Casey said it was the worst he has ever felt on a golf course
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R1 LEADERBOARD:
GB&Ire unless stated
-5 Jose Manuel Lara (Spa)
-4 Niclas Fasth (Swe), Graeme McDowell, Richard Green (Aus)
-3 Johan Edfors (Swe), Miguel Angel Jimenez (Spa)
Selected others:
-2 Luke Donald, Robert Karlsson (Swe), Lee Westwood
-1 David Howell
+2 Padraig Harrington
+5 Paul Casey
Paul Casey's hopes of winning the European Order of Merit were hit as he could only hit a five-over 76 in the first round of the Volvo Masters.
Jose Manuel Lara leads by a stroke from Graeme McDowell, Richard Green and Niclas Fasth after a five-under 66.
Padraig Harrington, who is second in the Merit race, also struggled with a two-over 73, but David Howell is four off the lead after a 70.
Robert Karlsson is best placed of Casey's rivals after a 69.
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In any other circumstances I don't think I would have kept playing
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Casey's efforts were not helped as he was suffering from a bout of flu, and the destiny of the Merit title may now be out of his hands.
"It was the worst I've ever felt on a golf course," said Casey. "I was up a few times last night and although it was not too bad starting out I was not feeling good.
"Then it just got worse and worse. My stomach really cramped up on the 10th tee and on the 11th I got an injection to stop the nausea and a pill to solidify the rest.
"It feels like flu because my whole body is aching.
"In any other circumstances I don't think I would have kept playing, but I'm not a fan of pulling out and I think I should keep going as long as I can or a doctor says otherwise."
Howell, who said on Wednesday he only had a 50-50 chance of competing, closed with two birdies, chipping in from 60 feet at the last.
"I would have gone to the ends of the earth to play this week and I'm glad I decided to play," said Howell. "I'm certainly pleased to be tracking the leaders."
Harrington said he felt his play on the day deserved a better score.
"To try to win any tournament you probably want to play well twice and have two average days," he said.
"This is one of the days I played well and I haven't scored."