Wow! BF victims cause of death disclosed

Chemotherapy for Immune Disorder Suggested as Avian Flu Treatment
	By Michael Smith, MedPage Today Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. March 02, 2006 Also covered by: ABC News

Review
STOCKHOLM, March 2 - A chemotherapy regimen used to treat an immune system disorder might increase survival of people who contract the H5N1 avian influenza virus, Swedish and Chinese researchers have suggested.

The hypothesis, proposed in the March 2 online issue of The Lancet, is based on clinical similarities between hemophagocytic lymphohistiocytosis (HLH) and post-mortem findings in people who have died of H5N1 infection.

The idea has yet to be tested and "might seem to be a substantial jump in therapeutic thinking," conceded Jan-Inge Henter, M.D., of the Karolinska Institute here.

But, he and colleagues argued, a combination of cytotoxic therapy used to treat HLH combined with antiviral and supportive therapy "is worth considering," especially since the mortality rate for people who catch the H5N1 virus is about 50%.

The hypothesis requires testing, but could be immediately ethically justified in patients with H5N1 combined with secondary HLH, they wrote.

HLH is characterized by an excess of both histiocytes and lymphocytes. The disease is associated with hypercytokinemia, cytopenia and acute encephalitis. The cause of death in HLH patients is often sepsis with multi-organ failure.

Post-mortem analyses of two patients who died of H5N1 in 1997 showed a reactive hemophagocytic syndrome as the most prominent feature, Dr. Henter and colleagues noted. Both patients had high levels of cytokines, including interleukin-2 and interferon gamma.

That finding has since been reported in several other cases, the investigators noted.

Another similarity is that many patients who die of H5N1 do so as a result of multi-organ failure, they said.

Also, many patients with HLH develop encephalitis, although it is rarely the cause of death. Acute encephalitis has been reported as the cause of death in two Vietnamese patients with H5N1.

"In brief, there are many clinical similarities between H5N1 infection and HLH," Dr. Henter and colleagues said. "Both disorders are also characterized by a malignant -- i.e., often fatal -- course of a prominent non-malignant inflammatory reaction, and patients with H5N1 could develop secondary HLH."

In 1994, a treatment protocol for HLH was developed, based on corticosteroids, etoposide, cyclosporine A, and intrathecal methotrexate. In one form of HLH -- Epstein-Barr-virus associated HLH -- the treatment has increased survival from 50% to 90%, the investigators noted.

The so-called HLH-94 protocol begins with etoposide and dexamethasone up front. A revised protocol, HLH-2004, suggested adding cyclosporine A up front, but Dr. Henter and colleagues said that approach should probably be avoided because renal problems are frequent in H5N1 infection.

Animal testing for safety is possible to justify treatment in other cases, but since the HLH-94 protocol has been used successfully in humans with severe virus infections for many, "we thought well-controlled use of the treatment in people with severe H5N1 infection would be reasonable and relevant in the current context," Dr. Henter and colleagues said.

They suggested that any testing of the idea should be reported to the HLH Study Center in Stockholm, and added that it might be worthwhile for the World Health Organization to "consider a platform for the undertaking of based on a modified HLH protocol (including corticosteroids and etoposide) in addition to supportive and antiviral therapy."

The authors concluded, "Obviously, we cannot guarantee any therapeutic efficacy, but it would be unfortunate if this therapy was effective but never attempted."

http://www.medpagetoday.com/Pulmonary/URIstheFlu/tb/2774

Ella

Thanks for researching this and posting this too.

The part about  "People can die of a cytokine storm within hours." is very accurate. Atleast I can say that from what I know and my circumstances with this was never validated as bird flu per se but the end result was identical so for me thats all i needed to know. What happened was it exculates very quickly from just feeling sick to going towards death and brain inflammation because of the inflammatory response-delirium , spleen enlarges, heart is affected by the virus-myocarditis, kidneys are affected and liver too...all the major organs then fail , largely because virus replicates so fast the body tries to combat it and instead the immune system just wipes the organ out. Death ensue's.

I read that steriod use would actually harm and cause mortality to be more likely, because it thereby blocks the immune system  and hinders and doesn't help or increase survival..So it's just this double edge sword...(the healthier and  stronger you are -works against you and lowering the immune system once you have the virus is also harmful ...

It seems the key is to find what they can do to fight the virus without harming the person at the same time, and to find a vaccine,short of clearing the world of this threat in general. I am not one who thinks one should ever try to lower their own immune system -although the elderly may have an edge that the younger people  will have with this., I just think we need to be aware of how the virus attacks to know when to get medical help if it becomes a problem with you or with someone you love, so I am glad we are talking about this.