Re: Approximately 68 deaths due to mystery fever in Lucknow district, Uttar Pradesh - possibly dengue
Re: Approximately 68 deaths due to mystery fever in Lucknow district, Uttar Pradesh - possibly dengue
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85551
Archive Number 20101028.3916
Published Date 28-OCT-2010
Subject PRO/EDR> Undiagnosed fatal illness - India (05): (UP) RFI
UNDIAGNOSED FATAL ILLNESS - INDIA (05): (UTTAR PRADESH) REQUEST FOR INFORMATION
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[1]
Date: Wed 27 Oct 2010
Source: Yahoo India [in Hindi, machine trans., summ. & edited]
<http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_6855343.html>
On Wednesday [27 Oct 2010] 3 more people died in the Ramabai Nagar
district. The death toll from the disease so far has reached 363 in
the last 3 months of this strange fever outbreak that the health
department could not control.
DM Saroj Kumar Tiwari the district chief medical officer said that
the village health team will be sending the facts with respect to
deaths and disease and anti-larval spraying of DDT in the affected
villages will be made.
--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>
[The implementation of DDT spraying to control mosquito larvae
mentioned in this report suggests that the etiological agent is
mosquito borne, but without indicating what that agent might be.
A map showing the location of Ramabai Nagar (also known as Kanpur
Dehat) district in Uttar Pradesh can be accessed at
<http://en.wikipedia.org/wiki/Ramabai_Nagar_district>.
A map of the districts of Uttar Pradesh, showing the location of the
affected Kanpur Dehat and Lucknow districts can be accessed at
<http://en.wikipedia.org/wiki/File:Uttar_Pradesh_Districts_Detail.svg>.
A HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/0dW6>. - Mod.TY]
******
Date: Thu 28 Oct 2010
Source: The Times of India, Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/city/lucknow/Viral-deaths-in-Khadra-due-to-dengue-Report/articleshow/6824850.cms>
The mystery has been solved. Majority of deaths due to "viral" fever
in the city [Lucknow] were due to dengue or a virus similar to it.
This has been confirmed by a 2-member committee comprising experts of
Chhatrapati Shahuji Maharaj Medical University (CSMMU). The committee
was formed by the state government to probe the cause of deaths in
Khadra locality. The tests were conducted by the Sanjay Gandhi
Institute of Medical Sciences (SGPGIMS).
The CSMMU committee comprising Dr Kausar Usman and Dr Uday Mohan
submitted its report to the state administration on Wednesday [27 Oct
2010]. The report probed the cause of death of 13 persons on 14 and
15 Oct 2010 in Khadra. According to the findings of the report, while
9 persons died of dengue or dengue like virus, 2 deaths occurred due
to gastroenteritis, one from heart attack, while the cause of one
death could not be ascertained. Similarly, of the 10 blood samples
sent to the SGPGIMS for testing, 6 [patients] were found to be
infected with dengue, one with malaria, while 3 were normal. The
samples were collected by the chief medical officer Dr AK Shukla from
Khadra, Gwari, and other localities in the state capital [Lucknow]
from where "viral" fever deaths were reported. Dr Shukla has also
sent 10 samples to the National Institute of Communicable Diseases in
Delhi for testing.
The significant part of the CSMMU committee was that it indicated
mutation in dengue virus. The team recommended further research to
identify the changed strain. The mutated viruses this year [2010] has
turned deadly. It is causing deaths within short span. Apart from
causing decline in platelet count in blood, the virus hits the liver
and kidney. This has resulted in increase in casualties and many
doctors do not know how to tackle it.
"We also found that living conditions in the slums of Khadra were
unhygienic. The piles of garbage all around can make such a locality
a centre of epidemic in the city," said Dr Kausar Usman, stressing on
the need of regular cleaning and proper garbage disposal. He added
that the [genetic] code of the mutated virus should be identified at
the earliest so that doctors can apply new protocol to treat the
patients. Similar were the views of the experts from SGPGIMS.
Interestingly, the health department has so far denied dengue deaths
in the city. According to official figures released by director
general health recently, Lucknow reported only 237 dengue cases and 8
deaths due to dengue [virus infection]. However, the investigations
by 2 premier institutes of the state have proved health department's
theory wrong. In fact, doctors in CSMMU said that on an average they
receive over 40 dengue patients from all over the state. Tests
conducted at CSMMU's microbiology department have also confirmed over
500 confirmed dengue patients so far. An equal number of dengue
patients can be found in the private hospitals and clinics. All major
government hospitals are packed with fever cases. Doctors said that
instead of hiding deaths, if the health department had focused on
cracking the virus code and anti-larva spray, over 90 percent of the
patients would have been saved.
--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>
[The reports of the "mystery fever" cases grow ever more confusing. A
previous report attributed the cases to malaria. In the report above,
there was only one malaria case in the small sample tested. One
wonders what "a virus like dengue" might mean, in the absence of
definitive laboratory test results. If the laboratory results were
based on serology, there is always the risk of cross-reactions among
the flaviviruses. Without genetic analysis, stating that the virus
has mutated cannot be confirmed. The committee was wise in calling
for virus isolates to be sequenced.
Apparently, the basis for stating that a mutant dengue virus is
involved is based on clinical observations. No case fatality rate is
given, so it is not possible to know if the number of deaths from
dengue virus infection is higher than usual.
This well may be an outbreak of mixed etiologies, with dengue,
malaria, and gastroenteritis having been mentioned. Fever is a
symptom of all of these infections, and many more pathogens. Further
information about this outbreak will be welcomed. - Mod.TY]
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For more information about other possible hemorrhagic flaviviruses (as per the ProMED moderator), such as Kyansaur Forest Disease and Al-Khurma virus, see:
http://www.promedmail.org/pls/apex/...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,24631
