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Fatal case of H5N1 bird flu reported in Alberta

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Pixie Quote  Post ReplyReply Direct Link To This Post Posted: January 12 2014 at 8:48am
A few more details, note the coronavirus 229E

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sat 11 Jan 2014
From: Kevin Fonseca <kevin.fonseca@albertahealthservices.ca> [edited]


Avian influenza A(H5N1) was detected in the respiratory samples and CSF [cerebrospinal fluid] of a young adult, who died from the infection 7 days after returning from a vacation in Beijing, China accompanied by a family member.

The individual left Canada for China on 6 Dec 2013 and was exclusively in Beijing, in urban locations. There was no contact reported with live poultry, no visits to wet markets, or handling of fresh poultry. Work is ongoing to obtain a detailed account of activities during the trip.

During the return flight on 27 Dec 2013, the individual experienced symptoms of malaise, chest pain, and fever and presented to the local Emergency Department on 28 Dec 2013. The complete blood count (CBC) showed a total white blood count (WBC) of 12.6 x 10 to the power of 9/L (reference range 4.0 - 10.0 x10 to the power of 9/L) with raised neutrophils (11.1 x 10 to the power of 9/L) and low lymphocytes (0.8 x 10 to the power of 9/L). A chest X-ray and CT scan revealed a right apical infiltrate. A diagnosis of pneumonia was made; the patient was prescribed levofloxacin and discharged home.

The individual returned to the same Emergency Department on 1 Jan 2014, now with worsening pleuritic [inflammation of the membrane surrounding the lung] chest pains and shortness of breath, a mild headache, exacerbated by head movement, right upper quadrant and epigastric pain, nausea and vomiting with no diarrhea. A chest X-ray showed a multi-lobar pneumonia, with moderate effusion, reflecting significant progression when compared with the X-ray from the 1st ED visit. A thoracentesis [a procedure to remove excess fluid in the space between the lungs and the chest wall], performed while in the ED, revealed a dark amber cloudy fluid that was sterile in bacterial culture. The CBC again showed a WBC count of 10.2 x 10 to the power of 9/L, neutrophil count of 9.5 x 10 to the power of 9/L, platelet count within the normal range, normal ALT, slightly elevated AST at 46 U/L (reference range 7 - 40 U/L) and LDH at 288 U/L (reference range 100 - 225 U/L).

Admission to a general medicine ward for investigation was facilitated, and treatment was initiated with intravenous piperacillin-tazobactam. On 2 Jan 2014, the individual reported visual changes and ongoing headache, and, coupled with increasing oxygen requirements, was admitted to the ICU for intubation and ventilation. In the early morning of 3 Jan 2014, the individual developed a sudden episode of tachycardia and severe hypertension followed by hypotension requiring inotropic support. At this point, pupils were dilated, and there was no response to pain. 

A CT brain scan suggested diffuse encephalitis and intracranial hypertension. The neurological examination was consistent with brain death. An MRI/MRA showed significant generalized edema, evidence of meningitis and ventriculitis [inflammation of the ventricles in the brain] and significant reduction in cerebral blood flow. A lumbar puncture was performed after brain death determination and prior to removal of ventilatory and inotropic support. The attending physician felt that, while unlikely, avian influenza was possible given the travel history and neurological symptoms, and contacted the local Medical Officer of Health on 3 Jan 2014 to report to public health. Contact tracing of family and hospital contacts was initiated as a precaution, given the severity of the illness and its rapid progression.

Laboratory investigations: Blood cultures were negative as were cultures of the broncho-alveolar lavage (BAL) fluids for a range of bacterial pathogens. Nasopharyngeal swabs and BAL were sent to the Provincial Laboratory for complementary viral investigations for influenza and other respiratory viral agents, and CSF for the herpesvirus group, enterovirus and parechoviruses.

Screening for influenza A and B and other respiratory viruses was performed on the respiratory samples (2 nasopharyngeal swabs and a BAL) through a combination of a direct fluorescent antigen (DFA) test (D3 Ultra DFA Influenza A/B reagent, Diagnostic Hybrids, Ohio), real time singleplex Taqman assays to influenza A and B assays targeting the matrix (M) gene of influenza A and NS1 gene of influenza B (1), and Luminex Respiratory Viral panel (Luminex, Ontario).

The swabs were negative by the DFA, however all these samples were positive for influenza A, with good Ct values in the Taqman assay, and were immediately subtyped, using real time assays to A(H1N1) pdm09 and seasonal H3 (2,3). Negative subtyping results were obtained on 2 independent runs, and when viewed in conjunction with recent travel history, strongly pointed to the possibility that this strain could be one of the avian subtypes known to occasionally infect humans. To investigate this possibility, a combination of real time and gel-based assays were performed to target the following genes H5, H7 and N9, on the viral RNA from the BAL, which had the highest titre of virus. Additionally, the M (matrix), NA (neuraminidase) and HA (haemagglutinin) genes were amplified and sequenced.

A compilation of the results from all these assays indicated that this strain was an influenza A(H5N1) subtype. Supplementary testing performed at the National Microbiology Reference Laboratory, Winnipeg, confirmed our findings that this was an avian influenza A (H5N1) virus.

Sequence data of the HA and NA genes from both laboratories showed the following. From the HA sequence this virus; (a) belongs to clade 2.3.2.1, (b) is a highly pathogenic influenza A(H5), based upon the presence of multiple basic amino-acid residues occurring at the cleavage site, (c) has a wild-type receptor binding site, consistent with preferential affinity for the avian alpha-2-3 sialic-acid receptor. The NA sequence shows genotypic sensitivity to oseltamivir (Tamiflu) based upon the histidine residue at position 275. This genotypic susceptibility result was considered to be helpful information as chemoprophylaxis with oseltamivir had been prescribed for close contacts of the individual.

Of interest is that the respiratory samples tested negative for influenza A in the Luminex Respiratory Viral panel but identified a human coronavirus 229E in the nasopharyngeal swabs, but not from the BAL. The negative influenza A results from this commercial assay were in contrast to the positive results obtained from the in-house Taqman assays.

The CSF collected also tested positive for influenza A and subtyped as H5. 

An autopsy was not done due to concerns regarding the risk of virus transmission.

This case identifies a number of key issues, the 1st being the rapid onset and tragic death of a young, healthy traveler due to an avian influenza A(H5N1) infection. The index of suspicion was low as travel was to an area in China where there have been no recent reports of the circulation of this virus, and coupled with no obvious exposure to poultry, the diagnostic work-up and consideration for A(H5N1) infection was very low.

The clinical course, detection of the virus in the CSF, and results of imaging studies are consistent with an infection of the brain. A review of the literature indicates that such events are uncommon in humans, although animal models show that this virus is neurotropic and neuroinvasive (4,5).

From a laboratory diagnosis aspect, this case shows the value of having screening assays, in-house or commercial, known to be capable of identifying all influenza subtypes. Often, the proprietary information of the target and detection sites of commercial assays makes it difficult to know if non-seasonal subtypes can be detected (6). In this case, the discrepant results between our in-house screening Taqman assays and the Luminex Respiratory Viral Panel were very helpful in indicating this strain was not a seasonal subtype.

The availability of advanced molecular tools at the Alberta Provincial Laboratory allowed us to suspect, within 24 hours of testing these samples, that this was an unusual strain. Such information was valuable in implementing appropriate communication processes to healthcare workers who cared for this patient and to regularly update the appropriate authorities.

Finally, this infection of a Canadian resident is the 1st case of influenza A(H5N1) occurring in North America. With the rapidity of travel between countries and continents and the globalization of many cultures, this will likely not be the last case to occur in North America.

References

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Newbie1 Quote  Post ReplyReply Direct Link To This Post Posted: January 13 2014 at 1:07pm
Here's a new pc on victim
http://beforeitsnews.com/survival/2014/01/human-fatality-rate-60-grave-concerns-that-h5n1-will-become-easily-transmissible-between-humans-2506122.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Pixie Quote  Post ReplyReply Direct Link To This Post Posted: January 13 2014 at 6:42pm
Old case 2005. Both had acute encephalitis ,no resp symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/15716562
N Engl J Med. 2005 Feb 17;352(7):686-91.
Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma.
de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, Nguyen BH, Beld M, Le TP, Truong HK, Nguyen VV, Tran TH, Do QH, Farrar J.
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Abstract
In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and increased levels of protein (0.81 g per liter). The diagnosis of avian influenza A (H5N1) was established by isolation of the virus from cerebrospinal fluid, fecal, throat, and serum specimens. The patient's nine-year-old sister had died from a similar syndrome two weeks earlier. In both siblings, the clinical diagnosis was acute encephalitis. Neither patient had respiratory symptoms at presentation. These cases suggest that the spectrum of influenza H5N1 is wider than previously thought.
Copyright 2005 Massachusetts Medical Society.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Saskabush Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 5:07pm
Hi Mahshadin

Wow... Now there is a visceral response. Go back and reread my post.

Cause of this outbreak is pure biology my friend.

No one caused it. Not unions, not satanists, not even evil new world order conspirators....

Just viruses doing what viruses do and do best.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Saskabush Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 6:04pm
Though I respect your contributions here, I respectfully submit that viruses and bacteria are very different and universal procedures of masking, limiting exposure to body excretions and fluids, and disinfection are less effective when dealing with viral infections.

"Virus - Bacteria Differences
Viruses are the smallest and simplest life form known. They are 10 to 100 times smaller than bacteria.
The biggest difference between viruses and bacteria is that viruses must have a living host - like a plant or animal - to multiply, while most bacteria can grow on non-living surfaces.
Bacteria are intercellular organisms (i.e. they live in-between cells); whereas viruses are intracellular organisms (they infiltrate the host cell and live inside the cell). They change the host cell's genetic material from its normal function to producing the virus itself.
There are some useful bacteria but all viruses are harmful.
Antibiotics can kill bacteria but not viruses.
An example of a disease caused by bacteria is strep throat and an example of an affliction caused by a virus is the flu."
www.mayoclinic.org

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Satori Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 8:33pm


H5N1: Anatomy of a killer – Canadian patient was brain dead by the time she was diagnosed


http://theextinctionprotocol.wordpress.com/2014/01/15/h5n1-anatomy-of-a-killer-canadian-patient-was-brain-dead-by-the-time-she-was-diagnosed/

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 9:52pm
Saskabush - I usually get to read all of the new comments, so there's no need to double post. I responded in the prepping thread.
"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Saskabush Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 11:28pm
Jacksdad
Not sure what happened but I only posted once. I did read your reply and agree my CAPS were out of place. My apologies to all.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: January 14 2014 at 11:58pm
No problem. And welcome to AFT, by the way.
"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: January 17 2014 at 9:24am
Maggie Fox: Look for weird flu symptoms, CDC reminds doctors
http://www.nbcnews.com/health/...

Maggie Fox NBC News

8 minutes ago

The case of a Canadian woman who died of H5N1 bird flu earlier this month has mystified flu experts, who say they are both puzzled by how she got the virus, and more than a little surprised that it was H5N1 and not a newer virus, called H7N9, that infected her.

The woman's unusual symptoms - she didn't have some of the more obvious signs of flu - prompted a health alert from the U.S. Centers for Disease Control and Prevention this week reminding doctors to be on the lookout for odd symptoms.

"It caught us a little unawares because we were expecting this to happen with H7N9," CDC flu expert Marc-Alain Widdowson told NBC News. "It came a little out of the blue."

The victim, a 22-year-old nurse from the central Canadian province of Alberta, had encephalitis - a swelling of the tissue surrounding the brain. She also had pneumonia, but her flu infection wasn't diagnosed right away and she apparently wasn't coughing hard.

By the time she came back to the hospital a few days later, she was already dying. Severe and unusual symptoms are a hallmark of avian influenzas, doctors say.

The CDC says people coming back from countries affected by any kind of avian flu should be on the lookout. "Clinicians should consider the possibility of avian influenza A (H5N1) virus infection in persons exhibiting symptoms of severe respiratory illness who have appropriate travel or exposure history," the Health Alert reads.
...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: January 17 2014 at 11:50am
China has obviously been hiding h5 cases for several years, and masterfully at that. Like Ive said, the only thing that makes sense with that Canadian case is that china has been up to its old cover up tricks again, and will soon be exposed.
https://www.facebook.com/Avianflutalk
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