Deaths of Suspect H5N1 Patients in Egypt Raise Concerns
Recombinomics Commentary 17:49
January 10, 2008
And in Suhaj doctor Mohamed Abdul Aal, the Ministry of Health and Population deputy, confirmed that results the analyses of the samples of the suspicion condition by the bird flu disease and that was dead an hour after its detention "the day before yesterday" in the hospital of Suhaj fevers to a patient that claims [is named] Ahmed Mahfouz Ali 43 years a sheikh in girls institute in Dar Es Salaam center, brought a passivity to the disease, and no relation for the death by the bird flu, and that the death reason is a bleeding in the oesophagus varices due to a hepatic fibrosis.
The above translation describes the second suspect bird flu patient to die. Both were 43M teachers or administrators. The first died in Cairo and his apartment was raided to confiscate the birds he kept. Although the birds were said to test negative for H5N1, the cause of death of the teacher was not made public. The teacher had typical bird flu symptoms, including breathlessness and pneumonia.
The translation of the symptoms of the administrator is also consistent with bird flu. The fatal H5N1 infections of the Gharbiya cluster a year ago led to liver problems, and bleeding is a common symptom of advanced avian influenza.
Egypt has not reported any confirmed H5N1 cases since the beginning of the year. However, the number of hospitalized cases grows daily (see satellite maps here and here). In the past Egypt has tested and treated large numbers of suspect cases, but the rise in these cases generally follows outbreaks of seasonal flu, which peaks in the spring. Last year a number of mild H5N1 cases were identified in March and April. However, all but one of the 17 final cases survived and most were in southern or central Egypt.
In contrast, early last season, the first seven cases were fatal, as were four of the five cases this season. These cases, and the daily reports of confirmed H5N1 in poultry (see satellite map) and hospitalization of suspect cases may be driving more patients to doctors offices for check-ups, but the possibility of false negatives is very real.
Last season only two of the three patients in the Gharbiya cluster were confirmed, although all three died with bird flu symptoms. The false negative in the third victim raises concerns about more false negatives. Similarly, early testing, followed by Tamiflu treatment can also yield false negatives, as can collecting samples from the wrong site or wrong time. In Turkey two years ago, the four siblings tested negative initially, even though three were unconscious and near death. H5N1 was detected from their lungs after death, and the surviving sibling was never confirmed.
In addition, the H5N1 in Egypt is likely to include the Uva Lake strain, which has now been detected throughout Europe and Kuwait. This new strain could impact the sensitivity of the testing in Egypt, again contributing to false negatives.
More detail on the suspect cases, including severity of disease and transfers to Cairo, would be useful.
Media Links
Recombinomics Presentations
Recombinomics Publications
Recombinomics Paper at Nature Precedings