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  • Nepal - Undiagnosed human illness

    PRO/AH/EDR> Undiagnosed illness, human - Nepal (Far Western Region): RFI

    UNDIAGNOSED ILLNESS, HUMAN - NEPAL (FAR WESTERN REGION): 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: Tue 20 Mar 2007
    From: ProMED-mail

    Source: The Himalayan Times (THT) [edited]
    <http://www.thehimalayantimes.com/ful...eDate=20070320>

    On Mon 19 Mar 2007, the Ministry of Health and Population (MoHP) sent
    a team of gastroenterologist and laboratory technicians from the Seti
    Zonal Hospital to Kailashmadaun of Dadeldhura and Jijadamaduan of
    Doti districts after the death of a woman due to "a mystery disease"
    on 18 Mar 2007. The team also included a rapid response group from
    the Dadeldhura district hospital comprising 2 health assistants and 2
    auxiliary health workers.
    According to the reports received here, a 32-year-old woman died on
    19 Mar 2007 on her way to the Seti Zonal hospital, while hundreds of
    villagers are suffering from the disease with symptoms of diarrhea,
    swollen feet, and hands. The patients have also been suffering from
    shortage of blood [anemia] and kidney failure.
    Dr. Manas Banerjee, acting director of the Epidemiology and Disease
    Control Division (EDCD), said that the disease could be a result of
    bacterial infection along with toxins. He said that nothing could be
    said [until] the laboratory results were out. "We will take all
    precautionary measures as soon as the lab results are out in the next
    few days," said Dr Banerjee.
    The disease has affected Kailashmadaun and Jijadamaduan VDCs [village
    development committees] [over the past] week.
    However, Dr Boglarka Remenyi, Paediatrics Registrar of the Royal
    Children's Hospital in Australia, [in Nepal] on vacation, said the
    "mystery disease" fits the classic description of hemolytic uremic
    syndrome. Reacting to a news report about the "mystery disease" via
    email to THT, she said, "hemolytic uremic syndrome is a triad of
    diarrhea, hemolytic anemia, and renal failure. It is a consequence of
    an infection by bacteria most commonly by _E. coli._
    "It seems essential to try to get a prompt bacteriological diagnosis
    and identify the source of this outbreak. The treatment for the above
    mentioned condition is expensive consisting of rehydration, support
    with blood products and renal dialysis," said Dr Remenyi, adding,
    "The focus should be on identifying the source and educating the
    locals on how to avoid becoming infected."
    --
    ProMED-mail


    [ProMED would appreciate more information about this outbreak.
    In yesterday's (19 Mar 2007) posting of what appears to be the same
    outbreak (Foodborne illness, fatal, boar - Nepal: trichinellosis
    susp., RFI 20070319.096), the symptoms noted were muscle pain, fever,
    respiratory problems, swelling of hands and legs, as well as
    difficulty swallowing, sore throat and "immobility" of upper and
    lower lips. Additionally, the outbreak appeared to be foodborne,
    associated with ingestion of meat of a wild boar.
    In this report, diarrhea, anemia, and renal failure with swelling of
    the hands and feet may have occurred "in hundreds of villagers".
    Exactly how many individuals have anemia and renal failure is not
    stated. The presence of fever, if it occurred, speaks against VTEC
    (Vero toxin producing _E. coli_, also called STEC (Shiga toxin
    producing _E. coli_), which usually does not have prominent fever and
    no mention of bloody diarrhea or gross blood passed per rectum, also
    speaks against VTEC. Also, in this report there is no mention of
    ingestion of wild boar meat.
    More information is needed including the results of stool cultures,
    looking for VTEC, the presence or absence of eosinophilia (a hallmark
    of trichinellosis), how many individuals had renal failure (hemolytic
    uremic syndrome occurs usually in no more than 5-10 percent of
    infections and renal failure in less), and if bloody diarrhea
    occurred. In addition, an outbreak curve is needed to assess the time
    span of the outbreak as well as any other epidemiological data
    including any potential food vehicles. If there is an implicating
    food vehicle such as the boar, is it still available for direct testing?
    This posting now identifies 2 districts (Dadeldhura and Doti), which
    are adjacent to each other in the Far Western region of Nepal and can
    be seen at
    <http://ncthakur.itgo.com/map04.htm>. - Mod.LL]</promed@promedmail.org></promed@promedmail.org>
    "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine
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