Difficulties of Diagnosing H1N1
11/21/09 - A CNN report discusses the case of 5 year old Trinity Olivares who presented with bouts of diarrhea and vomiting but no fever. Due to continued symptoms (but still no fever) overnite, the parents brought her to the local emergency room for her "stomach bug". Three hours later, she was dead. The final diagnosis was H1N1 infection.
A recent report in the Lancet reported that 36 of the 106 patients admitted to Gold Coast Hospital in Queensland, Australia did not have fever. Dr. Richard Wenzel, an infectious disease specialist from Virginia Commonwealth University in Richmond, visited Mexico City in the spring during the early H1N1 outbreak and noted that 1/3 of the adult patients admitted to the hospital were afebrile as well. According to the CDC, "depending on the case series, the proportion of persons who have laboratory confirmed 2009 H1N1 infection and do not have fever can range from about 10 to 50 percent."
Finally, a report in the October Journal of the American Medical Association from Canada notes that this influenza differs from seasonal flu as well by the greater likelihood of gastrointestinal symptoms (e.g. nausea and vomiting). In the Canadian study, Dr. Anand Kumar noted that "About 10 to 15 percent complained primarily of GI symptoms, and not the standard symptoms of cough and runny nose. That's unusual."
Therefore, this pandemic continues to surprise whether it be the age group, the increased mortality in women, the absence of fever or the presence of significant GI symptoms.
Mark M. Blatter, M.D.
Medical Director
Primary Physicians Research