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Re: Tracking World Wide Virulence of Swine Flu
Swine flu victim's muscles 'melted'
Adam Cresswell, Health editor | October 23, 2009
Article from: The Australian
AUSTRALIAN medical experts have warned doctors worldwide to be on the alert for a rare but alarming complication of swine flu after a teenage boy suffered "muscle melting" so severe his urine turned almost black.
The unnamed 16-year-old suffered fever and other flu symptoms for three days before his urine went dark and intense pain meant he could no longer stand or move his arms and legs.
He was admitted to Melbourne's Monash Medical Centre, where tests showed he was suffering a condition called rhabdomyolysis -- a condition caused when muscles are damaged and dissolve, flooding the bloodstream with their by-products.
Shortly after admission one blood test for creatine kinase -- an enzyme produced when muscles break down -- returned a reading of 164,149 international units per litre (IU/L), more than 700 times above a normal reading of less than 230 IU/L.
He was given antiviral drugs, morphine and large amounts of fluids, but his creatine kinase levels continued to soar and after four days in hospital peaked at 1,127,000 IU/L, before gradually declining.
He recovered and was discharged after eight days, and a follow-up two weeks later showed no lasting muscle weakness or significant other ill-effects.
The incident happened at the height of the swine flu outbreak in June, but has just been revealed in a paper published by five of the hospital's doctors in the Pediatric Infectious Disease Journal.
Rhabdomyolysis can be caused by factors including crush injuries, muscle overuse and alcohol abuse, but it can also be triggered by various infections including, rarely, seasonal flu. But this is the first time it has been noted in a swine flu patient.
The boy knew swine flu was circulating at his school, and he tested positive for the disease after his admission to hospital.
Jim Buttery, who was the boy's treating consultant and is senior author of the journal article, said doctors performed tests to make sure the muscle breakdown was not adversely affecting his heart.
Instead, the tests showed the damage was mostly confined to the boy's arms and legs. "His main complaint was pain -- he had a huge amount of muscle breakdown according to his biochemistry tests," said Dr Buttery, a pediatric infectious diseases physician at the Monash Children's Hospital and the Murdoch Childrens Research Institute.
"He had the highest creatine kinase I have ever seen in over 20 years of practice -- over 1 million.
"It's a tribute to how young people cope with significant disease. In older people that (degree of muscle breakdown) is associated with causing kidney failure, but he sailed through it."
Dr Buttery said the boy's pain was so severe it was unlikely he would have been able to remain at home, but had he attempted to do so he would have been at high risk of kidney damage.
"We believe that one of the reasons he stayed away from kidney trouble was that we flooded him with fluids to flush the muscle proteins out," he said.
"It took us a bit by surprise -- it's a rare complication of normal influenza that you don't see very often."
The journal article says rhabdomyolysis "should be considered" in any patient with flu-like symptoms who also has severe muscle weakness or pain, and warns doctors to expect "severe clinical manifestations of infection with this novel influenza virus in the coming respiratory virus season".
"We would expect to see further cases like this rarely, but we would still expect them to occur, either with swine flu or the normal flu," Dr Buttery said.
Swine flu victim's muscles 'melted'
Adam Cresswell, Health editor | October 23, 2009
Article from: The Australian
AUSTRALIAN medical experts have warned doctors worldwide to be on the alert for a rare but alarming complication of swine flu after a teenage boy suffered "muscle melting" so severe his urine turned almost black.
The unnamed 16-year-old suffered fever and other flu symptoms for three days before his urine went dark and intense pain meant he could no longer stand or move his arms and legs.
He was admitted to Melbourne's Monash Medical Centre, where tests showed he was suffering a condition called rhabdomyolysis -- a condition caused when muscles are damaged and dissolve, flooding the bloodstream with their by-products.
Shortly after admission one blood test for creatine kinase -- an enzyme produced when muscles break down -- returned a reading of 164,149 international units per litre (IU/L), more than 700 times above a normal reading of less than 230 IU/L.
He was given antiviral drugs, morphine and large amounts of fluids, but his creatine kinase levels continued to soar and after four days in hospital peaked at 1,127,000 IU/L, before gradually declining.
He recovered and was discharged after eight days, and a follow-up two weeks later showed no lasting muscle weakness or significant other ill-effects.
The incident happened at the height of the swine flu outbreak in June, but has just been revealed in a paper published by five of the hospital's doctors in the Pediatric Infectious Disease Journal.
Rhabdomyolysis can be caused by factors including crush injuries, muscle overuse and alcohol abuse, but it can also be triggered by various infections including, rarely, seasonal flu. But this is the first time it has been noted in a swine flu patient.
The boy knew swine flu was circulating at his school, and he tested positive for the disease after his admission to hospital.
Jim Buttery, who was the boy's treating consultant and is senior author of the journal article, said doctors performed tests to make sure the muscle breakdown was not adversely affecting his heart.
Instead, the tests showed the damage was mostly confined to the boy's arms and legs. "His main complaint was pain -- he had a huge amount of muscle breakdown according to his biochemistry tests," said Dr Buttery, a pediatric infectious diseases physician at the Monash Children's Hospital and the Murdoch Childrens Research Institute.
"He had the highest creatine kinase I have ever seen in over 20 years of practice -- over 1 million.
"It's a tribute to how young people cope with significant disease. In older people that (degree of muscle breakdown) is associated with causing kidney failure, but he sailed through it."
Dr Buttery said the boy's pain was so severe it was unlikely he would have been able to remain at home, but had he attempted to do so he would have been at high risk of kidney damage.
"We believe that one of the reasons he stayed away from kidney trouble was that we flooded him with fluids to flush the muscle proteins out," he said.
"It took us a bit by surprise -- it's a rare complication of normal influenza that you don't see very often."
The journal article says rhabdomyolysis "should be considered" in any patient with flu-like symptoms who also has severe muscle weakness or pain, and warns doctors to expect "severe clinical manifestations of infection with this novel influenza virus in the coming respiratory virus season".
"We would expect to see further cases like this rarely, but we would still expect them to occur, either with swine flu or the normal flu," Dr Buttery said.
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