Argentina: unusual serious cases in young people

[Shiloh]

Source: http://www.lanacion.com.ar/nota.asp?nota_id=1144216
(note: there are 2 graphs with this article...click above to see them)

Lungs to be "burned" in hours
There is a seriousness of patients' unusual '
General News: previous | next
Saturday June 27 2009


"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.

This has led to patients with these characteristics begin to be treated in an increasingly aggressive. THE NATION As reported yesterday, doctors from the Ministry of Health received the directive to take, from now on, all cases of influenza and potential influenza A (H1N1), with the recommendation to perform chest radiographs for patients with symptoms of fever and fatigue and internal quickly to all suffering from pneumonia.

"Today, it is known that the virus is circulating mass, the attitude we have with patients depends on clinical assessment made by the doctor not to become a serious case. It is not necessary to diagnose laboratory [confirming the new virus infection] to begin treatment, "said Dr. Vilma Savy, Chief of the Respiratory Virus Malbrán institute.

Concern about how this attack some young flu was confirmed to the nation on a coroner that, in recent hours, conducted two autopsies on two people killed by influenza A.

"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.

Changes in strategies for care of patients arriving with flu tables advanced aiming to be more aggressive: treat, then see what happens; leapfrogging. "This form of serious patient care will change the trend and prevent more deaths and pneumonia, said Dr. John, coordinator of the Emergency Committee of the Ministry of Health Epidemiological Aires.

For severe pneumonia, said San Juan, today patients do not receive empirical antibiotics and antiviral drugs but also does not delay the use of mechanical ventilation. "While generally expect 24 hours to see how it evolves, we do not, and if decompensation quickly reach intubation," said San Juan.

The province of Buenos Aires will, from next week, with rapid diagnostic tests that will discriminate in just 15 minutes by means of swabs, if the person is a carrier of influenza A. Anyway, the final confirmation will institute Malbrán. The new test will begin before the treatment, health authorities reported ranches.

[sharon sanders]

Great find Shiloh! Thanks!

[HenryN]

Originally Posted by Shiloh

Source: http://www.lanacion.com.ar/nota.asp?nota_id=1144216
(note: there are 2 graphs with this article...click above to see them)

Lungs to be "burned" in hours
There is a seriousness of patients' unusual '
General News: previous | next
Saturday June 27 2009


"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.

This has led to patients with these characteristics begin to be treated in an increasingly aggressive. THE NATION As reported yesterday, doctors from the Ministry of Health received the directive to take, from now on, all cases of influenza and potential influenza A (H1N1), with the recommendation to perform chest radiographs for patients with symptoms of fever and fatigue and internal quickly to all suffering from pneumonia.

"Today, it is known that the virus is circulating mass, the attitude we have with patients depends on clinical assessment made by the doctor not to become a serious case. It is not necessary to diagnose laboratory [confirming the new virus infection] to begin treatment, "said Dr. Vilma Savy, Chief of the Respiratory Virus Malbrán institute.

Concern about how this attack some young flu was confirmed to the nation on a coroner that, in recent hours, conducted two autopsies on two people killed by influenza A.

"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.

Changes in strategies for care of patients arriving with flu tables advanced aiming to be more aggressive: treat, then see what happens; leapfrogging. "This form of serious patient care will change the trend and prevent more deaths and pneumonia, said Dr. John, coordinator of the Emergency Committee of the Ministry of Health Epidemiological Aires.

For severe pneumonia, said San Juan, today patients do not receive empirical antibiotics and antiviral drugs but also does not delay the use of mechanical ventilation. "While generally expect 24 hours to see how it evolves, we do not, and if decompensation quickly reach intubation," said San Juan.

The province of Buenos Aires will, from next week, with rapid diagnostic tests that will discriminate in just 15 minutes by means of swabs, if the person is a carrier of influenza A. Anyway, the final confirmation will institute Malbrán. The new test will begin before the treatment, health authorities reported ranches.

1918 re-run. There are 26 confirmed fatalities with 15 more probables in and around Buenos Aires (as well as the infected pig farm).

[hawkeye]

this is very alarming as we are seeing the virus destroying the body. Are we certain that this is the same H1N1?

[JimO]

Forgive the dumb question, but are these symptoms characteristic of what is referred to as cytokine storm?

[HenryN]

Originally Posted by hawkeye

this is very alarming as we are seeing the virus destroying the body. Are we certain that this is the same H1N1?

It is almost certainly related, but is flu season in the southern hemisphere and influenza knows how to evolve.

[HenryN]

Originally Posted by JimO

Forgive the dumb question, but are these symptoms characteristic of what is referred to as cytokine storm?

Yes. Internal organs turn to into mush very quickly.

[HenryN]

Satellite map of pig farm

http://flutracker.rhizalabs.com/flu/...640625&zoom=14

At the above you have to switch to "satellite" view and zoom in or out.

[tropical]

#1: " the placement of young patients, between 15 and 50 years with pneumonia"


So the initialy "seasonal like"/mild picked free roaming allowing measures were a wrong move.

50 years (30-50) are not young

They can be young adult ~ 35, but adult or middle aged after.

[ironorehopper]

Argentina. Video: las distintas caras de la gripe A (H1N1)

Blogged with the Flock Browser

Posted by Giuseppe Michieli at 6/27/2009 06:24:00 PM 0 comments
Links to this post

[JimO]

Originally Posted by tropical

So the initialy "seasonal like"/mild picked free roaming allowing measures were a wrong move.

50 years (30-50) are not young

They can be young adult ~ 35, but adult or middle age after.

Hey! I'm pushing 50 and consider myself young.

[HenryN]

Here's the OIE report

http://www.oie.int/wahis/reports/en_...625_113641.pdf

[HenryN]

Here's Buenos Aires

http://flutracker.rhizalabs.com/flu/...9921875&zoom=9

[tropical]

Originally Posted by JimO

Hey! I'm pushing 50 and consider myself young.

Yes, confronted to the folks having 90 ...

Those having an biologic "30 year old body" in their 50's are not included ...

[wotan]

Well, 50 is young compared to the normal high risk age for flu.

[HenryN]

Commentary

[Dark Horse]

Some of the North American cases describe a harrowing death. Are there cases in the Americas like the Argentina cases, but for whatever reason they are not discussed or described by public health officials and hence the media?

[HenryN]

Buenos Aires locations of cases

http://www.ms.gba.gov.ar/EducacionSa...arte_26_06.jpg

[the doctor]

Originally Posted by Dark Horse

Some of the North American cases describe a harrowing death. Are there cases in the Americas like the Argentina cases, but for whatever reason they are not discussed or described by public health officials and hence the media?

Yes there have been many such cases and they are being tracked here on FTs. What we do not know is how many of the cases show signs like those described the Argentine coroner because our PH officials have suppressed this information giving us almost no information on cases since mid-May.

They cite HIPPA and patient privacy concerns as the reason and while a valid concern, it would not prevent them from releasing clinical details of the case and the autopsy findings which can easily done without compromising patient privacy.

GW

[tropicalgirl]

Hello everyone,

The automatic translation is not very good. I checked on the original and it "sounded" to me that they were not treating the cases with antivirals on time, they say there:

"Si bien generalmente se esperan 24 horas para ver cómo evoluciona, sugerimos no hacerlo y, si se descompensa rápidamente, llegar a la intubacion", precisó San Juan.

My "translation"

"Usually we wait 24 hours to see how it evolves, we suggest not to do so and, if it evolves too quickly, put in respirators", said San Juan.

Which makes me think that the doctors were waiting 24 hours to see how the patient evolves and were not putting them on respirators... I sounds like they were treating it as a normal mild flu, but with A/H1N1, specially on those with some condition, they shouldn't do that... that would explain so many deaths.

I wonder that most of these patients arrives at hospital with 24hs of symptoms (nobody runs to doctor so quickly, it's expensive, it's not the culture around here, so most people will wait until get really ugly) and if the doctors wait more 24hs so we got the 48 and it's too late for them. This is very sad. I hadn't heard about any change on the virus yet. Brazil is monitoring the borders with Argentina and Uruguay, we also have some outbreaks in cities in the border but we haven't had any deaths. Just one girl is in risk at hospital, but stable. As I don't believe that the virus which are around the border are different, what we see is the same virus killing in Argentina but not killing in Brazil. So we have one of these two situations:
a) people in Argentina are not being treated as it should (the right antiviral on time)
b) Brazil is hiding deaths or severe cases (which I really don't believe, we do have some free press, and the news would leak at net anyways)

I do hope that people in Argentina gets all the medical help they need...

[tropical]

Hi tgirl,

I shall added a c):

- or the dissemination in Brasil did not reach the levels in Argentina for whatsoever reasons, but it will follow the same short after

[the doctor]

Originally Posted by tropicalgirl

Hello everyone,

The automatic translation is not very good. I checked on the original and it "sounded" to me that they were not treating the cases with antivirals on time, they say there:

"Si bien generalmente se esperan 24 horas para ver cómo evoluciona, sugerimos no hacerlo y, si se descompensa rápidamente, llegar a la intubacion", precisó San Juan.

My "translation"

"Usually we wait 24 hours to see how it evolves, we suggest not to do so and, if it evolves too quickly, put in respirators", said San Juan.

Which makes me think that the doctors were waiting 24 hours to see how the patient evolves and were not putting them on respirators... I sounds like they were treating it as a normal mild flu, but with A/H1N1, specially on those with some condition, they shouldn't do that... that would explain so many deaths.

I wonder that most of these patients arrives at hospital with 24hs of symptoms (nobody runs to doctor so quickly, it's expensive, it's not the culture around here, so most people will wait until get really ugly) and if the doctors wait more 24hs so we got the 48 and it's too late for them. This is very sad. I hadn't heard about any change on the virus yet. Brazil is monitoring the borders with Argentina and Uruguay, we also have some outbreaks in cities in the border but we haven't had any deaths. Just one girl is in risk at hospital, but stable. As I don't believe that the virus which are around the border are different, what we see is the same virus killing in Argentina but not killing in Brazil. So we have one of these two situations:
a) people in Argentina are not being treated as it should (the right antiviral on time)
b) Brazil is hiding deaths or severe cases (which I really don't believe, we do have some free press, and the news would leak at net anyways)

I do hope that people in Argentina gets all the medical help they need...

I agree with your interpretation Tropical. Apparently for some unexplainable reason the doctors are withholding antiviral treatment even when patients are presenting with severe ILI and trouble breathing that is severe enough to warrant their hospitalization.

This is a poorly conceived policy and in my opinion one that the government health authorities are probably scrambling to change even as I write. We can expect them to do so ASAP. The WHO should ship Argentina some of the Tamiflu they have on reserve in case that country has very little of the drug in their stockpile, a possible reason for their withholding it.

The US could send them some too.

Since the novel strain will very likely pick up the 274 polymorphism conveying Tamiflu resistance over the next month or two, we are probably in a Use it of Loose it" condition at the moment. At the present, the novel strain is sensitive to Tamiflu, so if we don't use it now, all those millions of courses stored in the strategic stockpiles within the US and EU nations will go to waste.

GW

[sharon sanders]

Originally Posted by tropicalgirl

Hello everyone,

The automatic translation is not very good. I checked on the original and it "sounded" to me that they were not treating the cases with antivirals on time, they say there:

"Si bien generalmente se esperan 24 horas para ver cómo evoluciona, sugerimos no hacerlo y, si se descompensa rápidamente, llegar a la intubacion", precisó San Juan.

My "translation"

"Usually we wait 24 hours to see how it evolves, we suggest not to do so and, if it evolves too quickly, put in respirators", said San Juan.

Which makes me think that the doctors were waiting 24 hours to see how the patient evolves and were not putting them on respirators... I sounds like they were treating it as a normal mild flu, but with A/H1N1, specially on those with some condition, they shouldn't do that... that would explain so many deaths.

I wonder that most of these patients arrives at hospital with 24hs of symptoms (nobody runs to doctor so quickly, it's expensive, it's not the culture around here, so most people will wait until get really ugly) and if the doctors wait more 24hs so we got the 48 and it's too late for them. This is very sad. I hadn't heard about any change on the virus yet. Brazil is monitoring the borders with Argentina and Uruguay, we also have some outbreaks in cities in the border but we haven't had any deaths. Just one girl is in risk at hospital, but stable. As I don't believe that the virus which are around the border are different, what we see is the same virus killing in Argentina but not killing in Brazil. So we have one of these two situations:
a) people in Argentina are not being treated as it should (the right antiviral on time)
b) Brazil is hiding deaths or severe cases (which I really don't believe, we do have some free press, and the news would leak at net anyways)

I do hope that people in Argentina gets all the medical help they need...

Thanks for the translation Tropicalgirl!

[ironorehopper]

It could of some help the fact that among the most recent Italian H1N1v cases there are several Argentina imported cases.

For people used to manage with gene sequencing, it could be useful to track the most recent Italian deposited sequences at GenBank or GISAID.


About the hypertoxic infections in these Buenos Aires patients, it should be noted that antiviral drug oseltamivir alone probably would be of little or not help, if an updated treatment course will not be prepared soon, with the aim to reduce a bit the mortality rate.

Oseltamivir alone with a rapid evolutive clinical course may be too little and perhaps too late.

A comprehensive re-evaluation of both pathological evidences and possible treatment options is clearly urgently needed.

[Dutchy]

My feeling is Tropical Girl has a good point.

The stories from Argentina remind me of the stories of patients who died from H5N1 in Indonesia. Typically these patients were treated late, too late. This combined with an illness developing very fast sometimes.

May be for some reason the H1N1 patients in Argentina are treated too late with Tamiflu.

Not much information on patients who died in the USA and Canada is published .

We see and hear a few stories through family members. There is mentioning of late treatment or even refusal of treatment with Oseltamivir. Both in the USA and Canada.

Fast and aggressive treatment with an anti-viral seems to be the thing to do .

[tropicalgirl]

I just took a look on 2 major Argentina news sites

http://www.lanacion.com.ar/nota.asp?...56848&toi=6256
and
http://www.clarin.com/diario/2009/06...m-01947602.htm

They are not closing schools, public events, or any of these, the official recommendation is to wear masks and keep 2 meters distance. People sick should remain home.

Just yesterday the most affected cities suspended public and particular events...
Brazilians cities in the other side of the border affected by outbreakdecided to shut all the activities earlier in the week and we had no deaths in Brazil so far. Brazilian authorities recommend everyone in this affected city to stay home and avoid going out as much as possible. I can't understand why Argentina is taking so long to shut down schools, business and recommending everyone to stay home and so on with deaths happening there...

It seems to me that they are completely lost on what is the right thing to do, they don't wanna panic the population but they are not prepared also. They surely have economical issues and the politicians are not strong enough to make the hard decisions they have to (or they don't wanna do anything before elections taking place tomorrow?). They probably will declare national emergence soon... but nobody knows what does it means, since the minister says that does not mean that they will close schools and etc. (so surreal)

Too bad I'm not at the medical field (and don't have any researcher I can reach - if any is reading this ) but it would be lovely if anyone could check the virus of Brazilians infected in Argentina. I bet that they might be testing it already. But I'm not sure, since is too much going on now...

[ironorehopper]

According the most recent Italian Ministry of Health update, (http://www.salastampa.ministerosalut...2357_testo.rtf), among the fifteen imported cases, two were from Mexico, one from Argentina and all the other from USA.

I hope that the Argentina imported case viral sequence will be promptly available for evaluation by our flu experts.

[FrenchieGirl]

It looks like the policy is changing towards more aggressive treatment, viz:

Lungs to be "burned" in hours
There is a seriousness of patients' unusual '

"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.

This has led to patients with these characteristics begin to be treated in an increasingly aggressive. THE NATION As reported yesterday, doctors from the Ministry of Health received the directive to take, from now on, all cases of influenza and potential influenza A (H1N1), with the recommendation to perform chest radiographs for patients with symptoms of fever and fatigue and internal quickly to all suffering from pneumonia.

"Today, it is known that the virus is circulating mass, the attitude we have with patients depends on clinical assessment made by the doctor not to become a serious case. It is not necessary to diagnose laboratory [confirming the new virus infection] to begin treatment, "said Dr. Vilma Savy, Chief of the Respiratory Virus Malbrán institute.

Concern about how this attack some young flu was confirmed to the nation on a coroner that, in recent hours, conducted two autopsies on two people killed by influenza A.

"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.

Changes in strategies for care of patients arriving with flu tables advanced aiming to be more aggressive: treat, then see what happens; leapfrogging. "This form of serious patient care will change the trend and prevent more deaths and pneumonia, said Dr. John, coordinator of the Emergency Committee of the Ministry of Health Epidemiological Aires.

For severe pneumonia, said San Juan, today patients do not receive empirical antibiotics and antiviral drugs but also does not delay the use of mechanical ventilation. "While generally expect 24 hours to see how it evolves, we do not, and if decompensation quickly reach intubation," said San Juan.

The province of Buenos Aires will, from next week, with rapid diagnostic tests that will discriminate in just 15 minutes by means of swabs, if the person is a carrier of influenza A. Anyway, the final confirmation will institute Malbrán. The new test will begin before the treatment, health authorities reported ranches.

[HenryN]

Map of confirmed and fatal in Buenos Aires

http://flutracker.rhizalabs.com/flu/...921875&zoom=10

[Dutchy]

edited

Confirmed cases in Europe coming back from Argentina:

http://www.flutrackers.com/forum/sea...archid=1548296

Serbia, Italy, France, Portugal, Germany, Denmark, Belgium