Rhiza Labs FluTracker Forum

A new “strange disease” : H1N1 Pathology and Clinics

Seasonal influenza has been the clinical reference template to immediate hospital and health care issues, during the first few months of the rising pandemics. There were well tested protocols reflecting cumulative experience of many decades of different seasonal influenza strains. It covered a wide number of less common pathology expressions.

However, this already most criticized “guideline” did not cover a number of non-standard influenza pathologies; many of them discussed in this on other forums. On the other hand, the standard timing of formal publishing in specialized literature is clearly no match for the virus dynamic timing.

This “strange disease” thread is intended to reflect new non-standard pathological counterparts of the H1N1 virus structure and genetics. Condensed posts, arisen from concrete medical care experiences are welcome.

First post is a NEJM paper Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico, on 18 patients hospitalized last April.



Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico
Perez-Padilla,R et al.
N Engl J Med 2009;361.
http://content.nejm.org/cgi/content/full/361/7/680 - FULL paper.

PS: The name “strange disease” came from a classic book on 1918 pandemic.

I think this is a worthwile MMWR:

Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection
--- Michigan, June 2009
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a4.htm

Great posts:):thumbsup:
This link is down though?
http://content.nejm.org/cgi/content/abs%20a0904252v1

This post shows a less technical approach of H1N1 challenges. It presents a Doctor’s eye witness of panorama of ICU Winnipeg hospital H1N1 flu ARDS issues, by mid June (somewhat old ...).

It is not as technical as precedent NEJM paper and the MMWR report of this topic. On the other hand it shows the human perception of an ICU atmosphere some of us could possibly empathize with:

H1N1 flu patients in ICU challenging to manage
Updated Fri. Jun. 19 2009 7:47 AM ET
The Canadian Press

In a typical flu season, the Winnipeg hospitals where Dr. Anand Kumar works might see one, maybe two life-threatening cases of viral pneumonia caused by influenza.

So seeing 10, 15 and more flu patients in those same hospitals’ intensive care beds in June is still a shock, suggests Kumar, a critical care specialist who works at three different hospitals in the city.

“You just don’t see this many of them,” Anand says of the patients, struggling to survive H1N1flu infections.

“You don’t see rows and rows of patients on ventilators because they have respiratory failure, a viral pneumonia kind of thing. It’s unusual.”

At last count, Manitoba hospitals had 30 respiratory distress patients in the ICU, some confirmed H1N1 flu cases, others for whom tests are still pending.

In most people, H1N1 flu behaves like regular flu - it makes you feel miserable, you head to your bed and in time you recover. But in an as-yet unknown proportion of cases, the virus seems to quickly trigger severe illness.

A report compiled by the World Health Organization said between two and five per cent of confirmed cases require hospitalization. But no one yet knows how big a portion of the iceberg is above water (the confirmed cases) and how much remains submerged (cases that never come to the attention of medical authorities).

People who end up getting admitted to hospital are generally presenting with shortness of breath. And by the time they get to the ICU, swine flu patients - most much younger than your average hospitalized flu patient - are gravely ill from a viral assault on their lungs.

“They’re getting very bad, bad respiratory failure,” says Dr. Michael Gardam, head of infectious disease prevention and control for Ontario’s public health agency. Kumar and others describe patients whose care is challenging.

“The patients are difficult to manage. They’re unusually difficult to ventilate effectively,” he says, referring to the practice of putting patients who cannot breath adequately for themselves on a machine called a ventilator that takes over the job temporarily.

“They’re just really, really sick. It’s impressive how sick they are.”

Researchers are still trying to piece together how the new H1N1 virus attacks the bodies of those who develop a severe swine flu infection, and whether the damage is all the work of the virus.

One theory is that an over-exuberant immune response turns the body’s defences against itself. That has been seen in human infections with H5N1 avian influenza, but it’s not yet determined if this process - sometimes called a cytokine storm - is at play with swine flu.

“We don’t know right now how much is direct toxic effect of the virus versus the effect of the body’s immune system,” says Dr. Nathan Dean, chief of pulmonary critical care at LDS Hospital in Salt Lake City, where he’s treated about 25 swine flu cases in ICU over the past month.
Ask Dean what’s happening to his patients’ bodies and the response is both quick and rueful: “I would love to know.”

In addition to trying to keep these patients alive, clinicians like Anand and Dean are gathering data. The case studies they are writing, and which will shortly be competing for space in medical journals, will help doctors who haven’t yet see severe swine flu cases know how to handle them when they do.

Likewise, autopsies that have been performed on a number of people who died of their infections will help scientists figure out what the virus does in the body, information physicians may be able to mine for clues on how to improve a severely ill person’s chances of survival.

The additions to the scientific literature will be welcome.

Finding out what is going on with severely ill patients has been a struggle, says Dr. Frederick Hayden, an influenza expert at the University of Virginia who co-authored the recent WHO report.

Source:
http://toronto.ctv.ca/servlet/an/local/ ... ntoNewHome