# 1486
One of the problems that comes with diagnosing a disease that presents with `flu-like' symptoms is that damn near every viral (and some bacterial) illness presents with `flu-like' symptoms.
Fever, malaise, body aches, and respiratory difficulties are the four horsemen of infectious illnesses, and can be found in everything from Malaria and Dengue to community acquired pneumonia and seasonal flu.
And of course, it can present in bird flu.
There are rapid tests available to tell if a person is suffering from an influenza virus, but they are fairly expensive, aren't 100% accurate, and they don't tell you what strain of flu you might have.
PCR Testing for the H5N1 virus not only requires a sophisticated lab, but is expensive, time consuming, and the accuracy leaves a lot to be desired.
So, it isn't surprising that some patients are misdiagnosed.
It is a fair assumption that some of these misdiagnosed patients either recover and go home - or die, without ever being accurately diagnosed. While we latch onto every `confirmed' case of Human bird flu, we need to realize that we are probably not seeing the entire picture.
This from Jason Gale, reporting for Bloomberg, who has done a terrific job covering avian flu for quite some time.
Bird Flu Is Mistaken for Typhoid, Hampering Diagnosis (Update1)
By Jason Gale
Jan. 17 (Bloomberg) -- Bird flu has been mistaken by doctors for pneumonia, typhoid and at least four other diseases in Southeast Asia, causing treatment delays that might have worsened their patients' chances of survival, a study found.
Early signs of H5N1 avian-flu infection range from fever and cough to diarrhea and vomiting, researchers said in a report today in the New England Journal of Medicine. The disparate symptoms make it difficult to detect the disease clinically, with doctors in Indonesia and Thailand making a correct initial diagnosis in less than 12 percent of cases.
Treatment delays reduce survival rates in H5N1, which has killed three of every five of the 350 people known to have been infected. The median time for a patient to be seen by a doctor after symptoms began is four days, the authors said.
``There are substantial challenges to a rapid diagnosis,'' said Frederick Hayden, a doctor with World Health Organization's Global Influenza Program in Geneva and one of the study's 11 authors. ``We don't have right now an efficient, highly predictive and sensitive point-of-care diagnostic test for H5.''
Handling sick or dead poultry during the week before symptoms began is the most commonly recognized risk factor for H5N1, the authors said in a review that updated a 2005 report on clinical aspects of human avian-flu infection.
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Fever and pneumonia are the most common symptoms patients have at the time of their initial medical assessment, the authors said. Other clinical signs include sore throat, headache, conjunctivitis and muscle ache.
In Indonesia and Thailand, where 143 H5N1 cases have been recorded in total, some patients were initially diagnosed with tuberculosis, dengue, upper respiratory illness, leptospirosis and dizziness.
