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Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

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  • #91
    Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected
    Thailand authorities say pesticides possible cause of Sarah Carter's death

    UPDATED 1:30PM
    Published: Tue, 16 Aug 2011 12:38p.m.

    By Dylan Moran

    Thai authorities have released a report of their findings after investigating the death of New Zealander Sarah Carter, four other tourists and a tour guide in Chiang Mai over a one month period.....

    Read more:
    There is a link in the article to Thai authorities' full report.

    ETA: The article below seems to have the whole report available for you to read without have to read the Word doc.
    Phuket Expat Deaths Likely to be More Closely Investigated After Chiang Mai Report

    By Alan Morison
    Tuesday, August 16, 2011
    Last edited by Emily; August 16, 2011, 01:19 AM. Reason: Added second link

    Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

    i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

    (My posts are not intended as advice or professional assessments of any kind.)
    Never forget Excalibur.


    • #92
      Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

      Published Date: 2011-09-05 22:30:41
      Subject: PRO/MBDS> Undiagnosed deaths - Thailand (11): Chiang Mai
      Archive Number: 20110905.2715


      A ProMED-mail post
      ProMED-mail is a program of the
      International Society for Infectious Diseases

      Date: Tue 23 Aug 2011Source: The Department of Disease Control, Ministry of Public Health, Thailand [edited]

      Thai authorities have concluded their investigation into the deaths of 5
      tourists and a Thai guide. Following the months-long investigation,
      experts ultimately could identify the likely cause of death for most
      cases, but not the specific agents or mechanism of exposure. Experts
      also concluded that some, but not all of the cases appear to have been
      causally related. The conclusions, investigation constraints, and
      actions taken by Thai authorities are explained in detail below.

      The investigation covered the 6 deaths and associated illnesses of 3
      other tourists (travelling companions) in Chiang Mai between [11 Jan
      2011 and 19 Feb 2011]. The conclusions follow an exhaustive probe during
      which Thai and international experts from numerous disciplines were
      consulted in several rounds of face-to-face, tele- and video-conferences
      to consider the available scientific evidence. These included clinical
      and biological samples from patients, the results of on site
      environmental experiments, and chemical samples from one of the
      concerned hotels and a nearby market. Chemical and tissue samples were
      tested at certified laboratories in Thailand, the United States, Japan
      and Germany during the course of the inquiry.

      The investigation also included interviews with co-travelers and some
      family members in the US, Canada, France and New Zealand in an effort to
      gather information about all possible exposures. Potential viral,
      gaseous, toxin and chemical hypotheses were considered by domestic and
      international partners. Agencies partnering together during the
      investigation included the Department of Disease Control and the
      Department of Medical Sciences at the Ministry of Public Health; the
      Provincial Public Health Office, Chiang Mai; Ramathibodi Poisons Centre,
      Bangkok; the Ministry of Agriculture and Cooperatives; the World Health
      Organization (WHO), and the United States Centers for Disease Control
      and Prevention (US CDC). Staff of the consulates and embassies concerned
      were also kept informed.

      The final conclusions were reached by the official Chiang Mai
      investigation team in conjunction with a review panel of outside experts
      in infectious disease, toxicology, pathology and forensic medicine,
      epidemiology, and environmental science and pesticide use.

      Investigation findings:
      The people who died and fell ill were grouped under 4 events based on
      suspected causes. The case findings are as follow:

      Event 1:
      One American woman, age 33, died on [11 Jan 2011]. Her friend, a
      Canadian woman, age 29, fell ill but recovered. Both stayed in the same
      room at Hotel "A" and developed severe vomiting on the night of [8 Jan

      The diagnosis based on clinical and pathological findings is that the
      American woman died from myocardial injury (injury to the heart muscle).
      Laboratory tests indicate that drugs and other suspected viruses
      (Adenovirus, Echovirus, Ebstein-Barr Virus, Influenza A) are unlikely to
      be the cause. The suspected agent that caused her death is most likely
      to be chemical or biotoxin in nature, and it is probable that it might
      have been a rodenticide. However, the exact agent could not be
      identified because the quantity of sample from the case was
      insufficient. The 2 women are likely to have the same cause of illness,
      but no epidemiological linkage is found between them and other cases in
      other events.

      Event 2:
      One French woman, age 25, died on [19 Jan 2011]. She developed fever and
      other symptoms on [16 Jan 2011] before arriving in Chiang Mai where she
      checked in at Hotel "B" on [17 Jan 2011] with a female friend who
      remained well.

      Based on the evidence gathered and the clinical presentations of the
      case, investigators and experts concur that the French woman had
      evidence of acute severe myocarditis (inflammation of all the heart
      muscles) that represents a sporadic case most likely due to a viral
      infection, rather than exposure to a poison. The clinical symptoms and
      inflammatory cells found throughout the heart muscle (confirmed in 3
      different laboratories including 2 in Thailand and one at the US CDC)
      support this opinion. Although state-of-the-art tests were performed for
      many viruses and bacteria, no etiologic agent could be identified. Given
      that her illness began before she arrived in Chiang Mai, the
      epidemiological linkage to the other events is tenuous.

      Event 3:
      a) One New Zealand woman, age 23, died on [6 Feb 2011]. Her 2 female
      traveling companions, both age 23 and also from New Zealand, fell ill
      but recovered. All 3 women stayed in the same room and developed severe
      vomiting on the morning of [3 Feb 2011].
      b) One Thai woman, age 47, a tour guide, was found dead in her room on
      the morning of [3 Feb 2011].

      The 3 NZ women had severe metabolic acidosis (abnormal acid level in
      circulation) and 2 of them suffered myocardial injury (injury to the
      heart muscle). Clinical symptoms of the Thai woman are unknown since she
      was found dead in her room. Forensic autopsy found no abnormalities
      other than 40 percent occlusion of the right coronary artery. It is most
      likely she died from sudden cardiac arrhythmia (abnormal rhythm of the
      heart beat).

      The women grouped in this event stayed at Hotel "C." The Thai tour guide
      was in a room adjacent to that of the 3 NZ women. The investigation
      found that it is very likely the cause of the illnesses of these 4 women
      is the same given the timing of the onset of their illness and the
      proximity of their rooms. The cause is unlikely to be bacterial or
      viral. Insecticides in the organophosphate, organochlorine and carbamate
      group, such as chlopyrifos, are also unlikely to be the cause because
      they conflict with clinical specimens and blood tests.

      The clinical manifestation in the 3 NZ women, who were all hospitalised,
      could be explained by exposure to some chemicals such as those found in
      pesticides which contain aluminum or zinc phosphide (different class of
      pesticide than that mentioned in above paragraph).

      It should be noted that tests on blood and biological samples from the 3
      NZ patients at US CDC and German laboratories returned negative results
      for suspected chemicals such as sodium monofluoroacetate (compound 1080)
      and phosphine gas (by-product of phosphides). However, negative results
      from some of these toxic substances do not necessarily confirm their
      absence, as the suspected chemical compounds can be difficult to detect
      or can dissipate easily from biological specimens. Tests on the 2 rooms
      where the NZ and Thai women stayed found aluminum molecules on carpet
      samples; however, it cannot be definitively concluded that these came
      from a pesticide containing aluminum phosphide. The aluminum molecules
      could have come from the paint on the walls and ceilings or from fluids
      used to clean air-conditioning units. Aluminum is an ingredient in paint
      and air-conditioning cleaning fluids, and aluminum molecules were also
      found in other rooms sampled throughout in the hotel.

      Two separate rounds of environmental experiments on the air quality in
      the affected rooms were also carried out to test the hypothesis of
      poisoning by carbon monoxide, sulphur dioxide, nitrous oxide and nitrous
      dioxide, as the women stayed at the hotel during Chinese New Year when
      incense and ritual burning of silver and gold paper was carried out by a
      neighbouring shrine. The experiments found that only a small amount of
      these gases entered the rooms, and experts agreed that this amount
      seemed unlikely to have caused their illnesses.

      Event 4:
      An older couple from the United Kingdom -- a man (78) and woman (74) --
      were found dead in their hotel room on the afternoon of [19 Feb 2011].
      Consequently, their clinical symptoms were unknown. Forensic experts
      estimated the time of death to be between [17-18 Feb 2011]. Autopsies
      and standard panels of tests for chemicals, drugs and pesticides were
      performed but revealed no abnormal results. There is evidence of 40-80
      percent occlusion in 3 coronary arteries in the man, and 30-60 percent
      occlusion in the coronary arteries of the woman, which might suggest
      death caused by a cardiac event or arrest. It is not unusual for older
      people to die from cardiac arrest; however, it is uncommon for a couple
      to die of this cause at the same place and at around the same time.

      As they also stayed at Hotel "C," albeit on a different floor to that of
      the women in Event 3, the possibility that the cause of this event is
      related to Event 3 cannot be excluded.

      Despite the best efforts of the Thai authorities and their international
      partners in undertaking an exhaustive investigation, the specific agents
      that caused the deaths and illnesses in these events cannot be
      identified, and it cannot be determined exactly how people might have
      been exposed to them.

      However, the investigation team and the panel of experts agree that
      available evidence suggests the following:

      1. Event 1: The 2 cases in this event, an American and a Canadian woman,
      have similar clinical manifestations as those of the 3 NZ women in Event
      3. Although there is a possibility that these 2 events might have the
      same causative agent, investigators cannot find additional supporting

      2. Event 2: The illness and death of the French woman is not related to
      any other cases or events. It is a sporadic case of myocarditis, most
      likely of viral origin.

      3. Event 3: The 4 women, 3 New Zealanders and one Thai are most likely
      to have the same cause of illness, probably exposure to some toxic
      chemical, pesticide or gas, but the agent cannot be identified.

      4. Event 4: This event, involving the older English couple, is possibly
      related to Event 3, as they occurred in the same hotel, but again
      laboratories could not establish a direct link or the specific cause.

      Investigators spent 5 months pursuing numerous hypotheses about
      potential causes. More than 350 drug, chemical and organism tests were
      done on each fatality, and some 1250 tests in the New Zealand case, in
      laboratories in Thailand and overseas. A large number of personnel in
      Chiang Mai and Bangkok, along with consultants from the US CDC in
      Atlanta and the WHO in Geneva worked on the investigation of these
      events. Despite these efforts, and as difficult as it may be to accept,
      ultimately, the precise causes for the deaths and illnesses cannot be
      definitively identified or confirmed.

      Actions taken by Thai authorities to reduce future risks:

      1) A panel will be set up to investigate and recommend stricter measures
      for the use of chemicals, including pesticides, in hotel and market areas.

      2) A channel to receive notification of illnesses of tourists and
      expatriates has been set up. Visitors can post their notification at or call 053-216592. Events will be
      verified and investigated.

      3) Surveillance of hospitalised tourists, already in effect, will be
      continued, and a new protocol for investigation of fatal cases is being
      developed and implemented.

      4) Retailers of household and agricultural chemicals (pesticides) must
      declare a watch list of products whose procurement and sales are to be
      closely monitored. The provincial health office will carry out periodic
      checks on these items.

      5) Hotel operators must use only licensed pest control companies, and
      their contracts must specify which chemicals are to be used. Samples
      will be collected and sent for testing by the authorities twice a year.

      6) Municipal authorities are to give safety advice and monitor public
      celebrations where the burning of ritual papers and other materials are
      performed in communities, temples and shrines as part of traditional

      7) Food safety standards at eateries and among street vendors,
      especially around the Night Bazaar area frequented by tourists in Chiang
      Mai, are being reviewed and revised to assure safety and compliance.

      8) Health Education Cards to advise tourists about food safety and other
      health concerns will be made available to foreign visitors to the province.

      9) The Ministry of Public Health will apply these measures to safeguard
      tourists in other provinces.

      Communicated by:

      [The Department of Disease Control, Ministry of Public Health, Thailand
      has concluded the detailed and final conclusion of their investigation
      on undiagnosed deaths in Chiang Mai, Thailand. Detailed general and
      clinical information of the deaths and findings of previous
      investigations can be accessed at prior PRO/MBDS postings listed below.

      For maps showing Thailand's regions, see and provinces, see For the
      interactive HealthMap/ProMED-mail map of Thailand with links to other
      recent ProMED-mail and PRO/MBDS postings, see - Mod.SCM]


      • #93
        Re: Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

        Magic mushrooms on menu
        July 2, 2012 by Wanwisa Ngamsangchaikit
        Also the mysterious death of a 23-year-old New Zealand woman,Sarah Carter and several other tourists in Chiang Mai who allegedly stayed at the city?s Downtown Inn has still not been solved, although it is understood the hotel will be demolished.

        Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

        i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

        (My posts are not intended as advice or professional assessments of any kind.)
        Never forget Excalibur.