Why did a healthy young man die?

2009-08-05 00:00

NO one could have foreseen the death of a healthy 22-year-old from H1N1 or “swine” flu.

Stellenbosch student Ruan Muller last week became South Africa’s first fatality from the pandemic illness that has killed almost 1 000 people worldwide in just a few months, but otherwise healthy people do not usua­lly become severely ill, several experts said yesterday.

Tersia Kruger, a spokeswoman for Medi-Clinic, said the physician who treated Muller said after his death that he was “hesitant” to link it directly to H1N1.

When Muller saw this specialist after seeing three other doctors, and was admitted to the Durbanville Medi-Clinic, he apparently did not exhibit typical flu symptoms.

The physician focused on treating an aggressive atypical bacterial pneumonia, and Muller was only tested for H1N1 after his death on July 28.

Professor Wolgang Preiser, a virologist at Stellenbosch’s Centre for Infectious Diseases, said doctors have discussed Muller’s death. “There was no indication that his immune system was compromised, and no one could have foreseen the outcome early in his illness.

“He got all the correct treatment and we don’t know exactly what happened,” said Preiser.

Dr Lucille Blumberg, an epidemiologist at the National Institute for Communicable Diseases (NICD), said it is still true that most people get mild flu symptoms and do not need to be tested for the virus or be given anti-viral drugs.

She said seasonal and H1N1 flu sometimes leads to complications that can kill the elderly, babies and those whose immune systems are compromised.

H1N1 has caused severe illness and even death in a few healthy young people in other countries as well.

“People get seriously ill when the virus causes pneumonia, or leads to secondary bacterial pneumonia or when some young people suffer lung damage caused by an extreme immune response,” she said.

Experts speculated as early as May that this extreme immune response could be why H1N1 flu killed apparently healthy young people in Mexico, she said.

She said this immune reaction happens when cytokines are released to mobilise immune cells. If too many are released, this can cause an inflammation that causes fluid to build up in the lungs. It has been speculated that this could be why the 1918 flu killed so many young people.

Preiser and Kruger said it is not known if this played a role in Muller’s death. Blumberg warned that South Africa will have many more H1N1 cases in the next few weeks, and complications can be expected. She said that by Monday, 591 cases had been confirmed, and many are too mild to even be tested.

Meanwhile, Sapa reports that health workers were yesterday warned against overprescribing Tami­flu, the drug used to treat H1N1, as the illness could become drug-resistant.

This is according to Dr Chuma Makunga, from the National Institute of Communicable Diseases, who was speaking at a Pharmacy Conference at Sun City.

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