Announcement

**Giuseppe** · December 3, 2008, 03:11 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

VIRAL HEMORRHAGIC FEVER - BRAZIL (RIO de JANEIRO) ex SOUTH AFRICA:
REQUEST FOR INFORMATION
************************************************** ****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 2 Dec 2008
Source: O Globo [Trans. Port by Mod.MPP, edited]
<http://oglobo.globo.com/rio/mat/2008...-586808565.asp>

South African businessman dies in Rio victim of hemorrhagic fever
-----------------------------------------------------------------
A 53-year-old South African businessman died Tuesday morning [2 Dec
2008] at Casa de saude sao Jose, in Humaita, a victim of hemorrhagic
fever. The patient was admitted to the hospital on Saturday [29 Nov
2008]. Blood specimens were sent to the laboratories of the Oswaldo
Cruz Foundation (Fiocruz) for analysis. According to the hospital
press service, all isolation measures to ensure the safety of
patients and doctors were taken during the period in which the
patient was hospitalized.

It is unknown what the virus that may have caused the fever, but the
case is considered serious because the patient came from Africa. The
main [viral agent] suspected by the Ministry of Health is the
arenavirus, transmitted by direct contact with secretions from
infected rodents or patients. The diagnoses of dengue, malaria and
ebola were discarded. Other hypotheses under investigation include
leptospirosis, hepatitis and hantaviruses.

According to unofficial information, the coffin of the South African
will be sealed. The date when the patient arrived in Rio [from South
Africa] was not given, but before Saturday the patient had already
been cared for in Barra D'Or.

The Ministry of Health in Brasilia, at 7 PM this Tuesday [2 Dec 2008]
issued a statement that gives more details about the case. According
to the Ministry, there are no reports of similar symptoms among
health professionals who had contact with the patient. Also,
quarantine is not recommended as transmission occurs after the
appearance of symptoms. The incubation period is between 7 and 16
days.

The Ministry of Health reported the case to the Pan American Health
Organization (PAHO), as well as information on the measures adopted.
The South African Consulate in Rio de Janeiro, was also contacted, to
make the arrangements for transfer of the body.

[Byline: Antonio Marinho and Simone Intrator]

Statement from the Ministry of Health:
"With regard to patient from South Africa who died this Tuesday (2
Dec 2008), the Ministry of Health states that:

1. The process of investigation on the cause of death has already
begun, through laboratory tests on blood samples of patients that
will be conducted in the laboratories of the Oswaldo Cruz Foundation
(Fiocruz).

2. There are no reports of similar symptoms among health
professionals who had contact with the patient. These people have
been identified and will be monitored, in a preventive manner by the
health authorities.

3. Implementation of quarantine is not recommended, as transmission
occurs only after the onset of symptoms. The incubation period is
between 7 and 16 days.

4. The virus suspected of having caused the death of the patient
(arenavirus) can be transmitted by direct contact with secretions
from infected rodents or patients.

5. The Ministry of Health reported the case to the Pan American
Health Organization (PAHO), as well as the measures adopted.The South
African Consulate in Rio de Janeiro, was also contacted, the
arrangements for transfer of the body.

6. Technicians from the Ministry of Health remain in Rio de Janeiro
following the investigations.

7. The diagnoses of dengue, malaria and ebola have already been
discarded. Other etiologies, such as leptospirosis, hepatitis and
hantaviruses will be investigated."

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The above press release is an early report of a fatality due to a
presumed hemorrhagic fever that occurred in a South African visitor
to Brazil. An important piece of information that is not available in
the above report is the date of arrival of the affected individual in
Brazil, and locations of travel within Brazil prior to onset of
illness. The speculation of an arenavirus as the etiology at this
point in time would be based on laboratory results or epidemiologic
information that might link the businessman to the earlier fatal case
of a novel arenavirus identified in a woman who was medically
evacuated from Lusaka, Zambia to South Africa for treatment, and the
resultant 4 additional nosocomially acquired cases associated with
that fatality (see references below).

It is also possible that the above mentioned case (South African
businessman in Brazil) was in Brazil for a time period long enough to
have potentially had exposure to yellow fever virus, as Brazil is
endemic for yellow fever, and this current year has been a year with
significant yellow fever activity in the region (see references
below). It is also possible that this individual travelled to other
areas possibly in Africa or in South America before arriving in
Brazil. In addition, the possibility of hantavirus, leptospirosis and
other causes of hemorrhagic fever should be considered in the
differential diagnosis for an individual with exposure in South
Africa and in South America.

More information from knowledgeable sources would be helpful and
appreciated. - Mod.MPP]

[Maps of South Africa are available at:
<http://www.worldatlas.com/webimage/c.../africa/za.htm>
and a map of Brazil is available at:
<http://www.lonelyplanet.com/maps/south-america/brazil/> -CopyEd.EJP]

[see also:
Undiagnosed fatalities - S. Africa ex Zambia (10): arenavirus 20081028.3409
Undiagnosed fatalities - S. Africa ex Zambia (09): arenavirus 20081018.3300
Undiagnosed fatalities - S. Africa ex Zambia (08): arenavirus 20081013.3241]
Undiagnosed fatalities - S. Africa ex Zambia (07): arenavirus 20081012.3234
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Yellow fever - South America (32): Brazil (RGS), monkeys 20081113.3577
Yellow fever - South America (31): Argentina (MN), monkeys 20081023.3353
Yellow fever - South America (30): Brazil 20080730.2335
Yellow fever - South America (29): Brazil (SP), monkeys, susp. 20080722.2228
Yellow fever - South America (28): Brazil (Bahia 20080711.2122
Yellow fever - South America (27): Brazil (Para) 20080708.2070
Yellow fever - South America (26): Brazil (SP), Peru 20080608.1823
Yellow fever - South America (25): Brazil (SP), susp. 20080606.1806
Yellow fever - South America (22): Brazil, monkeys 20080406.1268
Yellow fever - South America (21): Brazil 20080406.1260
Yellow fever - South America (11): Brazil, Paraguay 20080302.0843
Yellow fever - South America (10): Brazil 20080229.0820
Yellow fever - South America: Paraguay, Brazil 20080217.0627
Yellow fever - South America (20): Argentina, Peru 20080401.1206
Yellow fever - South America (19): Paraguay 20080326.1136
Yellow fever - South America (18): Brazil (PR) 20080319.1061
Yellow fever - South America (17): Paraguay, Argentina 20080315.1029
Yellow fever - South America (16): Argentina, Paraguay 20080313.1009
Yellow fever - South America (15): Paraguay 20080308.0949
Yellow fever - South America (14): Paraguay 20080307.0936
Yellow fever - South America (13): Paraguay 20080304.0896
Yellow fever - South America (12): Argentina conf. 20080303.0874
Yellow fever - South America (09): Brazil 20080228.0810
Yellow fever - South America (08): Argentina, susp. 20080227.0790
Yellow fever - South America (07): Paraguay 20080226.0785
Yellow fever - South America (06): Paraguay 20080226.0772
Yellow fever - South America (05): Paraguay 20080223.0739
Yellow fever - South America (04): Paraguay, Brazil 20080221.0711
Yellow fever - South America (03): Paraguay, Brazil 20080219.0666
Yellow fever - South America (02): Paraguay, Brazil 20080218.0645
Yellow fever - Paraguay (04): (Asuncion) urban susp. 20080214.0583
Yellow fever, monkeys - Argentina (02): conf. 20080212.0568
Yellow fever - Paraguay (03): (San Pedro) - corr. 20080209.0533
Yellow fever - Paraguay (03): (San Pedro) 20080208.0511
Yellow fever - Paraguay (02): (San Pedro) alert 20080206.0475
Yellow fever - Paraguay (San Pedro) 20080205.0467
Yellow fever, monkeys - Argentina: (Misiones), susp. 20080205.0459
Yellow fever - Brazil (09) 20080203.0439
Yellow fever - Brazil (08) 20080124.0293
Yellow fever - Brazil (07) 20080119.0240
Yellow fever - Brazil (06) 20080116.0203
Yellow fever - Brazil (05): conf. 20080115.0194
Yellow fever - Brazil (04): susp. 20080111.0147
Yellow fever: Brazil (03) 20080110.0139
Yellow fever - Brazil (02): alert 20080109.0107
Yellow fever -- Brazil: (Goias) susp. 20080105.0056
-

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**Gert van der Hoek** · December 3, 2008, 06:19 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Snip from an article; I can't open the original article; machinetranslated.

The businessman came to Brazil on day 23, according to the Ministry of Health.

Two days later, "presented the first symptoms of hemorrhagic fever disease undiagnosed," said the ministry.

Only on day 28 tried to private hospitals.

He died on the morning of Tuesday in San Jose Clinic in Rio de Janeiro, an alleged victim of hemorrhagic fever.

http://www.brasilonline.ch/index.php?cc=C&cr=11&cs=46

Original source: http://noticias.terra.com.br/brasil/...-EI715,00.html

Edit: more from another source:

03/12/2008 02:37:00

Victim was in town for 10 days

River - An entrepreneur came to Brazil on day 23, according to the Ministry of Health Two days later, "presented the first symptoms of hemorrhagic fever disease undiagnosed," said the ministry. Only on day 28 tried to private hospitals.

"The ideal would be that the steps were refeitos him, and those who had contact, such as those that were on the same flight, were warned to stay alert for any symptoms such as fever," says Roberto Medronho, head of the Department of Preventive Medicine UFRJ.

The businessman gave training, on 25 and 26 (november ,ed), to five people from a provider of services for the sector of electric energy in Barra. Yesterday, the direction of the House of Saint Joseph Health issued a note stating that "all measures have been taken for their treatment and safety of employees and patients."

A quarter of CTI with negative pressure - which prevents the virus present inside it are scattered - was one of the security mechanisms used. Already the hospital network D 'Or said he received recommendations from the state remains silent.

http://odia.terra.com.br/rio/htm/vitima_ficou_na_cidade_por_10_dias_216397.asp

**Gert van der Hoek** · December 3, 2008, 08:44 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

machinetranslated

03/12/2008

Arena may have caused death of South African engineer, suspicion ministry

The Oswaldo Cruz Foundation (Fiocruz), linked to the Ministry of Health, is investigating the suspicion that the South African engineer William Charles, 53 years old, died as a result of hemorrhagic fever caused by the arena, common in Africa and transmitted by feces and rodents or urine of infected patients. He died the morning of yesterday (2), House of Health in San Jose on the south side of Rio de Janeiro.

Charles was in Brazil since November 25 to talk .. On Saturday (29), the engineer became ill and was hospitalized with a history of fever, vomiting, blood in urine, enlarged liver and small rashes on the skin. According to the House of Health San Jose, he was in solitary confinement during the period of hospitalization. The body remains in an isolated area of the hospital, which is awaiting guidance from the Ministry of Health

The technical Fiocruz already discarded the chances that the death of Charles has been caused by the ebola virus, hemorrhagic dengue, Marburg, leptospirosis, hantavirus or hepatitis. In a note, the Ministry of Health confirmed that the main suspicion is that the engineer has suffered from contamination by the arena.

According to the ministry, there are no reports of infection in people who were in contact with Charles. Also according to the memorandum, the health professionals who handled the engineer is being monitored by health authorities.

The ministry also clarified is not recommended for those who have quarantined with suspected virus, because the contagion occurs only after the onset of symptoms. The period of encuba??o the arena varies from seven to 16 days.

The South African Consulate in Sao Paulo, reported on the morning of today (3), which has not yet received a passport from Charles. Therefore, preferred not confirm the nationality of the engineer .

Access Denied

http://noticias.uol.com.br/cotidiano/2008/12/03/ult5772u1959.jhtm

**Gert van der Hoek** · December 3, 2008, 09:55 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

This source says,

Brazilian authorities suspect the businessman may have contracted an arenavirus , when he was taken to a hospital in South Africa, before arriving in Brazil.

**Treyfish** · December 3, 2008, 10:49 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Monitorial health department 50 people who had had contact with victim of hemorrhagic fever
03/12/2008 to 10h40m CBN,
- For measure of prevention, 50 people who had had contact with the South African engineer victim of hemorrhagic fever start to be monitored in this Wednesday for the Health department and the city departments and state of Health. They are employee of the two hospitals, of the company where it gave the training and of the hotel where he was housed. The engineer, of 53 years, died in the morning of the tuesday in the Nursing home Is Jose, in the Humait?. If the virus does not know which that can have caused the fever, but the main suspicion of the Health department he is arenav?rus, a type of microorganism in general related severe illnesses e, therefore, feared.
The examinations with samples of blood of the patient had been sent for analysis in laboratories of the Oswaldo Foundation Cross (Fiocruz) and must be ready in up to three days. In accordance with the infectologista Robert Medronho, head of the Department of Preventive Medicine of the UFRJ, the biggest risk is of the health professionals who had had contact with the engineer during the manifestation of the symptoms. It standes out that the people who had had contact with the engineer at the time of incubation of the illness, that lasts about ten days, do not have to be worried, therefore the contamination risk is practically zero. - I infect if of the one by means of the direct contact with vomit, excrements or secretions of the patient during the period of the fever - Medronho explains.
Virus is not so contagious as in the fi??o films The Nursing home Is Jose informed that during the period where the patient was interned, all the measures of isolation to guarantee the security guard of patients and doctors had been taken.
According to Medronho, patient with hemorrhagic fever must be isolated, but this does not want to say that the floor or the entire hospital must be emptied. The health professionals must use masks, gloves and apron to prevent the contamination. - Arenav?rus is not so contagious as it makes in to believe them the films of scientific fiction - the infectologista standes out. Before being interned in the Nursing home They are Jose, the engineer passed for the Hospital D' Bar; Or.
In accordance with the telejornal " Good Day Rio" , the only flight that left Joanesburgo for Brazil, in Saturday when arrived the engineer, was the SA-222 of the company South African Airways, for S?o Paulo. The South African would have come to the River in flight of the TAM. In the city, he was housed in the Transam?rica Hotel, the Bar of the Tjuca. It was in the city to aprestar service for the company Choice Tecnologies, also in the Bar. According to secretary of the company, the owners had travelled and alone they go to disclose itself in this fourth. - It does not have reason for alarm. It was a case alone and all the necessary cares are being taken. We are investigating. In the truth, it is one suspicion - it said Meri Baran, coordinator of the City department of Health, in interview to " Good Day Rio". The body of the South African, who remained in the unit of health until the end of the morning of this Wednesday, must be directed for the laboratory of the Army, of where it will be sent - Consulate saw - directly for Africa, in sealed up zinc coffin.http://oglobo.globo.com/rio/mat/2008...-586817813.asp

**Treyfish** · December 3, 2008, 11:04 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Engineer died in the River can have contracted the virus in the South Africa
Fernanda Thurler, JB Online RIVER - Specialists suspect that the death of the South African engineer, 53 years, was provoked by a contact with a type of virus that can be contracted through piss or excrements of rats, arenav?rus, in a hospital of Joanesburgo, the South Africa. It has stories of that a person visited the Z?mbia, country of the interior of Africa, then later it started to present the symptoms (high fever, calafrios, fatigue, vermelhid?o in the body and bleeds) and looked attendance in the hospital of Joanesburgo, where the entrepreneur was interned, recovering of a ortop?dica surgery.
Four employees of this unit of health had developed the illness, three had died and one, the health state is serious. It never had stories of exposition to arenav?rus in Brazil. But about 50 people who had possibly had contact with secretions of the engineer they are being monitored for the Secretariat of Monitoring and Health of the Health department.
It does not have I infect for air. - The transmission is made alone for people who had had contact with the blood, saliva, piss, vomits of the patient. The people who had had in same the places that the engineer, but without contact with corporal secretions of the victim they do not need to be worried. She does not have reason for alarm - she clarified the infectologista of the Friocruz, Jose Cerbino Grandson. Laboratories of the Oswaldo Foundation Cross (Fiocruz) had collected the material of the patient in the weekend and the preliminary results will be divulged in the maximum four days. Already the disgnostic of affection, malaria had been discarded and ebola. The virus alone is transmitted from the presentation of the symptoms. The evolution of the illness can take the death in up to 10 days after the first symptom, that is the fever. However, it has patients that they react to the treatment and until well that nor arrive to develop the illness. The entrepreneur, who had the preserved identity, arrived at the River in the friday (23), started to feel the symptoms in ter?a (25), he looked medical aid in the last friday (27), and only died hemorrhagic victim of febra in the Nursing home Are Jose, in the Humait?, South Zone.

http://jbonline.terra.com.br/extra/2...e03128050.html

**Treyfish** · December 3, 2008, 11:13 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Mystery disease claims SA man in Brazil

3 December 2008, 17:16
Rio De Janeiro - Brazilian authorities were on Wednesday working to identify a mystery illness that killed a 53-year-old South African man visiting Rio de Janeiro.

Rio's state health ministry said the man, whose name was not given, succumbed to a haemorrhagic disease after falling ill on November 25, two days after arriving in Brazil.

He was taken to hospital with fever, vomiting, blood in his urine and rashes.

Doctors suspected he had contracted an arenavirus, a group of viruses that includes Lassa fever, an infection endemic to west Africa that typically spreads to humans from proximity to rodents.

Dengue, malaria and ebola had all been ruled out, the ministry said.

While tests were being carried out, hospital staff who had treated him were being observed to see if they showed any symptoms.

Officials said the Pan American Health Organisation had been informed of the case and the man's body would be sent back to South Africa in a sealed zinc casket. -

http://www.capeargus.co.za/?fSection...4332511C266181

**Shiloh** · December 3, 2008, 11:56 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Source: http://news.iafrica.com/sa/1354660.htm

SA man's death baffles
Article By:
Wed, 03 Dec 2008 17:51

Brazilian authorities were on Wednesday working to identify a mystery illness that killed a 53-year-old South African man visiting Rio de Janeiro.

Rio's state health ministry said the man, whose name was not given, succumbed to a hemorrhagic disease after falling ill on 25 November, two days after arriving in Brazil.

He was taken to hospital with fever, vomiting, blood in his urine and rashes.

Doctors suspected he had contracted an arena virus, a group of viruses that includes Lassa fever, an infection endemic to west Africa that typically spreads to humans from proximity to rodents.

Dengue, malaria and Ebola had all been ruled out, the ministry said.

While tests were being carried out, hospital staff who had treated him were being observed to see if they showed any symptoms.

Officials said the Pan American Health Organization had been informed of the case and the man's body would be sent back to South Africa in a sealed zinc casket.

AFP

**Shiloh** · December 3, 2008, 01:18 PM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Source: http://www.reuters.com/article/healt...4B269V20081203
South African dies of suspected deadly virus in Rio
Wed Dec 3, 2008 1:00pm EST

RIO DE JANEIRO (Reuters) - Brazilian health officials were monitoring people in Rio de Janeiro for possible infections on Wednesday, after a South African man on a business trip died of a suspected hemorrhagic virus.

The body of the 53-year-old man, who arrived in Brazil on November 23 and began showing symptoms two days later, was being repatriated to South Africa in a zinc-sealed coffin, the Ministry of Health said in a statement.

Brazilian media reported officials as saying he may have been infected when he was a patient at a hospital in South Africa where four people died from a new strain of arenavirus, which also includes the germ that causes Lassa fever.

The health ministry said it had not confirmed that information, but said one of the suspected causes of death was the arenavirus, which is spread through the excrement or blood of rats and between humans through saliva or other body fluids.

It said it had discounted the deadly Ebola virus, but was still investigating whether the man, whose name was not given, could have been killed by hepatitis or leptospirosis, which is also transmitted by rodents.

The Globo network said on its website that about 50 people, including workers at the hospital where the man died and people who had been at a training course with him, were being monitored by health officials. The health ministry did not confirm that figure, saying only that some people were being monitored.

South African authorities had said at the end of October that the new virus appeared to have been contained.

The disease first infected a safari-booking agent in Zambia who was flown to South Africa on September 12 for treatment. She died two days later. A paramedic who accompanied her, a nurse from her intensive care unit and a cleaner who worked in the hospital room also died.

(Reporting by Stuart Grudgings, editing by Philip Barbara)

**Giuseppe** · December 3, 2008, 03:37 PM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

[Google Translation from Portuguese to English - see below original text and link. IOH]

NOTE TO PRESS - 02/12/2008

Regarding the case of the patient from South Africa who died this Tuesday (2 / 12), the Ministry of Health states that:

1.The man of 53 years arrived in Brazil on Nov. 23. On day 25, showed the first symptoms of hemorrhagic fever disease not yet diagnosed.

2.No 28th, two hospitals sought private Rio de Janeiro, with a history of fever, chills, vomiting, blood in urine, enlarged liver and small rashes on the skin. On December 2, the patient came to death.

3.The process of investigation of the cause of death is already underway, by means of examinations on blood samples of the patient, to be conducted in laboratories of the Oswaldo Cruz Foundation (Fiocruz).

4.No However, preliminary assessment has already dismissed the possibility of dengue, malaria or Ebola. Also investigated will be other chances, as LEPISTOPIROSE, hantavirus and hepatitis.

5.Um of the virus suspected of having caused the death of the patient is the arena. He can be transmitted by direct contact with secretions or blood from infected rodents or patients.

6.N?o there are reports of similar symptoms among health professionals who had contact with the patient. These people are being identified and will be monitored, in a preventive manner, the health authorities.

7.N?o is recommended the implementation of quarantine, as the contagion occurs only after the onset of symptoms. The incubation period of the virus varies from seven to 16 days.

8.The Ministry of Health reported the case to the Pan American Health Organization (PAHO), as well as the measures adopted in observing the International Health Regulations. The South African Consulate in Rio de Janeiro, was also contacted, the arrangements for transfer of the body, in sealed zinc coffin.

9.T?cnicos the Ministry of Health remain in Rio de Janeiro supporting the investigations along with the secretaries of State and Municipal Health

More information
Answering the press
(61) 3315-3580 or 3315-2351

-----
--

NOTA ? IMPRENSA - 02/12/2008

Com rela??o ao caso do paciente proveniente da ?frica do Sul que faleceu nesta ter?a-feira (2/12), o Minist?rio da Sa?de esclarece que:

1.O homem de 53 anos chegou ao Brasil no dia 23 de novembro. No dia 25, apresentou os primeiros sintomas de doen?a febril hemorr?gica ainda n?o diagnosticada.

2.No dia 28, procurou dois hospitais particulares do Rio de Janeiro, com quadro cl?nico de febre, calafrios, v?mitos, sangue na urina, aumento do f?gado e pequenas erup??es na pele. No dia 2 de dezembro, o paciente veio a ?bito.

3.O processo de investiga??o da causa da morte j? est? em curso, por meio de exames em amostras de sangue do paciente, que ser?o realizados em laborat?rios da Funda??o Oswaldo Cruz (FIOCRUZ).

4.No entanto, avalia??o preliminar j? descartou a possibilidade de DENGUE, MAL?RIA ou EBOLA. Tamb?m ser?o investigadas outras hip?teses, como LEPISTOPIROSE, HANTAVIROSES e HEPATITES.

5.Um dos v?rus suspeitos de ter causado a morte do paciente ? o arenav?rus. Ele pode ser transmitido por CONTATO DIRETO com secre??es ou sangue de roedores ou de pacientes infectados.

6.N?o h? relato de sintomas semelhantes entre os profissionais de sa?de que tiveram contato com o paciente. Essas pessoas est?o sendo identificadas e ser?o monitoradas, de forma preventiva, pelas autoridades sanit?rias.

7.N?o ? recomendada a realiza??o de quarentena, pois o cont?gio acontece apenas ap?s o aparecimento dos sintomas. O per?odo de incuba??o do v?rus varia de sete a 16 dias.

8.O Minist?rio da Sa?de comunicou o caso ? Organiza??o Pan Americana da Sa?de (OPAS), assim como as medidas adotadas, em observa??o ao Regulamento Sanit?rio Internacional. O Consulado da ?frica do Sul, no Rio de Janeiro, tamb?m foi contatado, para as provid?ncias de translado do corpo, em caix?o de zinco lacrado.

9.T?cnicos do Minist?rio da Sa?de permanecem no Rio de Janeiro apoiando as investiga??es juntamente com as Secretarias Estadual e Municipal da Sa?de.

Outras informa??es
Atendimento ? Imprensa
(61) 3315-3580 ou 3315-2351
-

http://189.28.128.100/portal/aplicacoes/noticias/noticias_detalhe.cfm?co_seq_noticia=56538

------

**Giuseppe** · December 4, 2008, 03:30 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

South African dies of mystery disease in Rio - ABC News (Australian Broadcasting Corporation)

South African dies of mystery disease in Rio

Brazilian authorities have been working to identify a mystery illness that killed a 53-year-old South African man visiting Rio de Janeiro.

Rio's state health ministry said the man, whose name was not given, succumbed to a haemorrhagic disease on Tuesday (local time) after falling ill on November 25, two days after arriving in Brazil to attend conferences.

He was taken to hospital with fever, vomiting, blood in his urine and rashes.

Doctors suspected he had contracted an arenavirus, a highly contagious group of viruses that includes Lassa fever, an infection endemic to west Africa that typically spreads to humans from proximity to rodents or from infected people's secretions.

Dengue, malaria and ebola had all been ruled out, the ministry said.

While tests were being carried out, hospital staff who had treated him were being observed to see if they showed any symptoms.

Results from the tests should be known by the weekend, the health ministry said.

Officials said the Pan American Health Organisation and South African consulate had been informed of the case, and that the man's body would be sent back to South Africa in a sealed metal casket.

A specialist at the Rio lab testing the man's blood samples, Jose Cerbino Neto, told a media conference: "The South African was infected by a very aggressive virus which is still not identified."

He added that the man had "probably caught it in a hospital in Johannesburg, where he had an orthopedic operation two weeks before coming to Brazil."

In that hospital, one patient from Zambia and three doctors are dead from an arenavirus, and one nurse is in serious condition."

- AFP
-

<cite cite="http://www.abc.net.au/news/stories/2008/12/04/2437521.htm">South African dies of mystery disease in Rio - ABC News (Australian Broadcasting Corporation)</cite>

**Gert van der Hoek** · December 4, 2008, 06:11 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

No need to panic - NICD

December 04 2008

It is highly unlikely that the death of a South African man in Brazil was caused by a new type of arenavirus, the National Institute for Communicable Diseases (NICD) said on Thursday.

"I think it is extremely unlikely. He has no risk factors," said doctor Lucille Blumberg of the NICD.

A test for the new type of arenavirus that killed four people in South Africa earlier this year would be done to assure the public that there was no cause for concern, she added.

"I think when the line is raised and people are so concerned, you need a negative test then to arrest the problem.

"You need a negative test to totally exclude it as possibility, to remove it from people's thoughts. That's the only reason we're doing it."

The results of the test, conducted in the United States, would be available in the "next few days", said Blumberg.

Foreign news agencies reported on Wednesday that the 53-year-old man fell ill on November 25, two days after arriving in Brazil to attend conferences.

Agence France-Presse said the man died after displaying symptoms of fever, vomiting, blood in his urine and rashes. Doctors in Brazil suspected he had contracted an arenavirus.

But Blumberg said: "The term virus is often loosely applied... he had no risk factors. Also, timewise, it absolutely does not fit."

The man went for a shoulder operation at Johannesburg's Morningside Medi Clinic in October.

Blumberg said the incubation period for the virus was up to 21 days.

The virus' first victim was Cecilia van Deventer, 36, who was airlifted from Zambia to the Morningside Medi Clinic in Sandton on September 12 in a critical condition.

Once in South Africa she was treated for tick bite fever and other potential infections, but died two days later.

On September 27, a Zambian paramedic who accompanied her into the country was admitted into the hospital with similar flu-like symptoms, fever and a skin rash. He died on October 2 at the clinic.

A third victim of the virus was a nurse from Morningside Medi-Clinic who attended to Van Deventer. She became ill with fever 18 days after Van Deventer was admitted to the hospital and consulted a general practitioner, receiving intravenous therapy, but also died.

A fourth person, a contract cleaner at the hospital, Maria Mokubung, 37, also died of the virus.

The NICD later concluded after a series of tests that the mysterious haemorrhagic disease was a new type of arenavirus, which is yet to be named.

Arenavirus is a highly contagious group of viruses, typically spread to humans from proximity with rodents or through the body fluids of infected people.

A fifth person, another nurse, also contracted the virus, but by that time doctors had already identified it. She responded well to treatment.

She was cleared of the disease mid-November.

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**Giuseppe** · December 6, 2008, 04:11 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

BRAZIL: UNDIAGNOSED FATAL HAEMORRHAGIC ILLNESS IN A SOUTH AFRICAN PATIENT, UPDATE (12/6/2008) [ProMedMail.org]

VIRAL HEMORRHAGIC FEVER - BRAZIL (04): (RIO DE JANEIRO) ex SOUTH AFRICA
************************************************** *********************
A ProMED-mail post
<http: org=""> ProMED-mail is a program of the International Society for Infectious Diseases
<http: org=""> *****
[1] Date: Fri 5 Dec 2008
From: Meri Baran <mbaran@rio.rj.gov.br>

A statement from the Superintendent of Health Surveillance
----------------------------------------------------------
I wish to inform you with respect to a South African national, a businessman, who died in Rio de Janeiro on Tue 2 Dec 2008. He traveled directly, by air, from Johannesburg, South Africa, to Rio de Janeiro, Brazil. He arrived in Rio de Janeiro on Fri 23 Nov 2008. He did not travel to any other location in Brazil prior to the onset of his illness.

He 1st showed signs of illness on 27 Nov 2008.

He manifested the following symptoms: high fever, chills, myalgia, a rash, vomiting, hematuria, hepatoesplenomegaly, jaundice, and exhaustion, which progressed to renal insufficiency and respiratory insufficiency.

He checked into a hospital on Fri 28 Nov 2008, and died on 2 Dec 2008.

15 days prior to his arrival in Rio de Janeiro, he had an orthopedic surgical procedure performed at Morningside hospital, Johannesburg, South Africa.

At this time there was an outbreak of an arenavirus [infection] in that hospital which originated with a patient who came to that hospital from Zambia. There were a resultant 4 additional hospital-acquired cases of the same disease.

We are investigating arenavirus, hantavirus, hepatitis, rickettsia, yellow fever, dengue fever, and leptospirosis.

We have a list of all his contacts at the 2 hospitals in Rio de Janeiro where he was seen, the hotel where he stayed and his job.

They will be monitored for 21 days following his death.
-- Meri Baran, MD Superintendent of Health Surveillance for the Secretary of Municipal Health of the city of Rio de Janeiro, Brazil.

<mbaran@rio.rj.gov.br>[ProMED-mail thanks Dr. Meri Baran for provision of this official account of the history of the South African businessman who died in hospital in Rio de Janeiro of a suspected viral hemorrhagic fever contrated prior to his arrival in Brazil. We await the outcome of the local investigations in Brazil and the laboratory tests being carried out elsewhere. - Mod.CP]
*****

[2] Date: 4 Dec 2008
Source: Pan American Health Organization, EID Updates Vol. 5, No. 13 (4 December 2008) <http: org="" english="" ad="" dpc="" cd="" htm="">

Febrile Hemorrhagic Syndrome in Brazil
--------------------------------------
On the first of December 2008, the Ministry of Health of Brazil reported the occurrence of a case of acute hemorrhagic febrile syndrome in a 53-year-old male from Johannesburg, South Africa, with onset of symptoms on 23 November.

The patient was hospitalized on 28 November with as suspected case of nephrolithiasis and died on 2 December. The main symptoms reported are described in Technical Note 03/12/2008 issued on 3 December 2008 by the Ministry of Health, Secretary of Health Surveillance (MS/SVS) of Brazil (in Portuguese).

Clinical-epidemiological investigation of this case is being carried out by a multidisciplinary team led by the Secretariat of Health Surveillance. A differential diagnosis is being carried out for several agents related to hemorrhagic syndrome, such as arenavirus, rickettsiosis, leptospirosis, hantavirus, malaria, and dengue, among others.

One of the diagnostic hypotheses being considered is that the patient could have been infected by the new arenavirus recently reported in Zambia and South Africa.

Laboratory tests are considering all these diagnostic hypotheses, working in collaboration with a team of professionals from South Africa who are actively involved in the investigation.

Monitoring of the contacts identified in this case is being carried out.

Other clinical cases have not been recorded to date.

The Pan American Health Organization is actively supporting the investigation of this case at both the level of its country office in Brazil and at its Regional headquarters.

Technical note:
In view of the fact that one of the hypotheses being considered is that the case might be that of infection by the new arenavirus, we reiterate following the recommendation for continued monitoring of contacts as laid down in the WHO guidelines Interim Infection Control Recommendations for Care of Patients with Suspected or Confirmed Filovirus (Ebola, Marburg) Haemorrhagic Fever in document BDP/EPR/WHO[1] dated March 2008, which recommends checking body temperature twice a day. Should fever develop, the contact should be examined by a designated physician. Source: Technical Note 03/12/2008 published on 3 December 2008 by the Ministry of Health, Secretariat of Health Surveillance (Ministerio da Saude, Secretaria de Vigilancia Epidemiologica / MS/SVS) of Brazil (in Portuguese).
--
ProMED-mail Rapporteur Marianne Hopp

[see also:
Viral hemorrhagic fever - Brazil (03): (RJ) ex South Africa 20081205.3828
Viral hemorrhagic fever - Brazil (02): (RJ) ex South Africa 20081203.3800
Viral hemorrhagic fever - Brazil (RIO) ex South Africa: RFI 20081202.3792
Undiagnosed fatalities - S. Africa ex Zambia (10): arenavirus 20081028.3409
Undiagnosed fatalities - S. Africa ex Zambia (09): arenavirus 20081018.3300
Undiagnosed fatalities - S. Africa ex Zambia (08): arenavirus 20081013.3241
Undiagnosed fatalities - S. Africa ex Zambia (07): arenavirus 20081012.3234
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139]
................................mpp/cp/ejp/lm
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</promed@promedmail.org></http:></mbaran@rio.rj.gov.br></mbaran@rio.rj.gov.br></http:></http:>

<cite cite="http://apex.oracle.com/pls/otn/f?p=2400:1001:237579562468542::NO::F2400_P1001_BAC K_PAGE,F2400_P1001_PUB_MAIL_ID:1000,75044">http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,75044</cite>

**Gert van der Hoek** · December 8, 2008, 03:46 AM

Re: Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

South African who died in Rio with strange symptoms suffered from maculosa fever

20:37 | The case put on alert to health authorities in Brazil suspected that the emergence of a strange virus of African origin

Río de Janeiro, (EFE).- .- The strange death of a South African citizen last week in Brazil was caused by maculosa fever, an infectious bacterial disease transmitted by ticks, health authorities reported today.

Representatives of the Ministry of Health at the Oswaldo Cruz Foundation (Fiocruz) said today during a press conference that was definitely ruled out the suspicion that the South African businessman William Charles Erasmus suffered a more dangerous "arenavirus."

The South African, aged 53, had arrived on Nov. 23 to visit the city on business, but suddenly fell ill to death Dec. 2 of the victim of a hemorrhagic fever in a hospital in Rio.

The case put on alert to health authorities also notified the Pan American Health Organization (PAHO) on suspicion of a strange virus perhaps of African origin.

Some 75 people who had had contact with the patient had been under special surveillance by health authorities isolated until today, when he ruled out the suspicion of "arenavirus."

The Fiocruz had already ruled out other possible acute infectious disease of viral origin, such as hepatitis, hantavirus, dengue fever and the dreaded Ebola.

Maculosa fever, also known as "fever of the Rocky Mountains," is transmitted by a species of tick host of the bacteria "Rickettsia rickettsii."

The Brazilian authorities suspected that the employer could have made an arenavirus when he was taken to a hospital in South Africa before arriving in Brazil.

. A month ago the World Health Organization (WHO) warned on the identification of a virus family Arenaviridae as responsible for an epidemic that had already ceased deaths in South Africa and Zambia.

http://www.elcomercio.com.pe/ediciononline/HTML/2008-12-07/Sudafricano-que-murio-Rio-extranos-sintomas-padecia-fiebre-maculosa.html

Announcement

Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

Brazil: A case of undiagnosed hemorrhagic fever in a south-african patient [rsoe edis]

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