Maryland tests confirm flu, bacterial co-infections in family case cluster

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Mar 7, 2012 (CIDRAP News) – Lab tests conducted by the Maryland Department of Health and Mental Hygiene (MDHMH) have revealed that two patients in a family cluster of four severe respiratory disease cases had the seasonal H3 influenza strain, complicated by bacterial co-infections, the department announced today.

State authorities and their colleagues in Calvert County have been investigating a cluster of severe respiratory illnesses that led to the deaths of an 81-year-old woman from Lusby and two adult children who cared for her after she got sick and until she died on Mar 1. Another of the woman's daughters is hospitalized with similar symptoms.

More lab testing and an investigation into the cases are ongoing, the MDHMH said in a press release. The release did not specify which two patients the flu confirmation pertained to.

The Calvert County Department of Health (CCDH) said in a statement today that initial tests on two of the four family members suggest that the serious respiratory infection suffered by all four is a complication of seasonal flu. It said a fourth family member is still hospitalized at MedStar Washington Hospital Center and is improving.

The elderly woman's 58-year-old son was treated at the same hospital, where he died on Mar 5, and his 51-year-old sister is receiving care, after first being treated at Calvert Memorial Hospital, the Washington Post reported yesterday. Their 56-year-old sister also died on Mar 5.

Janis Orlowski, MD, chief medical officer with MedStar Washington Hospital Center, told the Post yesterday that the siblings who died had influenza A infections, along with serious Staphylococcus (staph) infections that they likely acquired before they were hospitalized, given that they arrived with fever, aches, cough, and shortness of breath.

Health officials so far haven't released any information on what type of staph infection the patients had. Tom Skinner, a spokesman for the Centers for Disease Control and Prevention (CDC), told CIDRAP News that the CDC is expecting to receive some samples to test, and results will be shared with state and local officials first.

Healthy people can carry Staphylococcus aureus on their skin or in their noses, and the bacteria can cause non life-threatening skin infections. S aureus is also a common cause of pneumonia, particularly in older people and those with underlying medical conditions. Some S aureus pneumonia infections are caused by antibiotic-resistant strains such as methicillin-resistant S aureus (MRSA).

S aureus infections were cited in a number of pediatric flu-related deaths in the 2006-07 flu season. In January 2008 the CDC issued a health alert about a fivefold increase in pediatric flu deaths. At that time, the CDC had received reports of 73 pediatric flu deaths for the 2006-07 season. Of 69 cases with available information, 30 (44%) had bacterial coinfections, including 22 who were infected with S aureus; the 22 included 15 MRSA cases. The pattern was unusual, because some of the deaths occurred quickly in previously healthy children.

The CCHD said no other similar severe respiratory infections have been detected in the Lusby area recently, and local health officials are not reporting a significant increase in patients with flulike symptoms. They recommended that residents take standard precautions, such as observing good hand hygiene and limiting contact with sick people.

Officials urged residents who haven't been vaccinated against seasonal flu to be immunized by their providers or at local retail stores. The CCHD also said it would be administering the vaccine at the health department on a walk-in basis on weekdays.

See also:

Mar 7 MDHMH press release

Mar 6 Washington Post story

CDC background information on seasonal flu and staph infection

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