Saturday, August 1, 2009

Swine flu's potency revealed in report

AAP August 2, 2009, 12:01 pm

The six were admitted to the intensive care wards of three hospitals across northwestern Melbourne just as the influenza A(H1N1) virus was becoming established in the country.

The list includes an 18-year-old pregnant woman who went into premature labour after vomiting for four days and then, after successfully giving birth, she required emergency respiratory treatment.

Also on the list are two men who otherwise had "no identifiable risk factors" - such as asthma, smoking or obesity - which could explain the severity of their swine flu reaction.

"Here, we present the first six cases of H1N1 influenza ... in which patients required admission to intensive care in Australia," a group of doctors write in the Medical Journal of Australia.

"These cases highlight the small but significant risk of life-threatening respiratory failure associated with H1N1 influenza.

"All patients experienced a rapid (but reversible) decline in respiratory function, with most requiring complex respiratory support."

The patients are not identified but the report details their symptoms in the days before admission, and the extensive treatment they required during their hospital stay.

All were treated with Tamiflu, an anti-viral drug which stops the virus from spreading to new cells in the body, and all but the young mother spent more than 10 days attached to a mechanical ventilator.

The woman went to hospital after four days of cough, fever and vomiting though she initially went home after being rehydrated using an intravenous drip.

Doctors had discussed with her the possibility of a swine flu infection.

"She returned several hours later in premature labour," the doctors write.

"Twenty-four hours after delivering a 26-week live infant, she developed hypoxic respiratory failure ... (and) required a high level of inspired oxygen therapy by face mask."

Tests showed the mother, but not her baby, had the swine flu.

Those also in the list were:

- A 28 year-old woman who was overweight. She arrived at a hospital's emergency department after five days of a sore throat and lethargy, followed by two days of shortness of breath, coughing and chest pain.

- A "previously well" 24-year-old man who also had abdominal pain and vomiting, and who needed ventilation for 15 days.

- Another otherwise healthy man, aged 41, who suffered through a week of coughing and back pain before going to hospital with a fever.

- A 60-year-old man who went to the hospital suffering from an exacerbation of his lung disease where it was found he had the swine flu.

- And 26-year-old overweight man with a history of mild asthma who was on the ventilator for 10 days.

The doctors note the swine flu was a "benign disease" but that it could lead to severe respiratory complications.

"In our series, prompt diagnosis and intensive therapy was associated with favourable outcomes," they also write.

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