Infectious disease with life threatening complications and at least 3 deaths reported

[drjagathv]

Infectious disease with life threatening complications and at least 3 deaths reported
________________________________________
Infectious disease with life threatening complications and at least three deaths reported in North Central province; Sri Lanka.

By Dr V. W. Jagath Vasanthathilaka, Consultant Rheumatologist, Teaching Hospital Kandy. Sri Lanka.

Different kind of a fever found in the north central Province of Sri Lanka during the latter part of the year 2007 and early 2008 which needs further investigation is brought into notice here on the flue tracker. Following recent heavy rain and floods in the north Central province many kinds of communicable viral fevers and gastroenterological infections have been seen in the North Central and the Central province in Sri Lanka. An increased incidence of Chikungunya fever and dengue fever was also observed among our patients. At least a single patient with fever and pancytopenia (Pancytopenia is a situation where there is a significant reduction and a dangerous shortage of all types of blood cells which includes red and white blood cells as well as platelets which can be considered as a life threatening complication), associated with a bleeding tendency and the patient had obvious gum bleeding was admitted to the rheumatology unit in the General hospital Kandy who was also a known patient with rheumatoid arthritis. This patient with alarmingly low levels of all types of blood counts, recovered well with appropriate measures to improve blood counts, and the fever settled. This patient was also from the North Central province where the health authorities have reported at least 3 deaths and 27 cases with fever admitted to hospitals in and around Anuradhapura. We have also observed similar mysterious fevers spreading 10 years ago while we were working in the General Hospital Anuradhapura as medical specialists which appears to be occurring time to time needs further investigation as there is a risk of spreading these diseases to the other areas. This fever is distinctly different from Chikungunya fever which does not have a high mortality rate. Some of these patients may be having Dengue fever. It is worth looking for a variant of Chikungunya or whether it is a totally different kind of fever as their presentation and progression is different from that of dengue fever as well as Chikungunya fever. We welcome further reports on this type of febrile illnesses found in the North Central province; we have encountered only a single patient with a slightly different kind of a febrile illness so far. There are many reports emerging from the north Central Province. This strange looking fever needs further notifications, reports and investigations to understand the true nature of the illness in order to adopt necessary preventive measures.

Dr V. W. Jagath Vasanthathilaka, Consultant Rheumatologist, Teaching Hospital Kandy. Sri Lanka.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Viral fever has been reported in the Anuradhapura District ( North Central Province) in the areas of Galnawa, Kuranegama, Karuwalagaswava, Ihala Halmillawa villages in January 2008 and in the latter part of December 2007 after heavy rain. The total number of patients admitted to Galnawa hospital in january 2008 was reported to be over 100. Similar illnesses were seen time to time especially in 1999/ 2000 after heavy rain.

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Thank you Dr. Vasanthathilaka.

Have you noticed a change in the mosquito pattern?

We will begin tracking for this fever.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

There is an increase in mosquito breeding after heavy rain and accumulation of water in many locations.

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Viral flu strikes north central Sri Lanka after floods

Tuesday, January 8, 2008, 16:32 GMT, ColomboPage News Desk, Sri Lanka.

Jan 08, Anuradhapura: A viral flu is spreading in several villages in the Anuradhapura district, which was hit by floods recently.
According to hospital sources, the unidentified flu has already killed three people and 27 others are in serious condition.
The flu has affected the Galanawa, Kuranegama, Karuwalagas Wava, Halmillawa and Amunugama villages. The total number of patients admitted to Galanawa hospital is 116.


Medical officials believe the viral flu is an intermediate form of chikungunya and dengue fever.



However, post-mortem has revealed that one of the victims died due to dengue.



http://www.colombopage.com/archive_08/January8163233JR.html





<!--=JR=--><!-- -- News END --><!---------------------------------->

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Dr. Vasanthathilaka have you made a ProMed inquiry? We can do that for you if you have not.

S.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Dr. Vasanthathilaka have you made a ProMed inquiry? We can do that for you if you have not.

S.

We haven’t made a ProMed inquiry. We encountered only a single patient with fever and pancytopenia. Serology on this patient was repeatedly negative for Ig M and IgG dengue fever antibodies, fever lasted for seven days. IgM Chikungunya antibody test was also negative. Bone marrow biopsy did not reveal any features of an underlying malignancy or any features of bone marrow suppression due to drugs. ESR was 128 mm1st hour, antinuclear antibodies and the double standard antibody test was negative. However, the lowest blood counts recoded was WBC/ DC 0.99x10 9/L Neutrophils 27.5% Lymphocytes 52.5%, lowest platelet count recorded was to 10x10 9/L and the Hemoglobin levels dropped to 6.2 g/dl . Counts returned to normal after six days of appropriate treatment. We do not have the clinical details of the patients admitted to hospitals in the North central province at the moment. The ministry of health and the Epidemiology units may be investigating those reports. It is difficult to link those reports and our report without knowing the exact details. Only factor common to them is that this individual patient was also from the north central province. We are alert to the possibility of receiving more patients. Directorate may make a ProMed inquiry on behalf of us. Still it is too early for us to draw any conclusions on this matter as our resources are limited for thorough investigation, and we are awaiting more reports and news on this type of illnesses to clarify the situation. Close monitoring and appropriate supportive treatment provided for our patient was life saving that was until the immune system fights back the underlying infection, as it is the case in most of the viral fevers encountered by our patients. This report may be of use if we encounter similar illnesses in the near future. We encourage publication of further information on the recent outbreak of viral illness reported from the North Central province, especially when we consider the serious nature of this febrile illness, in order to provide optimum treatment for these patients suffering with fever and systemic complications.

Dr. V. W. Jagath Vasanthathilaka.
Consultant Rheumatologist. Teaching Hospital Kandy

 

[Anne]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Dr Vasanthathilaka, what kind of clinical symptoms had this patient?
and wich kind of fiever - very high ?

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Dr Vasanthathilaka, what kind of clinical symptoms had this patient?
and wich kind of fiever - very high ?

Thank you very much indeed regarding your interest and inquiry regarding this unusual presentation of a febrile illness in our region. This patient presented with fever which lasted for 7 days. Presentation was some what like that of a viral infection with predominant lymphocytes. In addition to the information mentioned in the previous posts, investigations were repeatedly negative for the Dengue and Chikungunya antibodies which can happen occasionally due the fact that these tests are not 100% sensitive. Patient developed gum bleading and the blood counts dropped rapidly while observing as an inward patient and developing a pancytopenia unrelated to medications or any underlying hematological disorder. Patient was a long term follow up patient with rheumatoid arthritis which was well under control with constant monitoring for any complications and the patient did not reveal any other long term condition to account for pancytopenia. Hematologists opinion was also obtained and a bone marrow biopsy did not reveal any other hematological disorder. Pancytopenia improved with ten packs of platelets transfusion, colony stimulating factor and two pints of blood transfusion. We have come across hundreds of patients with dengue fever and Chikungunya however the clinical presentation and the progression of this fever was totally different from that of the other two conditions mentioned above, and there are reports of three deaths from a suspected viral fever from the same ( North Central) Province. We still do not know whether it is a variant of Chikungunya or Dengue fever or else whether it is a totally new form of infection emerged after flood situation in the region where one of the regional hospitals was also underwater and the patients were evacuated in Dhambulla Hospital in the North Central province. We are in the process of gathering more information to obtain a clear picture.

Dr V W Jagath Vasanthathilaka.

 

[hawkeye]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Three die of mysterious fever
Monday, January 07,2008

COLOMBO: Three persons have so far died of a mysterious fever spreading at Galnewa in Anuradhapura after the recent floods in the area.
More than fifty persons have been treated at the Galnawa hospital within two weeks following the floods and thirteen of them whose condition was serious were transferred to the Anuradhapura General Hospital. Three of the thirteen had died.
The cause of the disease has not yet been identified, the District Medical Officer of Galnawa hospital Dr. Mrs. Asoka Karunaratna said.
The disease has spread in Sattaragama, Koranegama, Halmillawa, Lolugaswewa, Midellawa, Amunugama, Pattinigama and Handungama, Dr. Karunaratna said.
A group of doctors headed by Dr. Asanga Ranasingha from the office of the Director of Health Services of the North Central Province have gone to Galne


Fever epidemic on the decline
Tuesday, January 08,2008

COLOMBO: An epidemic of fever still unidentified that has broken out in Anuradhapura has reportedly claimed three lives. The epidemic is on the decline and blood samples of patients have been sent to the Medical Research Institute (MRI) for tests to identify the disease, government epidemiologist Anuradhapura, Dr. Asanga Ranasingha said Monday. “We suspect that the source of fever is contaminated water. However this has not been established so far and after the tests at the MRI we will know what the disease is. This could be Leptospyrosis, widely known as rat fever,” Dr. Ranasingha said.The first case of fever had been reported from Galnewa and later more cases were reported from Bulnewa, both are paddy cultivation areas. By yesterday there were 16 fever patients at the Anuradhapura General Hospital, he said.

Meanwhile, Deputy Chief Epidemiologist Dr. Prabha Palihawadana told the Daily Mirror that steps have been taken to contain the viral fever in Anuradhapura.

“All Public Health Officers in Anuradhapura have been instructed to be extra vigilant about the viral infection and rush patients immediately to the nearest hospital,” she said.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Dr Vasanthathilaka, what kind of clinical symptoms had this patient?
and wich kind of fiever - very high ?

Fever was law grade 99 c to 103 c and intermittent, differential diagnosis was wide, however, so far we could not confirm any of the possible underlying etiological factors, certain possibilities were excluded. There was no evidence of significant renal and hepatic complications. We need more information on the other possible patients reported from this region.

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

I am going to move this thread to current news.

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

<table border="0" cellpadding="0" cellspacing="0" width="544"><tbody><tr> <td><table border="0" cellpadding="7" cellspacing="0" width="544"> <tbody> <tr> <td class="pageheading">http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm

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Leptospirosis​

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Frequently Asked Questions​

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</td> <td width="97%">What is leptospirosis?</td> </tr> <tr align="left" valign="top"> <td>

</td> <td>How do people get leptospirosis?</td> </tr> <tr align="left" valign="top"> <td>

</td> <td>How long is it between time of exposure and when people become sick?</td> </tr> <tr align="left" valign="top"> <td>

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What is leptospirosis?

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans it causes a wide range of symptoms, and some infected persons may have no symptoms at all. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, and respiratory distress. In rare cases death occurs.

Many of these symptoms can be mistaken for other diseases. Leptospirosis is confirmed by laboratory testing of a blood or urine sample.​

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How do people get leptospirosis?

Outbreaks of leptospirosis are usually caused by exposure to water contaminated with the urine of infected animals. Many different kinds of animals carry the bacterium; they may become sick but sometimes have no symptoms. Leptospira organisms have been found in cattle, pigs, horses, dogs, rodents, and wild animals. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact, especially with mucosal surfaces, such as the eyes or nose, or with broken skin. The disease is not known to be spread from person to person.​

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How long is it between the time of exposure and when people become sick?

The time between a person's exposure to a contaminated source and becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases; after the first phase, with fever, chills, headache, muscle aches, vomiting, or diarrhea, the patient may recover for a time but become ill again. If a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis. This phase is also called Weil's disease.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months.​

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Where is leptospirosis found?

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children.​

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How is leptospirosis treated?

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. Intravenous antibiotics may be required for persons with more severe symptoms. Persons with symptoms suggestive of leptospirosis should contact a
health care provider.​

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Can leptospirosis be prevented?

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine.
Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.​

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[Anne]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

There was no evidence of significant renal and hepatic complications.
said Dr V W Jagath Vasanthathilaka.
I suppose the patient wasn't " yellow", and that ALAT or ASAT was OK

it was a "peripheric " pancytopenia ( not in bone marrow ).. ( I don't know the right english term , escuse me.. )

a lot of mosquitoes ( flooding )

it's not leptospirosis
it's not dengue or chikungunya ( or false negatives)


did you take special protection measures like gloves or mask ?

http://www.un.org/Depts/Cartographic/map/profile/srilanka.pdf

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

There was no evidence of significant renal and hepatic complications.
said Dr V W Jagath Vasanthathilaka.
I suppose the patient wasn't " yellow", and that ALAT or ASAT was OK

it was a "peripheric " pancytopenia ( not in bone marrow ).. ( I don't know the right english term , escuse me.. )

a lot of mosquitoes ( flooding )

it's not leptospirosis
it's not dengue or chikungunya ( or false negatives)


did you take special protection measures like gloves or mask ?

http://www.un.org/Depts/Cartographic/map/profile/srilanka.pdf

Thankyou very much indeed regarding your interest shown on this clinical presentation. Presentation and the clinical features were not very typical of leptospiroris. There was no ( Jaundice) yellow discoloration. This patient was also from the same area ( less than five miles distance from Galnewa) where there were three / four deaths reported. We were not aware of an unusual illness from that area when the patient was admitted with fever. General precautions were taken as it was for any other infectious disease, and precautions to prevent mosquito born illness spreading into other area were in place as there was an increased incidence of mosquito borne illnesses. Differential diagnosis includes many illness Ig G negative variant of a known infection cannot be excluded. Supportive treatment to maintain vital functions during the critical period was helpful.

Dr V W Jagath Vasanthathilaka

 

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Was the patient tested for kala azar?

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

There was no evidence of significant renal and hepatic complications.
said Dr V W Jagath Vasanthathilaka.
I suppose the patient wasn't " yellow", and that ALAT or ASAT was OK

it was a "peripheric " pancytopenia ( not in bone marrow ).. ( I don't know the right english term , escuse me.. )

a lot of mosquitoes ( flooding )

it's not leptospirosis
it's not dengue or chikungunya ( or false negatives)


did you take special protection measures like gloves or mask ?

http://www.un.org/Depts/Cartographic/map/profile/srilanka.pdf

The area which we have described is "Kekirawa" according to the http://www.un.org/Depts/Cartographic/map/profile/srilanka.pdf pdf document.

According to the Sri Lanka Map - Sri Lanka Satellite Image http://geology.com/world/sri-lanka-satellite-image.shtml this particular area is situated in the north central province. North of Matale , west of Polonnaruwa, towards east of Maho and south of Anuradhapura exactly around the Kalawewa ( Ancient man made reservoir) from where the Kalaoya waterway ( River) begins. Three deaths were reported from this area and the patient who recovered after fever and pancytopenia was also from the same area in the north central province. We can see the blue color wedge shaped massive reservoir on the map which was filled to the full capacity during the rainy season in early January 2008 , and there was flooding.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Was the patient tested for kala azar?

This patient was not tested for Kalar azar; this possibly is also always there, with several man made reservoirs located around this area. Kalar azar was rare in Sri Lanka, however there have been cases reported recently and there are patients presenting with skin manifestations presenting occasionally to the dermatology units. We do not routinely test for Kalar azar as it was rare, however we can always further investigate for this possibility if the patient develops additional clinical clues. As we considered earlier the differential diagnosis is wide and open.

 

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

The area which we have described is "Kekirawa" according to the http://www.un.org/Depts/Cartographic/map/profile/srilanka.pdf pdf document.

According to the Sri Lanka Map - Sri Lanka Satellite Image http://geology.com/world/sri-lanka-satellite-image.shtml this particular area is situated in the north central province. North of Matale , west of Polonnaruwa, towards east of Maho and south of Anuradhapura exactly around the Kalawewa ( Ancient man made reservoir) from where the Kalaoya waterway ( River) begins. Three deaths were reported from this area and the patient who recovered after fever and pancytopenia was also from the same area in the north central province. We can see the blue color wedge shaped massive reservoir on the map which was filled to the full capacity during the rainy season in early January 2008 , and there was flooding.

We still do not know whether we are dealing with the same disease where there were three or four deaths in the same area and the patient with pacytopenia wether it is an unrelated different kind of a presentation coincidentally found from the same area. We keep all those options and possibilities open until we find more information.

 

[Vibrant62]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Re: Infectious disease with life threatening complications and at least 3 deaths repo

To eliminate the possibility of an unusual flu presentation, such as H5N1, has a rapid test for flu A been conducted? The possibility could perhaps be excluded by running such a test on this and other patients from their blood samples? It is unlikely, but perhaps is a good one to cross off the list, especially bearing in mind the high levels of infections in birds that have been cropping up in many countries, although the risk and likelihood may be very low indeed.

Thank you for keeping us informed.