A 59-year-old man from Nong Bua Lamphu was yesterday declared the latest victim of bird flu, bringing Thailand's death toll to 17 since the disease was first detected in 2004.

The man is the third confirmed death from the infection this year. Officials said he was the first to die of complications rather than H5N1 itself.

"This case study has taught us that having the antiviral drug oseltamivir at hand doesn't necessarily mean we can cure it," said Dr Kumnuan Ungchusak, head of the Bureau of Epidemiology.

The case was the first that took almost a month from the day the patient fell ill to his eventual death, compared to past cases in which victims died within a few days of falling sick, Kumnuan said.

The Nong Bua Lumphu man, who lived in Nong Sang district, fell ill on July 14 with high fever and muscular pains. He was treated at the nearby primary care unit, but his condition did not improve, said Dr Prat Boonyawongwiroj, the permanent secretary for Public Health. Before his death, the man had been transferred to the Nong Sang district hospital and then to the Nong Bua Lumphu provincial hospital, where he died on August 10, the doctor said.

At first, doctors treating the man were not aware he had been in contact with sick chickens before falling ill, Dr Thawat Suntrajarn, the director-general of the Disease Control Department, said.

About two weeks after becoming ill, his wife finally told doctors he had touched some sick chickens earlier, Thawat said, explaining that was why doctors suspected he had leptospirosis instead of bird flu.

The patient had nursed about sick 40 chickens and treated some of them with a herbal drug, but most eventually died, Thawat said.

An autopsy revealed the man had succumbed to a drug-resistant bacteria called Acinetobacter, he said, adding the patient was given the antiviral oseltamivir right after his wife told doctors he had been in contact with sick chickens.

When the man was initially taken in for treatment, he was tested for H5N1 even though it was not known at that stage whether he had been in contact with sick poultry, Department of Medical Sciences chief Dr Paijit Warachit said.

The first advanced Polymerase Chain Reaction (PCR) test detected no signs of the H5N1 virus, nor did several repeat PCRs conducted later after the man's wife finally said that her husband had been in contact with sick chickens, Paijit said.

He was the first person to undergo nine PCR tests, yet the virus was still not detected until an autopsy was conducted on tissue taken from his lungs and faeces, he said.

That PCRs failed to detect the virus could be because of the effects of oseltamivir, which might have prevented the virus from being present in the respiratory-tract areas where swabs were taken for testing, according to Dr Tawee Chotpitayasundond, of the Queen Sirikit National Institute of Child Health.

The Department of Livestock Development, meanwhile, insisted Nong Bua Lumphu was not on the list of bird-flu districts and past testing on poultry had found no signs of H5N1 there.

There would be no culling of poultry in the province for now, Veterinarian Nirand Auengtrakul, director of the Bureau of Disease Control and Veterinary Services, said.

Governor Phairat Sakolphan has ordered an "X-ray check" across the province for the bird-flu epidemic.

Arthit Khwankhom

The Nation