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ProMed:UNDIAGNOSED ILLNESS - MEXICO: (SAN LUIS POTOSI) REQUEST FOR INFORMATION

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  • ProMed:UNDIAGNOSED ILLNESS - MEXICO: (SAN LUIS POTOSI) REQUEST FOR INFORMATION

    Source: ProMed
    http://www.promedmail.org/pls/otn/f?...3A1000%2C89417



    Archive Number 20110720.2190
    Published Date 20-JUL-2011
    Subject PRO/AH/EDR> Undiagnosed illness - Mexico: (SL) RFI
    UNDIAGNOSED ILLNESS - MEXICO: (SAN LUIS POTOSI) REQUEST FOR
    INFORMATION
    ************************************************** *********************
    A ProMED-mail post
    <http://www.promedmail.org>
    ProMED-mail is a program of the
    International Society for Infectious Diseases
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    Date: Sat 16 Jul 2011
    From: Christian A Garcia-Sepulveda <https://www.genomica.uaslp.mx>
    [edited]


    Three of 6 young Mexican mestizo civil engineers between 19 and 21
    years of age remain hospitalized (day +8) due to a febrile illness
    accompanied by muscle pain and spasms following contact with bats and
    their guano in the state of San Luis Potosi, Mexico. The 6 engineers
    were reported to have been working for ICA (a private engineering
    company contracted by the state government of San Luis Potosi, Mexico)
    cleaning road gullies and drainage channels/tunnels in the highway
    connecting Rayon and Tamasopo (roughly 21 deg 51'50.74" N, 99 deg
    29'34.09" W). 3 of the men are being attended at the Zonal General
    Hospital IMSS [Mexican Social Security Institute] no 2 in the state
    capital of San Luis Potosi and maintained in isolation. The
    whereabouts of the 3 other men has not been disclosed.

    --
    Christian A. Garcia-Sepulveda MD PhD
    Viral and Human Genomics Laboratory
    Facultad de Medicina - Universidad Autonoma San Luis Potosi (UASLP)
    Mexico
    <https://www.genomica.uaslp.mx>

    [The 3 patients described above were reported to have fever and
    muscle pain after working in drainage tunnels and having contact with
    bats and their guano; no mention was made of contact with other
    rodents, although this is a possibility. Acute undifferentiated
    febrile illnesses, that is, occurring in the absence of an obvious
    focus of infection, have several possible etiologies that vary with
    the geographic region in which they occur (1-3). Some are
    rodent-associated, such as, leptospirosis, _Hantavirus_ infection,
    _Bartonella_ infection, tularemia, and murine typhus. Specifically,
    infections with _Leptospira_, _Hantavirus_, and _Bartonella_ have been
    associated with bats (4-6). Also, _Histoplasma capsulatum_, the cause
    of histoplasmosis, grows in soil contaminated with bat guano. Other
    possible etiologies include scrub typhus, dengue, chikungunya,
    malaria, brucellosis, enteric fever, and melioidosis.

    The clinical manifestations and the epidemiological features of
    _Hantavirus_ infection and leptospirosis can be strikingly similar
    (7). Rodent-associated _Bartonella_ has been identified as causing
    acute febrile illness in immunocompetent adults in the rural
    southwestern United States (8). Tularemia and leptospirosis can be
    acquired from contact with water contaminated by the urine of infected
    hosts; melioidosis is also acquired by contact with contaminated
    water. However, melioidosis is usually endemic in parts of Southeast
    Asia and northern Australia, although sporadic cases of melioidosis
    are reported to have been acquired in Central and South America (9).
    Scrub typhus is restricted to a region that extends from northern
    Japan and far-eastern Russia in the north, to northern Australia in
    the south, and to Pakistan and Afghanistan in the west.

    Muscle spasm following bat exposure raises the issue of rabies.
    Patients may be unaware of bites by some rabid animals, such as bats.
    However, onset of symptoms of rabies usually occurs several weeks to
    more than a year after an animal bite, although may be as short as
    several days in some patients. A more detailed description of the
    clinical manifestations, epidemiology, and laboratory data is clearly
    needed.

    1. Manock SR, Jacobsen KH, de Bravo NB, et al: Etiology of acute
    undifferentiated febrile illness in the Amazon basin of Ecuador. Am J
    Trop Med Hyg. 2009; 81(1): 146-51. Available at
    <http://www.ajtmh.org/content/81/1/146.long>.
    2. Suttinont C, Losuwanaluk K, Niwatayakul K, et al: Causes of acute,
    undifferentiated, febrile illness in rural Thailand: results of a
    prospective observational study. Ann Trop Med Parasit. 2006; 100 (4):
    363-70. Available at
    <http://www.ingentaconnect.com/content/maney/atmp/2006/00000100/00000004/art00008>.
    3. Chrispal A, Boorugu H, Gopinath KG, et al: Acute undifferentiated
    febrile illness in adult hospitalized patients: the disease spectrum
    and diagnostic predictors - an experience from a tertiary care
    hospital in South India. Tropical Doctor 2010; 40 (4): 230-4. Abstract
    available at
    <http://td.rsmjournals.com/cgi/content/abstract/40/4/230>.
    4. Matthias MA, Diaz MM, Campos KJ, et al: Diversity of
    bat-associated _Leptospira_ in the Peruvian Amazon inferred by
    bayesian phylogenetic analysis of 16S ribosomal DNA sequences. Am J
    Trop Med Hyg. 2005; 73(5): 964-74. Available at
    <http://www.ajtmh.org/content/73/5/964.long>.
    5. Kim GR, Lee YT, Park CH: A new natural reservoir of hantavirus:
    isolation of hantaviruses from lung tissues of bats. Arch Virol. 1994;
    134(1-2): 85-95. Abstract vailable at
    <http://www.ncbi.nlm.nih.gov/pubmed/8279962>.
    6. Reeves WK, Rogers TE, Durden LA, Dasch GA: Association of
    _Bartonella_ with the fleas (_Siphonaptera_) of rodents and bats using
    molecular techniques. J Vector Ecol. 2007; 32(1): 118-22. Abstract
    available at <http://www.ncbi.nlm.nih.gov/pubmed/17633432>.
    7. Clement J, Neild G, Lemos Hinrichsen S, et al: Urban leptospirosis
    versus urban hantavirus infection in Brazil. Lancet 1999; 354(9194):
    2003-4. Available at
    <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)76782-9/fulltext>.
    8. Iralu J, Y Bai, L Crook, et al: Rodent-Associated _Bartonella_
    Febrile Illness, Southwestern United States. Emerg Infect Dis 2006;
    12(7): 1081-6. Available at
    <http://www.cdc.gov/ncidod/eid/vol12no07/pdfs/04-0397.pdf>.
    9. Inglis TJ, Rolim DB, De Queroz Sousa A: Melioidosis in the
    Americas. Am J Trop Med Hyg. 2006; 75 (5): 947-54. Available at
    <http://www.ncbi.nlm.nih.gov/pubmed/17123994>.

    Mestizo is a term used to describe people of mixed European and
    Native American descent. San Luis Potosi, one of the 31 states which,
    with the Federal District, comprise the 32 Federal Entities of Mexico
    is located in North-Central Mexico. San Luis Potosi can be located on
    a map of Mexico at
    <http://en.wikipedia.org/wiki/File:San_Luis_Potos%C3%AD_en_México.svg>
    and on an HealthMap/ProMED-mail interactive map at
    <http://healthmap.org/r/00ap>. - Mod.ML]

    .................................................m l/mj/mpp
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