Surviving the Flu

Treatment for critically ill patients saves teen’s life

Kaitlyn P

Kaitlyn Parmiter was simultaneously felled by type 1 diabetes, influenza and encephalitis in January of this year. As one of a handful of hospitals in the U.S. conducting clinical trials on intravenous antiviral drugs, Rady Children’s had the lifesaving drug she needed.

Kaitlyn Parmiter doesn’t remember much about January 2013. Then 12, she had been experiencing flu-like symptoms for about a week and was getting progressively worse. Aches and pains had given way to fever and vomiting. Her breathing was labored and she could barely stand up. Kaitlyn’s parents, Jason and Lindsay, suspected more was going on than just the flu.

At urgent care, Jason had to hold Kaitlyn upright so the nurse could get her weight. Still, there was a lot of flu going around at the time, and the doctor was unconcerned, suggesting the family monitor her condition and bring her back in three or four days if she didn’t get better. But her family was growing increasingly concerned.

“She was coherent at times, but incoherent at others,” says Jason. “I was just trying to get fluids into her, and I don’t think she was even aware of what was going on. She couldn’t even hold a glass of water.”

A little more than a day later, Kaitlyn was in a coma. In a hospital emergency room, physicians figured out what was happening. Kaitlyn definitely had the flu, but that was just the start. Her blood sugar levels were dangerously high. Kaitlyn was developing type 1 diabetes, an autoimmune disease that destroys insulin-producing cells in the pancreas. She was quickly transferred to Rady Children’s Hospital-San Diego.

As if the combination of influenza and diabetes were not enough, Kaitlyn was also experiencing brain swelling, a potentially lethal influenza complication called encephalitis.

“Kaitlyn was in really bad shape,” says John Bradley, M.D., director of the Division of Infectious Diseases at Rady Children’s and professor of pediatrics at UC San Diego. “She may have only had a few hours to live.”

Lifesaving Drug

Taken immediately to the pediatric intensive care unit, Kaitlyn was hooked up to a sea of equipment— multiple IVs, a respirator, dialysis.

The first order of business was reducing the brain swelling. Because Rady Children’s is a Level 1 trauma center, the staff has vast experience treating swelling in the brain. Slowly, they got it under control.

Still in a coma, Kaitlyn’s blood sugar was slowly stabilizing, but her flu was getting worse, and she had also developed pneumonia. Something needed to be done about the infection, but oral medications, such as oseltamivir (Tamiflu), were out of the question. She simply couldn’t keep them down.

This was not unique to Kaitlyn. Earlier flu pandemics had shown that oral antivirals can’t always be used for a disease that provokes vomiting.

“The need for intravenous antivirals became painfully clear during the most recent pandemic,” says Dr. Bradley. “Lots of kids who were vomiting couldn’t tolerate any oral medication. For kids like Kaitlyn, where there’s an underlying issue, we can’t let the infection run its course. We had to get it under control quickly to treat the brain swelling and pneumonia.”

Rady Children’s is one of a handful of hospitals in the United States conducting clinical trials on intravenous antiviral drugs, such as zanamivir (Relenza). Fortunately for Kaitlyn and her family, the team had IV zanamivir readily available to treat her flu.

“It was like a roller coaster,” says Lindsay. “We’d hear some good news, and we’d think she was getting better, but the next day there would be something else. The zanamivir made all the difference. That drug saved her life.”

Within a few days, Kaitlyn’s flu, encephalitis and pneumonia were clearing up.

Words of Wisdom

Kaitlyn must be diligent in regularly monitoring her blood sugar and injecting insulin when necessary. “She has to stick herself with a needle around 10 times a day, and that’s not easy for a 13-year-old,” says Jason.

Along with dealing with her diabetes, Kaitlyn also had to cope with aftereffects from the flu and pneumonia. Still, given what she experienced in January, she’s happy to be here.

“That was way too close,” says Jason. “We really thought we were going to lose her.” The Parmiters are not only grateful for Kaitlyn’s outstanding care, but for the encouraging words they continued to hear throughout her ordeal.

“Dr. Bradley didn’t want to give us false hope, but he was always trying to tell us we had a lot to look forward to,” says Jason. “He knew the experimental medication
would save her life.”

Intravenous drugs for severe flu

Oral medications can fight the flu, but they may not be effective in all cases.

“This became painfully clear during the flu pandemic in 2011,” says infectious disease specialist John Bradley, M.D. “If a child was vomiting [and hospitalized], we needed an IV alternative to oral Tamiflu.”

The realization led to two clinical trials at Rady Children’s Hospital-San Diego: one using IV oseltamivir (Tamiflu) for children younger than age 1 and the other testing IV zanamivir (Relenza) for older kids. The results have been very promising. The trial for IV oseltamivir is complete, and the Food and Drug Administration is reviewing the results. The IV zanamivir trial is still enrolling children.

Along with using these drugs in clinical trials to treat the sickest children, the medications can also be used through “compassionate use.” As a result, children who require IV therapy can receive the research drugs.

“Before we had these IV drugs on research protocols, there was no alternative therapy,” says Dr. Bradley. “You just hoped the influenza would run its course or that oral therapy was sufficient. Now we have effective treatments for all children.”
Originally published in U-T San Diego, October 2013.