Beriberi kills 3 AU troops; sickens at least 19

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

Leptospirosis remains possible, but unlikely as it would have been diagnosed by now. The fact that the number of new cases is declining is a good sign, as is the recovery of previously admitted cases. I really have no idea what the causative agent is, but I'm still leaning toward bacterial etiologies. I would think the swelling of the lower limbs might be a clue as that is not a common symptom at all.

I'm not sure why they suspect this is waterborne (as opposed to vector-borne, for example), but it is nice to see there is no evidence yet of person-to-person transmission.

I was starting to get a little worried because we hadn't heard about this in over a week.

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

We missed this article. I'm not sure what they "tested negative" for as we don't yet have a diagnosis, but I suspect what they meant to say was that they didn't have the illness (maybe they tested positive for cholera or something else).

http://www.newvision.co.ug/D/10/10/690186

UPDF soldiers discharged
Tuesday, 4th August, 2009 E-mail article Print article

UPDF soldiers serving on the African Union mission who were admitted to Nairobi hospital after contracting a water born disease have been discharged.

UPDF Army spokesman Lt.Col.Felix Kulaigye says the twenty three who were flown to Nairobi tested negative and are back in Somalia.

Late last month a strange disease attacked the peace keepers in Somalia affecting the peace keeping force.

He also maintains that the UPDF will not pull out of Somalia as demanded by the opposition, FDC President Kizza Besigye.

Its only Parliament to demand for the withdrawal, he says.

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

And this source acts like the disease was confirmed as leptospirosis. This article is four days old. Odd.

http://allafrica.com/stories/200908031211.html

The disease was later identified as a bacterial infection known as leptospirosis caused by rat's urine.

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

This posting is not about this outbreak, but I have been wondering about this possible diagnosis here. The symptoms are correct, and this would be difficult to diagnose. This is insect-borne, and occurs sporadically in East Africa. and a cluster of about 100+ cases of this might be difficult to diagnose.

Also even more bizarre (and never reported from Africa) is the possiblility that the parasite was ingested through contaminated food or water (fresh fruit with insects or insect feces in it has been implicated in South America).

Just a possiblility...

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78740

TRYPANOSOMIASIS - POLAND ex UGANDA (QUEEN ELIZABETH NATIONAL PARK)
*******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 10 Aug 2009
From: Malgorzata Paul <mpaul@ump.edu.pl> [edited]


[Rhodesian trypanosomiasis] in a Polish tourist returning from Uganda
---------------------------------------------------------------------
On 28 Jul 2009, a 61 year old Polish man was admitted to the Department and
Clinic of Tropical and Parasitic Diseases, University of Medical Sciences
in Poznan, Poland, with high-grade fever and multi-organ failure after a
tourist travel to Africa.

The patient spent 16 days in a tourist journey (no hunting) in Uganda and
Rwanda, and returned to Poland on 24 Jul 2009. He was travelling with his
wife in an 18-person group; the remaining travellers are all healthy.

He had been bitten by a tsetse fly during his visit in the Queen Elizabeth
National Park on 16 Jul 2009. On 20 Jul 2009, he noted a painful
erythematous skin lesion with central cupping on his left arm. Two days
later, he developed fever up to 40 deg C [104 deg F] with chills and
general weakness.

On admission on 28 Jul 2009, he presented with clinical signs of
generalized disease with fever, tachycardia, jaundice, respiratory
distress, dehydration, significant bleeding with DIC [disseminated
intravascular coagulation], skin rash, peripheral swelling,
hepatosplenomegaly, and oliguria.

The patient was conscious, very well oriented but seemed to be "too slow".
His general status was [of severe illness] and a clinical picture similar
to hemorrhagic fever, with spontaneous bleeding from the gums and oral
mucosa, numerous ecchymoses, petechiae on a large area of the skin of the
abdomen and chest, and abnormal bleeding on the sites of vein punctures.

A typical chancre with a black centre was still visible. Laboratory tests
showed thrombocytopenia, leucopenia, hypoglycemia, elevated liver enzymes,
metabolic (lactic) acidosis, electrolyte disturbances, highly elevated
concentrations of procalcitonin, and CRP [C-reactive protein],
hypoproteinemia, hyperbilirubinemia, beginning of renal failure with high
levels of urea and creatinine, proteinuria, and coagulation abnormalities
consistent with symptomatic DIC.

The diagnosis of acute African trypanosomiasis due to _Trypanosoma brucei
rhodesiense_ with a massive parasitaemia was made on the basis of blood
film examination. A thin blood smear showed 40-50 trypomastigotes (!) in a
high power field (1000x) and average of 116 parasites in a 400x
magnification field. When the Carpentier's cell was used for measurement,
we calculated 100 000 parasites per 1 microliter of blood. There were no
trypanosomes in the CSF [cerebrospinal fluid].

The patient received 7 doses of pentamidine, every 2 days (the last dose
today [10 Aug 2009]) with good tolerance. He required passive oxygen
therapy because of moderate ARDS [acute respiratory distress syndrome], and
intensive management including antihemorrhagic treatment, many transfusions
of plasma, albumins, ATIII and platelets, as well as antifebrile,
hepatoprotective, and diuretic therapy, correction of electrolyte and
gasometric disturbances. There were no signs of hemorrhages in the retina
and CNS [central nervous system].

He has qualified for haemodialysis but he has undergone 4 cycles of
plasmapheresis. The trypanosomes were not detectable in peripheral blood
after the 2nd dose of pentamidine. During the parasite clearance on the 3rd
day of hospitalization, he was hypotensive and required administration of
dopamine.

At present, the patient feels well and is improving very quickly; he
requires the supportive hepatoprotective therapy, slight correction of
fluids, and respiratory rehabilitation.

--
Malgorzata Paul, MD, PhD
Assistant Professor
Department and Clinic of Tropical and Parasitic Diseases
University of Medical Sciences
Przybyszewskiego 49
60-355 Poznan
Poland
<mpaul@ump.edu.pl>

[The Queen Elizabeth National Park is located in areas where there are
tsetse flies (see photograh at
<http://www.microbiologybytes.com/introduction/graphics/Tsetse.jpg>), and
thus there is a risk of infection if bitten.

Trypanosomiasis in Uganda is a zoonotic infection, with cattle as the main
reservoir; slowing the spread of infection depends on tsetse control.

Maps of the distribution of tsetse flies in Uganda can be found at
<http://www.fao.org/AG/AGAInfo/programmes/en/paat/maps.html> and The Pan
African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC) at
<http://www.africa-union.org/Structure_of_the_Commission/depPattec.htm>.

More information on Queen Elizabeth National Park is available at
<http://en.wikipedia.org/wiki/Queen_Elizabeth_National_Park>. Maps showing
its location can be seen at
<http://stable.toolserver.org/geohack/geohack.php?pagename=Queen_Elizabeth_National_Park¶ms=0_23_S_29_58_E_region:UG_type:landmark_source:dewiki>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00FJ>. - Mod.EP]

[see also:
Trypanosomiasis - Netherlands ex Tanzania (SE) 20090724.2613
Trypanosomiasis - Uganda: (DO) 20090315.1057
2008
---
Trypanosomiasis - Uganda (02): animal reservoir 20080512.1611
Trypanosomiasis - Uganda: animal reservoir 20080511.1604
Trypanosomiasis, bovine - Uganda (Tororo) 20080410.1316
2005
---
Trypanosomiasis - Uganda (Kaberamaido) 20050127.0294
2003
---
Trypanosomiasis, vector increase - Uganda (02) 20030506.1132
Trypanosomiasis, vector increase - Uganda 20030301.0514
2001
---
Trypanosomiasis, control measures - Zimbabwe 20010920.2284
Trypanosomiasis - Kenya 20010511.0912
2000
---
Trypanosomiasis, African, cattle - Botswana (02) 20000513.0732
Trypanosomiasis, African, cattle - Botswana 20000512.0725]

................ep/mj/sh

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

I think this is likely confirmation of Leptospirosis. The story has gone more or less dead for over a week. That would explain why.

http://www.ugpulse.com/articles/dai...PDF+soldiers+in+Somalia+to+return%A0&ID=11442

Ultimate Media

The President of the Peoples Development Party (PDP), Dr. Abed Bwanika has demand for an immediate return of the Uganda Peoples Defence Forces (UPDF) soldiers who are on a peace keeping mission in Somalia.

Bwanika, who is also a former presidential candidate, says that soldiers who were recruited to protect their mother country are now dying in a foreign land.

Reports recently indicated that 30 UPDF soldiers who are part of the peace keeping mission in Somalia were attacked by a strange disease which left at least three of the UPDF soldiers dead. The disease was later identified as a leptospirosis. Leptospirosis is caused by the urine of rats.

Bwanika while addressing journalists in Kampala today added that the Ugandan army should leave Somalia because Ugandan soldiers are now being used by foreign countries to serve colonial interests.

Somalia is locked up in civil unrest with fighting between the Al Shabab rebels and the Transitional Federal Government. The armies of Uganda and Burundi are in Somalia trying to restore peace in the country that has had running armed conflicts for a long time.

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

From Uganda's news today. The good news is that the death toll remains at five, exactly where it was over two weeks ago. The odd news is that this source is still calling it a "strange disease", not "confirmed Leptospirosis" as other sources have. Then again, the point of this article is the military news, not an update on the outbreak, so that might not be surprising.

http://www.newvision.co.ug/D/8/13/691323

AMISOM gets new commander
Friday, 14th August, 2009 E-mail article Print article

By Barbara Among
A new Force Commander for the African Union peacekeeping mission in Somalia has assumed office.

Maj. Gen. Nathan Mugisha took over from Maj. Gen. Francis Okello.

Mugisha takes over command at a time when the troops are facing increasing attacks from Islamic insurgents.

The team is also battling a strange disease that has claimed five peacekeepers.

The army, however, says the peace process has gained momentum and is enjoying overwhelming support from the international community.

The UN last year adopted a resolution to provide logistical support to AMISOM. In June this year, in Brussels, the international community pledged at least $213m (about sh 430b) towards AMISOM and the Somali security sector.

At the hand-over ceremony at Hallane, Mogadishu, the Special Representative of the Chairperson of the AU Commission, Nicholas Bwakira, praised AMISOMfor its achievements under very difficult circumstances.

The UPDF Commander for Land Forces Lt Gen Katumba Wamala called on African leaders to seek the support of the international community to help the Somalis overcome their problem.

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

Not leptospirosis. Wow. This story had gone dead for three weeks, and I had all but given up. Now this:

http://www.latimes.com/news/nationworld/world/la-fg-somalia-peacekeepers29-2009aug29,0,964713.story

Reporting from Mogadishu, Somalia - When a mystery illness swept through the African Union peacekeeping mission here, killing six soldiers and sickening dozens, doctors were stumped.

With help from the U.S. Centers for Disease Control and Prevention, they ruled out swine flu, tropical infection, rat-borne bacteria and even deliberate poisoning, as claimed by Somalia's insurgents.

But the culprit, doctors fear, is just as alarming: beriberi, a vitamin-deficiency disorder typically seen only in famines. Simply put, African Union soldiers appear to have died from a form of malnutrition.

It's the starkest example yet of how the mission in Somalia, which is authorized by the United Nations and largely funded by Washington, has become one of the most dangerous, yet least supported, peacekeeping operations in the world.

...


Most of those sickened were recovering thanks to vitamin B1 injections, according to AU doctor James Kiyengo. That treatment was followed by preventive thiamine supplements for all soldiers and a reexamination of meal plans. Soldiers complain that the mission supplies them with meat just two or three times a week, no eggs and only rarely fresh vegetables. Commanders said they hadn't come to a conclusion as to what caused the illness.

 

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Re: Beriberi kills 5-6 AU troops; sickens at least 50

Re: Beriberi kills 5-6 AU troops; sickens at least 50

The CDC finally got this one right, even though it took over a month. If vitamin injections are making such a huge difference, that is the cause. It was clear from above articles that treatment was making a huge difference. I had mistakenly assumed that treatment was only antibiotics (note the above post about no Tamiflu and no ribavirin and no anti-parasitics) when I posted that I was sure this was leptospirosis. Amazing how one little fact can change everything. The title of this thread will be changed shortly.

This is also a good example of just how much work the CDC does. They have been investigating this for over a month without significant mention in the press. Now if only they can figure out what is going on in Tsangano, Moxambique (and of course Morobe, Papua New Guinea, although it is not clear that the CDC is involved in that investigation yet).

 

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Re: Mysterious illness kills 3 AU troops; sickens at least 19

Re: Mysterious illness kills 3 AU troops; sickens at least 19

Can somone send the new article to ProMed? They posted on this twice as "suspected Leptospirosis", with the second posting suspecting anthrax as well, and it turned out not to be. Would be nice if they had the correct posting for accuracy.

 

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Re: Beriberi kills 3 AU troops; sickens at least 19

http://www.strategypage.com/qnd/somalia/articles/20090903.aspx

The 5,000 AU peacekeepers have proved able to deal with whatever local militias have thrown at them, but have suffered several hundred casualties in the 30 months they have been there. This includes 33 combat (mostly from roadside bombs) dead, and 20 dead from disease (including eight from malnutrition).

 

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Re: Beriberi kills 3 AU troops; sickens at least 19

There may be strong political reasons why Uganda does not want to accept the US CDC's prospective diagnosis (besides the fact that the reported symptoms don't quite fit). This is out of Uganda today. The statement about the outbreak being in April is just plain wrong though, and tends to further discredit this article.

http://www.newvision.co.ug/D/8/12/693573

Since 2007 when the UPDF deployed to Somalia, 12 Ugandan peacekeepers have been killed. In April this year, a strange disease killed two Ugandan peacekeepers under UGABAG III and affected 17 others who were flown to Nairobi Hospital for treatment.

Dr. Kiyonga said the outbreak had been contained and a team of doctors from Uganda, Burundi and WHO had carried out examinations, but were yet to release findings of the disease outbreak.

 

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Re: Beriberi kills 3 AU troops; sickens at least 19

This article from today is not about this outbreak, but contains the following lline. The death toll is back to six (not eight), and the diagnosis seems to still be beriberi:

http://www.latimes.com/news/nationworld/world/la-fg-somalia18-2009sep18,0,7474709.story

Before Thursday's attack, 33 peacekeepers had been killed in Somalia since the mission's start in early 2007. About 20 have died of disease and accidents, including six who died this summer from a malnutrition-linked disease.