News
Major breakthrough in cause of influenza related deaths
The expected turned out to be the unexpected, giving a different and uncommon twist to a common health issue.
As he peered at the cultures of two sets of sputum and respiratory secretions, as he had done for numerous specimens previously, instead of the usual spheres, rods and spirals, what he saw were shapes like little blooms.
“It was not bacteria, but a fungus,” says Consultant Microbiologist Dr. Muditha Abeykoon of the Polonnaruwa Hospital, who stumbled upon a different trend in post-influenza secondary infections.
It is a first for Sri Lanka and a major breakthrough in the cause of influenza related deaths.
“These findings in Polonnaruwa may also be applicable to other areas,” points out Dr. Abeykoon, explaining that, usually, most of the deaths due to influenza are associated directly with the illness or, with a secondary bacterial infection. He, however, had come upon influenza deaths associated with a secondary invasive fungal infection.
“This needs to be looked at closely to prevent more deaths,” is his urgent plea, as he identifies aspergillus as the culprit fungus. Dr. Abeykoon appreciates all the support he received from Polonnaruwa Hospital Director Dr. Sampath Indika Kumara, Chest Physician Dr. Nandika Harischandra, Histopathologist Dr. Jayantha Edirisuriya, Judicial Medical Officer Dr. Paneetha Seneviratne and the Intensive Care Unit and Microbiology Teams.
Before getting down to what he discovered, he says that, in the past two to three months, there were eight deaths out of about 50 patients at the Polonnaruwa Hospital who were confirmed as having influenza.
While the fact that, all eight had contracted Influenza ‘A’, confirmed through PCR (Polymerase Chain Reaction) testing at the Medical Research Institute (MRI) revealed, four patients had died due to their vulnerable condition, as they were suffering from co-morbidities such as Chronic Kidney Disease of Unknown Aetiology (CKDu).
Two of the remaining four brought forth a different trend – the isolates of their cultures, instead of showing up bacteria as the secondary infection does, exhibited the fungus aspergillus, the Sunday Times learns.
Dr Abeykoon says that, when a person is affected by influenza, which is the primary infection, the lungs get damaged, leaving room for bacteria to cause a secondary infection. But, in this case, the secondary-infection or super-added infection was by a different invader which was the fungus.
He also recalls a similar case a year ago, where too, the secondary infection after Influenza ‘A’ was aspergillus. “This is not a common phenomenon,” says Dr. Abeykoon, who had immediately contacted and got similar confirmation from the internationally well-known Prof Malik Peiris, a clinical and public health virologist based in Hong Kong. (Prof. Peiris rose to fame when he and his team isolated the corona virus that was causing much concern, as it spread the Severe Acute Respiratory Syndrome – SARS — worldwide, back in 2003.)
Giving the profile of the three patients in Polonnaruwa, who are tragically, no more, Dr Abeykoon says that, they were not immuno-compromised and, as such, need not have fallen victim to influenza and subsequently, to aspergillus. In such cases as these, dying is not common.
All three victims were from farming areas – a middle-aged farmer from Polonnaruwa; a 60-year-old woman from Dehiattakandiya; and a year ago, a woman in her 30s from Kantalai, who delivered a baby while affected with influenza.
Reiterating that the standard medical textbooks do not indicate such secondary fungal infections, he says that, this is due to these books being published in the west, where these fungi may not be very common. The situation is different in tropical countries such as Sri Lanka, where an environment replete with paddy cultivations harbours such fungi including aspergillus.
He came by it “quite accidentally”. Looking for bacterial pathology in the culture plates of sputum and respiratory secretions, what he found growing was mould or fungus. Considering it to be “significant”, he then took “deep samples” exhaled into the ventilator tubes, as the patients were being ventilated, and found that the fungus had invaded the lungs.
Tragically, this had been confirmed in the analysis of lung tissue taken at the postmortems, it is learnt. Dr Abeykoon has informed both the MRI and the Epidemiology Unit of his findings.
“We have effective anti-fungal medications, but they are costly,” he says, adding that, as the patients have to be treated for around three weeks, the cost becomes prohibitive. But it works. As evidence, he cites the case of these three patients who were on the path to recovery, when given the appropriate treatment, but died due to other causes.
What we need to check out is whether such fungal infections may be causing common complications which go undetected. We need to look for them actively, urges Dr Abeykoon, adding that, it is important to look more closely how fungi rampant in the country may be impacting on human health.