Are Neurotropic Bird Flu Deaths Complex?
Recombinomics Commentary
February 16, 2005
>> These cases have important clinical, scientific, and public health implications. In both cases, the clinical presentation led to diagnoses of gastrointestinal infection and acute encephalitis, which alone or in combination are common clinical syndromes in southern Vietnam. Patient 1 had no respiratory symptoms and a normal chest radiograph less than 24 hours before she died. Although Patient 2 showed signs of pneumonia during the last day of his life, a respiratory illness was not considered his most relevant clinical problem. Recently, another patient with influenza H5N1 was described with an initial presentation of fever and diarrhea alone.<<
The recent patient with H5N1 that had an initial presentation of fever and diarrhea alone may be what has been described in recent media reports as "complex" and in a "complicated manner" with regard to bird flu cases in Vietnam and Cambodia.
Clearly widespread screening of case clusters in Asia is indicated, including camps for Tsunami victims. There have been many reports of high fever and coma in Asia, without any indication that these patients were tested for H5N1. In the absence of tests of these patients it seems that H5N1 infections are likely to be more widespread than indicated in official and media reports.
The failure to screen unusual clusters of meningococcemia cases in the Philippines is a clear example of a failure to learn the lessons of the 1918 pandemic. There were several examples of clusters linked to funerals, with case fatality ratios approaching 100%.
The lack of testing these cases for H5N1 avian influenza represents a clear public health failure.
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