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**hawkeye** · June 15, 2006, 08:38 AM

Re: Indonesia - Jones Ginting suffering from brain infection

???
So is this infection secondary from H5N1 or is it completely seperate?

-hawkeye

**HenryN** · June 15, 2006, 09:21 AM

Re: Indonesia - Jones Ginting suffering from brain infection

PB2 E627K is neurotropic.

**hawkeye** · June 15, 2006, 09:27 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Thank you Niman. Wasn't it approx. 2-4 weeks ago we were following Jones Ginting's progress in relation to BF. Any idea why it's taken so long for these symptoms to appear? If it is infact related to PB2 E627K?

**HenryN** · June 15, 2006, 10:01 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Commentary at

http://www.recombinomics.com/News/06...tra_Neuro.html

**Jeremy** · June 15, 2006, 10:04 AM

Re: Indonesia - Jones Ginting suffering from brain infection

http://www.recombinomics.com/News/06...tra_Neuro.html
Commentary

Neurological Complications in H5N1 Patient in Medan Sumatra

Recombinomics Commentary
June 15, 2006

After being stated recovered from bird flu, JG must reside in the hospital and might not come home. He the diagnosis suffered the infection in and around the brain. If being forced to come home, JG could be suddenly unconscious.

"There were the infection and the clump of pus in and around his brain," said the Co-ordinator Tim the Handling of Adam's Hospital Bird Flu the Medan Owner, Adlin Adnan in Medan, on Thursday morning (15/6). This infection was known after being done pemindaian against JG. "The temperature of his body also was not yet stable," said Adlin.

This hospital, said Adlin, will coordinate with the Hospital of Sulianti Saroso Jakarta to memperlajari the patient's relations recovered bird flu and the brain infection. According to Adlin, the case that was suffered by JG was classified as rare and first happened in Sumatra.

The above translation indicates that the sole survivor of the H5N1 bird flu cluster near Medan, north Sumatra, has neurological involvement. Neurological involvement of H5N1 has been associated with PB2 E627K. This polymorphism is found in all human isolates that are H1, H2, or H3. PB2 in H5N1 has been associated with neurological problems in mammals. Mice infected with H5N1 have neurological involvement and E627K has been found in brain isolates. Similarly, tigers in Thailand infected with H5N1 have neurological symptoms and E627K. E627K has also been found in H5N1 from cats and dogs. Experimental ferrets infected with H5N1 with E627K have hind leg paralysis.

PB2 E627K is also associated with increased activity at lower temperatures (33 C), which would increase levels in the nose and throat of humans. Declan Butler reported that cases in northern Sumatra had increased levels of H5N1 in their nose and throat, suggesting the H5N1 from these patients had E627K. This change was found in H5N1 (A/Indonesia/6/2005) from the second confirmed case in Indonesia (see phylogenetic tree), suggesting E627K is also in the north Sumatra cases. Isolates from these cases also have an H5N1 wild type cleavage site, RERRRKKR, which was also present in the above examples of neurological involvement.

Neurological involvement of H5N1 is cause for concern. The effectiveness of neuraminidase inhibitors such as Tamiflu is unclear. In addition, the isolates from Sumatra are amantadine resistant, further limiting treatment options. This complication creates additional concerns linked to an H5N1 pandemic, which could significantly impact treatment centers and anti-viral stockpiles.

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**St Michael** · June 15, 2006, 11:17 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Neurological Complications in H5N1 Patient in Medan Sumatra

This is NOT good. If brain infection becomes a widespread component of any H5N1 pandemic, arresting the cytokine storm becomes pointless. Not good at all.

**Mellie** · June 15, 2006, 11:31 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Many of the barheaded geese and European swans infected with H5N1 died swimming in circles.

**hawkeye** · June 15, 2006, 12:22 PM

Re: Indonesia - Jones Ginting suffering from brain infection

Very disturbing indeed.

**Auburn Boy** · June 15, 2006, 12:55 PM

Re: Indonesia - Jones Ginting suffering from brain infection

Neurologic complications have been shown in a lot of cases of AI infection in various hosts now.

And there's that woman who died recently in Malaysia of apparent neurological illness. It was reported she was sick for a long time without telling her parants because she didn't want to go home from school.

The 1918 flu also caused lot of post flu psychosis. See chapter 32 and 33 of John Barry's "The Great Influenza."

Also, this was easy to find in google. Psychosis, H5N1, Neurologic gets this article:
http://pediatrics.aappublications.or...ull/114/5/e626

Conclusions. Neurologic symptoms and sequelae were associated with influenza A virus infection in children during the 2003?2004 influenza season in Houston, Texas. Influenza should be considered in the differential diagnosis in patients with seizures and mental status changes, especially if they present with respiratory symptoms or during an influenza outbreak. 

It would seem that in the case of J. Ginting, that the infection is still active in his brain, given that pus was noted (presumably from x-ray, cat scan, or MRI..,) and his temperature is still not stable after all this time.

As in the 1918 pandemic, we might end up with a generation of the population with residual mental disorder as a rusult of AI infection.

All in all, serious considerations here.

Thanks again to Dr. Niman for all the insightful commentary.

N.

**Goju** · June 15, 2006, 01:01 PM

Re: Indonesia - Jones Ginting suffering from brain infection

This is causing me pre flu psychosis.

**Theresa42** · June 15, 2006, 10:57 PM

Another story on Jones Ginting

toggletext-ed from Indonesian:

Jonnes Ginting suffered the Skunder Infection
June 16, 2006

Liputan6.com. Medan: Jonnes Ginting the bird flu patient from the Simbelang Fortification Village, the Karo Land Regency, North Sumatra, be forced still must undergo the maintenance in Adam's space of the isolation of the central Public Hospital the Owner, Medan, on Thursday (15/6). Although being stated recovered from bird flu, Jonnes evidently was known experienced the acute infection in the head part.

The condition for the patient cluster this bird flu was still being seen weak. The Jonnes face was seen pale. This situation was different to several the previous day after being stated recovered from bird flu. At that time Jonnes appeared fresh and healthy [read: WHO monitored the Movement of the Person from Indonesia].

According to M. Nur Rasyid, Deputy Director RSUP Adam the Owner, Jonnes no longer faced the problem of the bird flu virus. However was based on results scanning or the head inspection, this patient experienced the secondary infection. This was seen from the very spotty existence white in the Jonnes head part.

At this time Jonnes received the maintenance of the combination from the part neorologi or nerves and the internal disease. This maintenance was carried out to eliminate the infection in the head and avoid the fatal effect other. His article the secondary infection in the head part when immediately was not handled could result in paralysis. Because that of Jonnes for the time being was forced to have to postpone his wish to return home to the village although being stated recovered and free from the bird flu virus.

Halaman yang Anda cari tidak ditemukan

http://www.liputan6.com/view/7,124519,1,0,1150429701.html

**Theresa42** · June 15, 2006, 11:51 PM

Re: Indonesia - Jones Ginting suffering from brain infection

Bird flu patient checked for neurological symptoms
Jason Gale

FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?p=17052

**St Michael** · June 16, 2006, 08:58 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Bloomberg - Are you a robot?

http://www.bloomberg.com/apps/news?pid=10000080&sid=aG2HiPIGxZt4&refer=asia

Bird Flu Patient Checked for Neurological Symptoms (Update1)

June 16 (Bloomberg) -- Jones Ginting, the only survivor of seven members of an Indonesian family infected with bird flu, is being investigated for rare neurological symptoms associated with the illness.

Magnetic resonance imaging (MRI) scans of Ginting's brain are being checked for signs of infection, said Nur Rasyid Lubis, deputy director of the Adam Malik Hospital. He said the scans were taken late yesterday at the hospital in Medan, the capital of Indonesia's North Sumatra province.

``It's not yet clear whether he's suffering from a brain infection,'' Lubis said in a telephone interview today.

If confirmed, Ginting would be one of few human cases of avian influenza in which disease of the central nervous system has been observed. Doctors are studying the H5N1 avian flu strain to improve treatments and prevent illness. Human H5N1 cases provide opportunity for the virus to mutate into a pandemic form that may kill millions of people.

Avian flu has infected at least 226 people in 10 countries, killing 129 since late 2003, the World Health Organization said yesterday. In most cases, severe respiratory disease was the major symptom.

Diseases involving the central nervous system, including encephalitis, transverse myelitis and Guillain-Barre syndrome, have been associated with influenza in humans, according to Harrison's Principles of Internal Medicine, 13th edition. The cause of the disease isn't established, the medical book said.

Rare Symptoms

Neurological symptoms may occur during H5N1 illness, ``but probably not very frequently,'' said Menno de Jong, head of the virology department at the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, in an e-mail today.

If live virus particles are carried outside the lungs and surrounding tissues to other parts of the body, some antiviral treatments such as inhaled zanamivir, marketed by GlaxoSmithKline Plc as Relenza, may not be effective in treating H5N1 cases.

De Jong's team observed 18 H5N1 cases, including that of a 4-year-old boy, who had severe diarrhea, followed by seizures, coma and encephalitis, before he died. H5N1 virus was isolated from his cerebrospinal fluid, de Jong and colleagues wrote in a study published in the New England Medical Journal, Feb. 17, 2005.

The boy's nine-year-old sister died from a similar syndrome two weeks earlier before samples were taken. Neither patient had respiratory symptoms when their illnesses were first observed. The cases suggest that the spectrum of H5N1 avian flu is wider than previously thought, the study said.

Indonesian Cases

More than one person a week has died of H5N1 in Indonesia this year. Ginting and his relatives who died of the disease last month have attracted international attention because they represent the largest reported instance in which H5N1 may have been spread among people and the first evidence of a three-person chain of infection.

Ginting, a 25-year-old farmer from the village of Kubu Sembelang on the island of Sumatra, has been treated for avian flu in the hospital for more than 38 days. His 37-year-old sister is suspected of being the first family member to die from the disease. She was buried before samples were taken.

The woman's two sons, a sister, another brother, a nephew and a niece died from the virus between May 4 and May 22.

To contact the reporters on this story:
Karima Anjani in Jakarta at kanjani@bloomberg.net;
Jason Gale in Singapore at j.gale@bloomberg.net
Last Updated: June 16, 2006 00:03 EDT

**St Michael** · June 16, 2006, 09:28 AM

Re: Indonesia - Jones Ginting suffering from brain infection

Originally posted by St Michael

This is NOT good. If brain infection becomes a widespread component of any H5N1 pandemic, arresting the cytokine storm becomes pointless. Not good at all.

Well, according to the article above, this is a rare complication, so arresting the cytokine storm still has primary importance:

Originally posted by St Michael

http://www.bloomberg.com/apps/news?p...Zt4&refer=asia

Bird Flu Patient Checked for Neurological Symptoms (Update1)

June 16 (Bloomberg) -- Jones Ginting, the only survivor of seven members of an Indonesian family infected with bird flu, is being investigated for rare neurological symptoms associated with the illness.

...If confirmed, Ginting would be one of few human cases of avian influenza in which disease of the central nervous system has been observed.

...In most cases, severe respiratory disease was the major symptom.

Diseases involving the central nervous system, including encephalitis, transverse myelitis and Guillain-Barre syndrome, have been associated with influenza in humans, according to Harrison's Principles of Internal Medicine, 13th edition. The cause of the disease isn't established, the medical book said.

Rare Symptoms

Neurological symptoms may occur during H5N1 illness, ``but probably not very frequently,'' said Menno de Jong, head of the virology department at the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, in an e-mail today.

...De Jong's team observed 18 H5N1 cases, including that of a 4-year-old boy, who had severe diarrhea, followed by seizures, coma and encephalitis, before he died. H5N1 virus was isolated from his cerebrospinal fluid, de Jong and colleagues wrote in a study published in the New England Medical Journal, Feb. 17, 2005.

The boy's nine-year-old sister died from a similar syndrome two weeks earlier before samples were taken. Neither patient had respiratory symptoms when their illnesses were first observed. The cases suggest that the spectrum of H5N1 avian flu is wider than previously thought, the study said.