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  • Suspected Ebola case in Uganda (ex Sudan) tests negative



    Ebola suspect in Mbale
    Wednesday, 19th August, 2009 E-mail article Print article


    A nursing officer attending to an ebola suspect in the isolation room at Mbale Hospital


    By Daniel Edyegu,/b>
    in Mbale

    Medical workers in Mbale Hospital have been put on high alert following the admission of a patient suspected to have Ebola.

    Joseph (second name withheld) was referred to Mbale from Tororo Hospital at 11:00am on Tuesday after his condition deteriorated.

    A senior nursing officer in Mbale Hospital said precautionary measures had been taken. The patient has been isolated and access to his room restricted.

    “He has been bleeding from the nose, mouth and ears since admission. He also has blood in his stool and urine. We took laboratory tests and prescribed him on treatment for haemorrhagic fever,” said the medic yesterday.

    The medical staff became concerned when the bleeding persisted, although they put him on five litres of intravenous fluids, blood transfusion and intensive treatment.

    They said more blood samples were yesterday drawn from Joseph and taken to Entebbe viral institute for testing.

    David Obol, the chief administrator, said the hospital had provided medical workers accessing the patient with protective gear and disinfectants while awaiting the results.

    Yesterday, Joseph was in a pathetic state. He lay on the bed groaning, blood flowing from his mouth and nose. He was unable to talk.

    “Though the patient has all symptoms of Ebola, we cannot make conclusive statements until we receive his results from the viral institute,” said the medic.

    Joseph’s father narrated that his son was first treated for malaria in Sudan where he had been working as a casual labourer on a construction site.

    “He first developed high fever and sweated profusely. He was put on malaria treatment. When he failed to respond to the treatment, friends contacted us and we brought him back home for additional treatment at Tororo Hospital.” He said they were immediately referred to Mbale Hospital.

    Dr. Sam Zaramba of the Ministry of Health said last night that he had not yet received any report of the admission.

    Ebola is a group of viruses that cause haemorrhagic fever for which there is no cure.

    The various symptoms, that can appear suddenly, include diarrhoea, fever, fatigue, general pain and severe bleeding.

    The cause of death is usually hypovolemic shock (inadequate blood) or organ failure. The virus spreads through contact with bodily fluids and tissue of infected people.

    Ebola haemorrhagic fever has a high death rate, claiming between 50 and 90 percent of victims. The only way to stop or contain it is through prevention, rapid diagnosis and isolation of suspected cases.

    The last outbreak of Ebola was reported in the western district of Bundibugyo in December 2007. The disease killed 16 people out of the 51 cases that were reported.

    In the 2000 Ebola outbreak in Gulu, 428 people became infected, 173 of whom died.

  • #2
    Re: Suspected Ebola case in Uganda (ex Sudan)

    Sudan is known for outbreaks of an other hemorraghic illness: Rift Valley fever.

    Yesterday Saudi Arabia has lifted a temporary ban imposed on the import of all types of live animals from Sudan after an outbreak of Rift Valley fever.

    Comment


    • #3
      Re: Suspected Ebola case in Uganda (ex Sudan)

      That is a good point. This could be a case of Rift Valley fever, or of Ebola Sudan. Depending on how long the case was in Sudan, and when the patient left Uganda, Marburg might also be in the list of potential diagnoses. Independent of timing, they also must consder possiblilites such as measles or typhoid, which are common in both Uganda and Sudan. Also, as there is (as of now) only one case, possiblilites such as trypansomiasis and spotted fever (both insect borne) should be considered as both are prevalent in Africa and could produce those symptoms in a severe and untreated case.

      I am a little alarmed by the statement by the father that mentioned bringing him back home after he was ill. Hopefully, they didn't fly him out on a commercial jet, or things could get ugly if this is indeed contagious VHF. I can't imagine how else they would have transported him, though, as the patient is a laborer and unlikely to be able to afford a private craft.

      We'll have to wait for results out of laboratory testing. This shouldn't take too long. Actually, I would be fairly surprised if Ebola was confirmed, as there is no known significant exposure (we're not reading things about eating bushmeat or being bitten by a bat).
      Last edited by alert; August 20, 2009, 09:45 AM. Reason: other possiblities

      Comment


      • #4
        Re: Suspected Ebola case in Uganda (ex Sudan)

        And ProMed picks up the story with a posting based on post #1. What's notable here is the comments - there hasn't been a case of Ebola in humans in Sudan since 2004.



        EBOLA HEMORRHAGIC FEVER - UGANDA: (MBALE), SUSPECTED
        ************************************************** **
        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: Wed 19 Aug 2009
        Source: The New Vision [edited]
        <http://www.newvision.co.ug/D/8/12/691810>


        Ebola haemorrhagic fever suspect in Mbale, Uganda
        -------------------------------------------------
        Medical workers in Mbale Hospital have been put on high alert
        following the admission of a patient suspected to have Ebola
        haemorrhagic fever. The suspect was referred to Mbale from Tororo
        Hospital at 11:00 am on Tuesday [18 Aug 2009] after his condition
        deteriorated. A senior nursing officer in Mbale Hospital said
        precautionary measures had been taken. The patient has been isolated
        and access to his room restricted.

        The patient has been bleeding from the nose, mouth and ears since
        admission. He also has blood in his stool and urine. "We took
        laboratory tests and prescribed supportive treatment for haemorrhagic
        fever," said the medic yesterday. The medical staff became concerned
        when the bleeding persisted, although they put the patient on 5
        litres of intravenous fluids, blood transfusion and intensive
        treatment. They stated that more blood samples were taken yesterday
        from the patient and sent to the Uganda Virus Research Institute in
        Entebbe for testing. David Obol, the chief administrator, said the
        hospital had provided medical workers [caring for] the patient with
        protective gear and disinfectants while awaiting the results.

        Yesterday [?18 Aug 2009], the patient was in a pathetic state. He lay
        on bed groaning, blood flowing from his mouth and nose. He was unable
        to talk."Though the patient has all symptoms of Ebola hemorrhagic
        fever, we cannot make conclusive statements until we receive his
        results from the Virus Institute," said the medic. The patient's
        father narrated that his son was 1st treated for malaria in Sudan
        where he had been working as a casual labourer on a construction
        site. 'He 1st developed high fever and sweated profusely. He was put
        on malaria treatment. When he failed to respond to the treatment,
        friends contacted us and we brought him back home for additional
        treatment at Tororo Hospital.' He said they were immediately referred
        to Mbale Hospital. Dr. Sam Zaramba of the Ministry of Health said
        last night [18 Aug 2009] that he had not yet received any report of
        the admission.

        Ebolavirus [belongs to a family of viruses, the _Filoviridae_] a
        group of viruses that cause a haemorrhagic fever for which there is
        no cure. The various symptoms, that can appear suddenly, include
        diarrhoea, fever, fatigue, general pain and severe bleeding. The
        cause of death is usually hypovolemic shock (inadequate blood) or
        organ failure. The virus spreads through contact with bodily fluids
        and tissue of infected people. Ebola haemorrhagic fever has a high
        death rate, claiming between 50 and 90 percent of victims. The only
        way to stop or contain it is through prevention, rapid diagnosis and
        isolation of suspected cases.

        The last outbreak of Ebola haemorrhagic fever was reported in the
        western district of Bundibugyo [Uganda] in December 2007. The disease
        killed 16 people out of the 51 cases that were reported. In an
        ebolavirus outbreak in Gulu 2000, 428 people became infected, 173 of
        whom died.

        [Byline: Daniel Edyegu]

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

        [Uganda has had 2 outbreaks of Ebola haemorrhagic fevers in the past
        with the 1st being in Gulu, northern Uganda, in 2000 and then
        Bundibugyo district, western Uganda, in 2007. Both outbreaks were
        characterized by delays in detecting and confirming the initial
        cases, though both outbreaks were eventually successfully controlled.
        Identification of the initial cases usually delays due to the
        non-specific nature of the initial symptoms which include high fever
        of sudden onset, profuse sweating, malaise, vomiting, diarrhoea, and
        myalgia. There is therefore need for high index of suspicion among
        the health care workers if Ebola haemrrhagic cases are to be detected
        early enough. In the New Vision report the occurrence of bleeding and
        information of travel to Sudan where the last Ebola haemorrhagic
        fever outbreak was reported in Yambio in 2004, increases the degree
        of suspicion.

        There is however need for additional epidemiological information on
        the occurrence of similar symptoms among the patient's co-workers or
        neighbors in Sudan. Ccontact with wildlife should also be considered
        in investigation of the source of the patient's infection.


        For the interactive HealthMap/ProMED map of Mbale in Eastern Uganda see
        <http://healthmap.org/r/00Ib>. - Mod.JFW]

        Comment


        • #5
          Re: Suspected Ebola case in Uganda (ex Sudan)

          Tested negative.



          Tests rule out Ebola in Mbale
          Sunday, 23rd August, 2009 E-mail article Print article

          By Anne Mugisa and Raymond Baguma

          BLOOD samples of the patient admitted in Mbale Hospital suspected of having Ebola have been found free of the virus, the Uganda Virus Research Institute has said.

          The Ministry of Health spokesperson, Paul Kagwa, yesterday said the ministry was investigating other possible diseases the patient, whose name has been with held, might have.

          ?He is still in the hospital and he cannot be released until investigations are complete,? Kagwa said.

          The man was admitted last week after he was referred from Tororo Hospital with suspected Ebola.

          He bled from the mouth, nose, ears and passed blood in his stool and urine, which are all symptoms of the haemorrhagic fever.

          On Friday, the director of clinical services, Dr. Kenya Mugisha, said not all bleeding is caused by Ebola.

          A medical team was dispatched to Mbale to help handle the situation, Dr. Mugisha said.

          He added that the patient was in a stable condition.

          The patient?s relatives said he was first treated for malaria in Sudan where he worked as a casual labourer at a construction site.

          Ebola has a high death rate. The only way to stop or contain it is through prevention, rapid diagnosis and isolation of suspected cases. The last outbreak of the disease was reported in Bundibugyo in 2007.

          The disease killed 16 people out of the 51 cases that were reported.

          In the 2000, an Ebola outbreak in Gulu claimed 173 people of the 428 people who were infected.

          Comment


          • #6
            Re: Suspected Ebola case in Uganda (ex Sudan) - NOT

            With the fact that the patient has been stabilized, and no contacts have been reported as ill, I think it is very likely that he will be negative for all forms of VHF. As we said earlier, there are many things that can look like VHF.

            Someone please send the above article to ProMed.

            Comment


            • #7
              Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

              ProMed's East Africa division just posted the leading article in this thread with an RFI and the followign comments. Can someone please send the article that says the patient tested negative to ProMed?



              [Uganda has had 2 outbreaks of Ebola hemorrhagic fever in the past,
              the 1st in Gulu, northern Uganda in 2000 and the 2nd in Bundibugyo
              district, western Uganda in 2007. Both outbreaks were characterized
              by delays in detecting and confirming the initial cases, though both
              outbreaks were eventually successfully controlled.

              Identification of the initial cases is usually delayed because of the
              non-specific nature of the initial symptoms, which include high fever
              of sudden onset, profuse sweating, malaise, vomiting, diarrhoea, and
              myalgia. There is therefore need for high index of suspicion among
              the health care workers if cases of ebolavirus infection are to be
              detected early enough.

              In the newswire the occurrence of bleeding and information of
              international travel to Sudan where the last ebolavirus disease
              outbreak was reported in Yambio in 2004, increases the degree of
              suspicion. Good enough that all precautionary measures have been
              taken to limit nosocomial transmission and that the lab
              investigations are already underway to confirm the disease. There is,
              however, need for additional epidemiological information on the
              occurrence of similar symptoms among the co-workers or neighbors in
              Sudan; contact with wildlife or sick associates; and the current
              plans for contact identification/follow-up and community sensitization.

              Mbale, in Eastern Uganda, can be located on the HealthMap/ProMED-mail
              interactive map at http://healthmap.org/r/00If. - Mod.JFW]

              [see also:
              Marburg virus, Egyptian fruit bat ? Uganda 20090802.201034]

              [For additional background information on hemorrhagic fever,
              available from the general ProMED-mail list, the postings below can
              be found at
              http://www.promedmail.org. - Mod.JFW]

              Comment


              • #8
                Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

                Thank you to whoever sent the negative result to ProMed. Promed has just issued this. While it doesn't cite FT directly, it is clear (at least to me) that it is FT that inspired this second posting. Two postings like this just hours apart is unusual for ProMed.



                ProMED-EAFR:East Africa

                Most Recent Alert
                View printable version
                Published Date
                2009-08-25 10:46:30
                Subject
                PRO/EAFR> Ebola hemorrhagic fever - Uganda (02): (Mbale) NOT
                Archive Number
                20090825.201424
                Full Text
                EBOLA HEMORRHAGIC FEVER - UGANDA (02): (MBALE) NOT
                **************************************************
                Date: Sun 23 Aug 2009
                Source: The New Vision (Uganda) [edited]



                Tests rule out [ebolavirus] in Mbale, Uganda
                --------------------------------------------
                Blood samples of the patient admitted in Mbale Hospital suspected of
                having an [ebolavirus infection] have been found free of the virus,
                the Uganda Virus Research Institute has said.

                The Ministry of Health spokesperson, Paul Kagwa, yesterday [22 Aug
                2009] said the ministry was investigating other possible diseases the
                patient, whose name has been withheld, might have. "He is still in
                the hospital and he cannot be released until investigations are
                complete," Kagwa said.

                The man was admitted last week [week of 17 Aug 2009] after he was
                referred from Tororo Hospital with suspected ebolavirus disease. He
                bled from the mouth, nose, ears, and passed blood in his stool and
                urine, which are all symptoms of the haemorrhagic fever.

                On Friday [21 Aug 2009], the director of clinical services, Dr Kenya
                Mugisha, said not all bleeding is caused by [ebolavirus].

                A medical team was dispatched to Mbale to help handle the situation,
                Dr Mugisha said. He added that the patient was in a stable condition.

                The patient's relatives said he was first treated for malaria in
                Sudan where he worked as a casual labourer at a construction site.

                [Ebolavirus disease] has a high death rate. The only way to stop or
                contain it is through prevention, rapid diagnosis, and isolation of
                suspected cases. The last outbreak of the disease was reported in
                Bundibugyo in 2007. The disease killed 16 people out of the 51 cases
                that were reported.

                In 2000, an Ebola disease outbreak in Gulu claimed the lives of 173
                of the 428 people who were infected.

                [Byline: Anne Mugisa, Raymond Baguma]

                --
                Communicated by:
                ProMED-EAFR


                [Following the lab investigations, which ruled out Ebola hemorrhagic
                fever, there is need to investigate other possible causes.
                Shigellosis and other bacterial enteric infections are possible.
                Shigellosis patients usually present with fever and bloody mucoid
                diarrhoea among other symptoms. A search for possible sites of
                bacterial infection, together with cultures and blood smears, should
                be made. Presence of leucocytosis distinguishes bacterial infections.

                Typhoid fever is another possibility that can be confirmed by doing
                blood and stool cultures. Blood smears for malaria parasites are
                essential given that this is a malaria endemic area. Yellow fever and
                other _Flaviviridae_ present with hemorrhagic complications. Virus
                isolation and serological investigation serves to distinguish these
                viruses. Other diseases like viral hepatitis, leptospirosis,
                rheumatic fever, typhus, and mononucleosis produce signs and symptoms
                that may be confused with ebolavirus disease in the early stages of infection.

                For the interactive HealthMap/ProMED map of Mbale in Eastern Uganda
                see http://healthmap.org/r/00If. - Mod.JFW]


                [see also:
                Ebola hemorrhagic fever - Uganda: (Mbale) RFI 20090825.201420
                Marburg virus, Egyptian fruit bat - Uganda 20090802.201034


                For additional background information on hemorrhagic fever, available
                from the general ProMED-mail list, the postings below can be found at
                http://www.promedmail.org. - Mod.JFW]


                Undiagnosed fatalities - Congo DR: (BC), hem fever susp, RFI 20090626.2326
                Ebola hemorrhagic fever - Congo DR (08): (KS), WHO 20090218.0668
                Ebola hemorrhagic fever - Congo DR (07): (KS) 20090202.0462
                Ebola hemorrhagic fever - Congo DR (06): (KS) 20090124.0315
                Ebola hemorrhagic fever - Congo DR (05): (KS) 20090115.0173
                Ebola hemorrhagic fever - Congo DR (04): (KS) 20090114.0159
                Ebola hemorrhagic fever - Congo DR (03): (KS) 20090111.0113
                Ebola hemorrhagic fever - Congo DR (02): (KS) 20090108.0082
                Ebola hemorrhagic fever - Congo DR: (KS), WHO 20090102.0013
                2008
                ----
                Ebola hemorrhagic fever - Congo DR (03): (KS) 20081231.4133
                Ebola hemorrhagic fever - Congo DR: (KS), WHO 20081227.4086
                Undiagnosed illness - Congo DR (02): (KS), Ebola conf. 20081225.4068
                Undiagnosed illness - Congo DR: (Kasai) RFI 20081222.4027
                Undiagnosed illness - Congo DR: Kasai Occ, Ebola susp, RFI 20081009.3200
                Hemorrhagic fever, fatal - Congo DR: (KA), RFI 20080823.2630
                Ebola hemorrhagic fever, suspected - Congo DR (02) 20080702.2017
                Ebola hemorrhagic fever - Congo DR: susp., corr. 20080604.1790
                Ebola hemorrhagic fever - Congo DR: susp., corr. 20080604.1789
                Ebola hemorrhagic fever - Congo DR: susp. 20080603.1779
                Hemorrhagic fever, fatal - Congo DR: (KA), RFI 20080823.2630
                2007
                ----
                Ebola hemorrhagic fever - Congo DR (13): 20071121.3758
                Ebola hemorrhagic fever - Congo DR 20070910.2996
                Undiagnosed illness - Congo DR (Kasai Occidental): WHO, RFI 20070901.2882
                Viral hemorrhagic fever - Congo DR (Kasai Occidental): susp. 20070829.2837
                2006
                ----
                Ebola, primates - Congo Rep.: 20061208.3462
                Ebola hemorrhagic fever - Congo DR: susp. 20060315.0806
                2005
                ---
                Marburg hemorrhagic fever - Angola (54) 20051108.3269
                Marburg Hemorrhagic fever - Angola: confirmed 20050322.0831
                Undiagnosed hemorrhagic fever - Angola (05) 20050322.0827
                Undiagnosed hemorrhagic fever - Angola: RFI 20050315.0751
                2002
                ----
                Marburg hemorrhagic fever - Congo, DR 20020322.3799
                2001
                ----
                Viral hemorrhagic fever, suspected - Congo, DR (03) 20011210.2991
                2000
                ----
                Marburg hemorrhagic fever - Congo, DR (06) 20000331.0477
                Marburg hemorrhagic fever - Congo, DR 20000212.0194
                1999
                ----
                Marburg hemorrhagic fever - Congo, DR (04) 19991209.2137
                Marburg hemorrhagic fever - Congo, DR 19990915.1641]
                ...................................jfw/mj/be

                _______________________________________________
                ProMED-EAFR mailing list
                ProMED-EAFR@promedmail.org

                Comment


                • #9
                  Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

                  And ProMed posting #2. Note the bold text. I think the moderator is a bit confused. Marburg virus is not endemic to Sudan, and there is no evidence the patient was in Uganda within three weeks of being ill.

                  Also, Marburg is spread the same way as Ebola, so there likely would have been other cases in contacts, something that did not occur (as far as we can tell).



                  Archive Number 20090831.3061
                  Published Date 31-AUG-2009
                  Subject PRO/AH/EDR> Ebola hemorrhagic fever - Uganda (02): (ME), NOT, RFI


                  EBOLA HEMORRHAGIC FEVER - UGANDA (02): (MBALE), NOT, 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: Sun 23 Aug 2009 [the delay in posting is regretted - ProMED]
                  Source: The New Vision (Uganda) [edited]
                  <http://www.newvision.co.ug/D/8/13/692236>


                  Tests rule out Ebola [hemorrhagic fever] in Mbale
                  -------------------------------------------------
                  Blood samples of the patient admitted to Mbale Hospital suspected of
                  having Ebola hemorrhagic fever have been found free of the virus, the
                  Uganda Virus Research Institute has reported [see ProMED-mail post
                  Ebola hemorrhagic fever - Uganda: (ME), susp. 20090821.2962].

                  The Ministry of Health spokesperson, Paul Kagwa, yesterday [22 Aug
                  2009] said the Ministry was investigating other possible diseases the
                  patient, whose name has been withheld, might have. "He is still in the
                  hospital and he cannot be released until investigations are complete,"
                  Kagwa said.

                  The man was admitted last week [week of 17 Aug 2009] after he was
                  referred from Tororo Hospital with suspected Ebola hemorrhagic fever.
                  He bled from the mouth, nose, ears and passed blood in his stool and
                  urine, which are all symptoms of hemorrhagic fever.

                  On Friday [21 Aug 2009], the director of clinical services, Dr Kenya
                  Mugisha, said not all bleeding is caused by ebolaviruses. A medical
                  team was dispatched to Mbale to help handle the situation, Dr Mugisha
                  said. He added that the patient was in a stable condition. The
                  patient's relatives said he was first treated for malaria in Sudan,
                  where he worked as a casual laborer at a construction site.

                  Ebola hemorrhagic fever has a high death rate. The only way to stop or
                  contain it is through prevention, rapid diagnosis, and isolation of
                  suspected cases. The last outbreak of the disease [in Uganda] was
                  reported in Bundibugyo in 2007 [see ProMED archives listed below]. The
                  disease killed 16 people out of the 51 cases that were reported. In
                  2000, an ebolavirus outbreak in Gulu claimed 173 people of the 428 who
                  were infected.

                  [Byline: Anne Mugisa, Raymond Baguma)

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

                  [ProMED would be interested to know the final diagnosis. A likely
                  possibility is Marbug virus -- see ProMED refs. below.

                  A location map of Uganda is at:
                  <http://www.globaldiscipleship.net/uganda-map.jpg>
                  A map showing Mbale town & district on the Kenya border is at:
                  <http://www.richardsilverstein.com/tikun_olam/uganda&#37;20map.gif>
                  - Mod.JW]

                  [see also:
                  Ebola hemorrhagic fever - Uganda: (ME), susp. 20090821.2962]
                  2008
                  ----
                  Ebola hemorrhagic fever - Uganda (06): (Bundibugyo), new species 20081121.3675
                  Ebola hemorrhagic fever - Uganda (03): Arua, susp 20080122.0275
                  Ebola hemorrhagic fever - Uganda: (Bundibugyo) 20080104.0050
                  Marburg hemorrhagic fever - The Netherlands ex Uganda (02) 20080711.2115
                  Marburg hemorrhagic fever - The Netherlands ex Uganda 20080710.2107
                  Ebola hemorrhagic fever - Uganda (04): (Bundibugyo), WHO 20080221.0704
                  Ebola hemorrhagic fever - Uganda: (Bundibugyo) 20080104.0050
                  2007
                  ----
                  Hemorrhagic fever - Uganda (02): (Bundibugyo), Marburg NOT 20071116.3718
                  Ebola hemorrhagic fever - Uganda (11): (Bundibugyo) 20071215.4031
                  Ebola hemorrhagic fever - Uganda: (Bundibugyo), WHO 20071130.3869
                  Hemorrhagic fever - Uganda (04): (Bundibugyo), Ebola confirmed 20071130.3859
                  Viral hemorrhagic fever - Uganda (Kamwenge): Marburg conf. 20070801.2490
                  ........................................cp/mj/jw

                  Comment

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