Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified
http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/33698
'Mystery' Illness Likely Not Only in Cambodia
By Michael Smith, North American Correspondent, MedPage Today
Published: July 10, 2012
Take Posttest
The illness suspected of killing several dozen children in Cambodia is no stranger to the region, according to the CDC.
Some 40,000 cases of hand, foot, and mouth disease caused by enterovirus-71 have been reported since the start of the year in neighboring Vietnam, the CDC reported on its website, and other countries have been affected in recent years.
In fact, large outbreaks "occur frequently in some countries in Asia," the agency said in an advice to travellers that was released May 25. Affected countries have included China, Japan, Singapore, and Australia, as well as Vietnam.
But the question that is currently preoccupying investigators is why the disease appears to be so severe in the relatively small outbreak in Cambodia, a CDC spokesman told MedPage Today.
According to the World Health Organization, the outbreak killed 52 of 59 affected children, but Phnom Penh pediatrician Beat Richner, MD, who first called attention to the outbreak, reported 66 cases, with just two survivors.
Either way, the case fatality rate is markedly higher than health officials have seen in Vietnam, where just 20 deaths in 10 provinces have been reported.
Hand, foot, and mouth disease associated with enterovirus-71 can be mild, but
a rapidly fatal syndrome of brainstem encephalitis combined with neurogenic pulmonary edema was identified in 1999.
That
seems to match Richner's description of the symptoms seen in his Kantha Bopha children's hospitals: encephalitis followed by "total destruction" of the alveoli, which is the main cause of death.
But
in most outbreaks that fatal syndrome has been relatively rare. The CDC spokesman said the agency is working with Cambodian officials and the WHO both to pin down the cause of the deaths and to investigate why so many are fatal.
Although samples were not taken from all of the affected children, the WHO reported that a "significant proportion" of available samples tested positive for enterovirus-71
The Cambodian cases began showing up in April at the Kantha Bopha hospital in Phnom Penh, a regional pediatric center, with what the WHO called a "common syndrome of fever, respiratory and neurological signs."
They ranged in age from 3 months to 11 years, but most were younger than 3 years old.
Hand, foot, and mouth disease is contagious, although it usually leads to mild, self-limiting disease with few complications. Common symptoms include fever, sores in the mouth, and a rash with blisters on hands, feet, and buttocks.
It is usually a result of infection with coxsackievirus A16, but enterovirus-71 can also cause the illness.
[snip]
. This declaration by WHO?was neither professional nor necessary, but causing panic for nothing.?
CNN’s Sanjay Gupta is in Cambodia this week, covering a perplexing illness that, to date, has taken the lives of over 50 young children. Gupta, a neurosurgeon, has been talking with local doctors and officials from the World Health Organization in an effort to determine what, exactly, has caused these children to succumb and perish so quickly. Eleven hour time difference be damned, Gupta graciously made time to speak with us about his report and what he’s been able to learn so far. 
