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Dengue Fever Misdaignosis of Fatal H5N1Case Causes Concern

Recombinomics Commentary

September 26, 2005

Not old at intervals of, Karwati again cut off one chicken and only was eaten by his family. Further was reported Karwati on Monday September 19 experienced the fever. Because never recovered, Karwati was brought to RS Medika Cikarang that was located around 1 km from his house.

"He entered RS Medika on Tuesday morning." Initially Karwati was diagnosed suffered typhus. Afterwards vomited blood and the nosebleed, afterwards were diagnosed by dengue fever. However when tell about chronological before Karwati was sick, the RS side at once reconciled RSPI Sulianti Saroso, he said.

The above machine translation indicates that the latest confirmed H5N1 fatality was initially misdiagnosed as having dengue fever.  She was transferred to Sulianti Saraos because she had eaten a bird that had died suddenly.  Thus, had that history not been revealed, or if the bird appeared healthy because of an asymptomatic H5N1 infection, it is likely that the H5N1 would have been recorded as another dengue fever death in Indonesia.  Thus far this year Indonesia has recorded 538 fatalities from dengue fever.

The entire area is reporting unusually high number of cases of dengue fever.  The Philippines has recorded 259 dengue fever deaths.

Last year the index case of human-to-human transmission in Thailand was diagnosed as dengue fever because she vomited blood and had a nose bleed.  She fatally infected her mother, who was H5N1 positive.  Her aunt was also H5N1 positive.

The confusion of pandemic influenza with dengue fever was also seen in the 1918 flu pandemic.  Many patients had internal bleeding and bleeding under this skin.  This led to mis-diagnosis of dengue fever, typhoid, and cholera.

The spread of H5N1 in Indonesia suggests monitoring efforts in the region are far from adequate.  Indonesia now has 10 acknowledged H5N1 cases.  Six have died and one has been discharged.  Two are in South Sulaweto, indicating H5N1 in humans has spread far and wide.

The number of H5N1 cases in Indonesia and the area in general is unknown because of the lack of H5N1 testing combined with false negatives.  Indeed, only one of the three family members in Tangerang is an official H5N1 cases, although all three clearly died from H5N1 infections.

An increased screening of patients is long overdue, and the latest fatality should make it clear that the number of H5N1 case misdiagnosed as dengue fever may be very large.

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