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Viet Nam - Quang Ngai: Undiagnosed illness, 26 fatalities since April 2011

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  • #61
    Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified

    Orientia tsutsugamushi



    http://en.wikipedia.org/wiki/Scrub_typhus
    http://wwwnc.cdc.gov/eid/article/12/...27_article.htm

    http://wwwnc.cdc.gov/eid/article/12/2/pdfs/05-0967.pdf

    Scrub typhus is typically a nonspecific febrile illness;
    its severity may be influenced by the strain of O. tsutsugamushi,
    a person’s immune status, and other factors
    Diagnosis may be complicated in areas where the disease
    has not been documented recently or in regions lacking the
    capacity for laboratory confirmation. Illness develops after
    an incubation period of 6 to 21 days and usually begins
    with an eschar at the site of a chigger bite. Fever,
    headache, and myalgias are common, and a maculopapular
    rash may also be present. Nausea, vomiting, diarrhea, or
    lower respiratory symptoms can also occur. Manifestations
    such as pneumonitis, meningoencephalitis, jaundice, renal
    failure, and myocarditis can develop during the prolonged
    clinical course of untreated illness
    (6). Establishing the
    diagnosis and initiating prompt antimicrobial drug therapy
    are important because death rates for untreated scrub
    typhus patients are 1%–30% (5). Scrub typhus is effectively
    treated with doxycycline, and treatment should begin
    immediately upon suspicion of illness without awaiting
    laboratory confirmation.

    From October 2001 to October 2003, an outbreak of
    scrub typhus was confirmed among residents of the
    Republic of Palau, a Pacific island nation 900 km east of
    the Philippines (Figure 1). The outbreak occurred among
    residents of several remote southwest islands (7). These
    islands, ≈300 km from the capital of Koror, are difficult to
    reach, and affected persons required emergency evacuation
    by boat to Koror for treatment. This outbreak affected
    primarily children,
    and illness was characterized by fever
    and severe abdominal distress (7).

    Comment


    • #62
      Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified

      http://www.mysinchew.com/node/72895

      Mysterious skin disease in central Vietnam identified
      Foreign 2012-04-25 15:51
      HANOI, April 25 (Xinhua) -- According to Quang Ngai provincial health department, the mysterious skin disease which left 19 dead among the province is identified.

      Fourteen out of 26 blood samples from patients with a mysterious skin disease in Vietnam's central province of Quang Ngai (some 730 kilometers south of the capital Hanoi) have tested positive for the Rickettsia Virus, said Pham Hong Phuong, director of Quang Ngai provincial health department, local newspaper Vietnam News reported Wednesday.

      The virus is transferred from animals to people by lice or fleas, So far, 172 people have been infected with the virus and 19 victims in the province's rural communes have been reported dead.

      According to the report, the department has asked the province to provide financial assistance to equip medical facilities with blood filters and necessary medications to treat affected patients in a timely manner.

      The World Health Organisation (WHO) has also said that it is ready to support the Vietnamese government in tackling the disease, but a WHO official said on Tuesday that the organization had not yet received any requests for support from the Vietnamese Ministry of Health.

      The situation has turned more serious since the disease was first noticed last year. Despite the participation of several agencies, the mysterious killer still spreads out among the province.

      The initial symptoms of the illness are high fever, loss of appetite and a rash on the palms and feet. If it is not treated early, the disease can affect the respiratory system, causing eye and liver problems, miscarriages and multiple organ failures, local doctors said.

      Comment


      • #63
        Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified

        Rickettsia is a bacterial genus. There are actually several diffierent diseases caused by bacteria in this genus. Some of the more well known are spotted fever, scrub typhus, and Indian tick typhus (among many others: http://en.wikipedia.org/wiki/Rickettsia). As far as I know, they are all spread by insects. I'm not sure which rickettsial disease has been discovered as the cause of this outbreak; the articles seem to be missing this crucial detail.

        Comment


        • #64
          Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified

          we must wait for more bacteriological details.
          but knowing what it is, is a relatively good news for treatement ( antiobiotic )

          Comment


          • #65
            Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified

            Originally posted by Anne View Post
            we must wait for more bacteriological details.
            but knowing what it is, is a relatively good news for treatement ( antiobiotic )
            I agree. Antibiotics will save lives here. Difficult to imagine it took a year to reach this diagnosis, with most of the time spent concentrating on poisoning.

            Geography, which usually is an important clue to determine which agent is involved, doesn't seem to help me much here as I cannt find any previous reports of any rickettsial infections in Vietnam to compare to. Vietnam appears to be outside the regions listed in the Wikipedia article for many of the species.

            Comment


            • #66
              Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

              Apparently, several species have been reported from Southeast Asia before, including murine typhus, scrub typhus, and spotted fever:

              http://wwwnc.cdc.gov/eid/article/12/2/pdfs/05-0900.pdf

              Here's an anecdotal report of an unspecified Rickettsial infection from Hanoi from January 2012:

              http://maddybackpackworld.blogspot.c...n-vietnam.html

              And a murine typhus case from Vietnam imported into Japan:

              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294741/

              Comment


              • #67
                Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                This might be a clue (note no mention of ticks):

                http://www.reuters.com/article/2012/...8FP19620120425

                Fourteen out of 26 blood samples from patients suffering a mysterious skin disease in the central province of Quang Ngai have tested positive for the Rickettsia infection, which is transferred from animals to people by lice and fleas, Director Pham Hong Duong of the provincial health department said. So far 19 have died out of the 172 infected.

                Comment


                • #68
                  Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                  This is on the "second" outbreak, although the two could likely be related given similar symptoms:

                  http://www.baomoi.com/Home/SucKhoe/v...ai/8342710.epi

                  Add disease "tanning" in Quang Ngai



                  As of 24/4, Quang Ngai province had 25 cases of children from 3 months to 15 years were "tanning". In particular, three severe cases have been transferred to the provincial hospital treatment.



                  Photo: Newspaper Quang Ngai






                  The patients concentrated in two three and Son Cao Son Commune, Son Ha District with symptoms appearing several bruises on the body, mainly in the legs, arms and face. Time, these cases are communal examination of health workers, prescribe symptomatic treatment. Now, however, have not yet identified the cause of the disease.

                  Through the examination of the health sector Son Ha District, this is not a disease like hand dermatitis syndrome, feet occurred in the district of Ba. Initially, the district encouraged people to use safe water sources and carefully when using herbicides because these students are suspected illness due to exposure to herbicides.

                  Today (25/4), Quang Ngai Health Department will send medical staff to the Son Three to find out the cause, and steps taken to sample the final conclusion.

                  Disease "tanning" appeared in Son Ba from 04/09/2012.

                  Comment


                  • #69
                    Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                    see map of distribution
                    in this Pdf , vietnam is in the triangle.
                    http://www.jkscience.org/archive/vol...%20Typhus4.pdf

                    Geographical Distribution, Effect of Season &
                    Life Cycle of Scrub Typhus

                    Vol. 12 No. 2, April-June 2010 www.jkscience.org

                    Comment


                    • #70
                      Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                      beautifull and free.. scanner, radiology,


                      http://radiographics.rsna.org/content/27/1/161.full


                      and

                      http://www.annals.org/content/79/1/26.short


                      Scrub Typhus in South Vietnam

                      A Study of 87 Cases

                      1. STEVEN J. BERMAN, M.D.; and
                      2. WILLIAM D. KUNDIN, Ph.D.

                      + Author Affiliations
                      1. <address> <address>Taipei</address>, Taiwan </address>


                      Abstract

                      With the use of indirect fluorescent antibody or mouse inoculation methods, scrub typhus was diagnosed in 109 of 1650 febrile American servicemen in Vietnam. The fluorescent antibody test was positive in all 32 patients from whom rickettsia were recovered, but a rising antibody titer to Proteus OXK occurred in only 47&#37;, which included only 5 of 27 patients infected with Gilliam strain. The diagnosis was clinically suspected in only 51 patients. Generalized lymphadenopathy and lymphocytosis were commoner than either eschar or rash, and, in the absence of the latter findings, the illness was frequently mistaken for infectious mononucleosis. Early treatment with tetracycline shortened the duration of illness and suppressed the convalescence indirect fluorescent antibody titer. No relapses occurred in those patients who received tetracycline for at least 7 days.

                      Article and Author Information

                      • ▸From U.S. Naval Medical Research Unit No. 2, Taipei, Taiwan; the Department of Medicine, University of Washington, Seattle, Washington; and the Department of Tropical Medicine and Medical Microbiology, University of Hawaii, Honolulu, Hawaii.
                      • Grant support: Work Unit M4305.12.3005, Bureau of Medicine and Surgery, Navy Department.
                      • ▸Requests for reprints should be addressed to Editorial Department, NAMRU-2, Box 14, APO San Francisco 96263.
                        • Received November 22, 1972.
                        • Accepted March 22, 1973.

                      Comment


                      • #71
                        Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                        about Orienta tsutsugamushi
                        Formerly classified in the genus Rickettsia, it was withdrawn on the basis of its phylogenetic classification and specific phenotypic characteristics

                        http://ifr48.timone.univ-mrs.fr/Fiches/Otsu.html

                        Comment


                        • #72
                          Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                          http://vietnamnews.vnagency.com.vn/o...s-disease.html

                          Time to seek foreign help to identify mysterious disease

                          by Pham Diem Quynh



                          US ready to track down skin scourge

                          HCM CITY — The US Embassy yesterday announced it stands ready to support the Vietnamese Government in tackling the mysterious skin disease that has killed several people in Quang Ngai Province.

                          US Embassy spokesperson Christopher Hodges made the announcement after an official from the Ministry of Health said they would seek help from the World Health Organisation and the US's Centre for Disease Control and Prevention in investigating the disease.

                          "Our sympathy is with those affected in Quang Ngai. We have not yet received a formal request for assistance from the Ministry of Health but stand ready to help in any way we can," Christopher said.

                          Meanwhile, a delegation headed by Minister of Health Nguyen Thi Kim Tien and her deputy Nguyen Thanh Long yesterday began a four-day fact finding trip to the province.

                          Many people have speculated that the disease could have been caused by herbicides or even toxic substances left behind during the American War. — VNS

                          News of a "strange disease" in Ba To district, in the central province of Quang Ngai, has gone far beyond Viet Nam's borders.
                          BBC World on Saturday reported that 19 people, mostly children, had died from an unknown illness, while many others had fallen sick.

                          Of the 172 people that have died or fallen ill in the district by last Tuesday, 161 were from Ba Dien village. Typical symptoms are stiffness in the limbs and ulcers on the victims' hands and feet that are reminiscent of blisters. Some have also developed a serious liver disorder.

                          The rate of infection and re-infection has also risen dramatically over the last few weeks, leading to widespread panic, with worried parents keeping their children out of school and isolating themselves from contact with others.

                          Medical personnel have been advising villagers about hygiene, while they investigate the cause of the illness. Despite their actions, however, the disease has spread beyond the village.

                          When the illness first appeared a year ago, the ministry sent health experts to the site to collect water and soil samples, as well as blood and hair of the sick. But they could not figure it out.

                          Two days ago, following tests conducted by Health Ministry officials last week, the director of Quang Ngai Province's health department, Pham Hong Duong, said the rickettsia bacterium had been found in 14 out of 26 blood samples taken from patients. However, the cause of the disease has not yet been identified, Duong added.

                          The primitive bacterium is carried by ticks, fleas and lice, and can cause diseases such as typhus and rickettsialpox.,

                          Worried officials at Quang Ngai Department of Health have asked the health ministry to work with the World Health Organisation and other international institutions to investigate the cause of the disease.

                          The World Health Organisation said they were very concerned about the problem and ready to help Vietnamese government tackling the disease, but they had not yet received any request for help from the health ministry.

                          Following calls by the People's Committee of Quang Ngai Province, the Military Chemical Institute, under the Ministry of Defence, sent experts to Ba To District to investigate if water supplies and the soil contained toxic substances.

                          It is clear that we can't eradicate the disease until it is properly identified and named.

                          The practice of sacrificing buffalos to cure the illness of local Hre people will return if the disease is not quickly identified.

                          The health ministry should promptly seek international help with identifying the disease and its cause. Saving lives is the crucial thing here. — VNS

                          Comment


                          • #73
                            Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                            It appears Anne may have been correct as to the species of Rickettsia, but the outbreak may be more complicated than that:

                            http://www.thanhniennews.com/index/p...-unsolved.aspx

                            Fatal skin disease remains mystery after discovery of flea-carried bacterium
                            Last Updated: Thursday, April 26, 2012 05:30:00




                            A flea-carried bacterium has been found in blood samples taken from the patients of the skin condition that has killed 19 in central Vietnam over the past year, but local experts say it did not cause the disease.

                            A report on the VnExpress newswire Thursday quoted Dr. Nguyen Van Binh, chief of the Department of Preventive Health, as saying that the discovery of Ricketsia bacteria in the samples of patients “was just initial information for experts to make a reference, because it was not the cause, just one of the factors leading to the disease.”

                            Earlier, on Tuesday, a delegation of experts from the Ministry of Health announced that 14 out of 26 blood samples of patients in the central province of Quang Ngai’s Ba To District tested positive with Ricketsia, which causes scrub typhus fever and is often found in fleas, lice, mites, and ticks.

                            According to Binh, experts are still learning about the skin condition that creates ulcers on hands and feet that look like severe burns and induce stiffness in the limbs. In critical cases, it can lead to liver and lung failure.

                            Health Minister Nguyen Thi Kim Tien will also make a trip to the affected areas and meet with Quang Ngai’s authorities to discuss measures for curbing the disease, the news website reported.

                            In the meantime, Nguyen Xuan Men, deputy director of the provincial Department of Health, proposed that the health ministry issues a new treatment protocol for the disease as the current one has proved ineffective.

                            Since the disease broke out last April in the province's Ba To District, 176 people in the district as well as the nearby Minh Long District have been affected, Men said, adding that 73 percent of them are farmers while 20 percent are students.

                            He said the disease recurred in 60 percent of the patients after treatment, and more patients were reported during the rainy season than the dry season.

                            The official also noted that all the patients had increases in their liver enzymes, while 20 percent of samples taken from healthy people in Ba To also had high liver enzyme function.

                            So far Vietnamese agencies have launched a variety of tests and inspections in the affected areas, including searching for a suspected toxin and testing water, food and earth samples.

                            Most experts feel the disease is not infectious and was probably caused by arsenic contamination, or some plant protection chemical, VnExpress reported

                            Comment


                            • #74
                              Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                              Any reports on whether they have tested for heavy metals ?

                              Whilst arsenic can poison the liver, the description and pictures of the skin disease remind me of acrodynia, or pink disease, caused by inorganic mercury and primarily affecting children. Whilst you would normally expect mercury to cause kidney and neurological toxicity, there are conceivable circumstances under which it could preferentially hit the liver instead (i.e. if there were co-factors protecting kidneys and brain).

                              Comment


                              • #75
                                Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- unspecified rickettsia identified

                                about arsenic : bladder, kidney cancers and skin ( horrible : see picture )
                                http://www.scielosp.org/scielo.php?p...rttext&tlng=en

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