Swine influenza (H1N1) and acute appendicitis

[tetano]

Heart Lung. 2010 Jul 14. [Epub ahead of print]
Swine influenza (H1N1) and acute appendicitis.

Cunha BA, Pherez FM, Durie N.

Infectious Disease Division, Winthrop-University Hospital, Mineola, New York; State University of New York School of Medicine, Stony Brook, New York.
Abstract

BACKGROUND: During the swine influenza (H1N1) pandemic that began in 2009, many hospitalized adults had gastrointestinal symptoms. The most common symptoms associated with swine influenza (H1N1) were nausea, vomiting, or diarrhea. In the experience of the authors, swine influenza was not complicated by abdominal pain. There are a wide variety of infectious and non-infectious disorders that may present with a pain in the right lower quadrant, mimicking appendicitis, ie, pseudoappendicitis. Influenza predisposes to some types of bacterial infection, eg, influenza pneumonia may be complicated by simultaneous Staphylococcus aureus community-acquired pneumonia or subsequent community-acquired pneumonia due to Haemophilus influenzae or Streptococcus pneumoniae. It remains unclear if there is direct involvement of the appendix, ie, pseudoappendicitis as occurs with measles or if influenza itself somehow predisposes to increased frequency/severity of bacterial appendicitis. German clinicians first noted an increased incidence of acute appendicitis in children/young adults with influenza. The American and British cases of influenza and acute appendicitis compared to age-matched controls with more severe and of delayed onset/complicated by appendicial perforation/abscess. These reports noted an increased incidence/severity of acute appendicitis during influenza. METHODS AND RESULTS: A 15-year-old girl presented to the hospital with an influenza-like illness and right lower quadrant abdominal pain. Acute appendicitis was diagnosed by a computed tomography scan and the patient underwent emergency appendectomy. Subsequently, it was noted that she did not have leukocytosis and, in fact, had borderline leukopenia. Her differential white blood cell count also revealed relative lymphopenia. Neither leukopenia nor relative lymphopenia are features of acute bacterial appendicitis. These two findings in the setting of an influenza-like illness indicate the underlying presence of influenza. Post-operatively, respiratory secretion samples were sent for swine influenza (H1N1) testing. Both her respiratory florescent antibody (FA viral panel) was positive for influenza A, as was her RT-PCR for swine influenza (H1N1). The authors believe that this is the first case of swine influenza (H1N1) and acute bacterial appendicitis. Direct involvement of the appendix by swine influenza (H1N1) virus could not be demonstrated. CONCLUSIONS: The authors conclude that during the swine influenza (H1N1) pandemic clinicians should be alert to the possibility of an increased incidence/severity of acute bacterial appendicitis in patients with swine influenza (H1N1) infection. Copyright ? 2010 Elsevier Inc. All rights reserved.

PMID: 20633930 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/20633930

 

[kiwibird]

Re: Swine influenza (H1N1) and acute appendicitis

From a news report May 2009 - Malaysia

Girls kill quack
appendicitis risk in general, children with fever caused by quack
黃敬軒與疼愛他的外公張觀瑞，歡愉的給記者拍照，稚子天真之情溢于言表。黄敬轩grandfa ther and loved his concept Rui Zhang, joy to the press to take photographs, children are innocent and love溢于言表.
（勞勿31日訊）盲腸炎當普通發燒，勞勿縣醫院的庸醫，去年險害死一名5歲小童！ (31 Raub hearing) appendicitis when ordinary fever, Raub quack County hospital last year, the risk of a 5-year-old child killed!

住在雙溪內的男童黃敬軒（5歲），今日通過其大舅婆鄭寶蓮，向記者申訴其不公平的遭遇。 Living in the Sungai黄敬轩boy (5 years), today大舅both through its郑宝莲, told reporters his complaint of unfair treatment. 他是女童賴美茵的幼兒園同班同學。 He is Lai girls kindergarten Mainz classmate.

現年45歲的鄭寶蓮是雙溪內村委會及馬華領袖。 45-year-old Sungai郑宝莲is within the village and the MCA leaders. 她說，在去年尾，其小姑黃香的外孫黃敬軒因發燒及肚子痛，而被小姑夫婦帶往勞勿縣醫院24小時服務的急救室 求診。 She said that the end of last year, the grandson of the sister-in-law Huang Xiang黄敬轩fever and stomach pain, sister-in-law and his wife were taken to the county hospital Raub 24-hour emergency room treatment.

醫生態度欠佳 Poor attitude of doctors

她說，院方醫生照了X光及驗血后，即安排小敬軒在兒童病樓住了4天。 She said that according to Dr. Fang Hospital X-ray and blood test after the arrangement of small敬轩Floor disease in children living in four days. 有關醫生指小敬軒只是發燒而已，沒有什么大礙，留院觀察數日即可出院。 Doctors refer to the relevant small敬轩more than just a fever, there is no cause illness in most people, a few days stay in hospital for observation can be discharged.

黃敬軒向記者展示盲腸爆裂動手術后的傷痕。 Showed reporters黄敬轩burst appendix scars after surgery.
鄭氏指出，鑑于小敬軒的大便奇臭，又帶有綠色，狀況與其一名阿姨過去盲腸發炎及爆裂的情況相似 。 Cheng pointed out that, in view of the stool奇臭small敬轩, but also with a green, a situation with their aunt and burst past the inflammation of the appendix is similar to. 于是，其小姑即向輪值醫生提及，不料有關醫生卻反唇相譏，反問其小姑是醫生還是對方是醫生？ Thus, their sister-in-law referred to the rotating doctors, but doctors Unexpectedly retorted his sister-in-law to ask a doctor or other doctors?

?由于院方醫生的態度欠佳，加上小敬軒的身體越來越虛弱，臉青唇白，家屬被迫要求院方允許出院，再攜帶小敬 軒前往吉隆坡一間專科醫院，尋求治療。? "Because of the attitude of the hospital doctors are poor, a growing body of small敬轩weak, green lip white faces, their families forced to seek hospital discharge permit, and then carry a small敬轩to a specialist hospital in Kuala Lumpur, to seek treatment . "

?結果，經過掃描及仔細檢驗，証實小敬軒的確是盲腸發炎及爆裂，馬上為他動手術。住了幾天，再轉入吉隆坡中 央醫院繼續醫治，足足住了整個月，花了一萬多令吉，才救回一條寶貴的生命。? "As a result, after carefully scanning and inspection, confirmed that indeed a small敬轩inflammation and burst appendix, an operation for him immediately. Few days, and then transferred to Kuala Lumpur General Hospital to continue treatment for a whole month to live a full, spent the more than 10,000 ringgit only saved precious lives. "

右腳疼痛遇庸醫中年控訴差點送命 Pain when his right foot against the middle-aged doctor almost killed

?庸醫害死女童?事件引起迴響，疑勞勿縣醫院駐診醫生疏忽，以致險些送命的2名受害者，今日向中國報記者? 現身說法?，申訴他們慘痛的經歷。 "Quack kill the girl" incident response, the suspect in the county hospital Raub doctor negligence, which almost killed the two victims, reported today to the Chinese journalists "from his own experience," the painful experience of their complaint.

來自雙溪內新村的首名受害者陳晉來（45歲）揭露，今年3月初某個早上8時，他因右腳疼痛，前往勞勿縣醫院 急診室求診，醫藥助理為他打止痛針及抽血檢驗后，說沒有什么事，給了3種藥，就打發他回家。 Within the Village from Sungai the first victims to Chen Jin (45 years) revealed that early in March this year, a 8:00 am, his right foot pain due to workers not to the county hospital emergency room treatment, medical assistant needle pain for him and After the blood test, saying nothing, to the three kinds of medicine, it sent him home.

陳氏今午在雙溪內一間茶室，巧遇正在用餐的記者時，針對目前已轟動全村的小美茵猝逝事件，向記者報爆料，講 述其個人的遭遇。 Chan this afternoon in a teahouse in Sungai, met reporters are dining for the whole village has been a sensation Mainz death of a small incident, claimed to reporters reported about their personal experiences.

他說，由于他在去年尾曾患上基孔肯雅症，因擔心會產生后遺症，翌日就前往吉隆坡一間專科醫院檢 驗。 He said that he had been suffering from the end of last year Chikungunya disease, worried that there may be a result of after-effects the next day on a specialist for Kuala Lumpur Hospital for medical examinations.

?結果，掃描到心臟已受細菌感染，有生命危險，馬上接受治療。並在病情穩定后，再轉入吉隆坡中央醫院醫治。 ? "As a result, the heart has been scanned to bacterial infection, life-threatening, immediate medical treatment. And in stable condition and then transferred to Kuala Lumpur Hospital for treatment."

從事汽車銷售業的陳氏指出，他在隆市中央醫院足足住了43天，才痊癒及獲準出院，整個人也因此消瘦14公斤 。 Engaged in automobile sales industry, Chen said that he City Central Hospital in Long lived a full 43 days before they recovered and discharged, the entire people became 14 kg weight loss.

他強調，如果他聽信勞勿縣醫院該名醫護人員的話，后果可能不堪設想，可能連小命都不保。 He stressed that if he do not listen to workers health care workers in the county hospital, the consequences may be disastrous, not even life insurance.

廖中萊：攸關人命不容許醫藥疏忽事件 Liao Lesotho: life and death events do not allow pharmaceutical negligence

（吉隆坡31日訊）衛生部長拿督斯里廖中萊強調，他不容許任何醫藥疏忽事件發生，因為這除了涉及醫德，也是 攸關人命的事件。 (Kuala Lumpur, 31 hearing) of Health Minister Datuk Seri Dr Levin stressed that he would not tolerate any negligence on the incident of Chinese medicine, which in addition to involving medical ethics, but also the events of life and death.

他說，他已多次在會議上指示衛生官員，必須確保醫院提升服務。 He said he has instructed at the meeting of health officials, must ensure that the hospital to upgrade their service.

他非常關注勞勿縣政府醫院醫生，被指疏忽治療一名6歲女童，結果導致女童離奇身亡的案件。 Raub, he is very concerned about the county government hospital doctors, accused of negligent treatment of a 6-year-old girl, resulting in bizarre death of the girl's case.

廖中萊今日為馬來西亞菜業聯合總會第18屆第1次全國代表大會開幕后，對記者這么說。 Liao Levin of food industry in Malaysia today for the 18th Association of the 1st after the opening of the National People's Congress, said to reporters.

他說，昨晚受到通知后，他已指示一支特別調查小組到勞勿調查，要他們盡快提呈解剖報告。 He said last night after being notified that he had directed a special investigation team to investigate Raub, presenting them to the autopsy report as soon as possible.

小組到勞勿調查 Investigation team to Raub

?等待解剖報告的同時，一支由諾萊妮巴巴（公共衛生局主任）領導的特別調查小組，已下到勞勿馬上 調查。? "At the same time waiting for the autopsy report, a妮巴巴by nolay (Director of the Bureau of Public Health), led special investigation team had not immediately next to the labor investigation."

勞勿一名6歲女童頭痛、腹痛和嘔吐，服用政府醫生開出的藥水后，病情非但沒好轉，反而離奇身亡 。 Raub, a 6-year-old girl headache, abdominal pain and vomiting, taking the government out of medicine doctors, the disease not only failed to improve, but a strange death.

其父母對愛女死亡深感痛心，更控訴政府醫院醫生草菅人命，在為女兒看診時沒深入檢查病情，只用手摸摸女兒額 頭，便開出共6瓶的3種藥水。 Their parents are deeply saddened by the death of beloved daughter, but also to sue the Government for hospital doctors reality, for the doctor to see her daughter-depth examination of the disease did not only touch her hand on his forehead, he opened a total of 6 bottles of three kinds of syrup.

醫生須引以為鑑 Doctors are required to learn a lesson from the

（勞勿31日訊）勞勿雙溪內幼兒園董事長房松民，對于該園6歲班學童賴美茵不幸猝逝，，聲聲惋 惜。 (31 Raub hearing) Sungai Raub song within the public kindergarten, chairman of the Housing for the Park 6-year-old children rely on the United States ban the unfortunate death of Yin, sound sorry.

他希望勞勿縣醫院的醫生及醫護人員，引以為鑑，提升服務素質，仔細為病人看診及開藥，以免類似 事件再發生。 He hoped that the county hospital Raub doctors and medical staff, learn a lesson from experience, improve service quality, and carefully attending to patients and drugs to prevent recurrence of similar incidents.

房松民也是勞勿國際獅子會前任會長。 Housing is also a song people Raub, former president of Lions Clubs International. 他今早到勞勿積善堂向小死者家屬致哀時，向記者發表談話。 This morning, he Jishan Raub Hall to a small family of the deceased to the mast when talking to reporters.

房氏對于此事件深表關注，除了到勞勿縣醫院太平間慰問死者雙親及聆聽剖驗報告，今早偕幼兒園的園長和老師前 來送殯。 Housing's deep concern for this incident, in addition to the county hospital mortuary Raub condolences to the deceased parents and to listen to post-mortem report, this morning kai and kindergarten teachers to come to the funeral director.

逾百親友送殯 Friends and relatives over funeral

報導：和觀娣攝影：劉觀發 Report: Di and the concept of photography: Liu concept made

雙溪內幼兒園老師及親友們，上香向死者致祭。 Sungai in kindergarten teachers and relatives and friends, and pay his respects to the deceased致祭.
不幸于昨日凌晨3時許猝逝的賴美茵，經過昨晚的佛教儀式誦經超渡后，今日上午10時從勞勿積善堂舉殯，送往 勞勿新兩廣義山安葬。 Unfortunately, shortly after 3 am yesterday Lai death of Mainz after the ceremony last night, chanting Buddhist pray after 10 o'clock today from the Church举殡Jishan Raub, Raub sent to the two broad new mountain burial.

...snip
Source: Chinapress.com.my

also noted in May 2009 in New Zealand
Very unusual discussion with GPs wife and friends last week. It seems there is a virus circulating in NZ that mimics appendicitis. I know of three people, including one child, who have had surgery for appendicitis and their appendix has been removed, although completely healthy. I assume the surgeons think that seeing they are in there they may as well remove it and eliminate the potential for appendicitis in the future. This has all been in the last couple of weeks.