# 930
The following article on the 101st Indonesian patient in Indonesia adds a new wrinkle to the problem of surveillance and containment of the virus. First the article, then a discussion.
Bird flu patients in Indonesia reach to 101
www.chinaview.cn2007-06-24 19:02:45
JAKARTA, June 24 (Xinhua) -- The number of bird flu patients in Indonesia has increased to 101, spokesperson for the Health Ministry Lily S Sulistyowati said in press release here Sunday.
Lily said the latest human case affected by bird flu virus was a three-year-old child from Pekanbaru, Riau province, who has been ill since June 18 with fever without cough and cold.
She said the child identified as V was found to be affected by the H5NI virus based on the ministry's laboratory examination on June 22, 2007. Meanwhile, an examination conducted in Jakarta declared that V was affected by bird flu virus on June 23, 2007.
On June 19, 2007, V sustained a fever and was then rushed to Arifin Ahmad hospital in Pakanbaru. "V is now still under a medical treatment at the hospital in a better condition," she was quoted by Antara News Agency. Lily said an investigation result showed that V came in contact with a cock which suddenly died on June 16, 2007.
According to data available of the Indonesia's Health Ministry, 80 of its 101 bird flu patients died, or the death rate in Indonesia reached 79.2 percent.
Up until now, H5N1 has generally presented (as far as we know) with typical respiratory symptoms of influenza. The fever, cough, and in many cases pneumonia symptoms are pretty much a hallmark of the disease. It is, after all, an influenza.
There have been a few cases where the primary symptoms have been gastrointestinal, and we have seen cases that fulminated into multi-organ involvement, going beyond the respiratory system. So the presentation has varied a bit.
This latest case, a fever without respiratory symptoms, may be a fluke. Or it may represent a change in the virus. We need to wait and see if more cases like it turn up. But if they do, it will make detecting and containing the virus far more difficult.
It is possible that other cases like this have occurred in the past, and were never linked to H5N1, because the classic symptoms never appeared. It would be very easy to dismiss these cases as Dengue, or Malaria, or some other viral fever.
Suddenly, surveillance in Indonesia has just gotten tougher. When diagnosing FUO's, Fevers of Undetermined Origin, even without respiratory symptoms, doctors must now rule out H5N1 infection.
Given the prevalence of viral fevers in that part of the world, the whole H5N1 containment job may be about to get a lot harder.
