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General Health : Infectious Disease Last Updated: Apr 20, 2011 - 9:38:09 AM

H5N1 bird flu infection needs aggressive initial treatment
By Sara Andrews
Sep 10, 2006 - 3:47:00 PM

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10 Sep, ( - The H5N1 bird flu virus is concentrated in huge numbers in the throat following initial infection and needs to be aggressively treated during this stage, a new Vietnamese study has found. In contrast to the bird flu virus, common flu virus is concentrated in the nose rather than the throat.

The Vietnamese researchers said that the presence of H5N1 bird flu virus in the throat may help doctors quickly diagnose bird flu and treat it accordingly.

Menno de Jong of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City said that physicians could detect the H5N1 virus in diarrhea and other rectal secretions. In an interview conducted via e-mail by the Associated Press de Jong said the finding was an important factor in instituting infection control measures.

"Our observations suggest that early recognition and early treatment may provide the best benefit. Early recognition and diagnosis will pose a challenge for clinicians," he said.

In a report published in Monday's issue of Nature Medicine, the researchers described a study of 18 people infected with bird flu and compared them with eight people who had common flu infections. Wellcome Trust funded the study

They found that the avian influenza virus replicated more rapidly than common flu virus and reached high levels quickly. "Our observations suggest that H5N1 virus replicates to very high levels higher than common human flu in the respiratory system and that these high levels of virus ignite an overwhelming intense inflammatory response," de Jong said.

Another startling finding was that the H5N1 bird flu virus was detectable in the blood of those who died of the disease, but not in the blood of those who survived. "The virus in the bloodstream most likely is picked up during passage of the blood through the lungs where most virus replication occurs," he said.

According to World Health Organization figures 141 humans have so far fallen a victim to H5N1 virus. Although most deaths have occurred in Asia, the majority of them reported this year have occurred in Indonesia and Turkey.

The bird flu virus first surfaced in Asia in 1997 and then again resurfaced in 2003. Since then it has spread rapidly across Asia and Europe as well as Africa. Till now the virus has only been transmitted after close contact with infected birds and coming in contact with saliva, nasal secretions, and feces.

The fear is that if the virus mutates to an easily transmissible form between humans it would trigger a pandemic worldwide. In fact scientists reported in July in the journal Nature that multiple mutations had occurred in the Indonesian family cluster, but the significance of these mutations remains unclear.

Vietnam initially struggled to deal with bird flu as the death toll hit 42. Till August that remained the highest bird flu deaths recorded before Indonesia overtook Vietnam.

Indonesia has registered more bird flu deaths this year than any other country. In fact there were fears of human-to-human transmission in a cluster in which seven family members died of bird flu. The World Health Organization confirmed that partial human-to-human transmission had occurred in Indonesia.

Many studies have tried to determine if the H5N1 virus is vulnerable on any front. The Vietnamese study suggests that administering Tamiflu or oseltamvir during early infection ma sop he virus from replicating in large numbers.

"The focus of clinical management should be on preventing this intense cytokine response, by early diagnosis and effective antiviral treatment, the study authors said. Tamiflu is not a cure for bird flu. It brakes replication of the virus, thereby easing inflammation which is the cause of most flu symptoms and speeding the time to recovery.

But in the study 17 of the 18 patients received the drug, but the damage was already done, de Jong said. "Extensive damage to the lungs and possibly other organs are likely caused by both the direct effects of the virus as well as by the intense inflammatory response to the virus by the infected individual," de Jong said.

Health experts have warned against the overuse of Tamiflu, saying it would prove of little use if the H5N1 virus mutates to an easily transmissible form between humans.

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