Tweet
Published Date: 07/01/2014 20:57:41
Subject : - ( ? ) PRO / PORT > Deaths Brazil ( SP ) , unknown cause dengue outbreak ( ? )
Archive Number : 20140107.2157332
Deaths - BRAZIL ( TAUBATÉ , SÃO PAULO ) , UNKNOWN CAUSE, DENGUE , OUTBREAK ( ? ) ( ? )
************************************************** ********************************
A message / Una mensaje / of ProMED -PORT
ProMED - mail is a program of / es un program de la
International Society for Infectious Diseases
Date : Tuesday / Martes 07 January / enero 2014
Source : G1 [ 07.01.2014 ] [ edited ]
Taubaté 2 investigates suspicious deaths of dengue hemorrhagic fever
-------------------------------------------------- --------
Epidemiological Surveillance of Taubaté investigates the death of two men , aged 21 and 48, which occurred last Saturday ( 4 ) [ janeiro/2014 ] . The suspicion is that they have contracted dengue hemorrhagic fever .
According to the Department of Health , the youngest patient died about 30 minutes after being admitted in municipal hospital emergency department with high fever .
The other patient was treated in the emergency department of the Regional Hospital , apparently with the same symptoms . The State Department of Health reported that tests are being conducted by the Epidemiological Monitoring of town to investigate the causes of death .
According to the pulp, blood samples from two patients were collected for examination of dengue fever, meningitis and H1N1. The forecast is reported that folder so that the result is ready in 15 days .
-
[ Information about person - place - time , as well as the clinical picture , are scarce . However , some points deserve attention and put dengue only as a hypothesis, depending on the additional information , dengue may turn out to be the least likely.
A few points :
- Was no epidemiological link between the two cases ? What are the epidemiological history of both cases ?
- When there was the onset of symptoms ? How much time elapses between the onset and evolution to death ?
- For one of the cases there is information that evolves to death 30 minutes after the call . This was the first ( and only) service ? To seek care , the patient , who was " pre - death " already showed serious signs of hemodynamic instability , respiratory failure , evidence of severe organ dysfunction ? If yes, the origin was the residence itself?
- If material (possibly airway secretion , possibly fragments of post-mortem tissues ) were collected for investigation of influenza , possibly both showed signs of SARS ( Severe Acute Respiratory Syndrome ) .
- If there was the possibility of dengue hemorrhagic fever , there were signs of change in vascular permeability ( hemoconcentration , effusions , hypoproteinemia ) ? And what kind of hemorrhagic manifestations : petechiae ? suffusion ? digestive and / or respiratory bleeding ?
- There is mention that meningitis was investigated . Possibly, the hypothesis is meningococcal disease. Although cases of ( meningo ) encephalitis, dengue are likely to occur at first meningitis is not important differential diagnosis for dengue hemorrhagic fever , dengue hemorrhagic fever and meningococcal disease , but these may be differential diagnoses mutual .
- The cases were subjected to autopsy ? If not, should they? Preliminarily , which the macroscopic findings ? Samples for immunohistochemistry were forwarded?
Anyway , missing information , but dengue , there is, to date , of a hypothesis , apparently not as likely . At first , the rapid, almost fulminating , at least for the case, is not what is observed in dengue fever . Furthermore , despite the possible transmission , the epidemiological situation of dengue not (yet) been intensified in : 2 severe cases , fatal both on the same day unlikely that both ( if any ) is related to dengue hemorrhagic fever ? .
As always , meningococcal disease , and streptococcal estafilococcia are likely causes . Influenza , maybe. Blood cultures , samples for PCR were collected and counterimmunoelectrophoresis ? . Exogenous poisonings at first (especially if bond exposure in common ) , can not be discarded . There was Toxicological analysis?
Depending on the epidemiological history , spotted fever , hantavirus cardiopulmonary syndrome and leptospirosis should ( laughing ) be considered and investigated . Patients reside or have moved to areas of transmission of yellow fever ? There are always those hypothesis ( apparently) less frequent as arenavirose legionellosis ... that under certain circumstances be considered.
Additional information would be very welcome .
Anyway , let's watching .
- Mod RNA