Jones Ginting, the only survivor of seven members of an Indonesian family infected with bird flu, is being investigated for rare neurological symptoms associated with the illness.

Magnetic resonance imaging (MRI) scans of Ginting’s brain are being checked for signs of infection, said Nur Rasyid Lubis, deputy director of the Adam Malik Hospital. He said the scans were taken late yesterday at the hospital in Medan, the capital of Indonesia’s North Sumatra province.

“It’s not yet clear whether he’s suffering from a brain infection,'’ Lubis said in a telephone interview today.

If confirmed, Ginting would be one of few human cases of avian influenza in which disease of the central nervous system has been observed. Doctors are studying the H5N1 avian flu strain to improve treatments and prevent illness. Human H5N1 cases provide opportunity for the virus to mutate into a pandemic form that may kill millions of people.

Avian flu has infected at least 226 people in 10 countries, killing 129 since late 2003, the World Health Organization said yesterday. In most cases, severe respiratory disease was the major symptom.

Diseases involving the central nervous system, including encephalitis, transverse myelitis and Guillain-Barre syndrome, have been associated with influenza in humans, according to Harrison’s Principles of Internal Medicine, 13th edition. The cause of the disease isn’t established, the medical book said.

Rare Symptoms

Neurological symptoms may occur during H5N1 illness, “but probably not very frequently,'’ said Menno de Jong, head of the virology department at the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, in an e-mail today.

If live virus particles are carried outside the lungs and surrounding tissues to other parts of the body, some antiviral treatments such as inhaled zanamivir, marketed by GlaxoSmithKline Plc as Relenza, may not be effective in treating H5N1 cases.

De Jong’s team observed 18 H5N1 cases, including that of a 4-year-old boy, who had severe diarrhea, followed by seizures, coma and encephalitis, before he died. H5N1 virus was isolated from his cerebrospinal fluid, de Jong and colleagues wrote in a study published in the New England Medical Journal, Feb. 17, 2005.

The boy’s nine-year-old sister died from a similar syndrome two weeks earlier before samples were taken. Neither patient had respiratory symptoms when their illnesses were first observed. The cases suggest that the spectrum of H5N1 avian flu is wider than previously thought, the study said.

Indonesian Cases

More than one person a week has died of H5N1 in Indonesia this year. Ginting and his relatives who died of the disease last month have attracted international attention because they represent the largest reported instance in which H5N1 may have been spread among people and the first evidence of a three-person chain of infection.

Ginting, a 25-year-old farmer from the village of Kubu Sembelang on the island of Sumatra, has been treated for avian flu in the hospital for more than 38 days. His 37-year-old sister is suspected of being the first family member to die from the disease. She was buried before samples were taken.

The woman’s two sons, a sister, another brother, a nephew and a niece died from the virus between May 4 and May 22.