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  • #16
    Re: Sudden deaths and influenza

    Coroner: Old Mill Student Died of Respiratory Infection

    The Marin County Coroner’s Office said Friday that an Old Mill School kindergartner who died March 4 succumbed to an acute respiratory infection.

    But a series of tests that were conducted in the weeks following the 5-year-old boy’s death did not determine conclusively if the cause was Influenza A (H1N1), for which the boy had tested positive, or another virus.

    According to Sheriff’s Lt. Keith Boyd, the Coroner’s Office conducted a forensic examination, toxicology, histology and culture studies, as well as a review of the circumstances surrounding the death of the boy.

    Marin County Public Health Officer Jason Eberhart-Phillips said the tests were able to rule out a bacterial infection in the boy’s death, but not the exact viral cause. Influenza A (H1N1), widely known as swine flu, and cardiac hypertrophy, which is a thickening of the heart that results in a decrease in size of the chamber of the heart, were also listed as “significant conditions” in the boy’s death by natural causes.

    “We know from experience that the flu can kill and the H1N1 has and continues to cause death in a number of very unfortunate cases,” Eberhart-Phillips said. “But apparently there weren’t willing to ascribe the death exclusively to H1N1. What can commonly happen when someone is infected with flu is that they are infected with something else at the same time and the double whammy can result in an even more serious infection.”

    “He either died of Influenza A (H1N1) or he may have had another virus,” he continued. “It may have been that another virus was taking the opportunity to infect him at the same time he was infected with the flu.”

    The boy’s parents informed Old Mill officials on the night of March 3 that he was experiencing flu-like symptoms and would be kept at home the next day, according to the Sheriff's Office. Mill Valley Police and Mill Valley Fire personnel were called to the family’s home at around 8:30 a.m. the next morning, and the boy was rushed to Marin General Hospital.

    The boy died at 9:45 a.m. at Marin General after testing positive for influenza, sending shockwaves throughout the Mill Valley School District community.

    http://millvalley.patch.com/articles...tory-infection

    Comment


    • #17
      Re: Sudden deaths and influenza

      "I STILL can't believe he's gone." Those are the words of a young Bristol mother whose son died of swine flu.

      Stephanie Wiltshire's world was shattered when she found 16-month old Kevin dead in his cot just nine days before Christmas.

      His young life had been cut short by a combination of acute bronchitis and swine flu.

      "It shocked me and I still can't believe he's no longer here especially as I'd checked on him in his cot a few hours earlier,
      " she said.

      "He hadn't shown any signs of swine flu but after the post mortem examination I was told he had acute bronchitis and swine flu,
      " said Stephanie, of Bishport Avenue, Hartcliffe.

      She has another son, George, five, and now the Bridge Learning Campus Primary School where he is a pupil have presented a cheque to Stephanie to go towards research into the virus.

      "He was my wonderful little boy and George's best friend," said Stephanie, who has set up a memorial website for Kevin.

      She added: "Kevin is the most special little boy I have known, so smart and funny and sadly was taken from us in the night.

      "I don't know what form of swine flu it was but I've given the doctors permission to use some of Kevin's organs for research," she added.

      A medical report records Kevin's death as a "sudden death of a toddler with acute bronchitis. Virus A HINI contributed to the bronchitis."

      http://www.thisisbristol.co.uk/news/...l/article.html

      Comment


      • #18
        Re: Sudden deaths and influenza

        Emerging infectious diseases

        Pandemic (H1N1) 2009–associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance


        The emergence of pandemic (H1N1) 2009 influenza illustrated the need for improved surveillance to identify deaths resulting from emerging pathogens. Common methods for identifying infectious cause–related deaths include reports by health care providers and review of death certificates. These methods have limitations for identifying deaths caused by emerging pathogens because the disease may not be fully defined or death certificates may not indicate an infectious cause. During an emerging pathogen epidemic, it is important to investigate deaths occurring outside of traditional settings to determine if sudden deaths occurring in the community are a result of the novel pathogen.

        In 1995, the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP) Unexplained Deaths Program (UNEX) began in 4 states (1). Under UNEX, deaths likely resulting from an infection, but for which routine testing did not identify a pathogen, are investigated. State and CDC Infectious Diseases Pathology Branch researchers partner with medical examiners and hospital pathologists to review cases and autopsy reports. Expanded resources for specimen testing are provided, which increases the likelihood of a pathogen-specific diagnosis.

        ...



        During the spread of pandemic (H1N1) 2009, UNEX cases were reported to the Minnesota and Oregon health departments by physicians, infection preventionists, and hospital pathologists (Figure 1). Both states also conducted statewide surveillance by using Med-X. New Mexico detected cases through the New Mexico Office of the Medical Investigator and its Med-X system. Medical examiners investigated all decedents for influenza-like illness (ILI) based on pre- or postmortem findings as well as sudden deaths in previously healthy persons <50 years of age. Each state expanded its EIP Influenza Surveillance statewide during the pandemic (H1N1) 2009 pandemic. In addition, hospitalized persons with ILI, including decedents, were reported to the state health department by physicians, infection preventionists, and hospital pathologists.

        ...


        A total of 194 pandemic (H1N1) 2009–associated deaths were detected in this analysis, 160 (82%) through hospital surveillance and 34 (18%) through UNEX/Med-X. The additional surveillance resulted in the detection of 21% more total cases than hospital surveillance alone. Minnesota had the highest proportion of UNEX/Med-X–detected cases with 24% (16/50); Oregon had the lowest with 11% (8/68) (Table 1). Decedents detected by using UNEX/Med-X were more frequently of a nonwhite race (48% vs. 22%); an increased percentage of deaths of American Indians/Alaska Natives was detected through UNEX/Med-X versus hospital surveillance (21% vs. 4%).

        ...

        UNEX/Med-X decedents were more likely to have had an autopsy performed (85% vs. 17%) and were more likely to have died in their residences (53% vs. 8%) than decedents detected by hospital surveillance. The median age of UNEX/Med-X decedents was 37.5 years, compared with 51.0 years for hospital surveillance decedents (p<0.001) (Table 1). The proportion of UNEX/Med-X decedents among age groups decreased with increasing age (62% among those 0–4 years of age compared with 2.6% among those >65 years of age; Figure 2).

        More hospital surveillance than UNEX/Med-X decedents (89% vs. 68%) were determined to have >1 underlying condition. Specific underlying conditions were more frequently identified among hospital surveillance than UNEX/Med-X decedents, except for obesity (Table 2). Pneumonia, including viral pneumonia, was frequently reported among decedents. Acute respiratory distress syndrome was documented for 37% of hospital and 15% of UNEX/Med-X decedents. Two previously healthy children with nasopharyngeal swabs positive for influenza had evidence at autopsy of viral myocarditis.

        UNEX/Med-X surveillance captured 11%–24% of pandemic (H1N1) 2009–associated deaths in the 3 states. Other estimates of deaths resulting from pandemic (H1N1) 2009 may be increased with better data on nonhospitalized and sudden unexplained deaths (7,8). Estimates from surveillance in New York, New York, which included medical examiner and unexplained respiratory cause–related death surveillance, indicate 17% of decedents died at home and 6% had not sought any prior medical care

        ...

        Even with an emphasis on deaths among those <50 years of age, UNEX and Med-X programs are critical for detecting severe illnesses that rapidly progress to death and could otherwise go undetected. Partnering with medical examiners and pathologists to identify infectious cause–related deaths among persons who were previously healthy is important to give a clear picture of the entire mortality spectrum.

        Although it is important to accurately measure the impact of a disease, it is perhaps more important to quickly identify new serious disease threats. Approximately one tenth to one quarter of the influenza deaths detected in this study, and particularly those in younger, healthier persons, were not detected by hospital surveillance when influenza awareness was at its peak. This finding argues for surveillance systems like UNEX and Med-X as a means of quickly detecting emerging, severe infectious disease threats. Because pathogens are likely to emerge over broad geographic areas, we recommend a standardized approach to death investigations to fully understand the epidemiologic and clinical features of illness caused by a particular pathogen.

        http://www.cdc.gov/eid/content/17/8/101914.htm

        Comment


        • #19
          Re: Sudden deaths and influenza

          THE parents of a man who died from swine flu just hours after complaining of a sore throat and headache are hoping to organise an annual football tournament in his memory.
          Kind-hearted Garry Irvine, who lived with his parents Ian, 73, and Mary, 75, in Mayfield, Midlothian, was rushed to hospital after collapsing at home in January, but could not be saved.

          The 49-year-old's sudden death sent shockwaves through the local community as he had apparently been in good health almost to the day he died.

          Ian and Mary - a retired home help, who said Garry had "never been ill" prior to his death - had a shield made in their son's memory and had hoped local teams Arniston Rangers, of which Garry was a big fan, and Newtongrange Star would play a match to win it.

          ...

          Garry went to bed one afternoon in January because he wasn't feeling well. The next morning, after collapsing while being attended to by the doctor, he was rushed to the Royal Infirmary, where he was put on a life-support machine.

          However, there was nothing doctors could do and the machine was switched off that night.


          http://edinburghnews.scotsman.com/ed...for.6818967.jp

          Comment


          • #20
            Re: Sudden deaths and influenza

            Aborted sudden cardiac sudden death associated with influenza A(H1N1) infection

            Theofilos M. Kolettis, Associate Professor in Cardiology
            Anna P. Kotsia, Eleni Sourla, Theofilos M. Kolettis, John A. Goudevenos

            University of Ioannina, Greece

            Since the 2009 pandemic, the novel influenza A(H1N1) viral infection has been associated with a substantial mortality worldwide. The main cause of death has been acute respiratory distress syndrome, mostly in cases with severe concomitant underlying disease or in immunocompromised patients (1). We read with great interest the article by Komai et al (2), describing a case of fatal fulminant myocarditis associated with influenza A (H1N1) infection in an immunocompetent 51-year-old male patient. We would like to share our recent experience with influenza A (H1N1)-related myocarditis in a young man, presenting with out-of-hospital cardiac arrest. A previously healthy 27-year-old male had cardiac arrest at his home. The patient had a 2-day history of malaise, cough and fever for 2 days prior to clinical presentation. Basic cardiopulmonary resuscitation was initiated promptly and ventricular fibrillation was recorded by the emergency medical services after approximately 10 minutes. He was successfully defibrillated, intubated and mechanically ventilated. On admission, he was hemodynamically stable and ECG showed sinus tachycardia, without signs of ischemia/infarction. Laboratory data showed WBC of 13000/?L with 85% of neutrophil, creatine phosphokinase of 6600U/L and troponin I of 1.53 ng/mL. Transthoracic echocardiography revealed moderately reduced left ventricular function with diffuse hypokinesis and ejection fraction of 40%. No complications were noted and he was extubated 24 hours after admission. Chest X-ray was normal and coronary angiography revealed normal coronary arteries. Nasopharyngeal smear samples were positive for influenza A(H1N1) virus. Treatment included ?-blockade, ACE inhibitor, low molecular weight heparin and oseltamivir. During hospital stay, serial echocardiography showed gradual improvement of left ventricular function, which normalized 3 weeks after admission. He was discharged on day 21st in good medical condition, without neurological sequelae. While viral myocarditis is a well recognized complication of seasonal influenza A infection (3), limited information exists with respect to myocardial involvement and presentation in cases with influenza A(H1N1) infection. We report a case of aborted sudden cardiac death due to ventricular fibrillation, caused by myocarditis associated with influenza A(H1N1) infection. In addition to the case reported by Komai et al (2), two additional cases similar to ours have been reported, namely one resuscitated cardiac arrest(4) and a case of sudden cardiac death in a 18- year-old female (5). We conclude that ventricular fibrillation secondary to myocarditis is a rare but devastating complication of influenza A(H1N1) infection in otherwise healthy individuals. More epidemiological data are awaited.

            http://eurheartj.oxfordjournals.org/...32/3/283/reply

            Comment


            • #21
              Re: Sudden deaths and influenza

              Sudden death of an immunocompetent young adult caused by novel (swine origin) influenza A/H1N1-associated myocarditis

              Virchows Arch. 2011 Mar;458(3):371-6. Epub 2011 Jan 14.
              Sudden death of an immunocompetent young adult caused by novel (swine origin) influenza A/H1N1-associated myocarditis.
              Gdynia G, Schnitzler P, Brunner E, Kandolf R, Bläker H, Daum E, Schnabel P, Schirmacher P, Roth W.
              Source

              Institute of Pathology, University Hospital, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany.
              Abstract

              The main cause of death from novel (swine origin) influenza A/H1N1 infection is acute respiratory distress syndrome. Most fatal cases are immunocompromised patients or patients with a severe underlying disease. Here, we report a fatal case of acute interstitial myocarditis associated with novel influenza A/H1N1 infection in an immunocompetent young woman. A previously healthy 18-year-old woman experienced malaise, diarrhea, and fever for several days prior to a sudden collapse at home. Autopsy revealed a predominantly lymphocytic myocarditis in the absence of a significant respiratory tract infection. Infection with novel (swine origin) influenza A/H1N1 was confirmed by PCR analysis of blood as well as myocardial tissue. Influenza-caused diarrhea with consecutive hypokalemia potentially contributed to the fatal outcome of the myocarditis, characterized by ventricular fibrillation. In conclusion, sudden death by myocarditis may be a rare complication of novel influenza A/H1N1 infection in otherwise healthy individuals, even in the absence of significant respiratory tract infection.

              PMID:
              21234762
              [PubMed - indexed for MEDLINE]

              http://www.ncbi.nlm.nih.gov/pubmed/21234762

              Comment


              • #22
                Re: Sudden deaths and influenza

                Four-year-old girl who died as she slept had swine flu


                A distraught mother has told an inquest how she battled to save her daughter's life after she caught swine flu.

                Prabhleen Sarao gave four-year-old Gian mouth-to-mouth resuscitation after family members found her unconscious in bed.

                The youngster was taken by ambulance to Leicester Royal Infirmary, but doctors were unable to revive her and she died about half-an-hour later.

                Mrs Sarao, of Mowmacre Hill, Leicester, told the inquest at Leicester Town Hall: "She would not wake up, so we carried her downstairs and put her on the sofa. I knew instantly something was wrong. I was so shocked.

                "I got instructions over the phone from the ambulance service and tried giving her mouth-to-mouth, but I don't know if I did it correctly because I was panicking so much."

                The inquest heard Gian and other family members had been suffering from "fever-like symptoms" in the week before her death on December 5 last year.

                Mrs Sarao told the court her daughter had seemed to be getting better.

                On the day of Gian's death, Mrs Sarao said the youngster had been "playing and jumping up and down on the bed" with one of her aunts.

                Mrs Sarao put her daughter to bed at about midday, but when an aunt went to wake her up at about 4pm, she was unconscious and her lips and the tips of her fingers had turned blue.

                Pathologist Dr Roger Malcomson told the hearing that Gian died from a lung infection caused by the swine flu virus.

                He said this particular strain had been going around Leicester last winter and he recalled another child also catching the virus.

                Dr Malcomson said Gian's death could not have been predicted because the symptoms of swine flu – a high temperature, coughing and tiredness – were similar to normal flu.

                Coroner Catherine Mason recorded a verdict of death by natural causes


                http://www.thisisleicestershire.co.u...ail/story.html

                Comment


                • #23
                  Re: Sudden deaths and influenza

                  With the last increase to 4 the cases of sudden death in young healthy people in the United Kingdom.

                  Here 's list:

                  12/05/2010 child 4 years old from Leicester
                  12//06/2010 young man 24 years old in Wales
                  12/16/2010 child 16 months old at Bristol
                  01 / ?/2011 49 year old man in Scotland

                  These are 4 deaths in a single season in only one country.
                  How many similar deaths may be considered to have escaped the surveillance in the UK , in other European countries and in the world?

                  Comment


                  • #24
                    Re: Sudden deaths and influenza

                    Asthma contributed to Bath schoolboy's swine flu death



                    A schoolboy died of swine flu because of his underlying asthma just five days before Christmas, an inquest heard yesterday.

                    Ryan Hoe, 12, suffered a heart attack and died from the H1N1 strain of the disease after it struck his weak lungs.

                    Avon Coroner's Court heard Ryan had been fit and well but suffered mild asthma before he entered Royal United Hospital in Bath in December last year.

                    But Ryan, of Bathampton, suffered cardiac arrest and died at 3.30pm later that day. Deputy assistant Coroner Terrence Moore delivered a verdict of natural causes.

                    http://www.thisissomerset.co.uk/Asth...ail/story.html

                    Comment


                    • #25
                      Re: Sudden deaths and influenza

                      Raise to 5 the cases of sudden death in young healthy people affected from swine flu in the United Kingdom.

                      Here 's list:

                      12/05/2010 child 4 years old from Leicester
                      12//06/2010 young man 24 years old in Wales
                      12/16/2010 child 16 months old at Bristol
                      12/20/2010 boy 12 years old in Bathampton
                      01 / ?/2011 49 year old man in Scotland

                      Comment


                      • #26
                        Re: Sudden deaths and influenza

                        Northam parents to sue over Andrew Allen's hospital death

                        December 18, 2010


                        THE parents of a schoolboy who died hours after being sent home from hospital with Panadol plan to sue after a damning report found a doctor was only metres away, but was never called by an inexperienced nurse to treat their son.

                        ...

                        Andrew was taken to Northam Hospital on September 16 with a temperature of 40C. He was barely able to breathe or walk, his skin was mottled and he was sweating profusely.

                        Despite his condition, RN-A sent him home with junior-strength Panadol and a pamphlet on gastroenteritis.

                        Mrs Allan found her son dead in his bed early the next morning.

                        ..

                        An autopsy report shows he had swine flu and staphylococcal pneumonia
                        .



                        http://www.heraldsun.com.au/news/nat...-1225973342202

                        Comment


                        • #27
                          Re: Sudden deaths and influenza

                          In the italian forum I collected cases of children who died suddenly after a few hours or days of illness with gastrointestinal symptoms, as the australian boy who died in 2010.

                          In 2011 I counted 17 children, aged from 6 months to 7 years , in which an investigation was opened.
                          The causes of these as of others sudden deaths may be many, but what impressed me is the large number.

                          In the list there are also cases of 2010 and 2009 (including a child died with H1N1 flu)


                          The link to the thread:

                          http://www.flutrackers.com/forum/sho...d.php?t=176002

                          Comment


                          • #28
                            Re: Sudden deaths and influenza

                            Scand J Infect Dis. 2011 Nov 10.
                            Fulminant myopericarditis in an immunocompetent adult due to pandemic 2009 (H1N1) influenza A virus infection.
                            Davoudi AR, Maleki AR, Beykmohammadi AR, Tayebi A.
                            Source

                            Department of Infectious Disease, Mazandaran University of Medical Sciences, North Iranian Research Centre for Infectious Disease , Sari.
                            Abstract

                            Abstract Acute myopericarditis is a well-recognized but rare complication of numerous viral infections. Here we report a case of fulminant myopericarditis presenting with acute heart failure and a state of shock in a previously healthy young woman. H1N1 influenza A virus sequences were identified in throat and pericardial fluid, suggesting a viral source of the infection.

                            PMID:
                            22074554
                            [PubMed - as supplied by publisher]

                            http://www.ncbi.nlm.nih.gov/pubmed/22074554

                            Comment


                            • #29
                              Re: Sudden deaths and influenza

                              Mike Coston wrote a good piece on gastrointestinal bird flu infections

                              http://afludiary.blogspot.com/2011/1...ection-in.html

                              Gastric symptoms, including diarrhea and vomiting, afflicts about one in five people with swine flu.
                              I wonder if the virus through the intestinal epithelium can go directly into the bloodstream and cause e.g. phenomenon of thrombosis or strokes that are the cause of sudden deaths

                              Comment


                              • #30
                                Re: Sudden deaths and influenza

                                From Emerging Infectious Diseases
                                Deaths Associated With Pandemic (H1N1) 2009 Among Children, Japan, 2009-2010

                                Akihisa Okumura, MD, PhD; Satoshi Nakagawa, MD, PhD; Hisashi Kawashima, MD, PhD; Takashi Muguruma, MD, PhD; Osamu Saito, MD; Jun-ichi Fujimoto, MD; Chiaki Toida, MD; Shuji Kuga, MD; Toshihiro Imamura, MD; Toshiaki Shimizu, MD, PhD; Naomi Kondo, MD, PhD; Tsuneo Morishima, MD, PhD

                                ...
                                As of March 31, 2010, the Ministry of Health, Labour, and Welfare (MHLW) reported on its website (http://www.mhlw.go.jp/kinkyu/kenkou/...za/houdou.html) that 198 patients in Japan with pandemic (H1N1) 2009 had died, of whom 41 were children <20 years of age.

                                ..

                                For 34 (83&#37 children, a life-threatening event occurred within 2 days after influenza onset (Figure 2). Twenty-nine (71%) children died within 4 days after influenza onset (Figure 2)

                                ..

                                Cause of death was categorized as unexpected cardiopulmonary arrest (CPA) for 15 patients, encephalopathy for 15, respiratory failure for 6, myocarditis for 2, viral sepsis for 2, and incidental for 1. Median age of patients who died of unexpected CPA was 43 months. Only 1 of these patients had a preexisting condition. For 13 patients, unexpected CPA occurred outside the hospital; most patients were presumed to have been found several hours after CPA. Two patients experienced unexpected CPA in the hospital, 1 in the outpatient clinic and 1 during hospitalization. Chest radiographs and CT scans of the head and chest were unremarkable for all children examined.

                                ..

                                Encephalopathy was considered the cause of death for 15 patients (median age 62 months)

                                ...

                                Six patients were judged to have died of respiratory failure

                                ..

                                Two patients died of myocarditis; both were ≥12 years of age and previously healthy. One had unexpected circulatory collapse in a local pediatric clinic; the other was found lying on the floor at home without preceding respiratory or neurologic symptoms. At admission, both patients had markedly elevated creatine kinase (>9,000 IU/L) and markedly reduced cardiac output on cardiac ultrasonography; chest radiographs were unremarkable. In the clinic patient, intensive resuscitation, including intra-aortic balloon pumping and continuous hemodiafiltration, was performed but was ineffective.

                                ...


                                Most life-threatening events occurred on the day of or 1 day after influenza onset.
                                ..


                                Alanine transaminase and creatine kinase levels were significantly higher in patients with unexpected CPA than in those with respiratory failure.

                                ...

                                Discussion


                                Most cases were in young, previously healthy children who died after a brief fulminant illness.Unexpected CPA and acute encephalopathy were the leading causes of death. Children who died of respiratory failure often had preexisting conditions, whereas unexpected CPA occurred among younger children without preexisting conditions.

                                ..

                                Unexpected CPA was another leading cause of death associated with pandemic (H1N1) 2009 among children in Japan. Most cases of unexpected CPA occurred in previously healthy children <5 years of age. The elevated alanine transaminase and creatine kinase levels in these children could be attributable to postmortem changes. The direct cause of unexpected CPA is difficult to determine. One possible explanation is severe brain damage resulting in CPA; however, none of the patients in our study had obvious neurologic signs or symptoms until CPA, nor did they have any evidence of brain herniation. Abrupt onset of CPA suggests a cardiogenic origin such as fatal arrhythmia from undetected myocarditis.[29,30] Myocarditis associated with pandemic (H1N1) 2009 has been reported.[31,32] Gdynia et al. reported an unexpected death of a young adult caused by pandemic (H1N1) 2009–associated myocarditis.[31] The clinical course in this patient was characterized by sudden collapse at home followed by fatal arrhythmia. Viral sepsis may also be related to unexpected CPA. Clinical signs of viral sepsis are nonspecific and may be missed. Considering that most cases of unexpected CPA occurred outside the hospital, rapid progression of viral sepsis may have occurred. Unexpected CPA has also been reported in some case series.[5–7,24,33] Cardiac arrest outside the hospital was observed for 67 of 270 children who died in the United States.[24] In a report from England, 16 of 70 children who died were in CPA when seen in an emergency department.[7] Detailed postmortem examinations are necessary to clarify the mechanism of unexpected CPA.

                                http://wwwnc.cdc.gov/eid/article/17/11/pdfs/11-0649.pdf

                                Comment

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