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Neurological Complications in H5N1 Patient in Medan Sumatra

Recombinomics Commentary

June 15, 2006

After being stated recovered from bird flu, JG must reside in the hospital and might not come home. He the diagnosis suffered the infection in and around the brain. If being forced to come home, JG could be suddenly unconscious.

"There were the infection and the clump of pus in and around his brain," said the Co-ordinator Tim the Handling of Adam's Hospital Bird Flu the Medan Owner, Adlin Adnan in Medan, on Thursday morning (15/6). This infection was known after being done pemindaian against JG. "The temperature of his body also was not yet stable," said Adlin.

This hospital, said Adlin, will coordinate with the Hospital of Sulianti Saroso Jakarta to memperlajari the patient's relations recovered bird flu and the brain infection. According to Adlin, the case that was suffered by JG was classified as rare and first happened in Sumatra.

The above translation indicates that the sole survivor of the H5N1 bird flu cluster near Medan, north Sumatra, has neurological involvement.  Neurological involvement of H5N1 has been associated with PB2 E627K.  This polymorphism is found in all human isolates that are H1, H2, or H3.  PB2 in H5N1 has been associated with neurological problems in mammals.  Mice infected with H5N1 have neurological involvement and E627K has been found in brain isolates.  Similarly, tigers in Thailand infected with H5N1 have neurological symptoms and E627K.  E627K has also been found in H5N1 from cats and dogs.  Experimental ferrets infected with H5N1 with E627K have hind leg paralysis.

PB2 E627K is also associated with increased activity at lower temperatures (33 C), which would increase levels in the nose and throat of humans.  Declan Butler reported that cases in northern Sumatra had increased levels of H5N1 in their nose and throat, suggesting the H5N1 from these patients had E627K.  This change was found in H5N1 (A/Indonesia/6/2005) from the second confirmed case in Indonesia (see phylogenetic tree), suggesting E627K is also in the north Sumatra cases.  Isolates from these cases also have an H5N1 wild type cleavage site, RERRRKKR, which was also present in the above examples of neurological involvement.

Neurological involvement of H5N1 is cause for concern.  The effectiveness of neuraminidase inhibitors such as Tamiflu is unclear.  In addition, the isolates from Sumatra are amantadine resistant, further limiting treatment options.  This complication creates additional concerns linked to an H5N1 pandemic, which could significantly impact treatment centers and anti-viral stockpiles.

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