A Medical Mystery Man Bounces Back From Avian Flu

[waldwolf]

A Medical Mystery Man Bounces Back From Avian Flu

By KEITH BRADSHER

HANOI, Vietnam

IT started as a mild fever and severe chills on Jan. 9 that made Nguyen Thanh Hung's teeth chatter even when his wife, a nurse, covered him with blankets.

But within two days, as the avian influenza virus took hold, his temperature soared to 106.7 degrees and peaked close to that level every day for the next five days as he struggled for life in one of this city's best hospitals. Most of his right lung collapsed, every joint ached and the far wall of his hospital room seemed to approach and recede before his eyes.

"My whole skull hurt," he said, gripping his temples for emphasis. "It felt like pieces of my skull were detaching."

What happened next is one of two medical mysteries in Mr. Hung's case that have caught the attention of flu experts as they try to decipher whether his illness will come to afflict millions of people, and possibly hundreds of millions, around the world.

Unlike most people with confirmed cases of bird flu, Mr. Hung survived, for reasons that remain unclear but may have to do with his extraordinary physical fitness. The greater mystery is how he caught the disease, with strong evidence that he acquired it from his older brother, not from poultry, in a worrisome sign that the virus may be developing the ability to pass from person to person.

The World Health Organization has confirmed 14 cases of avian influenza in Vietnam this winter. Thirteen have died. Mr. Hung, 42, is the 14th case. Three weeks after he fell sick, he is already home from the hospital, tending his beloved bonsai trees, strumming his guitar and jogging a remarkable 14 miles a day.

International flu experts fear what could happen if the A(H5N1) avian influenza virus now circulating here were to recombine with human influenza to produce a virus capable of passing easily from person to person, causing a global pandemic.

Nobody knows when or even if the disease will evolve the ability to pass easily from person to person. If it does, researchers say they expect it to lose some of its deadliness, also noting that some people may already be catching the disease now without falling sick enough to attract attention.

SITTING barefoot and occasionally sipping tea in his small, tile-floored, two-story house in a middle-income Hanoi neighborhood, Mr. Hung, a slim man with a steady gaze, told of how the ordeal started when he took a three-hour bus trip to his hometown, Thai Binh, on Dec. 24.

He had gone to attend a wake for his elder brother's 19-month-old son, who had accidentally drowned - an incident so painful that Mr. Hung, who has no children, goes silent when asked about it, tears coming to his eyes.

Mr. Hung's elder brother, 46, and younger brother, 36, bought a live duck in the village market. The younger brother held the bird while the elder brother slaughtered and cleaned it before Mr. Hung arrived. The elder and younger brothers then made a pudding of raw duck blood, Mr. Hung said.

The elder brother, his brother-in-law and Mr. Hung each ate some of the pudding but decided it was too salty. So nobody else at the large extended family gathering ate any of it. After the lunch, Mr. Hung rode the bus back to Hanoi, where he works largely from home as a cement trader, spending a few hours a day with his cellphone constantly pressed to his ear. He said he did not go near any live poultry after his return to Hanoi.

Mr. Hung's elder brother became feverish on Dec. 27, said Dr. Nguyen Thi Tuong Van, the physician who oversaw the elder brother's care and then Mr. Hung's. The brother's family looked after him at home until Dec. 31, when they brought him, feverish and coughing, to Hanoi's Tropical Disease Institute, an elite hospital where Dr. Van is the deputy director of the emergency department.

Dr. Van said she and her colleagues did not initially suspect that the elder brother had bird flu, a disease that had seemed to vanish from humans in Vietnam in September, after an outbreak last winter.

The elder brother was given a range of drugs to relieve his symptoms. But the disease spread from his lungs to his kidneys and liver, and he died of liver damage on Jan. 9, Dr. Van said.

As is common in Vietnam, family members cared for the elder brother during his stay in hospital, feeding him and staying with him day and night. His wife provided most of the care, but Mr. Hung and his younger brother also came daily.

Mr. Hung's illness began the same day his brother died. Mr. Hung said he went immediately to the hospital where his wife worked. An X-ray showed a small shadow on his right lung, which was misdiagnosed as tuberculosis. He was sent to a tuberculosis hospital, where doctors were puzzled by his steadily rising fever, not a characteristic of tuberculosis.

His fever soaring, Mr. Hung was sent to the Tropical Disease Institute on Jan. 12 and put on numerous medications, including five drugs just for his liver, although not Tamiflu, a costly antiviral drug. He was still there when a chronically backlogged lab finally sent back word on Jan. 19 that the elder brother had died of bird flu, and soon after Mr. Hung received a diagnosis of the same disease.

THE mystery, then and now, is how Mr. Hung contracted the virus. Dr. Van, Mr. Hung and the Vietnamese government have taken the reassuring position that he contracted the virus by ingesting it along with the raw duck blood in the pudding. The government has warned the public against consuming raw poultry products, while playing down worries of person-to-person transmission.

Overseas flu experts are not convinced. Noting that avian influenza has previously seemed to have an incubation period of no more than a week, they are skeptical that Mr. Hung's symptoms would have appeared 16 days after the meal of blood pudding, and say it is more likely that he caught the disease from his older brother. "The incubation time is not that long; more than two weeks is impossible," said Guan Yi, an avian influenza specialist at Hong Kong University.

A single case of probable human-to-human transmission was documented in Thailand last autumn, but did not lead to a wider outbreak. That case appears to have involved greater personal contact than Mr. Hung's: a mother who cradled her sick daughter in her arms overnight until the girl vomited blood in the morning and died.

Dr. Van attributed Mr. Hung's survival to his extraordinary physical conditioning - he has been exercising since age 13, when he bicycled 90 miles a day to carry materials for his family's silk-weaving business. If he did catch the disease from his brother, flu experts noted, it is also possible that it was passed along in a somewhat less virulent form.

Mr. Hung said that he had long done breathing exercises as a form of relaxation, and that he resumed the breathing exercises as soon as his fever broke Jan. 18. He began running back and forth in his hospital room six times a day for 10 minutes at a time. The hospital released him from quarantine on Jan. 28, after tests showed him free of the disease. He immediately resumed jogging for an hour at dawn and for an hour just before going to sleep.

New York Times - February 5, 2005

Edited February 6, 2005 by waldwolf