Tanah Merah, Malaysia: 40 family members put under quarantine after 59-yr-old dies, 28-yr-old critical from unidentified respiratory pathogen - possible leptospirosis

[Emily]

http://www.thestar.com.my/news/natio...dies-of-virus/

Thursday, 9 February 2017 | MYT 10:46 AM
40 family members put under quarantine

by syed azhar
Thursday, 9 February 2017 | MYT 10:46 AM

TANAH MERAH: Forty members in a family have been quarantined at a hospital here after a 59-year-old man died of a type of virus that doctors have yet to identify.
The man suffered from a cough and had difficulty breathing before he died at the Tanah Merah Hospital on Monday.
His 28-year-old relative is in critical condition at the same hospital.
Both men had recently returned from Kajang, Selangor after a holiday with their families over the Chinese New Year period...

Kajang, Selangor is in Malaysia.

[Emily]

http://www.thestar.com.my/news/nation/2017/02/09/bacteria-could-be-cause-of-tanah-merah-mans-death/

Thursday, 9 February 2017 | MYT 5:03 PM
'Bacteria could be cause of Tanah Merah man's death'

by syed azhar

KOTA BARU: Samples of bacteria taken from a 59-year-old man from Tanah Merah, Kelantan who died mysteriously on Monday have been sent for tests at the Sungai Buloh Hospital in Selangor.
State Health Services director Datuk Ahmad Razin Ahmad Mahir said doctors believe that an airborne type of bacteria (klebsiella pneumoniae) could be the cause of the man's death.
...
He said that of the 37 people who came into contact with the deceased, 23 are from Kelantan, 14 from Selangor and two from Kuala Lumpur. So far, 11 of them are suffering from coughs and fever...

[alert]

11 mildly ill contacts is a lot. Klebsiella alone probably doesn't explain this outbreak. The large number of milder cases, clear evidence of H2H spread, and short incubation period looks like an influenza to me. Klebsiella as a co-infection might explain why some of the cases are more severe, but I don't think it would have caused this outbreak alone.

We have had several of these clusters of severe respiratory illness from around the world, that were initially reported as undiagnosed based on a negative rapid test (or even false negative PCR test) that were later confirmed as seasonal flu, often with a bacterial co-infection. Many of these have resulted from improperly collected samples, or simply samples taken late in the illness, once the pathogen was gone, but the damage was done. I think they should consider re-testing for flu.

I don't think there's enough travel or poultry connection reported yet to consider an avian influenza (and if it is indeed avian, this would qualify as efficient and sustained spread), and the timing is not consistent with something like SARS or MERS, even if the right exposures occurred.

[Emily]

Re-testing for flu sounds like a good idea, alert.

I think the doctor quoted below is in Malaysia. The translation gives the impression that the victims were less healthy than a previous article indicated.

http://www.sinarharian.com.my/nasion...iasat-1.625649
Machine translation:

KOTA BARU - State Health Department (SHD) Kelantan are investigating the death of a 59-year-old man suspected in last Sunday following an attack by a mysterious virus. Its director, Datuk Dr Ahmad Razin Ahmad Mahir said the investigation to identify the source of infection is carried out with the Selangor Health Department because the victim before a visit to the Batu Caves, Selangor.

"At the moment, we believe that the source of infection is bacterial pneumonia Kledsiella A Typical but can not be confirmed yet ... we informed the victims are people with diabetes, hypertension and asthma," he told reporters at his office in Wisma Persekutuan here today this...

But if this is something novel...

http://www.channelnewsasia.com/news/...m/3503202.html

1.5m visitors expected at Malaysia's Batu Caves for Thaipusam

• By Sumisha Naidu, Malaysia Correspondent, Channel NewsAsia
• Posted 08 Feb 2017 21:41
• Updated 08 Feb 2017 21:59

[Pathfinder]

Translation google

THURSDAY, FEBRUARY 9TH, 2017 @ 3:56 PM

Death arising befuddled

By Muhammad Rosli Sufian bhkb@bh.com.my

CHILD victim, Nashuruddin Nazmi, 19, a reporter interviewed the father, Nashuruddin Adam, 59, died on Sunday due to a mysterious virus after traveling home with family members in Kajang, Selangor last week. - Photos Syamsi Suhaimi

SUGAR LAND: A person died while another was admitted to the Intensive Care Unit (ICU) after returning from a holiday-Kajang raised questions among members of the families of the victims.

Nasruddin Adam, 59, died on Monday after complaining of cough and shortness of breath since Saturday.

Child victim, Nazmi Nasrudin Akmal, 19, said his father with 38 other family members vacationing in Kajang on 28 January to 31 January Chinese New Year, and sick after returning to Jakarta.

"My sister who was 27 years old then took the father to Hospital Tanah Merah (HTM) before being put to the Raja Perempuan Zainab II Hospital (HRPZII) and died on Monday," he said when met at Kampung Panglima Bayu, here, today.

"The day after my father died, another brother, Azri Osman, 28, who came from Rawang also showed similar symptoms and entered the intensive care ward (ICU) for treatment HTM.

"While four of my cousins aged between two years until the 30s showed symptoms such as shortness of breath, cough and diarrhea and in HTM and HRPZII quarantined for two days until Wednesday.

"All the members of our family have undergone screening in both the hospital on Monday and Tuesday for the cause of a disease of the family," he said.

"There we were just visiting the mall and did not visit any of the recreation center," he said.

http://www.bharian.com.my/node/246133

[Shiloh]

Klebsiella Pneumonia is suspected as cause of death: http://www.thestar.com.my/news/natio...ily-gathering/

[alert]

They are reporting the fatal case had diabetes, hypertension, and asthma: http://english.astroawani.com/malays...y-virus-131818 , something that would likely worsen any respiratory infection, including flu.

Did everyone who was ill visit those caves? Even if the fatal case did, it seems his son took ill two days after exposure to his father, something that makes H2H more likely than a common exposure.

That article also says that there has been no travel abroad (including specifically no umrah), so that rules out MERS.

[alert]

http://www.thestar.com.my/news/nation/2017/02/10/risda-officer-was-a-healthy-man-says-son/

Friday, 10 February 2017

Risda officer was a healthy man, says son






TANAH MERAH: Family members of a ?healthy? 59-year-old-man who suddenly died from symptoms similar to pneumonia are not only baffled but now they too have bad coughs and breathing difficulties.
Their misfortune began on Feb 5 when Rubber Industry Smallholders Development Authority (Risda) officer Nasrudin Adam became gravely ill, apparently after a family reunion event in Kajang.
He was admitted to the district hospital and died at Hospital Raja Perempuan Zainab II in Kota Baru the next day after complaining of breathing difficulties.
?My father was a very healthy man ? if not for his diabetes and hypertension,? said youngest son Nazmi Akmal Nasrudin, 19.





?He was very disciplined with his health and food consumption,? said the 19-year-old at his home in Kampung Panglima Bayu here yesterday.
?After his visit to Kajang last month, his health suddenly started failing,? he added. ?I cannot believe that he is now dead.?
Muhammad Azrin Othman, a 29-year-old relative who attended the same function in Kajang, has now been admitted to the hospital here after suffering the same symptoms as Nasrudin.
He is in critical condition requiring respiratory aid to breathe.
Nazmi Akmal, the youngest of three siblings, said Muhammad Azrin wasn?t the only family member with the symptoms.
?The others in my family seem to develop bad coughs and breathing difficulties too,? he said.

[snip]

[alert]

http://www.nst.com.my/news/2017/02/211228/mysterious-kelantan-respiratory-infection-isolated-case-says-health-dg

Mysterious Kelantan respiratory infection isolated case, says Health DG By FAIRUZ MOHD SHAHAR - 10 February 2017 @ 5:23 PM

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PUTRAJAYA: No new case of a potentially-deadly respiratory infection has been reported in Tanah Merah, Kelantan, following the death of a man from suspected pneumonia.
Health director-general Datuk Dr Noor Hisham Abdullah said no one other than two of the victim?s family members, who attended a family reunion in Kajang from Jan 27 to 31, has shown symptoms of infection as of yesterday.
?So far, all reported cases (of the respiratory condition) are among the family members of the victim who attended the family gathering in Kajang, Selangor.
"The ministry, and the Kelantan and Selangor State Health Departments, are closely monitoring the situation.
"We are also (trying to determine) if there is any respiratory (infection) within the community. The public is advised not to panic, as there has been no new case detected in the community so far," he said in a statement today.
"This is an isolated case.
"The public is advised not to make any speculation and to follow the latest developments issued by the ministry," Dr Noor Hisham stressed.
It was reported that a man died from suspected pneumonia and two others were warded over a respiratory infection.
They were admitted to the Tanah Merah Hospital after complaining of breathing difficulties and severe bouts of coughing upon returning from a trip to Kajang.

[alert]

Maybe it wasn't H2H after all...

http://www.thestar.com.my/news/natio...kajang-family/
Health D-G: Leptospirosis detected in three from stricken Kajang family

by loh foon fong





PETALING JAYA: Leptospirosis has been detected in three family members who fell sick after a family gathering in Kajang, says Health director-general Datuk Dr Noor Hisham Abdullah (pic).
He said laboratory tests on samples from a baby at the Hospital Tanah Merah, an adult from Hospital Raja Perempuan Zainab II and another patient from the Hospital Tengku Ampuan Rahimah Klang had shown a strong positive for leptospirosis.
Leptospirosis is a bacterial infection that can cause high fever, severe headaches, vomiting, muscle pain, conjunctivitis, cough and a short-lived rash.
If left untreated, the infection may be life-threatening, and could lead to brain damage, kidney failure, internal bleeding and loss of lung function.





The tests were negative for respiratory viruses and Legionella, he said.
"The incubation period for leptospirosis is seven to 14 days, which means the patients might have contracted the leptospirosis before going to Kajang.
"We are investigating the source of contamination such as water and other sources," he said.
Dr Noor Hisham said that tests are still ongoing to see if there are other infections as well.
As of noon Friday, 12 from the family had symptoms of respiratory infection with one death, six in stable condition in hospital while five others received outpatient treatment.
No further cases of infection have been detected.
"As such, the respiratory tract infection cluster is isolated," he said.
On Thursday, it was reported that 40 people were quarantined at the Tanah Merah Hospital after a man died of a suspected viral infection after a family gathering in Kajang.



Read more at http://www.thestar.com.my/news/natio...1F0ADr3c5eC.99

[alert]

http://www.nst.com.my/news/2017/02/211271/leptospirosis-detected-three-12-victims-respiratory-infection-symptoms

Leptospirosis detected in three of 12 victims with respiratory infection symptoms By FERNANDO FONG - 10 February 2017 @ 11:35 PM

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KUALA LUMPUR: The Health Ministry confirmed this evening that they have detected leptospirosis in three of the 12 victims with respiratory infection symptoms.
Health director-general Datuk Dr Noor Hisham Abdullah said: ?We are still investigating the source of contamination. We are still conducting more tests before we can issue a statement,? he told the
New Straits Times yesterday.
?It is not a mysterious virus outbreak.?




[snip]

[alert]

http://www.dailyexpress.com.my/news.cfm?NewsID=115735

Trio have leptospirosis and not 'mystery virus'
Published on: Sunday, February 12, 2017

Johor: Three individuals in Kelantan were confirmed to have contracted leptospirosis as of Friday, and it was believed to be linked to the recent floods in Tanah Merah, Kelantan. Health Minister Datuk Seri Dr S. Subramaniam said the three of them, along with three others had previously been admitted to Tanah Merah Hospital (HTM) due to allegedly suffering a 'mystery virus' after attending a family gathering in Kajang, Selangor.
He said the three other individuals, however, were still being treated at HTM, pending tests.
"We're still not sure where they contracted leptospirosis. However, if we look at the time of the early symptoms, there is a possibility it had begun in their hometown in Tanah Merah, before they headed to Kajang.
[snip]

[Emily]

Looks like leptospiral pneumonias are increasing.

https://www.ncbi.nlm.nih.gov/pubmed/17414132