New York autopsies show 2009 H1N1 influenza virus damages entire airway (like 1918, 1957)

In fatal cases of 2009 H1N1 influenza, the virus can damage cells throughout the respiratory airway, much like the viruses that caused the 1918 and 1957 influenza pandemics, report researchers from the National Institutes of Health (NIH) and the New York City Office of Chief Medical Examiner. The scientists reviewed autopsy reports, hospital records and other clinical data from 34 people who died of 2009 H1N1 influenza infection between May 15 and July 9, 2009. All but two of the deaths occurred in New York City. A microscopic examination of tissues throughout the airways revealed that the virus caused damage primarily to the upper airway—the trachea and bronchial tubes—but tissue damage in the lower airway, including deep in the lungs, was present as well. Evidence of secondary bacterial infection was seen in more than half of the victims.

The team was led by James R. Gill, M.D., of the New York City Office of Chief Medical Examiner and New York University School of Medicine, and Jeffery K. Taubenberger, M.D., Ph.D., of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. The findings are reported in the Archives of Pathology & Laboratory Medicine, now available online and scheduled to appear in the February 2010 print issue.

"This study provides clinicians with a clear and detailed picture of the disease caused by 2009 H1N1 influenza virus that will help inform patient management," says NIAID Director Anthony S. Fauci, M.D. "In fatal cases of 2009 H1N1 influenza, it appears the novel pandemic influenza virus produces pulmonary damage that looks very much like that seen in earlier influenza pandemics."

The new report also underscores the impact 2009 H1N1 influenza is having on younger people. While most deaths from seasonal influenza occur in adults over 65 years old, deaths from 2009 H1N1 influenza occur predominately among younger people. The majority of deaths (62 percent) in the 34 cases studied were among those 25 to 49 years old; two infants were also among the fatal cases.

Ninety-one percent of those autopsied had underlying medical conditions, such as heart disease or respiratory disease, including asthma, before becoming ill with 2009 H1N1 influenza. Seventy-two percent of the adults and adolescents who died were obese. This finding agrees with earlier reports, based on hospital records, linking obesity with an increased risk of death from 2009 H1N1 influenza.

The researchers examined tissue samples from the 34 deceased individuals to assess how 2009 H1N1 influenza virus damaged various parts of the respiratory system. "We saw a spectrum of damage to tissue in both the upper and lower respiratory tracts," says Dr. Taubenberger. In all cases, the uppermost regions of the respiratory tract—the trachea and bronchial tubes—were inflamed, with severe damage in some cases. In 18 cases, evidence of damage lower down in the finer branches of the bronchial tubes, or bronchioles, was noted. In 25 cases, the researchers found damage to the small globular air sacs, or alveoli, of the lungs.

"This pattern of pathology in the airway tissues is similar to that reported in autopsy findings of victims of both the 1918 and 1957 influenza pandemics," notes Dr. Taubenberger.

The researchers also examined 33 of the 34 cases for evidence of pulmonary bacterial infections. Of these cases, 18 (55 percent) were positive for such infections. Not all of those individuals who had bacterial pneumonia along with 2009 H1N1 virus infection had been hospitalized, however, indicating that some had acquired their bacterial infections outside of a health-care setting. This raises the possibility, say the authors, that community-acquired bacterial pneumonia is playing a role in the current pandemic. "Even in an era of widespread and early antibiotic use," write the authors, "bacterial pneumonia remains an important factor for severe or fatal influenza."

Computerized tomography (CT) lung images were available in four cases of pulmonary bacterial infection. In all four cases, the CT scans showed an abnormality known as ground-glass opacity, which are patches of rounded haze not seen in normal lung images. It is not known, say the researchers, whether the abnormalities detected by CT in the four cases also occur in people who have milder H1N1 infections. They call for additional investigation into the utility of CT scans as a tool to help clinicians identify and better treat severe H1N1 infections.

Visit www.flu.gov for one-stop access to U.S. government information on avian and pandemic influenza. Also, visit NIAID's flu Web portal at http://www3.niaid.nih.gov/topics/Flu/.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov .

The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Reference: JR Gill et al. Pulmonary pathological findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Archives of Pathology & Laboratory Medicine. Published online Dec. 7, 2009. {Note: Full text of the paper is available at www.archivesofpathology.org}

Accuracy of rapid H1N1 flu tests questioned

Video at link

Updated at 03:24 PM today

UNDATED — (12/01/09) — Some doctors are using rapid tests to check children for H1N1 flu. Sometimes, those tests don’t tell the whole story - with dangerous consequences.

Medical tests are supposed to help people, but this rapid flu test may have hurt nine-year-old Hayli Murphy.

Julie Murphy, Hayli Murphy’s mother: She was right there. She was on death’s door.

Back in September, Hayli first started showing signs of the flu, so her mother, Julie Murphy, took her to the emergency room.

Reporter: When you brought Hayli into the emergency room the first time, they did a test and they told you she doesn’t have the flu.

Julie Murphy: She’s fine. She doesn’t have the flu. She’s got a virus, high fevers. Take her home.

But at home, Hayli’s temperature climbed to 104 degrees. The next day, her mother took her back to the E-R, where again, the rapid test said she did not have the flu.

Reporter: You expect when a test says negative, that it’s negative.

Julie Murphy: That it’s negative, yeah

Reporter: Well, what did you find out?

Julie Murphy: I found out different.

The next day, Hayli was so sick her mother had to carry her into the emergency room. Hayli spent the next six weeks in intensive care, where doctors used a different, more reliable test. As it turns out, Hayli did have H1N1.

The test that was used on Hayli Murphy twice missed her flu. It’s relatively inexpensive and it’s wrong a lot.

Reporter: When these tests say you don’t have the flu, how often are they wrong?

Dr. Rhonda Medows, Georgia Dep’t. of Community Health: Anywhere from 90 to 30 percent of the time.

Dr. Medows warns doctors in her state not to use rapid flu tests because they’re wrong so often. “I’m telling them they don’t really need them. They need to focus more on their clinical exam. I don’t see the value.”

We contacted three big makers of rapid flu tests used in the United States. One gave us a statement.

The company BD said, “As with other rapid tests, doctors should be aware that a negative result does not fully exclude the possibility that the patient has influenza. Following a negative rapid test, physicians have the option to proceed to more advanced tests.”

Dr Roberto Monge was one of the first doctors who treated Hayli in Fort Myers, Florida.

Reporter: Twice Hayli received this rapid flu test and twice it was wrong.”

Dr. Monge: This test is not as good as we would like it to be.

Reporter: Do you think in Hayli’s case this test might have misled the doctors?

Dr. Monge: No, I don’t think so. This was handled very well.

Monge says doctors did not rely only on the rapid test, but also on a physical exam and their best judgment. All of which led them to believe she did not have H1N1.

Reporter: If you had listened to those tests.

Julie Murphy: Hayli would have been dead within the next 24 hours.

http://abclocal.go.com/wjrt/story?section=news/health&id=7147447

The below comment can be found on page 2 under the comments section of the below link

http://www.startribune.com/lifestyle/health/virus/78612267.html?elr=KArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUsZ

Sensitivity to the H1N1 patients and family is welcome
My son, age 26, a construction worker, with no underlying health conditions was also sticken with ARDS. My son was tested three times for H1N1 before the test finally returned positive. Recovering from what was diagnosed as a viral infection, my son suddenly experienced chest pains, shortness of breath and excessive coughing. Within eight hours of these symptoms, he was hospitalized. His entire left lung was white. The disease rapidly progressed to the right lung. He was airlifted to the St. Cloud hospital and put on a respirator which he remained on for four weeks. During this time he experienced kidney failure which required daily dialysis treatments. He had a collapsed lung and other organ inflammation. He was also a candidate for Permivir, which we saw results within two days. He was in the St. Cloud Hospital for five weeks, four weeks in ICU. He is home recovering but will not be able to return to work for at least the next three months. His lungs are heavily scarred, he lost 30 pounds and continues to experience chest pain and shortness of breath.
For those that do not believe this disease is this serious, they can assist us in paying the approximate $3 million in medical bills. It is really disheartening that people are so insensitive to these issues and doubt what is written. I always thought it would never happen to us, it always happened to someone else. Those five weeks in the hospital when my son was given less than 30% chance of surviving this illness was the worse time of my life. Try putting yourself in that position and see how you feel!

here another article about false negative H1N1 tests

WA:

Many people who test negative may be sick with swine flu

Tuesday, Oct. 27, 2009
By Michelle Dupler, Herald staff writer
http://www.tri-cityherald.com/kennewick_pasco_richland/story/768496.html#

Tri-City health officials say people sick with flu symptoms most likely have swine flu — even if they tested negative for flu.

Dr. Larry Jecha, health officer for the Benton-Franklin Health District, said about 40 percent of people who have flulike symptoms but who test negative for flu using the Influenza A rapid test actually have the H1N1 virus, known as swine flu.

“That’s why we’re encouraging diagnosis with symptoms because it’s more accurate,” Jecha said Monday.

Flu tests require people being tested to have a certain amount of virus in their bodies, so the test won’t detect flu in the first few hours after symptoms appear or after a person has been sick for more than a day.

“We only have a 24-hour window where they are going to be positive,” Jecha said.

That’s why health officials have emphasized that people with flulike symptoms need treatment rather than testing.

this healthy kid died from H1N1 and his dad is a medical doctor .

http://www.timesunion.com/ASPStories/Story.asp?StoryID=865653&LinkFrom=RSS&TextPage=1

NY:

Learning from Trevor’s death in H1N1 fight

Monitor flu-like symptoms, breathing trouble, father of Clifton Park boy warns

By TIM O’BRIEN, Staff writer
First published in print: Saturday, November 14, 2009

CLIFTON PARK — The devastated father of a 7-year-old boy whose death is suspected to be from the H1N1 virus cautioned parents that if their children have flu-like symptoms and trouble breathing, it is a dangerous combination that should be carefully monitored.

this thread below has many many stories of healthy people who are dead from h1n1

Also we’ve been posting ongoing swineflu articles here

http://www.freerepublic.com/focus/f-news/2278371/posts

(((Freeper ET(end tyranny) wrote the below comment to me on another thread . Her sister inlaw was very healthy until she got H1N1 . We have been praying for freeper ET(end tyranny) sister in law who is still in the ICU from the swine flu .)))

That sounds almost exactly like my sister in-law’s case. Her lungs showed almost completely white. (both of them) and when asked about survival, early on, the docs wouldn’t say. She was gray, with no color. They had a tube going into a neck artery that when right to the heart for monitoring. She still gets fed through a tube.

She exercises her legs on her own. She can’t walk at all at this point. I think she is hoping to lessen the time in rehab when they finally let her our of ICU.

She looks at the newspaper ads and keeps pointing to the diet coke. It’s going to be a long time before she gets that, and if those kidneys don’t shape up, who knows.

She writes on the table that we all should get the H1N1 shot.

One day standing in line at the check out, some guy was telling the cashier that he thought the H1N1 was all hype. I told him if he had a relative in ICU with it, he might think differently. When I told him about her case, the blood drained from his face.

I really think some people think its over hyped, but, I think its because the media hasn’t really been reporting on the hospitalizations and deaths. I think that is because of the vaccine shortages. Can you imagine the chaos if people realized that saint obama wasn’t delivering on the needed vaccines?

7,984 posted on Monday, December 07, 2009 1:32:10 PM by ET(end tyranny)

The people who do die from H1N1 their lungs get attacked and the lungs look like the victims who died from the H5N1 avian bird flu .

Swine flu hitting young, healthy adults hardest (Canada)
http://www.theglobeandmail.com/news/national/swine-flu-hitting-young-healthy-adults-hardest/article1203826/

The young and healthy who feel invincible from the H1N1 “swine flu” influenza pandemic may not be as bulletproof as they think, warn public health experts.

Nearly two-thirds of Canadians hospitalized due to swine flu, and half of those who have died, had no underlying health conditions.

Experts do not yet understand why the new strain affects some healthy people so severely, ravaging their lungs with an aggressive pneumonia and forcing them to spend weeks in hospital, attached to breathing machines.-———————————————————————

Lungs of fatal swine flu patients badly damaged
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090903/h1n1_lungs_090903/20090903
Sep. 3 2009

The lungs of people who have died from swine flu look more like those of the victims of H5N1 avian influenza than those of people who succumb to regular flu, the chief of infectious diseases pathology at the U.S. Centers for Disease Control says.

Study of about 70 fatal H1N1 cases so far also reveals there may be more incidences of co-infections with bacteria than was earlier thought, Dr. Sherif Zaki told The Canadian Press in an interview.

The damage to lung tissue is consistent with that inflicted by ARDS or acute respiratory distress symptom, Zaki says, referring to an often-fatal, difficult-to-treat syndrome that can have a number of causes. The U.S. National Heart, Lung and Blood Institute estimates about 30 per cent of people who develop ARDS die.

“In terms of the disease, yes, it (H1N1) is remarkably different than seasonal flu,” Zaki says. “The pathology looks very similar to H5(N1).”

these below links are child deaths from H1N1

Here is another person’s tracking efforts:
http://www.flutrackers.com/forum/showthread.php?t=127174

Here is a list with photos/details, but it’s only a partial list:
http://www.singtomeohmuse.com/viewtopic.php?t=3755

Here are some links for anyone interested in the H1N1 swine flu

This is a thread on another forum PFI by Poster Homebody for US Child Deaths - August - October

Homebody does an amazing job with the thread ....

You need to first click on this link for the information & read the thread ...

http://www.singtomeohmuse.com/viewtopic.php?t=3649&start=0

In Memory Of...
These children deserve to have their stories told.

List of all US deaths: http://spreadsheets.google.com/ccc?key=rZIWyvI97h892s2bmCVlm6A&pli=1 (by Howmanydays)
List of all US pediatric deaths: http://www.singtomeohmuse.com/viewtopic.php?p=249344&highlight=#249344 (by Get A Grippe)
_____________________________________________________

A partial list of children who died in May and June: http://singtomeohmuse.com/viewtopic.php?p=255202#255202

Also there is another website

http://www.flucount.org/ that has Worldwide H1N1 (Swine Flu) Infection Data

These are other flu websites that track H1N1 cases , deaths , articles , etc...

pandemic flu information website:

http://www.singtomeohmuse.com/viewforum.php?f=1

Swine Flu.org. H1N1 Swine Flu Information & Discussion

http://www.swineflu.org/default.asp

Comprehensive Flu Thread, Latest reports, States, Countries, Closings.

http://www.timebomb2000.com/vb/showthread.php?t=330395&page=59

Flu Trackers

http://www.flutrackers.com/forum/index.php

Antibiotics should help with opportunistic bacterial infections but they're saying that hasn't been the case with these H1N1 deceased.

Pulmonary Pathologic Findings of Fatal 2009 Pandemic Influenza A/H1N1 Viral Infections(pdf)

Autopsy Evidence of Acute Bacterial Pneumonia and Detection of Bacteria

Autopsy evidence of acute pneumonia was seen in 19 of 34 cases (56%) and was necrotizing/extensive in 5 cases (15%). Thirty-three of 34 cases were examined for evidence of pulmonary bacterial infection by tissue Gram stain. Of these, 18 (55%) showed bacterial pneumonia, 16 being morphologically compatible with streptococci and 2 with staphylococci. Of the 30 cases evaluated by postmortem bacteriologic culture and immunohistochemistry, 10 (4 of whom had been hospitalized before death) had evidence of bacterial infection: 6 with Streptococcus pneumoniae, 2 with Streptococcus pyogenes, 1 with S pneumoniae and S pyogenes, and 1 with methicillin-resistant Staphylococcus aureus (Tables 2 and 3).21,22 Most of these bacterial-positive cases (15 of 18; 83%) also had histologic evidence of acute pneumonia, consistent with the high percentage of secondary bacterial pneumonia described in fatal cases from earlier pandemics.23–25 The remaining 3 had acute and organizing DAD with chronic inflammatory cells and bronchiolitis.

I counted 13 dead on arrival. When I hear opportunistic, I think of Pneumocystis Carinii. Staph and Strep are common, community acquired bacteria.

The cough and sore throat could be H1N1 . Some people only have 2 symptoms from the H1N1 flu. Also some people who get H1N1 don’t have a fever.

Can your doctor spot H1N1?
By Caleb Hellerman, CNN Medical News Senior Producer
November 20, 2009 1:26 p.m. EST

http://www.cnn.com/2009/HEALTH/11/20/h1n1.fever.doctor/

Comment: The article begins with the story of 5-year-old Danelle Olivares who died from H1N1 and “never even ran a fever.”

[SNIP]

The World Health Organization and U.S. Centers for Disease Control and Prevention each list fever as a defining feature of H1N1. But that’s being called into question, most recently in the medical journal the Lancet. This week, physicians in Queensland, Australia, wrote that 36 of the 106 patients admitted to Gold Coast Hospital with confirmed H1N1 infections actually had no fever.

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