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(( More info on child H1N1 Death in which H1N1 Flu caused her heart to stop working ))

Child’s death a flu mystery

Otherwise healthy Otay girl didn’t have unusual symptoms

By Keith Darcé
Union-Tribune Staff Writer
2:00 a.m. October 16, 2009
http://www3.signonsandiego.com/stories/2009/oct/16/childs-death-flu-mystery/

Alitza Ortiz Sanchez didn’t have a high fever, cough, runny nose or sore throat.

That’s why her parents, who live in Otay Mesa, didn’t suspect swine flu when they first brought their sick 5-year-old daughter to a physician on the morning of Oct. 8.

But when the girl developed a terrible headache and purplish swelling around her eyes the next day, her parents knew something was wrong. Alitza was dead 35 hours later, becoming the first child in San Diego County to succumb to the H1N1 influenza virus.

Last night, mother Itzya Sanchez and father Miguel Ortiz joined family members at a funeral home near Tijuana’s City Hall for a wake. Inside the coffin, Alitza wore a red princess dress modeled after an outfit in the Disney movie “Beauty and the Beast.”

“For Halloween, she wanted to be a princess, so we bought her a new one” for the funeral, Sanchez said. “We didn’t think something like this could happen to us.”

Alitza’s fate, which her family detailed yesterday, puzzled local medical experts and made parents fear their children might now be more vulnerable to the disease.

“I was terrified,” said Brandi Ware, as she walked her kindergartener, Mikalia, and her first-grader, Mikiah, yesterday morning to Howard Pence Elementary School, where Alitza attended kindergarten. “I’m planning to go get the vaccinations as soon as possible.”

Swine flu vaccine shots and nasal sprays are starting to arrive in the county, but supplies will remain limited for several weeks.

Dr. John Bradley, director of the infectious-disease division at Rady Children’s Hospital in San Diego, tried to offer reassurance yesterday. He said Alitza’s case was highly unusual and that most people who contract swine flu suffer only mild symptoms and recover in a few days.

Still, Alitza’s death offered a tragic warning.

“It reminds us that even common viruses like influenza” should be taken seriously, Bradley said. “Common viruses can cause death, and we don’t like to think about that.”

For months, epidemiologists have known that younger patients are more likely than adults to be hospitalized or killed by swine flu.

Nearly half of the 272 patients receiving hospital treatment for the virus from April to mid-June in the United States were under 18 years old, according to an article published by The New England Journal of Medicine last week.

A separate study by the federal Centers for Disease Control and Prevention found that children and teenagers accounted for about 8 percent of swine flu deaths in the country.

While two-thirds of those victims had serious underlying health problems, such as nervous-system disorders and chronic lung disease, the rest were otherwise healthy.

Swine flu deaths among children have continued to climb in recent weeks with the start of the new school year. CDC officials listed Alitza as the 82nd juvenile fatality from the disease in the United States.

Alitza’s illness struck near the end of a two-week school break.

“Her dad had just taught her how to swim without her life vest,” said the girl’s aunt, Melina Hernandez. “She loved playing dress-up, putting on those press-on nails. She was just the happiest little girl.”

Sanchez, 29, is a homemaker, and Ortiz, 24, works as an auto detailer. They live in an apartment with two other children.

The family resided for a while in Tijuana but moved back to San Diego about seven months ago.

Alitza’s parents initially took her to a physician in Tijuana because they lack health insurance, the family said.

After a urine test indicated a possible urinary tract infection, the doctor prescribed a medication and told them to return the next day.

Alitza slept well that night, her mother said, but in the morning she vomited after eating soup. “We just thought it was the medicine having a reaction,” Sanchez said.

By the time they arrived at the doctor’s office for the follow-up visit, Alitza’s heart was racing. Troubled by the development, the physician sent the family back across the border to Rady Children’s Hospital.

Border agents recognized the health emergency and let them cross without waiting in line.

Sanchez and Ortiz arrived at the emergency room early in the evening last Friday. The staff took Alitza to a small room where she was given an IV and connected to a heart monitor.

Before long, she was having severe stomach pain. “She was yelling and crying,” Sanchez said.

Minutes later, Alitza’s heart stopped beating.

Doctors were able to resuscitate Alitza. Then they rushed her to the intensive-care unit, but her heart continued to fail. She was pronounced dead around 1 a.m. Saturday.

It could be weeks before physicians know exactly what killed Alitza, but they already have several theories.

They know the H1N1 virus had infiltrated the girl’s cardiac muscles because enzymes that normally reside inside heart cells were flowing through her blood, a sure sign of significant tissue damage, Bradley said.
While it’s common for influenza to infect muscles — that’s why the flu often causes body aches — the virus rarely spreads to the heart. When it does, the result can be swift and deadly.

The infection can interfere with the heart’s specialized cells, which conduct electricity and orchestrate the organ’s pumping action, Bradley said. “If you don’t have a coordinated contraction, blood doesn’t pump out,” he said.

Another possibility is encephalitis, or brain swelling caused by infection. The headaches that tormented Alitza could be a signal of this condition.
“We look for hallucinations, for a child who doesn’t recognize the people around her or sees things crawling on the walls,” Bradley said.

To solve the mystery, Bradley and other doctors will examine organ samples taken from Alitza’s body and pore over the large amount of information gathered during her care.

Bradley said he’s certain of one thing: Sanchez and Ortiz couldn’t have done anything more to save their little girl’s life.

“The parents did everything right in this case,” he said.

Union-Tribune
Keith Darcé: (619) 293-1020