You said: "On the other hand, it is plausible that cytokine storm shows up sometime in the present pandemic."
Happy Scientist says:
Shows up? Look through the CDC press briefing: 05/15/2009
"Stacey Singer: Hi. Thanks for taking my call. My question is in the serious cases where we′re seeing hospitalizations in this country and in Mexico and the deaths as well, has the cytokine storm frequently play a role in the deaths? What are people dying of when they′re trying?
Dan Jernigan: The issue of cytokine storm is one that clearly influenza has been associated with in the past. We have reason to believe that could be a part of the cause here. The numbers of individuals that have died that we actually have appropriate tissues and enough information to study is still pretty small. We have seen that some individuals do appear to have what looks like viral pneumonia. So that is a direct infection of the lower respiratory track by the flu virus. And so as we learn more, I think we′ll be able to say if there are unique features about the H1N1, but what we are seeing so far are the kinds of outcomes that have been previously described for influenza, but that′s something that we are very interested in and we want to learn more about. "
Dan Jernigan statement released May 15, just maintains that cytokine storm “could
be a part of the cause here” [Mexico].
Read the FLU then compare the descriptions in that book to this
I essentially agree
with the Diary of a Flu Year description typical development of a fatal influenza infection viral attack, followed by an opportunist bacterial infection. The same is true about the condensed description of the cytokine storm event.
On the other hand, I argue an intermediary scenario, (ARDS plus MODS pathology) does occur. This conjunction was actually observed in severe patients on Hospital ICU.
An excess of dead cells degradation products can induce kidneys failure, a frequent onset of MODS – Multiple Organ Distress Syndrome. The concomitant use of mechanical ventilation AND hemodialysis is sometimes required to supplement kidney function. This conjunction of interventions, as was informally told, already controlled a number of severe cases which ultimately recovered.
The unusual transformation of the lungs tissue, from spongy material into scar tissue, describen on the Flu Diary, does indeed occur on severe cases of S-OIV H1N1. As a matter of fact, this lung elasticilty alteration (and concomitant tendency to collapse) is one of the non-standard challenges on H1N1patients [mechanical] ventilation.
It has been proposed that unusual hight positive pressure could be required. This idea was presented in a South American physician meeting (from Chile, as I can recall). I learned this approach from a hospital ICU physician who went to this meeting, so my translation may lack important details. Otherwise, not very complex concepts involved.Trouble is
: non-standard ventilator higher POSITIVE pressure can be necessary to expand the otherwise collapsed lungs, which are fibrous and and thick (inflammation). This effect was first verified by RX checking the actual lung response to different pressures. A number of S-OIV H1N1 young adults responded better to higher positive pressures.
On the other hand, standard respirator pressure settings are mostly designed to ventilate the rather elastic tissue of a secondary bacterial infection. I feel that this positive pressure approach deseve further checking.
: There were two issues of Recombinomics Commentary
covering Argentina on June 27. Here is the Buenos Aires La Nacion newspaper link on this issue (in Spanish, google translation needed):http://www.lanacion.com.ar/nota.asp?nota_id=1144216
I also quote a couple of translated paragraps from the mentioned Commentary
(underlines are mine):
"We're seeing the placement of young patients, between 15 and 50 years with pneumonia, some rapidly evolving towards a gravity which for many is unusual, in which the lung is' fire 'in a matter of hours," said Dr. Jorge San Juan, head of the Department of Intensive Care Hospital Muñiz.
"The bodies were viscera, meninges and brain swollen, a little common factor in death from influenza. Additionally, the lungs were in bad shape, with some spots we could not identify. The studies sent pathology, " said the coroner who asked not to publicize his name until the health authorities take note of it found.
The inflammation quick progress on lungs, in aggressive viral pneumonia in young adults. This sudden evolution of otherwise healthy, young people, is atypical and paradoxal to doctors. Bear in mind that last pandemic was in 1968. Very few (if any) members of hospital staff had did experienced last pandemics. It is unexpected response. Hardly seen on influenza young adultspatients! Well, this is ARDS! Not as radical as cytokine storm (many patiend did survived ARDS+MODS!), and yet agressive enough.
Otherwise, [non specified] viscera meninges and brain presents inflammation
(not necessarily uncontrolled). The newspaper does not clarify if these unusual occurred at the same time and in all patients. In the cytokine storm scenario, other tisues would show more than inflammation. They would become mushy and tend to liquefy (roughly analogue to Ebola pathology).
Otherwise, I have not seen so far any unambiguous cytokine storm detection on S-OIV H1N1 patients. On the other hand, I still think it is plausible that cytokine storm shows up, and any kind of “early warning” protocol could prove useful.