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  • Bird flu mistaken as dengue, typhoid in Indonesia

    <TABLE cellSpacing=0 cellPadding=0 width="100&#37;" border=0><TBODY><TR><TD class=padlrt8 colSpan=2>Bird flu mistaken as dengue, typhoid in Indonesia <!-- headline one : end -->

    </TD></TR><TR><TD class="georgia11 padcell8" colSpan=2><!-- more than 7 paragraphs --><!-- story content : start -->KUALA LUMPUR - SOME cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.
    Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 per cent in other places, the figure is highest, or at 81 per cent, in Indonesia.
    Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnoses and the late administration of drugs were partially responsible for the high mortality rates.
    'It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms),' Mr Giriputro said.
    Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Mr Giriputro's figures.
    Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Mr Giriputro said fatalities mounted the later the drug was administered.
    <!-- show media links starting at 7th para -->The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.
    'It's best if given less than 24 or 36 hours after the onset of symptoms,' he said.
    While rapid test kits are now used to diagnose the disease in animals, Mr Giriputro said these tools were much less reliable in people.
    'It depends on the viral load (in samples taken from patients),' he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken.
    In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centres in areas where H5N1 cases have occurred.
    'When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results),' Mr Giriputro said.
    While H5N1 remains essentially a disease among birds, experts have warned for years now that it could trigger a pandemic, killing millions of people, if it ever manages to become easily transmitted among humans. -- REUTERS

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  • #2
    Re: Bird flu mistaken as dengue, typhoid in Indonesia

    post below is duplicate of reuters story above

    http://nz.news.yahoo.com//080620/9/68y5.html


    Friday June 20, 09:10 PM
    Bird flu 'misdiagnosed in Indonesia'

    Some cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.
    Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 per cent in other places, the figure is highest, at 81 per cent, in Indonesia.
    Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnosis and the late administration of drugs were partially responsible for the high mortality rates.
    "It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms)," Giriputro said.
    Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Giriputro's figures.
    Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Giriputro said fatalities mounted the later the drug was administered.
    The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.
    "It's best if given less than 24 or 36 hours after the onset of symptoms," he told Reuters later.
    While rapid test kits are now used to diagnose the disease in animals, Giriputro said these tools were much less reliable in people.
    "It depends on the viral load (in samples taken from patients)," he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken.
    In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centres in areas where H5N1 cases have occurred.
    "When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results)," Giriputro said.
    While H5N1 remains essentially a disease among birds, experts have warned for years now that it could trigger a pandemic, killing millions of people, if it ever manages to become easily transmitted among humans.

    Comment


    • #3
      Re: Bird flu mistaken as dengue, typhoid in Indonesia

      See also several recent posts and some discussion on the subject of diagnosing H5N1, Dengue and Typhoid in Indonesia in this thread, starting from post # 339 :


      http://www.flutrackers.com/forum/sho...=63842&page=12
      Last edited by sharon sanders; June 20, 2008, 06:26 AM. Reason: changed link. I re-split that thread.

      Comment


      • #4
        Re: Bird flu mistaken as dengue, typhoid in Indonesia

        Originally posted by Dutchy View Post
        See also several recent posts and some discussion on the subject of diagnosing H5N1, Dengue and Typhoid in Indonesia in this thread, starting from post # 339 :

        http://www.flutrackers.com/forum/sho...=63842&page=12
        It is worth noting that the story on mis-diagnosis was put out by Reuters, as the wire services start to understand the real deal in Indonesia.
        Last edited by sharon sanders; June 20, 2008, 06:27 AM. Reason: fixed link in quote

        Comment


        • #5
          from http://www.flutrackers.com/forum/sho...=63842&page=12


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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164698"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> H5N1 can present as pneumonia, denque, upper respiratory illnesses, and typhoid in Indonesia.





          Update on Avian Influenza A (H5N1) Virus Infection in Humans
          <!-- AUTHOR_DISPLAY --> Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus




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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164700"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by Florida1
          H5N1 can present as pneumonia, denque, upper respiratory illnesses, and typhoid in Indonesia.





          Update on Avian Influenza A (H5N1) Virus Infection in Humans

          <!-- AUTHOR_DISPLAY -->Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus

          http://www.flutrackers.com/forum/showthread.php?t=51845

          </td> </tr> </tbody></table>
          Yes. But in Indonesia more than 80% of the case's presentation were influenza-like illness, pneumonia and severe influenza. It is not impossible to accept the reality of co-morbidity in some of recent cases. Don't restrict your view, people!
          In fact Indonesian live amidst endemic Dengue Fever (and Dengue Haemorrhagic Fever), Malaria, Tubercolosis, severe malnoutrition conditions, viral hepatitis, infectious gastroenteric diseases... Nothing new, since the early cases of bird flu in humans presented with GI symptoms, septic shock with hemorrhages.
          Again, nothing precludes to co-morbid presentation of human birdflu infections.
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          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> From WHO's Avian Influenza FAQ page
          http://www.who.int/csr/disease/avian...dex.html#drugs

          - snip-
          What are the most important warning signals that a pandemic is about to start?

          The most important warning signal comes when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to-human transmission is occurring.

          Studies of viruses, conducted by specialized WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.

          Question: Given this newly evolving culture of obfuscation, how is the Pandemic Alert Level even remotely meaningful anymore?
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          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by ironorehopper
          From Alertnet newswire, post #330:

          ''Indonesian authorities were still trying to confirm a suspect 111th bird flu death, he added. (...)''

          Another confirmation is anticipated.

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          Probably the 54F, who was lab confirmed locally.
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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164710"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by Farmer
          From WHO's Avian Influenza FAQ page
          http://www.who.int/csr/disease/avian...dex.html#drugs

          - snip-
          What are the most important warning signals that a pandemic is about to start?

          The most important warning signal comes when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to-human transmission is occurring.

          Studies of viruses, conducted by specialized WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.

          Question: Given this newly evolving culture of obfuscation, how is the Pandemic Alert Level even remotely meaningful anymore?

          </td> </tr> </tbody></table>
          When the UN regulations were revised, WHO was given more power to investigate diseases like avian influenza (which could cross international borders). They were allowed to send and receive e-mails from apprpriate contacts to investigate suspected outbreaks.

          WHO has control over situation updates, which list confirmed cases. The two clusters in March were in the same WHO update. If the fatal "lung inflammation" of a relative was mentioned in associated with the one confirmed case, and fatal dengue fever was listed for the brother of the second confirmed case, and fatal typhus was listed with the confirmed case in the latest update, it would be quite clear to most of the casual observers who look at situation updates that there was some highly suspect activity happening in Indonesia.

          The deaths of the relatives are not at issue, although the cause of death is.

          WHO needs to start sending shots across the bow, or they will know less and less, as countries try to hide more and more.
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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164711"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Commonground, I agree completely with your analysis (post 339). Dengue and typhus are difficult to diagnose by lab methods and we see almost nothing on what tests they are using to make these diagnoses. Trying to sort out the cause of acute febrile illness by clinical symptoms is problematic due to overlap of symptoms and 'political correctness'.

          WHO, Promed and other official sources seem too ready to accept implausible causes of these infections. I think it's important that we try and keep track of these clusters which seem to be logically linked to confirmed H5N1 cases.

          Some recent news reporting out of Indonesia and other places seems encouraging in that they are addressing these problems of trying to be more discriminatory in making a proper diagnosis. (What person in what country would not want their disease properly diagnosed so that it could be properly treated?)

          It would also be useful to have more information on confirmatory tests of cases of mild disease for which tamiflu appears to be useful. We are losing a lot of valuable information here is we can't do the basics of linking together what type of medical treatment is working for what specific disease. And in the case of H5N1 what type of treatment is working relative to changes in the sequence data.
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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164718"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by ironorehopper
          Yes. But in Indonesia more than 80% of the case's presentation were influenza-like illness, pneumonia and severe influenza. It is not impossible to accept the reality of co-morbidity in some of recent cases. Don't restrict your view, people!
          In fact Indonesian live amidst endemic Dengue Fever (and Dengue Haemorrhagic Fever), Malaria, Tubercolosis, severe malnoutrition conditions, viral hepatitis, infectious gastroenteric diseases... Nothing new, since the early cases of bird flu in humans presented with GI symptoms, septic shock with hemorrhages.
          Again, nothing precludes to co-morbid presentation of human birdflu infections.

          </td> </tr> </tbody></table>

          Thanks IOH. I agree, co-infection is highly likely in many cases. This data simply points out the diagnosis at the onset of illness.

          This is why complete visibility is essential. Many of these diseases are endemic in Indonesia.

          International Organizations have a difficult mission as they are "invited" into member countries.......or not.
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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164732"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by kent nickell
          Commonground, I agree completely with your analysis (post 339). Dengue and typhus are difficult to diagnose by lab methods and we see almost nothing on what tests they are using to make these diagnoses. Trying to sort out the cause of acute febrile illness by clinical symptoms is problematic due to overlap of symptoms and 'political correctness'.

          WHO, Promed and other official sources seem too ready to accept implausible causes of these infections. I think it's important that we try and keep track of these clusters which seem to be logically linked to confirmed H5N1 cases.

          Some recent news reporting out of Indonesia and other places seems encouraging in that they are addressing these problems of trying to be more discriminatory in making a proper diagnosis. (What person in what country would not want their disease properly diagnosed so that it could be properly treated?)

          It would also be useful to have more information on confirmatory tests of cases of mild disease for which tamiflu appears to be useful. We are losing a lot of valuable information here is we can't do the basics of linking together what type of medical treatment is working for what specific disease. And in the case of H5N1 what type of treatment is working relative to changes in the sequence data.

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          I think much of the diagnosis is based on what is most common. I don't think that either dengue ot typhoid diagnosis are based on any specific lab tests, which is why the positive H5N1 in a family member is the appropriate guide for diagnosing other family members with identical symtoms, especially since all of these index cases are fatal (if the patient survived, antibody tests could be run, but these highly suspect diagnosis are for FATAL cases).

          These clusters really are not that complex and don't require highly unlikely co-infections, expecially when there are no specific lab tests to support dengue fever, typhus, or "lung inflammation".
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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164733"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Quote:
          <table border="0" cellpadding="6" cellspacing="0" width="100%"> <tbody><tr> <td class="alt2" style="border: 1px inset ;"> Originally Posted by kent nickell
          Commonground, I agree completely with your analysis (post 339). Dengue and typhus are difficult to diagnose by lab methods and we see almost nothing on what tests they are using to make these diagnoses. Trying to sort out the cause of acute febrile illness by clinical symptoms is problematic due to overlap of symptoms and 'political correctness'.

          WHO, Promed and other official sources seem too ready to accept implausible causes of these infections. I think it's important that we try and keep track of these clusters which seem to be logically linked to confirmed H5N1 cases.

          Some recent news reporting out of Indonesia and other places seems encouraging in that they are addressing these problems of trying to be more discriminatory in making a proper diagnosis. (What person in what country would not want their disease properly diagnosed so that it could be properly treated?)

          It would also be useful to have more information on confirmatory tests of cases of mild disease for which tamiflu appears to be useful. We are losing a lot of valuable information here is we can't do the basics of linking together what type of medical treatment is working for what specific disease. And in the case of H5N1 what type of treatment is working relative to changes in the sequence data.

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          Dengue fever is a relatively common problem in Indonesia and periodically reaches epidemic proportions in Jakarta and other parts of Indonesia, usually every 4-5 years. Rarely fatal in fit adults, the patient is often left debilitated and requires considerable time for convalescence. Dengue Fever is most common during the rainy season (November - May) as the mosquito requires clean standing water to reproduce.
          Dengue occurs due to infection by a flavivirus which is transmitted by the bite of the Aedes mosquito. (Unlike malaria, this disease occurs in greater Jakarta - urban dengue occurs in nearly all tropical countries).
          SYMPTOMS

          Certainly in the first stages of illness, dengue fever is difficult if not impossible to clinically distinguish from the many other possible causes of similar symptoms and signs.
          IN ADULTS:
          Following the deposit of the dengue virus in the skin by the bite, there is a an incubation period of 2 - 14 (usually 4 - 8) days.
          Thereafter onset of symptoms is usually abrupt, coinciding with viremia (the virus multiplying in the bloodstream) with chills, headache, backache, weakness, pain behind the eyes, flushing of the face, muscle and joint pain, and lassitude. The joint and back pains can be very bad indeed; hence the older name 'breakbone fever'.
          The temperature rapidly rises, often to 40&#176;C (104&#176;F), and there is a low heart rate (compared to the degree of, and other causes of, high fever). The blood pressure is often low also. A transient rash which blanches under pressure may be seen during the first 24 hours of fever.
          During the 2<sup>nd</sup> to 6<sup>th</sup> day of fever, nausea and even vomiting may occur, and the patient may develop one or more of the following; skin hypersensitivity, generalized swelling of regional lymph nodes, swelling of the palms, changes in taste sensation, loss of appetite, constipation, anxiety and depression.
          Within 2 to 4 days a temporary improvement can occur with a sudden drop in temperature and subjective improvement - for 24 hours until there is a second rapid temperature rise. A generalized morbilliform (“measles-like”) rash appears a characteristic rash on the trunk, limbs, palms and soles especially. (This second febrile phase does not invariably occur). This rash usually disappears in 1-5 days, the skin in these areas turns bright red and may peel. The temperature should fall back to normal and the infectious episode is effectively over.
          Epistaxis (“nose bleeds”), petechiae (“red skin spots”) and purpuric skin lesions (“purple skin spots / bruises”) can occur at any stage of the disease, varying with age, sex, and type of dengue virus. Bleeding from the gastrointestinal tract, and excessive vaginal bleeding if menstruating can also occur, but do not usually occur in the majority of cases.
          IN CHILDREN:
          A fever occurs in nearly all dengue infections in children; the other most common symptoms are a red throat, a (usually mild) runny nose, cough, and mild gastrointestinal symptoms which of course may present similar to pharyngitis, influenza, and upper respiratory infections.
          The presentation of dengue in the younger child is much less characteristic than in the older child and adult as above.
          CONFIRMING THE DIAGNOSIS

          There are no immediately useful tests for dengue fever which are unequivocally accurate. However the laboratory can be used to aid confirmation of a clinically suspicious case:
          • The white cell count is often low unlike in bacterial causes of fever.
          • The dengue blot test can give both false positive and false negative results, especially in the first week of the disease.
          • The diagnosis will in a large proportion of cases be based on clinical presentation and a characteristic
            drop of platelets in the blood (platelets are often low - normal is 150,000 - 400,000).
          Definite confirmation of the diagnosis of dengue infection can be made by sophisticated tests, but the results are not available for two weeks or more after the onset of the illness (because two separate blood samples need to be tested (by the same lab) for dengue antibody levels, the first as soon as possible after the onset of the illness, the second 10-14 days later).
          Convalescence can take weeks, and bed rest and antipyretics and analgesics are required. An attack produces immunity for a year or more, but only to the one of the four flavivirus strains responsible for the intial illness.
          DENGUE HAEMORRHAGIC FEVER / DENGUE SHOCK SYNDROME

          A rare complication of dengue fever, dengue haemorrhagic fever, can occur, most often in small children and elderly adults. This can sometimes be a serious illness. If DHF / DSS occurs it will usually do so by day 3-5 of the fever.
          IN CHILDREN
          In children, the progression of disease is not always characteristic. A relatively mild first phase with an abrupt onset of fever, malaise, vomiting, headache anorexia and cough is succeeded 2-5 days later by weakness and, sometimes, physical collapse. Frequently, spots appear on the forehead, arms and legs, along with spontaneous bruises and bleeding from punctures where blood was taken. The more ill child may breathe rapidly and often effortfully; the pulse may be weak, rapid, and thready. Almost always patients have a positive “tourniquet test” (where a tourniquet i.e. a blood pressure cuff is applied and the skin demonstrates petechiae and / or bruising).
          The WHO criteria for DHF are a platelet count of less than 100,000 and a haematocrit 20% greater then normal. Such children need to be hospitalized and watched for potential DSS. Such shock can be a mortal illness and requires rapid and careful in-hospital management with assiduous correction and replacement of fluid, electrolytes, plasma and sometimes fresh blood / platelet transfusions. The most useful laboratory test in suspected DHF is estimation of thrombocytes (platelets) which will be very low. In contrast to uncomplicated dengue fever the white cell count is more often high. Mortality ranges from 5 - 30% (in untreated native populations) and the highest risk is to infants under 1 year.
          TREATMENT

          There is no specific treatment for the infectious cause - the dengue virus - in either dengue fever or DHF / DSS. The symptoms can and should be treated, and in the rare cases of DSS, treatment for shock as well as a low platelet count is both essential and available - including fresh blood and / or platelet transfusion -but there is no medicine or vaccine anywhere available that can act specifically against the virus.
          It has been suggested that DHF is more likely if the patient has previously had an attack of dengue within the last calendar year (generally within the last 8-12 months), and that the occurrence of DHF relates to this previous "sensitization". Previous exposure may raise the incidence of subsequent DHF, presumably (as experiments have shown) by the antibody elicited in response to the first infection, being capable of enhancing the infection due to the virus found in the second episode.
          Uncontrolled bleeding distinguishes this from uncomplicated dengue fever. Bleeding can occur from the gums, nose, intestine, or under the skin as bruises or spots of blood especially under a tourniquet - this test should be employed if there is any suspicion. The liver is often enlarged.


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          </td> </tr> </tbody></table> <!-- / user info --> </td> </tr> <tr> <td class="alt1" id="td_post_164741"> <!-- message, attachments, sig --> <!-- icon and title --> Re: Indonesia Human Cases - April 9, 2008+
          <hr style="color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> Thanks Henry, these problems can make it especially difficult to pull out the mild cases of H5N1. Typhus appear to be in the same category of difficulty to make an accurate lab diagnosis. Also a lot of patients therefore just get empiric treatment which now likely includes tamiflu. Would be interesting to know how well tamiflu use is tied to any sort of lab diagnosis of H5N1.

          Typhus refers to a group of infectious diseases that are caused by rickettsial organisms and that result in an acute febrile illness. Arthropod vectors transmit the etiologic agents to humans.


          Typhus

          Typhus refers to a group of infectious diseases that are caused by rickettsial organisms and result in an acute febrile illness. Arthropod vectors transmit the etiologic agents to humans. The principle diseases of this group are epidemic or louse-borne typhus and its recrudescent form known as Brill-Zinser disease, murine typhus, and scrub typhus.

          Epidemic typhus occurs in Central and South America, Africa, northern China, and certain regions of the Himalayas. Outbreaks may occur when conditions arise that favor the propagation and transmission of lice. Brill-Zinsser disease may occur in approximately 15% of people with a history of primary epidemic typhus.

          Murine typhus occurs in most parts of the world, particularly in subtropical and temperate coastal regions. It occurs mainly in sporadic cases, and incidence is probably greatly underestimated in the more endemic regions. Rats, mice, and cats, which are hosts for the disease, are particularly common along coastal port regions. Temperate climates may have a rise in the flea vector and a subsequent rise in the incidence of murine typhus in the summer months. Prior infection with R typhi provides immunity to subsequent reinfection.

          Scrub typhus occurs in the western Pacific region, northern Australia, and the Indian subcontinent. Incidence of scrub typhus is largely unknown. Many cases are undiagnosed because of its nonspecific manifestations and the lack of laboratory diagnostic testing in endemic areas. However, a report of incidence of scrub typhus in Malaysia was approximately 3% per month, and multiple infections in the same individual may occur because of a lack of cross-immunity among the various strains of Orientia tsutsugamushi.

          Epidemic typhus has the most severe clinical presentation of the typhus group of rickettsial infections. In severe disease, gangrene may occur and lead to loss of digits, limbs, or other appendages. The vasculitic process may also lead to CNS dysfunction, ranging from dullness of mentation to coma, multiorgan system failure, and death. The mortality rate in untreated persons may be as low as 20% in healthy individuals and as high as 60% in elderly or debilitated persons.

          Since the advent of widely available antibiotic treatment, mortality rates have fallen to approximately 3-4%. The mortality rate for treated patients with murine typhus is 1-4% and less than 1% for scrub typhus.

          Laboratory studies are not particularly helpful in confirming a diagnosis of typhus. These studies assist the clinician in assessing the degree of severity of the illness and in helping exclude other diseases in the differential diagnosis.



          The American Journal of Tropical Medicine and Hygiene, established in 1921, is published monthly by the American Society of Tropical Medicine and Hygiene. It is among the top-ranked tropical medicine journals in the world publishing original scientific articles and the latest science covering new research with an emphasis on population, clinical and laboratory science and the application of technology in the fields of tropical medicine, parasitology, immunology, infectious diseases, epidemiology, basic and molecular biology, virology and international medicine.


          Seroepidemiologic Evidence for Murine and Scrub Typhus in Malang, Indonesia

          Indonesian military personnel stationed in Malang, East Java were among troops deployed to central Cambodia as part of the United Nations' Transition Authority Cambodia peace-keeping operation in 1992. Predeployment blood samples obtained from a cohort of Indonesian soldiers indicated a high prevalence of antibodies to antigens of Rickettsia typhi or Orientia (formerly Rickettsia) tsutsugamushi, the etiologic agents for murine and scrub typhus, respectively.
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          • #6
            Re: Bird flu mistaken as dengue, typhoid in Indonesia

            Commentary at

            Comment


            • #7
              Re: Bird flu mistaken as dengue, typhoid in Indonesia

              Originally posted by niman View Post
              It is worth noting that the story on mis-diagnosis was put out by Reuters, as the wire services start to understand the real deal in Indonesia.
              Could not agree more, it is worth noting and it is a good thing to have this information together.

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              • #8
                Re: Bird flu mistaken as dengue, typhoid in Indonesia

                Commentary

                Comment


                • #9
                  Re: Bird flu mistaken as dengue, typhoid in Indonesia

                  Link to article quoted in Niman's commentary above:

                  Comment


                  • #10
                    Re: Bird flu mistaken as dengue, typhoid in Indonesia

                    Thank you everyone for participating in this discussion. Thank you to Reuters and CIDRAP for further illuminating the disease status issue in Indonesia.

                    What we are doing here at FT is exploring the data. In the absence of fully documented epidemiological surveys and studies, we are looking at other data, namely: symptoms, onset dates, illness progression, test results, local environmental conditions, family disease status, exposure opportunities, etc.

                    We are not declaring any stage in the WHO pandemic stages chart. FT will never do that. It is not up to us to decide what the pandemic level is. WHO and several countries have differing stage level charts. We can better spend our effort finding, posting, developing, analyzing, discussing, and disseminating ideas.

                    This is what we do best. We present the facts, opinions, and ideas.

                    Viewers can decide for themselves.

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                    • #11
                      Re: Bird flu mistaken as dengue, typhoid in Indonesia

                      WHO Commission By Omission On H5N1 H2H In Indonesia
                      Recombinomics Commentary 18:06
                      June 20, 2008

                      Heymann told Reuters the WHO encourages all governments to provide information freely to their populations, but it is their decision.

                      Today's WHO statement, citing information from the Indonesian health ministry, said the 16-year-old girl was from South Jakarta and fell ill on May 7; she was hospitalized May 12 and died 2 days later. There was evidence that she had been exposed to sick and dead poultry, the agency said.

                      A WHO official who requested anonymity told CIDRAP News this week that the agency had been aware of recent H5N1 cases in Indonesia despite the delay in receiving official notification.

                      Speaking before the latest case confirmations, the official said, "The fact that you don't yet have official notification of any cases doesn't mean there isn't unofficial awareness." He said the two recent cases didn't change WHO experts' assessment of the risk posed by the virus.

                      If the cases had signaled more of a threat, the information would have been handled differently, he suggested. "If we were dealing with something much more serious, I think there would be a very, very different approach by all involved in getting the information. If you had a cluster of something behaving in an unusual fashion, the pressure to share it would be very high."

                      The above official and unofficial comments from WHO are curious. Officially, WHO is saying that information on human H5N1 cases in Indonesia should be shared, and WHO routinely publishes situation updates shortly after confirmation of human H5N1 cases. However, unofficially, WHO had knowledge of the above May case long before receiving notification from Indonesia, which was withheld in violation of IHR regulations which require notification of human cases within 24 hours.

                      The withholding of the information from the situation update is somewhat understandable because the confirmation of the case was not official. However, when WHO did publish the update, the exposure to sick and dead poultry was mentioned, but the exposure to the brother of the confirmed case was not. He had died 10 days prior to the death of the confirmed case, strongly suggesting that he infected the confirmed case. Although the brother was misdiagnosed with typhus, neither the typhus diagnosis nor his death was included in the update. Similarly, the hospitalization of another brother after the death of the confirmed case was also not mentioned. The second brother tested negative for H5N1, but false negatives are common in Indonesia, especially for samples collected after the start of Tamiflu treatment. Such treatment is common for contacts of confirmed cases.

                      Thus, this cluster had at least three family members, and the death of the first brother strongly suggests that he was H5N1 infected and infected his sister, who may have then infected her other brother, based on disease onset dates. WHO consultants are well aware of the frequent misdiagnosis of H5N1 cases in Indonesia. Such misdiagnosis in patients who were subsequently H5N1 confirmed were tabulated in a New England Journal publication from the beginning of this year.

                      On condition of anonymity, the WHO official above noted that this cluster was not behaving in an unusual manner. This comment is supported by additional clusters in March, which also included an H5N1 confirmed case linked to a fatally infected family member who was diagnosed as having lung inflammation or dengue fever. However, although such clusters are common in Indonesia, these clusters do not appear in WHO situation updates, or in WHO comments on new cases. As noted above, the WHO update implies the confirmed May case was from poultry exposures, instead of the dead brother who had a disease onset date consistent with human to human (H2H) transmission to his sister.

                      Although the H2H transmissions in Indonesia are not unusual, most of the general public who accept official denials or WHO omissions at face value would be surprised at the level. Moreover, the reliance on tests of samples collected after Tamiflu treatment for diagnosis leads to significant under-reporting of cases and clusters.

                      Thus, although WHO officially supports transparency on human H5N1 infections, its situation updates are glaring examples of commission by omission of significant data supporting frequent H2H transmissions in Indonesia.


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                      • #12
                        Re: Bird flu mistaken as dengue, typhoid in Indonesia

                        Community Health Centres need the Addition of Medical Specialists

                        Several doctors did not yet get complete information about the bird flu illness. "Ultimately, they did not know signs of the illness.

                        Must be increased by the specialist doctor in the Community Health Centre," Chairman's words of Ikatan Doctor Indonesia (IDI) the Medan Branch Dr. M. Nur Rasyid Lubis, SpB-FInaCS to the reporter, on Wednesday (18/6), responded to the number of doctors who did not know the sign of bird flu.

                        According to Rasyid, the sign of bird flu of the beginning really resembled the sign of common flu.Because of not yet getting information about the deadly illness, the big possibility of the doctor only diagnosed him as common flu.

                        Therefore, the socialisation of bird flu must continue to was done in a continuous manner especially for the medical circle and the public's community.

                        The socialisation responsibility must not be to the government but all the sides.

                        He said, at this time the Community Health Centre still the lack of the specialist doctor's power so as the handling of various illnesses including bird flu was apparently slow.

                        Because of this, IDI took the strategic policy by making the survey of the community about important not him the specialist doctor in the Community Health Centre.

                        If precentage the community more often wanted the existence of the specialist doctor, then IDI will make the recommendation letter to Pemko Medan place the specialist doctor in every Public Health Center.

                        "At least during 2009 this program operating maximal," he said while added must have four internal disease specialist doctors, midwifery, the operation and the child's specialist.

                        JAKARTA, Waspada.co.id - Presiden RI Prabowo Subianto, yakin dalam waktu dekat kemampuan akademis anak-anak Indonesia akan meningkat berkat program Makan


                        credits Commonground

                        Comment


                        • #13
                          Re: Bird flu mistaken as dengue, typhoid in Indonesia

                          See also here :

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