Swine Flu can induce Rhabdomyolysis --rare complication

[indigo girl]

Australlia news report:

Swine flu victim's muscles 'melted'

http://www.theaustralian.news.com.au/story/0,25197,26247834-5013404,00.html

The suffering of this child must have been intense, and very difficult for his family to watch. He made a full recovery.

He was admitted to Melbourne's Monash Medical Centre, where tests showed he was suffering a condition called rhabdomyolysis -- a condition caused when muscles are damaged and dissolve, flooding the bloodstream with their by-products.

He was given antiviral drugs, morphine and large amounts of fluids, but his creatine kinase levels continued to soar and after four days in hospital peaked at 1,127,000 IU/L, before gradually declining.

Rhabdomyolysis can be caused by factors including crush injuries, muscle overuse and alcohol abuse, but it can also be triggered by various infections including, rarely, seasonal flu. But this is the first time it has been noted in a swine flu patient.

(hat tip FlaMedic)

This painful condition is not unheard of with influenza. Two years ago, the same thing happened to a young girl in the Nebraska area. She had one of the seasonal influenzas.. As I recall, she had few other s/s of flu. She did not survive.

In Lincoln, Nebraska, 11 year old Ahn Do died of influenza after exhibiting unusual symptoms including diarrhea and infection of her muscles (Omaha World Herald).

According to her father and state health officials, Anna Do died within five days of feeling ill. Her father said she did not get a flu vaccination this year.

Lab results on Tuesday confirmed Anna had influenza A. Nebraska's state

epidemiologist, Dr. Tom Safranek, said the girl had no known medical conditions and

that the virus appeared to have struck her in an unusual way - by attacking her muscles.

[snip]

Chi Do said his daughter came home from school early on Feb. 6 because she felt

nauseous. He treated her with over-the-counter medications and said she wanted to

return to school the next morning, but changed her mind during the drive in.

At home, she vomited, had diarrhea and complained of cramps in her thighs and legs -

instead of the runny nose, headache and fever more typical of the flu.

http://web.mac.com/monotreme1/iWeb/Pandemic%20Influenza%20Information/Blog/9FCED644-09E0-4418-AED4-922C04388F25.html

Unfortunately, the original links to articles on this case have disappeared from the media sources. The only reference I could find was a blog, but this is pretty much how I remember the information. It was so unusual enough to read symptoms such as this when discussing seasonal flu that I never forgot it. I will continue to search for other references on this subject.

[oramar]

Thanks for sharing info on a rare condition that I have never before heard about. Shows that the virus can attack in many different ways.

[musiklover]

Wow! This is also the first that I've seen Rhabdo linked to the flu/swine flu. Working Tele I've seen cases with ETOH and some serious elderly falls victims with other complications.

[NotReady4PrimeTime, RN]

Had this boy (from the first story in Indigo's post) been admitted tour unit, we would have had him on CRRT so fast his CK would never have gotten that high. Thanks for posting the story Indigo, I'll be keeping a suspicious eye out for it. First sign of pink pee and we're calling in the cavalry!

[CherryAmes_RN]

wow! didnt know rhabdomyolysis could happen with influenza! thanks for sharing. poor kids.

[ZenaBethune]

Is anyone asking......are the diseases occurring after the flu .....because that would take years to show up, or is it occurring after they received the H1N1 Flu Vaccine and then present with these life threatening conditions?

[NRSKarenRN, BSN, RN]

diseases are occuring after the flu infection as reported in this 1990 article:

the pediatric infectious disease journal:

january 1990 - volume 9 - issue 1 - ppg 60

influenza-associated rhabdomyolysis in a child

1997: influenza a clinical pediatrics

2009 original report:

melting muscles: novel h1n1 influenza a associated rhabdomyolysis

the causes of rhabdomyolysis | ehow.com

[NRSKarenRN, BSN, RN]

from cdc:

what symptoms did hospitalized patients have?

the symptoms of novel h1n1 flu virus in people are similar to the symptoms of seasonal flu, although vomiting and diarrhea has been reported more commonly with h1n1 flu infection than is typical for seasonal flu. cdc studied the hospital records of 268 patients hospitalized with novel h1n1 flu early on during the outbreak. in this early subset of cases with significant clinical data, fever (93%) and cough (83%) were the two most reported symptoms. this is not surprising since cough and fever were part of the case definition. other symptoms were shortness of breath (54%), fatigue/weakness (40%), chills (37%) and myalgias (muscle soreness) (36%). (see table below) severe illnesses and death has occurred as a result of illness associated with this virus.

http://www.cdc.gov/h1n1flu/surveillanceqa.htm#11

questions and answers: nejm article "hospitalized patients with 2009 h1n1 influenza in the united states- april-june 2009"

what were the different age groups of hospitalized patients?

unlike seasonal flu, few cases of severe illness associated with 2009 h1n1 have been reported among people 65 years of age and older. in fact only 5% of patients hospitalized in this study were 65 years of age or older. in comparison, this group makes up more than 60% of the seasonal flu hospitalizations in the u.s. each year. forty-five percent of the patients hospitalized in this study were children younger than 18 years old, and 50% were adults, ages18 to 64.

how many of the hospitalized patients had underlying medical conditions?

a large proportion (73%) of patients hospitalized with 2009 h1n1 had one or more underlying conditions, including asthma, diabetes, heart, lung, or neurologic disease, or pregnancy. asthma was the most common underlying medical condition, and was found in 29% of children and 27% of adults. although underlying medical conditions were common, severe illness among young healthy persons was also identified.

aricle reports that getting antivirals early (within 3 days onset) vs 8 days later (reported in some deaths) is important, especially with those having underlying respiratory illness like asthma.