Brazil: Two siblings die of 'mysterious' disease - Invasive Strep pyogenes infection confirmed - several additional fatalities reported

[tetano]

A 28-year resident of San Carlos, 213 km from Sao Paulo, is admitted to the Intensive Care Unit (ICU) of the Holy House with the same symptoms of unknown disease that killed two brothers who lived within the municipality. Symptoms are fever, spots in the body, cough, sore throat and breathing difficulties - the same Brisolari presented by Andrew, 31, and Alessandra Brisolari, 39, died earlier this month. The information is the newspaper Folha de S. Paul.

According to the Secretary of Health of S?o Carlos, Artur Pereira, state of the patient, who was not named, is serious but stable. She was breathing without the help of devices and should be observed. In the city, all health services have been warned to warn about other cases. The Epidemiological studies performed in women referred to the Instituto Adolfo Lutz - the diagnosis must be filed within 30 days.
She was treated with antibiotics and drugs indicated for the H1N1 virus that causes influenza A. About the deaths, Pereira said that initial tests have ruled out meningitis, dengue hemorrhagic fever, hantavirus, yellow fever, spotted fever, leptospirosis and the H1N1 virus. The city urged people to avoid poorly ventilated environments

http://noticias.terra.com.br/brasil/noticias/0,,OI5367745-EI306,00-SP+mulher+e+infectada+por+doenca+misteriosa+em+Sao+Carlos.html

[Ronan Kelly]

Re: 3 rd woman is infected with 'mysterious' disease in San Carlos

The earlier cases;

There was [not] meningitis that killed the brothers Andrew and Alessandra Brisolari


In a statement released at the end of Monday morning, 12, the Municipal Health Secretary, ruled out meningitis as the cause of the deaths of Andrew and Alessandra Brisolari. On Friday, 09, told a news conference, Secretary of Health of S?o Carlos, Arthur Pereira, had away dengue hemorrhagic fever, leptospirosis, hantavirus, or yellow fever as a cause of death.

So far the Health Department did not rule out the flu, or H1N1.

Below is the statement issued by the City of San Carlos

The Municipal Secretariat of Health, through the Monitoring Committee, announces that, according to the analysis of laboratory tests, the "meningitis" was also removed as the probable cause of death of the brothers Andr? and Alessandra Brisolari Brisolari. In last Friday (9) had already been discarded Dengue, Dengue Hemorrhagic Fever, Yellow Fever, Hantavirus and Leptospira.

People directly involved with the acute febrile syndrome who had mild to moderate clinical manifestations are in good general health, but remained under observation.

The Monitoring Committee also emphasizes that so far (September 12 - 11am) there is no report of new cases.

The Committee reinforces the public to step up care of basic hygiene, like washing hands before meals and do not put your hands in your mouth or eyes, drawing attention to the symptoms such as fever, red spots on the body and, especially, lack of air. In this case, look for a Health Unit

San Carlos, September 12, 2011.

City of San Carlos

Municipal Health

http://www.portalnews.net.br/sao-carlos/5165-nao-foi-menigite-que-matou-os-irmaos-andre-e-alessandra-brisolari.html

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Another earlier article.

http://eptv.globo.com/noticias/NOT,3,3,367781,Saude+investiga+morte+de+estudante+de+doutorado+da+USP+Sao+Carlos.aspx

Health investigates the death of a doctoral student at USP
Dengue fever or symptoms suggest meningitis, his sister is in a coma
08/09/2011 - 19:02

from the Newsroom
Change font size A + A-


Updated at 12h54 the day 9 / 9

The Municipal Secretariat of Health is investigating the causes of death of a doctoral student at USP, on the morning of Thursday (8), in S?o Carlos. According to the city, the symptoms suggest that Brisolari Andrew, 31, may have been the victim of dengue fever or meningitis.

According to relatives, his sister was hospitalized in a coma with the same symptoms. The student body was taken to the Death Verification Service of the State Hospital Am?rico Brasiliense. The autopsy has been performed and the result of the report of the Institute Adolfo Lutz will leave within a month.

The press office said the city Surveillance went to the home of the victim and locked it possible breeding sites of mosquito that transmits dengue. The shares will only be taken against meningitis after the release of test results.

Brisolari The funeral is scheduled for this Friday (9) at 9am

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Assuming they are correct as to everything they have excluded, I wonder if they have tested for plague. There are also several viral hemorragic fevers that are very rare but native to South America. The "spots in the body" may make flu less likely.

Please send this one to ProMED...

http://eptv.globo.com/noticias/NOT,3,3,370159,Em+meio+a+mortes+sem+explicacao+secretario+de+Saude+Artur+Pereira+deixa+o+cargo+em+Sao+Carlos.aspx

In the midst of yet unexplained deaths, health secretary leaves office
Official announcement will be made on Monday (26) by Mayor Oswaldo Barba
23/09/2011 - 15:00

From the Newsroom
Change font size A + A-


After four years, the Secretary of Health of São Carlos, Artur Pereira, will resign on Monday (26). The official announcement will be made by Mayor Oswaldo Barba.

Pereira was appointed in 2007 and left the folder at a delicate time, as the city awaits the report of the Institute Adolfo Lutz on the causes of the deaths of two brothers this month. A third person is admitted to the Intensive Care Unit (ICU) of the Holy House of the city with similar symptoms.

Artur Pereira is a professor of Medicine, Federal University of São Carlos (UFSCar) and must return to teaching. The name of the new secretary has not yet been confirmed.

Deaths

In an interview with regional newspaper on Wednesday (21), Patel has advised that all patients who had progression of symptoms of fever, cough or associated with spots by the body and neck pain, which were not resolved within four days, they need being under observation.

Also according to the secretary, all health services in the municipality and private are on alert for cases that are not experiencing a rapid evolution, are investigated and, if necessary, there is a hospital for observation.

The Epidemiological Investigation Committee, created after the deaths, not yet identified whether the disease was caused by a bacteria or a virus. The City Council ruled that meningitis, dengue hemorrhagic fever, hantavirus, or yellow fever may [not] have caused the death of Brisolari brothers Andrew, 31, and Alessandra Brisolari, 39, on Sept. 8.

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

http://www.jornalacidade.com.br/editorias/cidades/2011/09/22/paciente-sofre-de-doenca-misteriosa-em-sao-carlos.html

Thursday, September 22, 2011 - 23h47

Patient suffers from mysterious illness in San Carlos
Symptoms are fever, spots in the body, cough, sore throat and difficulty breathing; brothers died earlier this month

A resident of San Carlos, 28, is admitted to the ICU of Santa Casa of the city with the same symptoms of unknown disease that killed two brothers who lived in the city.

Symptoms are fever, spots in the body, cough, sore throat and breathing difficulties - the same Brisolari presented by Andrew, 31, and Alessandra Brisolari, 39, died earlier this month.

According to Secretary of Health of S?o Carlos, Artur Pereira, state of the patient, who was not named, is serious, but stable.

[Giuseppe]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Source: Globo, automatic translation from Portuguese to English: http://eptv.globo.com/noticias/NOT,3...ao+Carlos.aspx


Woman is in ICU with the same symptoms of siblings who died

Causes of death are still investigated by the commission; Two suspected cases were discarded

21/09/2011 - 20:59 EPTV


A woman is admitted to the Intensive Care Unit (ICU) of the Santa Casa de S?o Carlos with the same symptoms of the brothers who died for 13 days in the city, according to Health Secretary, Arthur Pereira. The causes of death are still unknown and being investigated by a commission.

According to Pereira, all patients who had progression of symptoms of fever, cough or associated with spots by the body and neck pain, which were not resolved within four days, must be under observation. "We have an adult in the ICU for observation, but without pulmonary involvement, without shortness of breath, which is an important warning signal from these symptoms," he said.

Also according to the secretary, all health services in the municipality and private are on alert for cases that are not experiencing a rapid evolution, are investigated and, if necessary, there is a hospital for observation.

The Epidemiological Investigation Committee, created after the deaths, not yet identified whether the disease was caused by a bacteria or a virus. "If the reported symptoms appear, you need to seek a health service. It is important to hand hygiene and be careful at the contact between people, "warned the secretary.

Death

The City Council ruled that meningitis, dengue hemorrhagic fever, hantavirus, or yellow fever may have caused the death of Brisolari brothers Andrew, 31, and Alessandra Brisolari, 39, on Sept. 8.

Andrew was sick about 15 days before he died. He was hospitalized on 7 and died the next morning. His sister, Alessandra Brissolari, 39, died with the same symptoms after 16 hours.

The City of San Carlos said that the self-medication with antibiotics may have worsened the health of children. The award of the Institute Adolfo Lutz due out in October.

The two brothers lived with their father in a house in the Southern Cross Garden Alessandra worked in the Department of Finance of the Municipal Health and Andr? in a chemical laboratory at USP, where she was studying doctorate, and as a teacher Sesi.

-
------

[Giuseppe]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

I wonder whether measles is possibly circulating in the area.

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

I wonder whether measles is possibly circulating in the area.

Interesting idea. "Spots" on the body might mean a lot of different things. It would help if they published a picture...

It appears the first two fatalities may have presented late in the illness, with the report that one of them had already been ill for 15 days. Whatever agent caused their illness might be long gone by the time they were tested. There do appear to have been at least a handful of milder cases that have been "discarded" as due to the mystery disease. The most recent case seems to have no pulmonary involvement.

[Ronan Kelly]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Up until August, 18 cases of measles had been confirmed in Brazil, seven of whom had a travel history to Europe.

http://portal.saude.gov.br/portal/arquivos/pdf/nota_tecnica_cgdt_cgpni_8_2011.pdf

Brazil then undertook a massive vaccination campaign which has been extended to Sep 30;



16/09/2011, at 23.40

Immunization against measles is extended until 30 days


Children should be vaccinated with more than one and less than seven years in all municipalities of the states that have not reached the goal

The follow-up vaccination campaign against measles, expected to close on Friday (16), was extended until the 30th of this month. So far, more than 16 million children under the age of one to seven years, were immunized against the disease throughout the country. The figure represents 94.70% of the target audience, which is 17,094,514. The goal is to vaccinate 95% of this age. (Check out the results of vaccination below)

Children should be vaccinated with more than one and less than seven years, all municipalities in the states that have not reached the goal. Of the eight states (SP, MG, RJ, RS, PE, BA, CE and AL) who started the campaign in the first phase, June 18, Bahia has only an extension of the campaign. The vaccine is the only way to protect against measles. Even children who have already taken the vaccine should be immunized again.

The Secretary of Health Surveillance, Ministry of Health, Jarbas Barbosa, explains that the extension of the campaign will allow state managers to identify the municipalities that have not reached the goal to intensify the campaign in these locations. "It is important that all children are vaccinated against measles for this disease does not return to circulation in the country," said the secretary.

The head of the National Immunization Program (NIP), Carla Domingues, states with low rates of immunization are more vulnerable to disease outbreaks, particularly those with large influx of tourists. She notes that in many countries measles is still an endemic disease. "If the importation of cases, there may be transmission of the virus. So it is very important that all states reach the goal set by the Ministry of Health, "he noted.

Investment-The Ministry of Health invested R $ 146.7 million in the purchase and distribution of doses, needles and syringes (the vaccine is injected) and passed an additional $ 16.3 million to states and municipalities to organize the campaign in the municipalities in two stages of the campaign.

The vaccination campaign against measles occurs every three to five years to strengthen the protection of children against disease and keep Brazil no widespread transmission of the virus. Planned for 2011, the campaign took place throughout the country, the second phase of vaccination against polio, Aug. 13. But with the outbreak of measles in Europe, the Ministry of Health, along with states and municipalities, decided to anticipate the action in priority areas.

Symptoms - Measles is an acute, highly contagious. The most common symptoms are fever, dry cough, rash (red spots), runny nose and conjunctivitis. Transmission occurs from person to person through secretions expelled by the patient to cough, speak or breathe. The transmission period ranges from four to six days before the onset of the rash until four days after the appearance of stains. The vaccine is the most effective means of prevention.

History-The measles vaccine is now used in Brazil in the mid-1960s, though without a continuity plan. The disease, introduced by settlers in the discovery of the Americas, was responsible for epidemic and high child mortality in association with malnutrition. Between 1969 and 1971 was the main cause of death in children between one and four years of age in Latin America, according to a study conducted by PAHO. In the 70s, in Brazil, the mortality was 5% of the infected. From 90 years, the vaccination strategy was reinforced, reaching over 95% coverage in the last decade, with the adoption in the country of MMR vaccine for children aged one year. In 2010, the Ministry of Health requested PAHO (Pan American Health Organization) certification of disease-free country.

In 2011, until July 19, states and municipalities to the Ministry of Health reported the occurrence of 18 cases of measles in Brazil, associated virus type 4-D, which circulates in Europe. The words, they are imported cases. The cases were reported in the states of Rio Grande do Sul (7), Rio de Janeiro (4), Sao Paulo (3), Bahia (1), Mato Grosso do Sul (1), Piau? (1) and the Federal District ( 1). Importantly, since 2000, the virus does not circulate in wild country.

Results of vaccination UF


UF
Total

Goal
Doses
Cob.

AC
96,800
80,065
82.71

AM
453,769
347,795
76.65

AP
84,288
68,672
81.47

PA
901,061
725,299
80.49

RO
158,411
136,623
86.25

RR
57,869
41,701
72.06

TO
151,189
141,492
93.59

NORTH
1,903,387
1,541,647
80.99

AL
335,015
323,570
96.58

BA
1,324,102
1,253,929
94.7

EC
791,360
771,819
97.53

MA
783,657
671,311
85.66

PB
356,449
334,653
93.89

PE
841,379
848,674
100.9

PI
307,711
287,763
93.52

RN
292,200
269,950
92.39

SE
207,638
202,556
97.55

NORTHEAST
5,239,511
4,964,225
94.75

ES
302,240
294,172
97.33

MG
1,580,409
1,594,991
100.9

RJ
1,235,980
1,192,846
96.51

SP
3,339,134
3,359,529
100.6

SOUTHEAST
6,457,763
6,441,538
99.75

PR
879,743
823,866
93.65

RS
805,694
802,475
99.6

SC
499,305
482,419
96.62

SOUTH
2,184,742
2,108,760
96.52

DF
236,967
224,913
94.91

GO
539,567
503,660
93.35

MS
234,108
216,880
92.64

MT
298,474
252,306
84.53

C. WEST
1,309,116
1,197,759
91.49

BRAZIL
17,094,519
16,253,929
95.08

http://portal.saude.gov.br/portal/aplicacoes/noticias/default.cfm?pg=dspDetalheNoticia&id_area=1498&CO_NOTICIA=13300

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

That probably makes measles very unlikely. With only 11 indigenous cases in the entire country for the year, the chance that there are enough undetected cases in that area this month to have three severe ones like that is low.

Given the wide range of excluded diagnoses and the sparse description of the illness, there just isn't enough information here to take much of a guess. There is quite a wide range of illnesses that have been reported from Brazil as "undiagnosed" in ProMED posts of previous years. It is not even clear to me that this is all one illness; the most recent case seems to have a different presentation and no respiratory symptoms.

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

There is apparently a large chickenpox outbreak going on in the schools in Sao Carlos, but it is not clear if this is related:

http://eptv.globo.com/noticias/NOT,3,3,370070,Com+surto+de+catapora+em+6+escolas+notificacoes+superam+as+de+2010+em+Sao+Carlos.aspx

Chickenpox in adults can produce respiratory complications, but it is not clear if you would have three such severe cases in a short time period, and the chickenpox rash is quite distinctive...

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Two weeks old, but more symptomatic detail (adds vomitting) and no mention of the rash. There may also be a milder case mentioned here. This sounds more flu-like; perhaps the tests came back negative because of the late sampling.

http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=pt&tl=en&u=http://eptv.globo.com/noticias/NOT,3,3,367896,Irma%2Bde%2Bestudante%2Bde%2Bdoutorado%2Bda%2BUSP%2Btambem%2Bmorre%2Bcom%2Bmesmos%2Bsintomas%2Bem%2BSao%2BCarlos.aspx&usg=ALkJrhg-5Bq3OxuWSeVaFOt_dAUUKcYLSA

Sister doctoral student at USP also dies with the same symptoms
Health is investigating the case, symptoms suggest meningitis or dengue
09/09/2011 - 11:09 09/09/2011 - 11:09

Updated at 17:50

The sister of college students doctorate at USP, who died on Thursday morning (8) , died with similar symptoms in the Santa Casa de São Carlos, at around 23.30 on Thursday. Brissolari Andrew, 31, who was also professor of chemistry at Sesi, may have been the victim of dengue fever or meningitis, according to city officials.

Brissolari Alessandra, 39, worked in the Department of Finance of the Municipal Health and was the brother of the same symptoms, fever and flu. The boy's body underwent an autopsy at the Death Verification Service of the State Hospital Américo Brasiliense. The result of the report comes out three to four weeks.

The boy's body was buried at 9:30 this Friday. The sister will be buried at 13:30 in Our Lady of Mount Caramel Cemetery. The press office of the City of San Carlos said it will manifest itself on the afternoon of Friday, at a news conference.

Worry

The parents are worried because they do not know what caused the deaths. "The medical staff was unable to know by now what happened. If it was a bacteria, you need to take drug or vaccine to protect themselves," said the cousin of the victims Edmilson Biondi.

Decicino Daniele, who also is a cousin of the victims, said he had contact with the two brothers on Monday (5). "I came to their house and Alessandra said he was like a nursing home because everyone was cold. Andre was having a relapse of the flu and did not stop anything in his stomach," he said.

Afraid of being ill, on Thursday (8) Daniele sought a health and epidemiological surveillance to ask directions. "It would need to await the report of the examination and autopsy of Alessandra and Andrew had nothing to be done."

The press office said the city was the Epidemiological Monitoring of the victims to the house and locked it possible breeding sites of mosquito that transmits dengue. The shares will only be taken against meningitis after the release of test results.

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Apparently, several contacts may have had a milder illness...

http://www.afolha.com.br/noticias.php?noticia=3062

13/09/2011 - 00h00

Brisolari: Meningitis is ruled out as cause of death of siblings


By Marco Rogério / Photo: San Carlos Now



Municipal Health Department has issued a statement announcing that more than one pathology was ruled out as the cause of family tragedy


Meningitis was ruled out yesterday as the death of the brothers Andrew and Alessandra Brisolari through a statement issued by the Municipal Health, the Monitoring Committee. According to the analysis of laboratory tests, the statement said, the "meningitis" was also removed as a condition that likely would have caused the deaths of the brothers who had fever, throat infection and blemishes in the body. In last Friday (9) the municipal secretary of Health, Artur Pereira, had discarded other diseases such as Dengue, Dengue Hemorrhagic Fever, Yellow Fever, hantavirus and leptospirosis.
People directly involved with the acute febrile syndrome who had mild to moderate clinical manifestations are in good general health, but remained under observation. The Monitoring Committee also emphasizes that so far (September 12 - 11am) there is no report of new cases.
The Committee stresses that the population must redouble care basic hygiene, like washing hands before meals and do not put your hands in your mouth or eyes, drawing attention to symptoms such as fever, red spots on the body and, above all, lack air. In this case, look for a Health Unit
The municipal secretary of Health, Artur Pereira, ensures that the three hypotheses can be viruses, bacteria or food poisoning. Patel also revealed that monitoring is being conducted in a family and the people who had contact with the brothers Brissolari in recent days. He said both were sick for about 15 days and would also be self-medicating. "Andre taught at SESI, but there is no risk for students."
The Secretary explained that the disease met fever and throat infection, followed by staining body. "It is an acute febrile syndrome accompanied by spots of the body. They discarded the chance of dengue hemorrhagic fever, hantavirus and leptospirosis. " However, he did not rule out the possibility of both having been infected by the H1N1 virus, which causes the so-called "swine flu". It was also not ruled out that the brothers were victims of a meningitis.
Andrew, who was a doctoral student at USP, died on Thursday morning (8) and Alexander died with similar symptoms in the Santa Casa de São Carlos, at around 23.30 on Thursday. Brissolari Alessandra, 39, who worked in the Department of Finance of the Municipal Health and was the brother of the same symptoms, fever and flu. The boy's body underwent an autopsy at the Death Verification Service of the State Hospital Américo Brasiliense.
The result of the report comes out three to four weeks. A spokesperson for the State Department of Health reported that before the results have not as manifest.


Note from the City of San Carlos


The Municipal Secretariat of Health, through the Monitoring Committee, announces that, according to the analysis of laboratory tests, the "meningitis" was also removed as the probable cause of death of the brothers André and Alessandra Brisolari Brisolari. In last Friday (9) had already been discarded Dengue, Dengue Hemorrhagic Fever, Yellow Fever, Hantavirus and Leptospira.
People directly involved with the acute febrile syndrome who had mild to moderate clinical manifestations are in good general health, but remained under observation.
The Monitoring Committee also emphasizes that so far (September 12 - 11am) there is no report of new cases.
The Committee reinforces the public to step up care of basic hygiene, like washing hands before meals and do not put your hands in your mouth or eyes, drawing attention to symptoms such as fever, red spots on the body and, especially, lack of air. In this case, look for a Health Unit


San Carlos, September 12, 2011.
City of San Carlos
Municipal Health

[alert]

Re: 3 rd woman is infected with 'mysterious' disease in Sao Carlos

Case solved.

This is a common bacterium; no indication if the third case from the first post of this thread was also infected by it, or if she had some other illness. It is also possible that the deceased brother and sister might have had pre-existing conditions that made them more susceptible to this.

It is also possible, but there is no evidence for it, that this could have been a bacterial superinfection on top of an influenza infection.

http://eptv.globo.com/noticias/NOT,3,3,370630,Demora+para+a+procura+de+tratamento+agravou+saude+de+irmaos+diz+prefeitura+Sao+Carlos.aspx

Delay in seeking treatment worsened health of siblings, says city
Infection caused by a common bacterium caused their deaths earlier this month
26/09/2011 - 20:27

The delay in seeking treatment worsened the health of the brothers who died on Sept. 8 in San Carlos, according to city officials. A report released on Monday (26) pointed out that an infection caused by bacteria resulted in deaths.

The deaths were caused by a common bacterium found in the throat region. Normally, it brings complications, but the case of Andrew and Alessandra Brissolari worsened to an infection. According to the city, when the brothers started the treatment, the infection had already reached the blood.

Relatives of the brothers say that Andrew went to the doctor when he felt severe pain in the neck, two days before he died.

Transmission

Transmission occurs through personal contact or shared objects such as cutlery and towels. "In the post-mortem biopsies in one of the two brothers grew the bacteria Streptococcus pyogenes. She lives a long time with us humans and usually causes a sore throat. It remains sensitive to treatment with simple antibiotics like penicillin, "said the new health secretary, Marcus Vinicius Franzini Bizzarro.

According to him, the brothers came to be treated with antibiotics, but the picture was already too severe.

Death

Andrew was sick about 15 days before he died. He was hospitalized on September 7 and died the next morning. His sister, Alessandra Brissolari, 39, died with the same symptoms after 16 hours.

Changes in Health

The conference that explained the causes of death of the brothers was also marked by the announcement of changes in the Department of Health

Arthur Pereira was Health Secretary for just over four years. He is a professor at the Federal University of São Carlos and wants to get back to an academic career. "It's important that we can renovate, build, bring people. Management needs more trained professionals and will, "he said.

Bizzarro, 35, who took over the portfolio, has worked in public and private hospitals and was working as doctors in the Mobile Emergency Care (SEMC). The new secretary has a postgraduate degree in health care management.

[alert]

Re: Two siblings die of 'mysterious' disease in Sao Carlos - Invasive Strep pyogenes infection confirmed

I believe Strep pyogenes is the strain of bacteria that has caused a number of severe infections in Hong Kong over the past year:

http://www.flutrackers.com/forum/showthread.php?t=168949