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CIDRAP- Niger, Tanzania probe two unknown-illness outbreaks

Shiloh

Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-pers...-tanzania-probe-two-unknown-illness-outbreaks


Niger, Tanzania probe two unknown-illness outbreaks
Filed Under:
Misc Emerging Topics
Lisa Schnirring | Staff Writer | CIDRAP News
|
Nov 20, 2013


Health officials in Africa are investigating two separate outbreaks of unknown illness, a small one in Niger that has killed nearly a third of patients and a larger one in Tanzania in which no deaths have been reported so far, the World Health Organization (WHO) African regional office said today.

Deadly outbreak in Niger

In Niger, the outbreak as of the middle of October had sickened 23 patients in two villages in Tera District, located in the country's Tillaberi Region. The area is located in far southwestern Niger, not far from the Burkina Faso and Mali borders. Seven deaths have been reported, according to the WHO report.

Symptoms included fever, dysphagia, nosebleeds, vomiting, neck pain, submandibular lymphadenopathy, and ulceronecrotic tonsil lesions. However, none of the patients had a pseudomembrane at the back of the throat, which is a hallmark feature of diphtheria. Also, nosebleeds, which occurred in five patients, isn't a common diphtheria symptom.

Throat swabs from five patients were negative for diphtheria, and blood tests from two patients were negative for mononucleosis. These tests were done at the Centre for Medical and Health Research (CERMES), a Pasteur Institute lab that operates under Niger's public health ministry.

Given the unusual symptoms, negative lab tests for diphtheria, and high case-fatality rate, further investigations are needed to determine the outbreak's scope, source, and risk of further spread, the WHO said. The office said the WHO is assisting Niger's health ministry investigators and has deployed an epidemiologist to provide technical support in coordinating the work.

Almost 800 cases in Tanzania

Meanwhile, Tanzania's health ministry is investigating an unknown disease in Kasulu district, located in the northwestern part of the country not far from the Burundi border. Since late August, 794 illnesses have been reported, none of them fatal, according to a separate WHO outbreak report.

The main symptoms are fever, headache, vomiting, and abdominal pain, but tests for dengue fever conducted on some of the patients were negative. The WHO said more tests are under way to determine the cause of the outbreak and that health officials are weighing several possibilities, including dengue fever, yellow fever, and hepatitis A or E.

In response to the outbreak, health officials have intensified health education about environmental hygiene and sanitation and have strengthened surveillance and lab analysis of samples, according to the report.

Monitoring challenges

Sharon Sanders, editor-in-chief of the infectious disease message board FluTrackers, told CIDRAP News that the group's volunteers follow developments in the two countries, but added that Africa is a challenging area to monitor, because the news coming out of the region is sparse. She said malaria and cholera seem to be chronic in the area over the past months, and health officials in Niger recently detected the country's first diphtheria cases in 7 years.

She said it's not unusual to see news stories about "unknown" diseases appear in the African media, which are usually resolved in a few weeks after global health groups arrive to assist with testing. However, Sanders said it is unusual for a WHO division to report an unknown disease outbreak.

"We are going to carefully watch this," Sanders said, adding that reports of nasal bleeding in the Niger outbreak patients is worrying and that she would like to know if bleeding is a feature in any of the Tanzanian cases.

See also:

Nov 20 WHO Africa regional office Niger outbreak notice

Nov 20 WHO Africa regional office Tanzania outbreak notice
 
Re: CIDRAP- Niger, Tanzania probe two unknown-illness outbreaks

ProMED responds with some possible diagnoses.

Personally, the outbreak in Niger seems very unusual to me and it is difficult to imagine any known cause for it. Fever and nosebleed might also suggest typhoid fever, but some of the other symptoms just don't match any better than they would for Lassa.

The outbreak in Tanzania could be almost anything. Yellow fever, which is listed as a possible diagnosis, seems unlikely with the lack of fatalities so far.

Published Date: 2013-11-23 04:36:39
Subject: PRO/EDR> Undiagnosed febrile illness - Niger, Tanzania: RFI
Archive Number: 20131123.2069748

UNDIAGNOSED FEBRILE ILLNESS - NIGER, TANZANIA: 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: Wed 20 Nov 2013
Source: Center for Infectious Disease Research and Policy (CIDRAP) News [edited]
http://www.cidrap.umn.edu/news-pers...-tanzania-probe-two-unknown-illness-outbreaks


Health officials in Africa are investigating 2 separate outbreaks of unknown illness, a small one in Niger that has killed nearly a third of patients and a larger one in Tanzania in which no deaths have been reported so far, the World Health Organization (WHO) African regional office said today [20 Nov 2013].

In Niger, the outbreak as of the middle of October [2013] had sickened 23 patients in 2 villages in Tera District, located in the country's Tillaberi Region. The area is located in far south western Niger, not far from the Burkina Faso and Mali borders. According to the WHO report, 7 deaths have been reported.

Symptoms included fever, dysphagia, nosebleeds, vomiting, neck pain, submandibular lymphadenopathy, and ulceronecrotic tonsil lesions. However, none of the patients had a pseudomembrane at the back of the throat, which is a hallmark feature of diphtheria. Also, nosebleed, which occurred in 5 patients, isn't a common diphtheria symptom.

Throat swabs from 5 patients were negative for diphtheria, and blood tests from 2 patients were negative for mononucleosis. These tests were done at the Centre for Medical and Health Research (CERMES), a Pasteur Institute lab that operates under Niger's public health ministry.

Given the unusual symptoms, negative lab tests for diphtheria, and high case fatality rate, further investigations are needed to determine the outbreak's scope, source, and risk of further spread, WHO said. The office said that WHO is assisting Niger's health ministry investigators and has deployed an epidemiologist to provide technical support in coordinating the work.

Meanwhile, Tanzania's health ministry is investigating an unknown disease in Kasulu district [Kigoma region], located in the north western part of the country not far from the Burundi border. Since late August [2013], 794 illnesses have been reported, none of them fatal, according to a separate WHO outbreak report.

The main symptoms are fever, headache, vomiting, and abdominal pain, but tests for dengue fever conducted on some of the patients were negative. WHO said more tests are under way to determine the cause of the outbreak and that health officials are weighing several possibilities, including dengue fever, yellow fever, and hepatitis A or E.

In response to the outbreak, health officials have intensified health education about environmental hygiene and sanitation and have strengthened surveillance and lab analysis of samples, according to the report.

Sharon Sanders, editor-in-chief of the infectious disease message board FluTrackers, told CIDRAP News that the group's volunteers follow developments in the 2 countries, but added that Africa is a challenging area to monitor, because the news coming out of the region is sparse. She said malaria and cholera seem to be chronic in the area over the past months, and health officials in Niger recently detected the country's 1st diphtheria cases in 7 years.

She said it's not unusual to see news stories about "unknown" diseases appear in the African media, which are usually resolved in a few weeks after global health groups arrive to assist with testing. However, Sanders said it is unusual for a WHO division to report an unknown disease outbreak.

"We are going to carefully watch this," Sanders said, adding that reports of nasal bleeding in the Niger outbreak patients are worrying and that she would like to know if bleeding is a feature in any of the Tanzanian cases.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[The information provided for the Niger outbreak is general, and does not provide enough specific information to suggest which etiological agent may be responsible for these cases. However, one possibility is Lassa fever virus, which is endemic in neighboring Nigeria. The reservoir host for that virus is the multimammate mouse, _Mastomys_, 2 or more species of which are present in the Tillaberi region in south western Niger (http://maps.iucnredlist.org/map.html?id=12868) along the Nigeria border. The USA CDC (http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lassaf.htm) lists Lassa fever clinical signs as, "fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult." No mention of tonsil lesions similar to those in the Niger cases is made in the CDC description. Other possibilities include Marburg and Ebola virus infection, although no mention is made of a maculopapular rash that is common with infections by these viruses. If these are yellow fever cases, one would think that symptoms of that disease are specific enough to raise suspicions of that etiology. A confirmed case of yellow fever occurred in Niger in April 2013 (see ProMED-mail archive no. 20130609.1762775) and Niger health authorities should be familiar with that disease.

Although dengue has been ruled out in the Tanzania febrile disease outbreak, no mention is made about testing for chikungunya virus infections. However, no mention is made of acute and persistent arthralgia that is characteristic of infections with that virus. There are many other infectious agents that can cause the symptoms seen in the Tanzania cases.

ProMED-mail would appreciate receiving further information about these 2 outbreaks, and especially laboratory results, as they become available.

Maps showing the location of the Tillaberi region in Niger can be accessed at http://en.wikipedia.org/wiki/Tillabéri_Region and http://healthmap.org/r/6_*-; the Kigoma region in which the Kasulu district in Tanzania is located can be seen at http://en.wikipedia.org/wiki/Kigoma_Region and http://healthmap.org/r/9f1T. - Mod.TY]
 
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