Autopsies on people who have died from the new strain of A(H1N1) flu show this virus is different from seasonal influenza, even if it has not yet caused more deaths, experts told a meeting on Tuesday.
Americans who died from swine flu had infections deep in their lungs, Sherif Zaki of the US Centers for Disease Control and Prevention (CDC) told a meeting of flu experts, including damage to the alveoli — the structures in the lung that deliver oxygen to the blood.
This in turn caused what is known as acute respiratory distress syndrome — an often fatal development that leaves patients gasping for breath.
The WHO has confirmed 3,205 deaths globally from swine flu, but experts agree all estimates of the extent of the pandemic are grossly understated because so few patients are tested.
Seasonal flu kills, too — about 250,000 to 500,000 people a year globally, the WHO says — but not in the same way as swine flu, which frequently causes severe disease in young adults and children.
“It is very rarely you see what we call diffuse alveolar damage in fatal seasonal influenza,” Zaki told a meeting sponsored by the US Institute of Medicine, which advises government on health matters.
Seasonal flu causes bronchitis and other upper respiratory disease.
But Zaki, the chief infectious disease pathologist at the CDC, said the new virus had burrowed into the lungs of the 90 or so people he examined after they died, and they had huge amounts of the virus in their blood.
“This is almost exactly what we see with avian flu,” Zaki said. “This looks like avian flu on steroids.”
Yoshi Kawaoka of the University of Wisconsin said tests in monkeys showed the virus lives and replicates 1,000-fold better in the lungs than does seasonal flu.
He said the No. 1 drug of choice against H1N1 — Roche’s and Gilead Sciences Inc’s Tamiflu — lowered the so-called viral load in the lungs just enough to help the body fight back.
Experimental flu drugs lower it even more — notably Daiichi Sankyo’s CS 8958 and another drug called T-705 or favipiravir, made by Fujifilm Holdings unit Toyama Chemical, Kawaoka said.
Zaki said 90 percent of the fatalities he looked at had some condition that would predispose them to serious disease.
They had a median age of 38 and one victim was a two-month-old infant who died within a day of getting sick.
Nearly half — 46 percent — were obese, many had fatty liver disease, 27 percent had heart disease and 22 percent had asthma, he said.
Guillermo Ruiz-Palacios of Mexico’s National Institute of Medical Sciences and Nutrition said many Mexican patients with severe disease were also obese.
In addition, patients came in late for treatment and many were infected with a second common virus, called parainfluenza virus.
Just under one-third of the US deaths — 29 percent — had a so-called secondary bacterial infection, usually Streptococcus pneumoniae, Zaki said.
Ruiz-Palacios also said the new virus can be found in the urine and feces of patients, something that may affect how it spreads.
Meanwhile, in Britain, doctors said swine flu patients whose damaged lungs make them unable to breathe may have a better chance of survival if they get an artificial lung technique that’s twice as expensive as standard treatment.
Doctors compared a procedure that pumps blood through an artificial lung rather than using mechanical ventilation, when air is blown into the lungs at high pressure.
Their study found that 63 percent of the patients in respiratory failure who were selected for the lung bypass technique survived for at least six months without disability, compared with 47 percent assigned to receive conventional ventilation.
The finding, reported yesterday in the medical journal The Lancet, suggests the bypass equipment made by companies including Medtronic could rescue more severe swine flu cases.
In Australia’s New South Wales state, one in seven patients critically ill with the new H1N1 strain received the procedure, known as extracorporeal membrane oxygenation or ECMO.
“We have already used ECMO during the first wave of the pandemic with good effect,” said Giles Peek, a surgeon at Glenfield Hospital in Leicester, England, and lead author of the study, in a statement.
“We are expecting ECMO to prove an invaluable weapon in the fight against the winter resurgence of the infection,” Peek said.
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