Ill this fall? Maybe it wasn't swine flu after all

[NRSKarenRN, BSN, RN]

philadelphia inquirer posted 2009-11-12

ill this fall? maybe it wasn't swine flu after all

higher outbreak of rhinovirus seen at children's hospital of philadelphia

i had swine flu. it is almost a badge of honor, suggesting that the speaker survived the first pandemic of the 21st century and is immune to the next wave.

it also may be wrong.

tests at children's hospital of philadelphia suggest that large numbers of people who got sick this fall actually fell victim to a sudden, unusually severe - and continuing - outbreak of rhinovirus, better known as a key cause of the common cold

neither the federal government nor the states track rhinoviruses in the way they do "surveillance" for influenza, based on samplings of doctor diagnoses, emergency-room visits, and lab reports. children's hospital of philadelphia is one of the few institutions that routinely checks for them whenever it tests for influenza and other viruses.

rhinovirus - named after the greek word for nose - is known to circulate year-round, and typically to peak shortly before and after flu season. children's recorded rising numbers in september, right on schedule. then they kept rising.

"the rate of activity was unbelievably high," richard l. hodinka, director of the clinical virology laboratory, said yesterday. "what got my attention was not only the numbers we were seeing in the laboratory, but physicians saying there was severe disease."....

...besides the sheer numbers of rhinovirus, coffin was surprised that it was causing more problems - wheezing, pneumonia, fever, and lower-respiratory-tract infections - than are normally associated with the common cold, which typically infects the upper respiratory tract. that has led her to suspect that a strain not seen here before may be responsible. the cdc's lab will attempt to identify the strain....

...and doctors in louisville, ky., at least, noticed a similar phenomenon: serious illness (in both children and adults) that did not test positive for influenza. they, too, were surprised to find rhinovirus.

"we haven't thought of it as something that causes kids to be really sick and need to be admitted to the icu," said kris bryant, hospital epidemiologist at kosair children's hospital....

[RhiaRN75, RN]

How ironic! I just came over to the flu forum to ask a specific question and it seems you may have already answered it!

For whatever reason, I've seen a huge increase in really sick people who look like classic flu, but tested negative on the rapid swabs. We even sent out a few viral cultures on pts w/ chronic respiratory issues who were admitted in near critical condition w/ 'classic' flu. I haven't seen the results yet, so I'll have to make sure I follow up on that tonight.

I know the rapid swabs are not the most reliable tests, which is why it drives me nuts that a few docs want them for everyone. I know you have to get a good swab to be as accurate as possible, but to have almost every swab result negative has me wondering. The few pts who do test positive for flu A are not nearly as sick as those who test negative. If there's a possible new rhinovirus, plus H1N1 and the sesonal flu, I'm worried. There'll be no 'peak', and anyone unvaccinated has the potiental to become ill with three seperate respiratory illness in one season. Throw a little RSV or mycoplasma into the lot and we'll be rocking and rolling until July.

Is anyone else seeing something similar to this? Pts negative on flu tests but still very ill?

[Kringe38]

This is just great. A killer...cold?

[indigo girl]

Is anyone else seeing something similar to this? Pts negative on flu tests but still very ill?

Yes. They were also negative by PCR. But, positive for H1N1 at autopsy...

If you look at some of the cases in our threads on the severe cases this has happened at least a few times.

One of our frequent flyer psych patients was admitted to ICU two days after her last discharge from our unit. She was negative by the rapid test as well as by PCR. The docs suspected flu, and she was indeed positive at autopsy.

Why are the PCR's negative also, I wondered? Maybe the answer lies in the link below. It is an unproven theory at this point, but in light of the recent news reports on viral mutation released today, I am beginning to wonder if this speculation might have some truth to it.

http://www.recombinomics.com/News/11190903/D225G_False_Neg.html

These mixtures could be generating false negatives in cases where the level of D225G is high. Virus with D225G would quickly move to the lower respiratory tract and the low levels of wild type in the upper respiratory tract would be cleared by the host's immune response. These patients would be infected and seriously ill, but the reduction or absence of virus in the upper respiratory tract would test negative. The CDC has warned that rapid tests have a sensitivity of 10-70% . Thus, in some circumstances only 10% of H1N1 infected sample test positive. This low sensitivity seems to be somewhat linked to H1N1 samples.

The negative data would lead to more testing for other respiratory viruses, which may explain the data reported for rhinoviruses in the Philadelphia area. No unusual strain has emerged, suggesting that the viruses may simply represent opportunistic infections associated with the H1N1 infection that is testing negative.

The detection of such opportunistic infections is similar to results generated when SARS first emerged. Since there was no direct test for the SARS CoV initially, many additional tests were run, and different labs would find different candidate respiratory viruses. However, after the SARS CoV was discovered and developed into a diagnostic test it was clear that SARS was causeed by SARS CoV and the other viruses were just opportunistic passengers.

[RedWeasel, RN]

I have had whooping cough this fall-so there is always that possibility....