The bird flu or the case of “the birdcage”

The movie The Birdcage was about a cabaret nightclub in a 1996 comedy film classic directed by Mike Nichols.  Robin Williams represented himself to be someone that he was not–for his son’s benefit–to satisfy the son’s fiancé and her moralistic parents.  The deception was carried off with passion and complete disregard for the real merits of the circumstances; unfortunately for Williams, the parents uncovered the deceitfulness. However, as it turned out, in that unusual instance, the parents were found capable of making the correct decision after the facts were known.  That is similar in several respects to our forensic expert casework.  Once in a great while, a client will tell you one version of the forensic assignment, and then, after a site inspection and reviewing the facts, you discover what is missing.  Only one decision is then possible: it is the expert’s first responsibility as a professional to always correctly determine the facts and report what really happened. Now, to our story, which we will call The Birdcage.

This environmental site assessor was asked to inspect the interior of a large home in an expensive residential tract inside one of the older incorporated cities within the County of Los Angeles.  The assignment was to perform an indoor air quality (IAQ) inspection for “unhealthy air” and determine why all of the family members of the client had “suddenly taken ill” for some strange reason inside the home.  The client was hoping to have GEI inspect their residence and issue a report stating that the visible mold inside the residence, from an obvious roof leak, was causing the allergic reactions and subsequent illnesses of the family members.

Responding within 48 hours, proper culture dishes were prepared by the microbiology laboratory under our direction, and the Anderson air impactor and Gast vacuum pump were loaded into the environmental site assessor’s truck.  All the other gear was checked out, inspected and disinfected if necessary for a complete IAQ determination of the airborne contaminants that might be the cause of the mysterious “unhealthy air” that was reported by the client.

Upon arrival at the residence, our assessor was struck by the fact that no drapes were installed in the windows facing the street, and that a white-swirled-paint material covered the inside of the windows.  Before ringing the doorbell, he walked along the exterior building wall to glance into the home through small openings in the swirled paint to see if it was vacant, when suddenly a family member answered the door in her bathrobe.  It was early in the afternoon!  Each extended greetings, and the assessor was invited to enter the home for the IAQ inspection.  The female had a pale skin color, and a running red nose.  She carried a KleenexTM tissue paper in one hand.  Once inside the front door, he was immediately struck with the intensity of a strange odor, the darkness of the room and with great surprise–the entire living room floor was covered with birdcages from wall to wall.  Not only did these cages fill the living room, but most of all bedrooms, the hallways and the kitchen.  These were not your smaller variety parakeet cages—these were cages each large enough for a bevy of parrots! And, guess what the cages contained?  You might have already guessed it.  Parrots.

The assessor was invited to inspect the interior of the home, after a few lights were turned on.  Sick people were in small cots in every room except the kitchen (there was no room for a cot in the kitchen). What our assessor witnessed was unimaginable, that is to say, inconsistent with what a prudent person would call reasonably acceptable for the living area inside your home.  Not only did the home reek with a foul (no pun intended), unpleasant odor, but it had bird feces and feathers scattered about the underside of each cage on carpeting in the living room and linoleum floors of the kitchen.  Filthy outdated newspapers were spread helter-skelter about parts of the floors.  Photographs were later reviewed by our office staff before record storage, and believe us—it was a real mess!

The home did have a roof leak in the enclosed patio roof, between the exterior of the roof drip line and the header connection at the patio roof.  This was probably related to improper caulking of the construction joint (and bolt penetrations in the stucco for the header) or improperly applied roof flashing under the composition roofing.  Mold growth was visible on the ceiling and water stains were apparent.  The assessor excused himself and immediately called our client to report the situation.  He then told the tenant that GEI would not continue our inspection of this home because the facts were not as originally presented to the assessor. It appeared to us that an illegal activity was being carried out inside the home, and the tenant’s desire to present a case to their landlord was completely misguided.  Suffice to say: we should have been inspecting the site for the property owner.  The assessor left the site and invoiced the client for the visual inspection.  The client paid the bill promptly.

What happened here?  Why did the assessor leave the property without performing the IAQ inspection? Doesn’t GEI always complete their assignments?  Aside from the obvious stench or odor inside the residence, and the visible cleanliness aspects of the assignment, what else is wrong with this picture?  After all, isn’t the opinion of one person regarding the way another person lives, really a non-issue in the collection of facts in a forensic case?  Not necessarily.  Here is why.

Most of us know that animal feces and urine carries with it the ability to hold and accelerate the growth of common bacteria and fungal spores, some of which are dangerous to humans.  We have all heard of coliforms being dangerous, which of course is related to the transfer of fecal waste products cycling from animals to humans or humans to humans.  We are told to wash our hands after going to the bathroom, and before handling food.  How can the droppings from a small bird do any damage to us humans?  Birds are all around us.  Why were all those people sick inside the residence?

Influenza viruses come in types A, B and C with related subtype (influenza type A only) and strains (type A subtype and type B only).  Humans can carry all the types of influenza, but wild birds are the natural hosts for only Type A and various strains. Wild birds usually do not get sick from influenza virus, whereas domestic poultry and other birds may die.  Influenza type B is only found in humans and type C is reported to cause only mild illness in humans.  The pathways for spreading of the influenza through type A in birds are related to changes (drift or antigenic shift) in newer strains replacing older strains.  New influenza A subtypes created by antigenic shift (abrupt or quick change) would subject humans to a virus for which there is no known vaccine and create a possible pandemic. Laboratory identification of influenza A virus subtypes requires identification of surface proteins. Fungus or common mold is a plant that carries viral protein and travels in the digestive system of a bird, but the mold is rarely identified.  A bacterium is a unicellular microorganism of the classSchizomycetes that exhibits both plant and animal characteristics, and is allied to fungi.

One of the interesting questions the environmental assessor has been asked recently is “What is this illness called ‘bird flu’ that we have been reading about in the newspapers, and hearing on the news, and how dangerous is it?”

Influenza A subtypes can be low pathogenic or high pathogenic (HP) avian influenza viruses and subtype HPAl is the most widely known, virulent or dangerous in poultry.  Type A flu viruses may adapt over time from birds to transfer to humans and spread.  What we commonly call “bird flu” is avian influenza A subtype H5N1.  What we commonly call “human flu viruses” are influenza A subtypes H1N1, H1N2 and H3N2; these are the only known subtypes of “human flu viruses” according to the U.S. Government Center for Disease Control and Prevention.  In 2003-2004, when over 100 million poultry died or were killed to control the danger in Asia due to “bird flu” or H5N1, we had an antigenic drift to humans.  Persons who handled or cleaned the poultry were at the greatest risk.  Avian pathogens have not been easily and rapidly identifiable in samples.

Bird-to-human infections from bird flu, aka avian influenza A (H5N1), have occurred in Asia and we are currently not prepared for a worldwide pandemic of bird flu, which “could sicken nearly 30 million people to the point of hospitalization.”(1) The question of vaccinating the globe for bird flu was answered by Michael Osterholm of the University of Minnesota: “…a vaccine for a pandemic flu strain wouldn’t be available until at least six months after the pandemic started.  And at that point, the supply would only cover 14% of the global population.”(2)

During a three-month period in early 2004, there were 35 confirmed cases of pathogenic influenza A bird flu in Thailand and Vietnam that resulted in 23 deaths.  If you include the human deaths in Cambodia following this, during large outbreaks of bird flu in poultry, you would find the average mortality at about 50%. The H5N1 viruses isolated in poultry and humans during this time showed that they had developed strains that are now resistant to two of the four medications now known to exist that are approved by the FDA that are used as influenza antiviral H5N1 drugs in humans.  The two drugs left are oseltamivir and zanamivir. (3)

A recently applied quantitative laboratory method called polymerase chain reaction (PCR) is used to identify avian pathogens. (4)  Tracing the genetic structure of bird droppings can now lead the environmental assessor to identify these organisms. Parrot fever is now identified by the pathogen C. psittaci, a bacterium that produces the disease called Psittacosis.  This is an acute, infectious disease caused by filterable virus (filter passing virus, chiefly protein or inert pathogenic agents).  When transmitted to humans, it causes fever with nausea in an illness similar to influenza or typhoid fever. Catching this could really ruin your whole day. Another avian infectious microorganism Histoplasma capulatum can cause pulmonary infection after inhalation, aka Histoplasmosis, a disease causing fever and affecting our chest and lungs.  In the reference text Microfungi, Suzanne Gravesen states that these fungus “…cause pulmonary infections which can be misdiagnosed and classified as other types of lung disease.” (5)

Without confirmation tests, the chances are good that all those parrots inside the house and their droppings were related to the illnesses of the occupants!

Is there a moral to this story? Certainly. Unfortunately, The Birdcage was the entire interior of the house that the tenant was renting.  Our expert’s suggestion: Get a permit to have over a hundred exotic birds in a residential neighborhood, keep your bird collection outside the house, clean up after them and test regularly for pathogens. Incidentally, the city in which this inspection took place was contacted by telephone and under city ordinance, they allow only five parakeets or three parrots to be caged inside a home.

(1) Albert Osterhaus: Bird Flu. Erasmus Medical Center, Rotterdam, The Netherlands. Journal:NATURE, 5/25/2005.
(2) Michael Osterholm: Reported in OCR by Malcolm Ritter in interview at the University of Minnesota. Associated Press. 5/26/2005, p.13.
(3) CDC publication: Key Facts About Avian Influenza & Avian Influenza Infection in Humans. June 2005, p.1-4.
(4) Aerotech P&K: A Rapid PCR Screen For Avian Infectious Organisms. Technical Bulletin 125. 5/23/05.
(5) Gravesen, Frisvad, Samson and Munksgaard: Microfungi. High Tech PrePress, Copenhagen. 1stedition, 2001, p.66.