayden, professor of clinical virology at the University of Virginia School of Medicine in Charlottesville. Doctors have not been able to explain why Robb almost died while his partner, Susanna Gillies, and their 5-year-old son both escaped uninfected, Gillies said in an interview. 'Couldn't Shake It' Robb's illness began like <http://www.cdc.gov/flu/about/disease/index.htm>most flu cases. Forty-eight hours after returning from a daylong business trip to Melbourne on July 9, he was laid up in bed. "I just thought it was the flu, but I couldn't shake it," he said over the telephone from his home on the outskirts of <http://www.christchurch.org.nz/>Christchurch, New Zealand's third-biggest urban area. "I started getting rundown, then came the body shivers and sweats, and I felt very tired with a major, major headache." Robb's cough became so persistent on the evening of the fifth day of his illness that he moved to the sofa to avoid disturbing Gillies, he said. Having not eaten in days, he was pale, feverish, and too weak to sit up and panting rapidly, recalled Gillies, a 36-year-old bookkeeper. "I just wasn't able to take deep breaths," Robb said. His condition worsened the next day, said Gillies, who called New Zealand's<http://www.healthline.co.nz/intro.html>Healthline, a free 24-hour telephone medical advice service. "Twice they said they didn't want to see him. There was nothing they could do for the cough. Just keep the fluids up," she said. Just before 5 p.m., when shops in Christchurch were preparing to close, Gillies called the hotline a third time. 'Last Chance' "I thought this was my last chance to get something for him before the weekend," she said. "Luckily they asked me more about his symptoms and said I should bring him in." Robb arrived at the clinic an hour later struggling to breathe with a temperature of more than 39 degrees Celsius (102 Fahrenheit), Gillies said. "They thought he had pneumonia and told us to go straight to the accident and emergency department," Gillies said. Robb's blood <https://www.health.harvard.edu/diagnostic-tests/oxygen-saturation-test.htm>oxygen saturation was 58 percent, indicating his body was so dangerously starved of air that its tissues were being damaged. He was taken that evening to intensive care, where he was sedated so a tube could be inserted into his airway for mechanical ventilation, and he was given <http://www.bloomberg.com/apps/quote?ticker=ROG%3AVX>Roche Holding AG's antiviral drug Tamiflu, antibiotics and painkillers, Gillies said. Three-Week Loss A week later, the breathing tube was inserted directly into Robb's windpipe to avoid it damaging his vocal cords and to enable him to be brought out of the coma. Days later he was moved back to the wards and discharged on July 31. In less than three weeks, he had shed 13 kilograms (29 pounds) from his stocky, 75-kilo, 1.62-meter (5'4") tall frame. In New Zealand, about one in seven people hospitalized with H1N1 have needed intensive-care treatment, the Ministry of Health said in a Sept. 11 <http://www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-update-150-110909?Open>statement. In most cases, flu remains in the nose, throat and bronchi, where it causes a runny nose, sore throat and cough until the body's immune systems eliminates it, usually within a week. The pandemic strain is more adept than seasonal flu at infiltrating the lower branches of the airway, where it can cause complications such as those that occurred in Robb's case, including viral pneumonia, said Stephen Toovey, a senior research fellow at London's <http://www.ucl.ac.uk/medicalschool/index.shtml>Royal Free and University College Medical School. Lung Attack While the pandemic virus tightly latches onto cells in the upper respiratory tract like seasonal virus, it also attacks cells in the lungs, researchers at London's <http://www3.imperial.ac.uk/>Imperial College wrote in a study reported Sept. 10 in the journal <http://www.nature.com/nbt/>Nature Biotechnology. In severe cases, influenza can damage the capillaries surrounding the tiny grape-like sacs, known as alveoli, where gas is exchanged through the blood. Damaged alveoli can bleed, causing <http://www.ucsfhealth.org/childrens/health_professionals/manuals/29_PulmHemorrhage.pdf>pulmonary hemorrhage and blood clots. "What makes it go from the bronchus to the alveoli is the $64,000 question," said<http://search.bloomberg.com/search?q=John+Nicholls&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>John Nicholls, associate professor of pathology at the University of Hong Kong, who has studied how cells interact with viruses like the H5N1 bird flu strain and SARS. Previous bouts of flu, particularly caused by strains similar to the H1N1 virus, may give some protection, he said. Inflammatory chemicals are produced by the immune system to fight the infection and repair the damage. An <http://www.nature.com/nature/journal/v443/n7111/full/nature05181.html>over-exuberant response can worsen the effect by filling the lungs with fluid and cause permanent scarring that restricts the lungs. "Pathologically, it's identical to what happens with H5N1 infection," known commonly as bird flu, said Shindo, the WHO doctor investigating case. "Pathologists say if they weren't told it was H1N1 they would diagnose H5N1 as the cause." To contact the reporter on this story: <http://search.bloomberg.com/search?q=Jason+Gale&site=wnews&client=wnews&proxystylesheet=wnews&output=xml_no_dtd&ie=UTF-8&oe=UTF-8&filter=p&getfields=wnnis&sort=date:D:S:d1>Jason Gale in Singapore at<mailto:[email protected]>[email protected] Last Updated: September 13, 2009 12:00 EDT --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to Mark Crispin Miller's "News From Underground" newsgroup. 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