ST. PAUL, Minn. (AP) - A child from the Twin Cities area has become the first person in Minnesota to die of swine flu, state health officials said Monday.

The Minnesota Department of Health said the child died late last week after a brief hospitalization. State medical epidemiologist Aaron DeVries said the child had multiple medical conditions before falling ill. Lab tests confirmed the H1N1 swine flu virus.

"Clearly the underlying health problems played a major role in why this child became so sick," said DeVries.

DeVries said the child was not an infant. He described the child as "younger" but wouldn't release the child's age, gender or other details. He said swine flu has become widespread so it is difficult to determine exactly how the child contracted the virus.

State health officials have confirmed 274 swine flu cases in Minnesota, including the one in the child who died. But they're only testing people at high risk for complications - those whose immune systems are compromised, pregnant women, health care workers and hospitalized patients. Fifty-seven of the Minnesota cases have been hospitalized at some point in their illness.

DeVries said there are many others who have or have had the virus without being tested. He said swine flu has reached every part of Minnesota.

"The best analogy is an iceberg where we're only detecting the top portion," he said.

U.S. health officials were tracking nearly 18,000 confirmed or probable swine flu cases in the country as of Friday, including 45 confirmed deaths. The World Health Organization's global count approached 36,000 cases in 76 countries on Monday, including 163 deaths.

Dr. Ruth Lynfield, the state epidemiologist, said most cases are mild but the illness can be grave for those with underlying health problems. That's got health officials keeping close tabs on the situation.

"This flu is very widespread, and we expect to see many more cases across the state," Lynfield said in a prepared statement.

Officials are urging people to take basic precautions, such as washing hands frequently, covering coughs and staying home when sick. Those with health problems should call their medical provider if they develop fever, cough or a sore throat.

(Copyright 2009 by The Associated Press. All Rights Reserved.)