It may be happening more than we ever realize, those negative test results occurring in patients with real flu like symptoms, that is. The CDC admits these flu tests are not always accurate. It took 3 tests for them to get a positive result in this now terminal case. Now, this is not so unusual a happening, say with the H5N1 bird flu virus, and there it is certainly cause for concern with such a virulent virus, but this Utah woman was diagnosed eventually with the supposedly "mild" swine flu virus. It is not really so important that we always know if someone has swine flu or not, UNLESS they are very sick. If they are, and it really is influenza despite that negative test result, not treating with Tamiflu within the first 48 hours could cost a life.
Indonesian physicians experienced by now in treating H5N1, bird flu cases already know about this. We could benefit from their experience. If they have a very sick patient, and the case looks like bird flu, they treat it with Tamiflu even if the test comes back negative especially if there is another positive case in the family.
If they don't, the patient dies. This seems rather elementary, but I guess it is not.
There are many reasons why truly positive cases will return a negative test result. Poor technique in the collection process, improperly stored or handled specimens, a primer that is not up to date with the strain of virus being tested, and even collecting the specimen during the wrong stage of illness will affect the results.
One other reason not relative to this post, but something probably seen rather often in Indonesia, is that if you treat with Tamiflu and then test, your patient is likely to test negative. This is what is seen when "the Tamiflu Blanket" is applied. The Indonesians would blanket a family or an entire village with Tamiflu sometimes when it appeared that cases were spreading human to human in certain parts of the country.
I am fairly certain that there are some other terminal cases that were misdiagnosed or diagnosed only after death. I do know that Judy Trunnel, that unfortunate pregnant woman who died in Texas was only diagnosed at autosy, but I don't know if she was tested before that so if anyone does know about this please post it, or I will look later today. And, the other terminal pregnant case in El Paso, Texas, who died is another one to check on...
I would like to get a sense for how often this may be happening.
Quote from www.sltrib.com
Cyndi Bemis, a spokeswoman for the Utah Department of Health, confirmed the adult who died Saturday was a woman but said she did not know if underlying health problems were a factor.
A family member identified the woman as Francine Rushton, 47, and said she contracted the flu about two weeks ago but was initially told it was not the H1N1 type, despite her mother's diagnosis with H1N1 that week.
"She tested negative, so they sent her home and told her to get fluids and rest," said Craig Whitehead, Rushton's brother. Because her mother's health had improved on Tamiflu, the family "begged them to administer Tamiflu" to Rushton, Whitehead said. Doctors said they would not without a positive flu test.
Rushton's third test came back positive, more than a week after she first fell ill, Whitehead said. "By then it was too late," Whitehead said.
Rushton's family is urging flu patients to be vigilant about their symptoms and assertive in seeking treatment.
"Don't take it lightly," Whitehead said. "I sat at work three weeks ago and scoffed, 'What's the big deal?' ... Now I feel differently about it."
There have been 688 confirmed cases of the flu in Utah, including 25 cases among health care workers. A majority of those diagnosed with the virus in Utah have been between the ages of 5 and 24.
(hat tip pfi/howmanydays)
Jun 16, '09
quote from op of indigogirl:
"the rapid influenza antigen test used in health clinics and doctor's offices to make an initial flu diagnosis has a sensitivity rate of 50 percent to 70 percent compared to viral tests done in a lab, according to the cdc.
"however, much lower sensitivities have been reported," said tim uyeki, a physician with the cdc's influenza division. "false negative results clearly occur. this means that a fair amount of infections are missed by this test." rolfs said that "depending on the test, depending on the situation, [the test] may miss half of the people who have it. so those tests are not perfect." " which makes the public health stats poorly indicative of the actual incidence of this disease!
as i recall, the cdc recommended early in this pandemic episode, that anyone with flu s/s should be treated "as if" they had h1n1, and that the unreliability of the test would justify skipping it (or something like that).
i posted somewhere on another thread, that i had flu s/s in early may and although my h1n1 test was negative, the doctor at "medexpress", where i went for care, (rather than expose patients in an er to my possible communicability) prescribed tamiflu and doxycycline (for later secondary infection prevention).
he explained that the tests function better as an indicator of h1n1, later in its disease process, but since i was in the first 48 hours of my illness, tamiflu had to be given then, to be effective. i was very impressed with that doctor's knowledge, early on; and so i was compliant in filling the prescription and taking it (which often may not be done by many patients).
p.s. the cost of the test was $82.
Last edit by lamazeteacher on Jun 16, '09
: Reason: separation of posts, punctuation
Jun 22, '09
Hmmmmmm........episodic immune deficiency with autism........ ?? connection???
Actually I've never heard of "episodic" immune deficiency other than that which has been documented during stressful, sleep deprived, and post illness/surgical situations and extreme physical exertion, when any of us could be described that way.
Autistic persons are more stressed, could be sleep deprived due to frequent nightmare-like brain activity during sleep; and they often exhibit long periods of extreme activity. When I worked a summer with developmentally disabled teens at a high school, we were able to slow down an autistic 17 year old's repeatedly injurious (to herself and others) behavior, by placing her in a cozy ceiling suspended "individual hammock" swing.
That might calm many of us down. I must try that when I get upset by some of the posts I see (not in this thread, of course).
Last edit by lamazeteacher on Jun 22, '09
: Reason: clarity
Jun 23, '09
by VickyRN Guide
Quick question - what are the early signs and symptoms of H1N1? I work occasionally in a small community hospital ER, and am very interested in the information you're posting. Thank you, Indigo Girl and others.
Last edit by VickyRN on Jun 23, '09