Announcement

**alert** · August 10, 2017, 07:49 AM

It is not clear at this point whether this is an infectious condition or not.

Published Date: 2017-08-09 21:16:29
Subject: PRO/EDR> Ebola-like illness - Uganda (02): (LW) EpiCore response
Archive Number: 20170809.5239672
EBOLA-LIKE ILLNESS - UGANDA (02): (LUWERO) EPICORE RESPONSE
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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: 9 Aug 2017
Source: Dr. Henry Kyobe Bosa [edited]

Samples collected yesterday [8 Aug 2017] from the 3 surviving suspects in the Luwero VHF [viral hemorrhagic fever] alert have tested negative by PCR for all Ebola, Marburg, CCHF [Crimean-Congo Hemorrhagic Fever], RVF [Rift Valley Fever], and Sosuga viruses at UVRI [Uganda Virus Research Institute].

The district is already aware of these preliminary findings. Testing is underway for the one sample collected from the deceased case.

--
Communicated by:
ProMED-mail

[ProMED-mail greatly appreciates the additional information provided by Dr. Bosa on the 3 surviving contacts. Any further information on these cases or the primary case would be greatly appreciated. - Mod.JH

**Pathfinder** · August 11, 2017, 10:06 AM

Uganda on high alert after reporting 3 suspected deadly viral hemorrhagic fever cases

Source: Xinhua| 2017-08-11 18:39:29|Editor: ying

KAMPALA, Aug. 11 (Xinhua) --...

Anthony Mbonye, acting director general of health services in a statement issued here said that three females are being monitored for suspected deadly Ebola, Marburg, Congo Crimean Hemorrhagic Fever, Rift Valley Fever and Sosuga viruses at Asili Hospital in Luwero.

"There are currently three female cases admitted at Bishop Asili Hospital, Luweero and are under observation," said Mbonye.
...
Mbonye said the laboratory results for an earlier suspected VHF case that died in Luwero turned out negative.

The suspect, a 20-year-old female presented with high fever, dizziness and blood secretions from her ears and mouth.

"Results from the Uganda Virus Research Institute indicate that all cases were negative for Ebola, Marburg, Congo Crimean Hemorrhagic Fever, Rift Valley Fever and Sosuga viruses," said Mbonye.

"The Post Mortem reports indicate high levels of carboxyhemoglobin (due to carbon monoxide poisoning) that led to the death of the suspected case," he said
...

http://news.xinhuanet.com/english/20..._136518740.htm

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Source: http://health.go.ug/press-release

UPDATE ON LUWEERO VIRAL HEMORRHAGIC FEVER (VHF) ALERT

Kampala – 11/08/2017- on the 7th of August 2017, the public health emergency operation center (PHEOC) at the Ministry Of Health received report of a death of a suspected case of a Viral Hemorrhagic Fever (VHF) in Luweero District. The suspect, a 20-year old female presented with a high fever, dizziness and blood secretion from her ears and mouth.
...

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Fri, 08/11/2017

**alert** · August 14, 2017, 10:49 PM

Published Date: 2017-08-14 17:17:44
Subject: PRO/AH/EDR> Ebola-like illness - Uganda (03): (LW)
Archive Number: 20170814.5247693
EBOLA-LIKE ILLNESS - UGANDA (03): (LUWERO)
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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: Fri 11 Aug 2017 12:55 PM EAT
Source: New Vision [edited]
http://www.newvision.co.ug/new_vision/news/1459654/research -institute-demystifies-strange-luweero-disease

Results from the Uganda Virus Research Institute (UVRI) have [possibly] demystified the strange disease that early this week led to the death of a 20-year-old female in Luweero.

According to a statement from the ministry of health, the female who suffered high fever, dizziness, and blood secretions from her ears and mouth died from high levels of carboxyhemoglobin, as a result of carbon monoxide poisoning.

There are currently 3 female cases admitted at Bishop Asili hospital, Luweero. However, results from UVRI indicate that all cases were negative for Ebola, Marburg, Crimean-Congo hemorrhagic fever, Rift Valley fever, and Sosuga viruses.

"The ministry of health team is working closely with the District Health Team to monitor, review, and manage these cases as well as orienting health workers on management and referral protocols of suspected cases," reads the statement.

[Byline: Vicky Wandawa]

--
Communicated by:
ProMED-mail

[While it is good news this victim does not seem [to] have any of the hemorrhagic diseases mentioned, the reported clinical signs do not completely fit with carbon monoxide poisoning either.

Signs and symptoms of carbon monoxide poisoning may include any or all of the following:
- a dull persistent headache
- confusion
- dizziness
- weakness
- blurred vision
- shortness of breath
- loss of consciousness.

I have never known carbon monoxide to cause bleeding from the ears. Other than hemorrhagic diseases, bleeding from the ears may be associated trauma to the ear drum, pressure changes (such as with diving) causing rupture of the ear drum, an infection in the middle ear, or a foreign body in the ear.

Trauma to the eardrum may result in from a tear or puncture and present as:
- acute hearing loss
- persistent ringing in the ear or ears
- vertigo (a feeling or sensation of spinning)
- vertigo induced nausea and/or vomiting
- rare occasions may include a small amount of fluid, but seldom blood.

An infection, especially of the middle ear may present as:
- fever associated with pain in the ear or pressure in the ear
- unsteady balance
- inability or difficulty sleeping.

Abrupt changes in pressure to the ear or within the ear may present as:
- acute pain in the ear or intense pressure feeling in the ear
- a ringing sensation in the ears
- dizziness
- in rare cases blood or fluid from one or both ears.

Foreign bodies in the ear are most apt to cause bleeding from the ears. Other clinical signs and symptoms associated with this may include:
- fluid or blood discharge from the affected ear, or if both ears if they are both damaged
- pressure in the ear(s)
- pain
- hearing loss
- dizziness
- nausea and/or vomiting.

None of these ear conditions would be associated with blood from the mouth.

So while the individual may have had carbon monoxide poisoning, it seems there is still more to the story.

This piece is a follow-up to ProMED-mail post Ebola-like illness - Uganda (02): (LW) 20170809.5239672 - Mod.TG

Although several virus infections that might be responsible for the hemorrhagic symptoms reported have been ruled out, 2 important viruses not mentioned remain on the rule-out list. They are yellow fever and Lassa fever viruses. There is also a possibility that an as of yet undescribed virus or bacterial pathogen might be responsible. The report above does not indicate if further isolation, or DNA or RNA detection, of an infectious pathogen was attempted. - Mod.TY

Announcement

Luwero, Uganda: Report of woman dying after unexplained hemorrhage, 3 house mates ill - negative for Ebola, Marburg, CCHF, RVF, Sosuga

Luwero, Uganda: Report of woman dying after unexplained hemorrhage, 3 house mates ill - negative for Ebola, Marburg, CCHF, RVF, Sosuga

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