Chiang Mai: Unexplained myocarditis - 7 deaths - pesticide poisoning suspected

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Apparently, Legionella is under investigation...

http://www.bangkokpost.com/news/local/225378/authorities-aim-to-unravel-hotel-deaths

CHIANG MAI

Authorities aim to unravel hotel deaths
Published: 8/03/2011 at 12:00 AM
Newspaper section: News

Authorities in Chiang Mai will today attempt to conclude the cause of the unusual deaths of three foreign tourists and a Thai tour guide who checked in at a city hotel last month.

Muang Chiang Mai police station chief Pol Col Phitsanu Oonhaseri yesterday said all parties concerned, including local police, public health officials, staff of the Communicable Disease Control Department, the doctors who conducted autopsies on the dead at Maharaj Nakorn Chiang Mai Hospital, and scientific crime detection officers would meet today to determine the causes of the deaths.

The three foreign tourists and the female Thai guide died after checking into Downtown Inn in Muang district last month.

The four have been identified as Thai tour guide Waraporn Yingmahasaranont, 47, who died in her room on Feb 3, New Zealand tourist Sarah Carter, 23, who apparently succumbed to food poisoning at Chiang Mai Hospital on Feb 6, and British couple George Everitt, 78, and Eileen Everitt, 74, who died in their hotel room on Feb 19.

Chiang Mai governor ML Panadda Disakul will announce the forensic results to restore confidence among tourists.

According to Pol Col Phitsanu, officials have collected samples from the air-conditioning vents at Downtown Inn as a bacterial infection known as Legionnaires' disease may have been a possible cause of death.

However, the officer said rooms at the two-star hotel had separate air-conditioners, not a central air-conditioning system.

Police have ruled out robbery as a possible cause as the rooms of the guests who died at the hotel had been locked from the inside and none of their valuables were missing.

Winai Junsiri, a representative of Downtown Inn, said the hotel management was ready to cooperate with police and would like authorities to conclude the cases soon as they had affected the number of visitors to Chiang Mai in the lead-up to the Songkran festival.

According to Mr Winai, who is the manager of The Park Hotel which is in the same business group as Downtown Inn, the British consul in Chiang Mai has not raised any concerns about the deaths of the British couple but the death of the New Zealander had led to negative news reports in that country about Thailand.

He said Carter and her friends had arrived from Krabi on the evening of Feb 3.

They checked in to the hotel and then went to the Night Bazaar and returned to the hotel.

Mr Winai said they had not dined at the hotel but they vomited after they returned. All three were hospitalised and Carter died later.

It was earlier reported that the British couple died of an unusual enlargement of their heart muscles and their arteries had become blocked.

The Thai tour guide was found dead in front of the bathroom in her room.

 

[JimO]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

So it sounds like the three girls had enlarged heart muscles with clogged arties, as did the English couple. Can Legionella cause this condition?

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

According to Emily's post #11, that is possible, but very unlikely. I would also think that someone would have reported some respiratory symptoms if Legionella was involved.

If the British couple was in the room directly below Ms. Carter, a poisoning, possibly an inhaled one, seems likely.

http://www.abc.net.au/news/stories/2011/03/08/3158473.htm?section=world

Thai police pressed on mystery tourist deaths
By Simon Santow

Posted 11 hours 36 minutes ago

Audio: Thai police pressed on mystery tourist deaths (The World Today) Related Story: Food poisoning kills Thailand tourist Pressure is mounting on Thai authorities to explain the mysterious deaths of four people staying at the same hotel at popular tourist destination Chiang Mai.

A New Zealander backpacker, a retired British couple and a Thai tourist guide all died after staying at the Downtown Inn at Chiang Mai in the north of the country.

The deaths happened in the space of two weeks last month and authorities are under pressure from the families of the dead and from the tourist industry to explain what locals describe as a "strange coincidence".

more at above link...

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

This certainly makes things a lot less clear, as this fifth death has nothing to do with that hotel.

It is odd, and possibly an important clue, that seven "tourists" have contracted of this illness, whatever it is, with five deaths but no locals have yet been reported as affected.

http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10711193

Another mystery death in Thailand
By Stuart Dye 5:21 PM Wednesday Mar 9, 2011 Share Email
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Expand Mariam Soraya Vorster, left, died mysteriously in Chiang Mai just weeks before New Zealander Sarah Carter, right. Photos / SuppliedA fifth tourist has died in Chiang Mai, Thailand, in circumstances eerily similar to New Zealander Sarah Carter's mysterious death - which health officials initially blamed on food poisoning.

American Mariam Soraya Vorster, a 33-year-old from Seattle working as a guide in Chiang Mai, died on January 11 - just over three weeks before 23-year-old Sarah died.

Ms Vorster's husband Tony Pandolo told the Herald his wife was perfectly fit and healthy and became sick with symptoms of food poisoning before she died.

"I kept asking about the health department, or what the next steps would be with the restaurant," Mr Pandolo said. "No one really seemed to know, and it turns out no one really did anything.

"Soraya had an autopsy at University Hospital in Chiang Mai on January 12 or 13 and we still have no results."

Ms Vorster's death is one of five in a six-week spell in Chiang Mai.

Local woman Waraporn Pungmahisiranon died two days before Sarah and British pensioners George and Eileen Everitt died less than two weeks later.

Those deaths were all in the same hotel - the Downtown Inn.

Mr Pandolo said his wife was staying in a different hotel, but the symptoms were the same.

At a press conference in Bangkok yesterday, Chiang Mai Governor Pannada Disakul said: "We have to admit that these deaths coming one after another are nothing more than coincidence.

"We have done and will continue to do our utmost to make tourists confident in our city."

The press conference was told Mr and Mrs Everitt, 78 and 74, died within minutes of each other of heart attacks.

The couple's son Stephen Everitt yesterday told the Herald that was not a believable explanation.

"They had no history of heart problems or any other problems," said Mr Everitt from his home in Lincolnshire.

"They were active and healthy for their age and it has come as a total shock.

"And now they want me to believe they both had heart attacks at the same time. It doesn't make sense. How can it be coincidence?"

Yesterday's press conference, which did not include details of Ms Vorster's death, was told tests were still being conducted into Sarah's death.

Tests on tissue taken from Sarah Carter had been inconclusive and samples had been sent for analysis to the United States and Japan, said Dr. Pasakorn Akaraseri, of the Communicable Disease Department of Thailand's Ministry of Health.

He said there was no evidence to suggest that any of the deaths were as a result of the guests eating food bought at the local market or on the street.

Sarah and two friends - Amanda Eliason and Emma Langlands - became sick in the Downtown Inn in Chiang Mai on February 4. Sarah died in hospital two days later.

Amanda and Emma recovered and are now back in New Zealand.

Richard Carter, Sarah's father, said the press conference was a "fob off".

"It doesn't sound like there's any real investigation going on here.

"You start to wonder how many other deaths there have been that are being swept under the carpet."

Mr Carter said the New Zealand Government needed to put on more pressure to find out how many similar deaths there had been in the last few years so travellers could make informed decisions.

"At the moment it's pot luck. People head off on holiday and then 'bang' they're dead."

Foreign Minister Murray McCully said the comments from the press conference were "not wholly convincing and we intend to give them closer scrutiny".

"We will look into the matter further. I gather there is still some work being done of a forensic nature of some samples and we are looking forward to seeing that material too.

"It's clear that we need to ask some more questions."

Asked if the Government would launch its own inquiry Mr McCully said that was too early to consider.

"Let's not get ahead of ourselves, let's just ask the questions methodically as we go forward... Clearly the obvious questions need to be asked and answered fully."

- additional reporting Andrew Drummond, NZPA

 

[Emily]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

The family of the young Seattle woman who died in Thailand in the 2009 hotel cluster noticed the current cases. This is their blog.

http://jillstonge.blogspot.com/

Chemical poisoning of some kind seems to be one of their suspicions. There are some test results posted there. They also posted this link about another young female tourist who died in Thailand in 2009.

http://phuketwan.com/tourism/young-tourist-dies-mysteriously-patong-11340/

Tragic Riddle of Young Tourist's Death in Patong

By Chutima Sidasathian and Alan Morison
Friday, July 17, 2009
THE SUDDEN unexplained death of a young woman tourist on Phuket has left a grieving father asking questions about what killed his daughter.

Student nurse Sherifa Waleed Khalid, 24, was found dead in her room at the Thara Patong Beach Resort in Patong yesterday...

That same paper covered is wondering about a link between the 2009 and 2011 cases:

http://phuketwan.com/tourism/fifth-mystery-death-chiang-mai-riddle-laleena-link-13793/

Fifth Mystery Death in Chiang Mai Riddle: Laleena Link?

By Phuketwan Reporter
Wednesday, March 9, 2011
A FIFTH mysterious death has been revealed as Chiang Mai's ''fatal attraction'' begins to impact on the city's ability to appeal to tourists.

The death of 33-year-old American Mariam Soraya Vorster, who was working as a guide in Chiang Mai, means that five deaths took place within six weeks - and authorities have yet to find believable causes for any of them. ...

I wonder about an insecticide used in the hotels that might affect people with health issues, the elderly and young women more than young men for some reason?

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

The red text differs from an above report.

http://www.newstalkzb.co.nz/newsdetail1.asp?storyID=192071

Pressue on officials over Thai deaths
10/03/2011 8:24:00



Sarah Carter died in a Chiang Mai hotel last month
Pressure's increasing on Thai authorities as relatives in the UK and US join New Zealand authorities in calling for answers over the unexplained deaths of five people.

One of them is Auckland woman Sarah Carter. All five stayed at the same hotel in Chiang Mai.

Bangkok journalist Andrew Drummond says the "coincidence" line being run by authorities isn't washing with relatives of victims.

"I think the fact that the Governor of Chiang Mai, the Head of Police and the Chief Medical Officer of the city turned up together at a press conference to try and allay fears, something which they don't seem to have done, suggests it has become a major political issue," he told Newstalk ZB's Mike Hosking this morning.

Mr Drummond says there have been no post-mortem results at all. Some tests have been sent to the US and Japan for analysis.

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

A friend of the 33-year old deceased American is posting on this in the forum:

http://www.thaivisa.com/forum/topic...n-chiang-mai-just-a-coincidence/page__st__175

and explicitly indicates that the American did not stay at that hotel.

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

http://www.monstersandcritics.com/n...atisfied-that-tourist-deaths-were-coincidence

New Zealand not satisfied that tourist deaths were coincidence
Mar 9, 2011, 23:07 GMT


Wellington - The New Zealand government is not satisfied with claims that the deaths of five tourists, including one of its citizens, in Thailand early this year were simply a coincidence, Foreign Minister Murray McCully said Thursday.

He said Thai explanations of the deaths that occurred within a six-week period were 'not wholly convincing and we intend to give them closer scrutiny.'

Governor of Chiang Mai, Pannada Disakul, said at a news conference on Tuesday, 'We have to admit that these deaths, coming one after another, are nothing more than coincidence.'

'That's the sort of language you get with a cover-up,' Richard Carter, father of Sarah Carter, 23, who died on February 6, told reporters.

Convinced that the deaths were not a coincidence, he said, 'It doesn't sound like there is any real investigation going on here.'

McCully told Radio New Zealand there was no evidence to suggest that the deaths of Carter, an American woman, a local tour guide and a British pensioner couple in Chiang Mai between January 11 and February 19 were not a coincidence.

But he added, 'It's clear that we need to ask some more questions.'

McCully said that while Chiang Mai officials were keen to restore confidence in the area as a tourist destination, his ministry would consider putting a travel advisory on its website to record any concerns that New Zealanders should be aware of before travelling to Thailand.

Four of the victims, including Carter, died in the same hotel, the Downtown Inn. Two other New Zealanders travelling with Carter also became sick but recovered.

The Thai health ministry said there was no evidence they suffered food poisoning after eating at a local market.

The husband of American Mariam Soraya Vorster told the New Zealand Herald she had similar symptoms.

The son of British couple George Everitt, 78, and Eileen, 74, said Thai officials claimed they both died on February 19 after heart attacks.

'They were active and healthy for their age,' he told the Herald. 'They had no history of heart problems. It doesn't make sense. How can it be coincidence?'

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

"Not many" is not the same thing as "none". I wonder how many additional cases or deaths there might have been.

Two additional musings. First, the cases we know of could not have had contact with each other. The Thai tour guide died the day before the girls from New Zealand arrived. And the New Zealand girls were removed to a hospital at least six days before the British couple arrived. If there were additional cases, it is possible that a chain of transmission may have occurred.

Secondly, presuming the body taken down the fire chute was indeed the Thai tour guide, it would have been the first case at that hotel. I don't know if the authorities would have suspected there was anything worth covering up unless there had already been other cases of which we are not yet aware. Although, since this is a tourist hotel, even a death by natural causes might be something that hotel owners might not want their guests to see...

http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=10711571

Survivor of Thai poisoning gives blood samples
By Stuart Dye 5:30 AM Friday Mar 11, 2011 Share Email
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Expand The Kiwi trio ate at the Anusarn Market. Photo / Brett PhibbsA survivor of the Thailand poisonings has been asked to supply more blood samples to help uncover the cause of five deaths in six weeks.

Amanda Eliason was left in intensive care after falling ill in a Chiang Mai hotel room together with friends Sarah Carter and Emma Langlands.

The 23-year-old pulled through after undergoing a heart procedure and is now back in New Zealand.

Her father, Peter Eliason, yesterday said Amanda would supply more blood for Thai health officials.

They have said the deaths of Sarah Carter, two other tourists and a local woman are "nothing more than coincidence".

A fifth death, at another hotel nearby, is so far unexplained.

Mr Eliason said that was very difficult to believe and Amanda hoped her blood samples could provide some clues.

"We just want to get to the bottom of it and stop the possibility of it happening in the future.

"When I was over there I asked how many similar cases they had and I was told, 'Not many'.

"You just wonder now what is being covered up."

Amanda, Sarah and Emma became sick in the Downtown Inn in Chiang Mai on February 4. Sarah died in hospital two days later.

It has since emerged that British pensioners George and Eileen Everitt and local woman Waraporn Pungmahisiranon died in similar mysterious circumstances in the same hotel within two weeks of Sarah.

And a fifth woman - 33-year-old America tourist Mariam Soraya Vorster - died three weeks earlier in similar circumstances, though she was not staying at the same hotel.

Tests on tissue taken from Sarah have now been sent to experts in the United States and Japan.

NZ Foreign Minister Murray McCully hopes to get information from Chiang Mai health authorities in the next few days.

"We're seeking whatever forensic information might be available and that's something we'll work our way through over the next few days," a ministerial spokesman said.

Mr McCully did not need to send Foreign Affairs and Trade officials to Chiang Mai because New Zealand had a "very good" official in the ambassador in Bangkok.

"He has been asked to ensure that we extract the required information."

- Additional reporting NZPA

By Stuart Dye | Email Stuart

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

http://www.monstersandcritics.com/n...ailand-tourist-deaths-under-way-officials-say

Lab tests on Thailand tourist deaths under way, officials say
Mar 11, 2011, 5:29 GMT


Bangkok - It will take at least a month for laboratories to return the results on the cause of four tourists' deaths in the same guest house in northern Thailand, Thai officials said Friday.

'We will have to wait at least a month for lab results from the CDC (Centers for Disease Control Prevention) in the US and a similar lab in Japan,' said Panakda Disakul, governor of the city of Chiang Mai, 650 kilometres north of Bangkok.

The New Zealand government has expressed dissatisfaction with Thailand's handling of the investigation into the deaths, which occurred at the same hotel over a six-week period.

[snip]

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised - echovirus suspected?

Re: 23 Year old dies of myocarditis - 2 friends hospitalised - echovirus suspected?

http://www.stuff.co.nz/world/asia/4760041/Tests-link-virus-to-dead-Kiwi-tourist

Tests link virus to dead Kiwi tourist

Tests have revealed that Kiwi backpacker Sarah Carter had a highly infectious virus that can cause the same heart condition that killed her in Thailand last month.

Thai health authorities are still investigating what caused the sudden deaths of Ms Carter, 23, and four others in Chiang Mai within five week, including an elderly British couple, an American woman and a Thai woman.

Ms Carter and Kiwi friends Emma Langlands, 23, and Amanda Eliason, 24, became seriously ill with vomiting and heart complications while staying at the Downtown Inn in the northern tourist city.

Ms Carter died of myocarditis, or acute inflammation of the heart muscle, on February 6, and Ms Eliason needed emergency heart surgery. Their illness was initially blamed on food poisoning from a seaweed toxin.

Thai doctor Pasakorn Akarasewi met New Zealand embassy staff for a two-hour briefing on Thursday night to report the investigation's latest findings.

His report includes newly released autopsy tests, which showed Ms Carter had echovirus, a highly contagious disease linked to dirty, overcrowded conditions, which can cause myocarditis.

Dr Akarasewi, Bureau of Epidemiology director for Thailand's Department of Disease Control, said doctors were unsure what caused the Kiwis' illnesses.

"After the group of three New Zealanders, we set up the joint investigation team," he said.

Soon after, the team heard about the deaths of elderly British couple George and Eileen Everitt in the same hotel only two weeks later. Members also heard about Thai woman Waraporn Pungmahisiranon, 47, who died in the room next to Ms Carter on February 3 – the day before the New Zealanders became severely ill.

Dr Akarasewi said autopsy results showed the British couple had blocked heart arteries, which could have caused their deaths.

A fifth victim, American woman Mariam Soraya Vorster, 33, who died on January 11, though not in the Downtown Inn, had symptoms that were "in the same pattern" as Ms Carter's.

Although her death occurred a month earlier, an autopsy had been performed before her cremation in Chiang Mai, he said.

Thai police had checked the Downtown Inn's air conditioning and facilities but found nothing untoward.

Ad Feedback - The Dominion Post

 

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Re: 7 cases of unexplained myocarditis - 5 deaths - echovirus suspected

Re: 7 cases of unexplained myocarditis - 5 deaths - echovirus suspected

Apparently, if this is due to echovirus, these would be only the most severe cases, which would explain the strange clustering of cases. The timing might be a bit off however (although we don't know the source of exposure) as the incubation period listed below is considerably longer than this cluster appears to have.

http://en.wikipedia.org/wiki/Echovirus

Echovirus

An ECHO (Enteric Cytopathic Human Orphan) virus, is a type of RNA virus that belongs to the genus Enterovirus of the Picornaviridae family.[1] Echoviruses are found in the gastrointestinal tract (hence it being part of the enterovirus genus) and exposure to the virus causes other opportunistic infections and diseases.

HistoryThe first isolation of echoviruses occurred from the feces of asymptomatic children early in the 1950s, just after cell culturing had been developed. The echo– part of the name was originally an acronym for "enteric cytopathic human orphan" virus: Orphan virus means a virus that is not associated with any known disease. Even though Echoviruses have since been identified with various diseases, the original name is still used.[2]

DescriptionEchovirus is highly infectious, and its primary target is children. The echovirus is among the leading causes of acute febrile illness in infants and young children, and is the most common cause of aseptic meningitis.[3] Infection of an infant with this virus following birth may cause severe systemic diseases, and is associated with high infant mortality rates. The echovirus can mimic symptoms caused by other common bacterial and viral infections.

Viral structure and infectionAn echovirus measures 24-30 nanometres (nm), and is similar to other viruses, since it has a naked protein capsid, which makes up 75% of the virus particle that encloses a dense central core of single-stranded RNA. This RNA has a length of approximately 7.5 kilobase (kb), contains an RNA replicase, viral-coded proteins, and a single polyprotein that is responsible for the formation of structural proteins and other proteins necessary for cellular replication. The structural proteins determine host range and play a very important role in delivering the RNA genome into the cytoplasm of new host cells.[3]

Some viral replication of an echovirus occurs in the nasopharynx after infection and then spreads to regional lymph nodes. However, most viral particles are swallowed and they reach the lower gut tract, where the virus is presumed to bind to specific receptors. The virus then spreads to the lower intestinal tract, replicating but not causing any major cellular effects along the way. Next, the virus spreads to many secondary sites in the body such as the central nervous system, liver, spleen, bone marrow, heart and finally the lungs. Additional replication of the virus will occur, causing symptoms 4 to 6 days after infection. The most deadly part however is delayed when symptoms of a central nervous system disease start to appear. Enteroviruses are capable of infecting any cell in the body. These viruses are highly infectious. They can spread through the air to other hosts 1–3 weeks after infection and can spread through feces to other hosts eight weeks after infection.

Symptoms and diagnosisEchovirus disease occurs disproportionately in males and children. Infection within the first two weeks of birth can cause devastating and potentially fatal disease. In this population, death usually results from overwhelming liver failure or myocarditis, rather than infection of the central nervous system. Older children and adults have a better prognosis. Myocarditis is the most frequent complication in adults.

ECHO virus, like the other Enteroviruses Coxsackievirus A and B, typically causes a mild, nonspecific illness with a low fever. Echovirus may also produce a rash that spreads from the face down to the neck, upper extremities, and chest. Laboratory diagnosis is made with acute and convalescent titers of serum antibodies to Echovirus.

Cause of infection
Causes of echovirus infections (Acute meningitis) can be placed in several categories. Main causes of infection are from overcrowded conditions such as the poor districts of a city and poor hygiene. Echoviruses are transmitted person-to-person; the fecal-oral route is the predominant mode, although transmission sometimes occurs via respiration of oral secretions such as saliva. Indirect transmission occurs through numerous routes, including via contaminated water, food, and fomites (inanimate objects). Contaminated swimming and wading pools can also transmit the virus. Also, there are well-documented reports of transmission via the contaminated hands of hospital personnel.

Treatment
No specific treatment for echovirus infection is currently available. Care is directed at relief of symptoms. The anti-viral drug pleconaril interferes with the binding of the echovirus particle to the cell membrane and the drug also hinders the uncoating of virions by attaching itself to the viral protein capsid.[3] The pharmaceutical company, ViroPharma Incorporated, ended development of pleconaril in 2004.

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

The forum in which several people involved in the investigation are posting is again below. Now it is reporting several additional deaths, including 3-4 Thai men, with similar symptoms, but no link to the original hotel. It is conceivable, IMO, that the high-profile tourist deaths may have been reported first for obvious reasons, but may only represent a part of a larger outbreak.

http://www.thaivisa.com/forum/topic...n-chiang-mai-just-a-coincidence/page__st__225

 

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Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

The spelling in this article is the original; it might be the result of a non-English speaker, or perhaps or a voice recognition.

Coxsackie B virus, like echovirus above, is an enterovirus. It is not clear exactly which virus has been detected.

http://www.bangkokpost.com/news/local/226240/who-asked-to-look-into-suspicious-chiang-mai-deaths

HEALTH

WHO asked to look into suspicious Chiang Mai deathsPublished: 12/03/2011 at 12:00 AM
Newspaper section: News

CHIANG MAI : The Disease Control Department has askede World Health Organisation to help examine a series of mysterious deaths in Chiang Mai aftere Coxsackie B virus was found ine body of a New Zealand tourist who diedere last month.

The department insistede virus might not bee cause of death of Sarah Carter, 23, who died at Chiang Mai Hospital on Feb 6, or four other people who have died since New Year andere should be no panic about a viral epidemic ine province.

Four ofe five people who died stayed ate Downtown Inn Hotel in Chiang Mai. They all passed away over a period of 16 days.

Two foreign tourists and a Thai tour guide were found dead ate hotel last month. Aird foreigner staying ate hotel later died in hospital.

A fifth case of a recent unexplained death ine province has since come to light,ough she stayed somewhere else.

American Mariam Soraya Vorster, 33, died on Jan 11 after being admitted to a private hospital ine province. Her case came to light on Wednesday.

Vorster's husband Tony Pandolo tolde New Zealand Heraldat his wife fell ill with symptoms of food poisoning before she died.

Vorster did not stay ate Downtown Inn Hotel, but at another hotel ine province's central district.

Police have ruled out foul play ine deaths, but health authorities are now investigating other possible causes. Oneeory isate victims may have contractede Coxsackie B virus, possibly from eating contaminated food.

The department has invitede New Zealand embassy to take part ine investigation into Carter's death.

Pasakorn Akarasewi, director ofe Bureau of Epidemiology, saide Coxsackie B virus can pass from human to human. It causes stomach upsets and in some cases heart damage and death. It is not common in Thailand.

Dr Pasakorn said Chiang Mai health authorities have inspectede hotel wheree New Zealand tourist died, and surrounding areas.

Carter waseird person to have died from "mysterious reasons" ine province since January.

The second death was Thai tour guide Waraporn Yingmahasaranont, 47, who died in her room ate Downtown Hotel on Feb 3.

British couple George Everitt, 78, and Eileen Everitt, 74, who died ine same hotel as Waraporn and Carter on Feb 19, weree fourth and fifth cases.

Chiang Mai provincial health office said a preliminary report showed Vorster,e first known suspicious death bute most recent to come to light, had suffered from inflammation ofe heart muscle although officials have yet to reach a conclusion one cause of death.

Surasi Wisarutarat, Chiang Mai deputy chief health officer, saide health office sent tissue samples from Vorster's body to a lab ine US. The results should be known in about a month.

As fore British couple, Dr Surasi said authorities could say onlyatey died of an acute heart attack.

Epidemiologists were unable to investigatee case of tour guide Waraporn as his body has been cremated.

Chiang Mai governor ML Panadda Disakul said he had mete New Zealand charge d'affaires and explainede issue. He said provincial authorities had formed a working group to investigatee cases and were waiting fore results of medical examinations.

Authorities are concernedate mysterious deaths will affect Chiang Mai tourism which has only just recovered from last year's political turbulence.

Local authorities will step up measures to control hygiene in shops, restaurants, markets, stalls and street vendors.

Stricter control will also be imposed on guest houses, apartments and boutique hotels because most visitors to Chiang Mai stay atese places.

"We will work closely withe private sector to restoree image ofe province beforee Songkran festival next month,"e governor said.

 

[Giuseppe]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Coxsackie virus type B (B1, B4, B5 for example) are sometimes involved in the so-called Hand-Foot-and-mouth condition.

For example:

Hong Kong: Vigilance reminder on Hand, Foot and Mouth Disease (7/12/10)


[Source: Centre for Health Protection, Hong Kong PRC SAR, View Original Article.]

The Centre for Health Protection (CHP) of the Department of Health has reminded members of the public to stay vigilant against hand, foot and mouth disease (HFMD) and enterovirus (EV) infections upon receiving report of three cases of complications suspected to be due to EV infection.

The first patient was a 25-year-old man with good past health who presented with fever, chills, dizziness and headache on July 7 and was admitted to Ruttonjee Hospital the next day. He further developed vesicular and papular rash over hands and feet on July 9. He was discharged today (July 12). His symptoms were clinically compatible with viral encephalitis. Laboratory tests today found his cerebrospinal fluid specimen positive for EV. Investigation revealed that the man's younger brother had symptoms of HFMD a week ago and had already recovered. His other home contacts were asymptomatic.

The second patient was a 25-month-old boy who had good past health. He had fever and generalised convulsion on July 10 and was admitted to Princess Margaret Hospital. Physical examination showed ulcers and red spots over posterior pharynx and the clinical diagnosis was status epilepticus complicating herpangina. His fever subsided today and he is now in stable condition. His throat swab was today tested positive for EV.

The third patient was a 23-year-old man who developed fever on June 6. He presented with rash over hands and diarrhoea on June 9 and was admitted to Prince of Wales Hospital the same day. He was diagnosed to have HFMD clinically. The patient was once admitted to intensive care unit because of septic shock with multi-organ failure and myocarditis. Afterwards, his condition improved gradually. He had already recovered and was discharged today. His serum was tested positive for Coxsackievirus B5 antibody.

-
-----

 

[alert]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

And now a ProMED post.

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87530

Archive Number 20110312.0802
Published Date 12-MAR-2011
Subject PRO/EDR> Undiagnosed deaths - ThaiIand, RFI

UNDIAGNOSED DEATHS - THAILAND, REQUEST FOR INFORMATION
******************************************************
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: Sat 12 Mar 2011
Source: The Dominion Post via stuff.co.nz [edited]
<http://www.stuff.co.nz/world/asia/4760041/Tests-link-virus-to-dead-Kiwi-tou=>


Tests link virus to dead Kiwi tourist
-------------------------------------
Tests have revealed that a female backpacker from New Zealand had a
highly infectious virus that can cause the same heart condition that
killed her in Thailand last month [February 2011]. Thai health
authorities are still investigating what caused the sudden deaths of a
23 year old backpacker and 4 others in Chiang Mai within 5 weeks,
[comprising] an elderly British couple, an American woman, and a Thai
woman.

The Kiwi backpacker and 2 friends became seriously ill with vomiting
and heart complications while staying at the Downtown Inn in the
northern tourist city.

The deceased died of myocarditis (acute inflammation of the heart
muscle) on 6 Feb 2011, and one of her companions needed emergency
heart surgery. Their illness was initially blamed on food poisoning
from a seaweed toxin.

Thai doctor Pasakorn Akarasewi met New Zealand embassy staff for a
2-hour briefing on Thursday night [10 Mar 2011] to report the
investigation's latest findings. His report includes newly released
autopsy tests, which showed the backpacker had [an] echovirus
[infection], a highly contagious disease linked to dirty, overcrowded
conditions, which can cause myocarditis.

Dr Akarasewi, director of the Bureau of Epidemiology for Thailand's
Department of Disease Control, said doctors were unsure what caused
the Kiwi backpacker's illness. Soon after, the team heard about the
deaths of an elderly British couple in the same hotel only 2 weeks
later. Members also heard about a 47 year old Thai woman who died in
the room next to the Kiwi backpacker on 3 Feb 2011 -- the day before
the New Zealander became severely ill. Dr Akarasewi said autopsy
results showed the British couple had blocked heart arteries, which
could have caused their deaths.

A 5th victim, a 33 year old American woman who died on 11 Jan 2011
though not in the Downtown Inn, had symptoms that were "in the same
pattern" as the backpacker. Although her death had occurred a month
earlier, an autopsy had been performed before her cremation in Chiang
Mai, he said.

Thai police had checked the Downtown Inn's air conditioning and
facilities but found nothing untoward.

--
communicated by:
Denis Legion
<legion@q-net.net.au>

[Similar reports from other sources forwarded by Denis Legion differ
in detail but do not shed additional light on these events. In one
report the backpacker's father is quoted as saying: "It is almost
beyond belief the deaths could be a coincidence. It seems beyond
coincidence that there should be 3 deaths or 4 in rooms adjacent to
each other over a very short period of time."

Echoviruses were originally discovered in human faeces, unassociated
with human disease during epidemiological studies of polioviruses. The
viruses were named echoviruses (enteric, cytopathic, human, orphan
viruses). These viruses were defined as picornaviruses isolated from
the gastrointestinal tract tract that produced a cytopathic effect in
cell cultures but did not induce detectable pathological lesions in
suckling mice. Altogether, 34 viruses were assigned echovirus serotype
designations but some were reclassified later. It is not unlikely that
a specific echovirus could be responsible for myocarditis in a
vulnerable individual, but an outbreak linked to specific location is
problematic. Further information on the specific diagnoses and the
microbiological investigations undertaken would be appreciated in due
course.

Chiang Mai is located in the mountainous north of Thailand and is a
favourite destination for tourists, attracting backpackers as well as
a more upmarket clientele of all ages. The hotel involved has been
rated a 2/3 star establishment.

 

[Giuseppe]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

I don't understand the position of ProMed moderator since - as I posted earlier - Hong Kong regularly reported HFMD cases caused by Echoviruses (see http://www.flutrackers.com/forum/showpost.php?p=398299&postcount=35 ).

Coxsackievirus B (B1, B4, B5) were isolated in patients with HFMD, a disease transmissible through direct contact will ill patient or objects, food contaminated with patients' body fluids.

 

[alert]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

I don't understand the position of ProMed moderator since - as I posted earlier - Hong Kong regularly reported HFMD cases caused by Echoviruses (see http://www.flutrackers.com/forum/showpost.php?p=398299&postcount=35 ).

Coxsackievirus B (B1, B4, B5) were isolated in patients with HFMD, a disease transmissible through direct contact will ill patient or objects, food contaminated with patients' body fluids.

I believe his position is that clusters of echovirus cases are not unusual, but clusters of fatalities would be. HFMD is a very mild illness in most cases, and is rarely fatal in adults. Four fatalities due to such viruses in one hotel in three weeks would be extremely unusual, but there is no indication in any article how many other people might have had milder cases.

 

[alert]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

This appears to be from the Thailand MOH. There are several new cases here, including a fatal case in a Frenchwoman (who apparently died before the New Zealander), but none of the new cases seem linked to the one hotel. Counting cases and comparing them to the known ones, I think the other mild case is the Canadian woman.

Also of interesting note is that only one of the cases apparently had a fever, and one of the cases apparently took ill before getting to Chiang Mai. That might point to something other than infection in Chiang Mai.

It might also be an important clue that all the myocarditis cases are female, and all have been tourists (the Thai woman did not have myocarditis according to this release). IMO, the epidemiology on this one might hint at a toxic exposure, even an intentional one (homicide).

http://www.thaivisa.com/forum/topic...n-chiang-mai-just-a-coincidence/page__st__225

http://www.ddc.moph.go.th/pnews/showimgdetil.php?id=243

Disease Outbreak News
Myocarditis cases in Chiangmai – update 1 (11 March 2011) On 9 February, the Department of Disease Control was requested by the Chiangmai Provincial Health Office to assist in an investigation into myocarditis cases. The joint investigation team found four clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another two patients with mild symptoms. These six patients were among three separate groups of tourists visiting Chiang Mai, Thailand, between 9 January and 4 February 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3). Of these six patients three died (one each from the USA, France and New Zealand). Five of them became ill while visiting Chiang Mai and one developed symptoms three days before arriving there. Common features of the illness among these patients include vomiting without diarrhea and lack of respiratory symptoms. One patient had a fever but all others were afebrile. Extensive epidemiological investigation has not revealed any common exposures across the three groups. Laboratory testing of blood and stools to date has not revealed anything except for evidence of infection by an echovirus in one patient and by a Coxsackie virus in another patient from New Zealand. Autopsies on two of the dead patients (American and French) were done by forensic medical expert of Chiang Mai University. The autopsies found nothing abnormal except for inflammation of the heart muscle. The Department of Disease Control has shared this information with the WHO and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation (IHR) focal points of France and the European Community.

In a separate episode, since 3 February, there were three other deaths in the same hotel where the three New Zealanders stayed. This included an elderly British couple and a 47 year old Thai woman. As these three deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the two elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death. Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare. The Department of Disease Control will continue its intensive investigation and collaborate with the WHO, IHR authorities and embassy contact persons of the USA, France and New Zealand to determine the causes of myocarditis in all these cases, which may be of the same or of different etiologies. While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

 

[alert]

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Re: 23 Year old dies of myocarditis - 2 friends hospitalised

Here's my summary of what we know to this point:

Sarah Carter, 23F, from New Zealand took ill in room 518 of the Downtown Inn in Chiang Mai, Thailand on the night of February 2, and died in hospital two days later. Autopsy indicated myocarditis, and case has tested positive for Coxsackie B virus.

Amanda Eliason, 24F, from New Zealand, travelled with Sarah Carter, took ill at the same time in the same place, but had emergency heart surgery for myocarditis and survived. May have tested positive for echovirus.

Emma Langlands, 23F, from New Zealand, travelled with the above two cases, took ill at the same time, was hospitalized briefly, but had a milder illness, no myocarditis, and has not tested positive for anything.

Thai woman, name unclear, 47F, found dead in room 516 of the Downtown Inn on the day of February 2. No clear cause of death, no myocarditis, has not tested positive for anything yet.

Miriam Soraya Vorster, 33F, from USA (either California or Washington state has been reported), died January 11, hotel other than Downtown Inn, autopsy confirms myocarditis, no cause found.

Mr. and Mrs. Everitt, 78M and 73F, British, found dead in room 423 of the Downtown Inn on February 19, coronary blockages, but no myocarditis. Were still alive as of the 17th.

An amateur detective in Chiang Mai has taken pictures of the various rooms in the hotel (http://www.udonmap.com/udonthaniforum/kiwi-girl-dies-of-food-poisoning-t20031-15.html).

And now from the MOH report:

Woman, 23-33, from France, died of myocarditis sometime between January 9 and February 4, hotel other than Downtown Inn, no cause found.

Possible second Frenchwoman, 23-33, may have travelled with above case, mild illness.

Possible Canadian woman, 23-33, may have travelled with either the deceased Frenchwoman or Miriam Vorster, mild illness (?). May be the same individual as second Frenchwoman (?).

One of the 2-3 cases mentioned above may have been ill prior to arrival in Chiang Mai.

From the ThaiVisa forum:

3-4 Thai males, fatal, no dates of death or autopsy results given.

The reporting is slightly unclear, but all together, there may be 10-15 undiagnosed cases/deaths in Chiang Mai, and the most recent date of a reported myocarditis case appears to be February 4.