(Personally, I suspect the symptoms reported may be incorrect, perhaps intentionally so, as no health professionals have visited the village. That might explain the puzzling diagnoses suggested below. - alert)
Published Date: 2015-03-24 11:38:29
Subject: PRO/EDR> Undiagnosed skin disease - India: (KA) fatal, children, blindness, RFI
Archive Number: 20150324.3247565
UNDIAGNOSED SKIN DISEASE - INDIA: (KARNATAKA), FATAL, CHILDREN, BLINDNESS, 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: Fri 20 Mar 2015
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/...s-disease.html
While 3 children have died of a mysterious disease at Kurattihosur village (a 16-year-old girl, a 13-year-old boy, and an 11-year-old girl), many other children have been suffering from the disease in the village over the last 6 months.
Initially, pimples are seen all over the body of the patients. They burst after some time, and this leads to wounds that do not heal with any treatment, posing a threat to the lives of the affected children. In some instances, the children have lost their sight.
A village resident said that the disease had so far claimed the lives of 10 children and that more were suffering from it, but no one from the Health department or any elected representative had visited Kurattihosur.
Dr Pandu Vijayan, the district health and family welfare officer, has promised to visit the village to take stock of the situation.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The news report above describes an outbreak of a generalized, non-healing blistering skin condition that has affected a relatively large number of mainly children (although the exact number of affected individuals and the age distribution are not given) in a village in southern Karnataka, India over a 6-month period. The illness has resulted in the deaths of at least 10 individuals and blindness in others.
The differential diagnosis for generalized blistering skin disorders is extensive. Although the description of the outbreak occurring in this Indian village is incomplete, some conditions to be included in the differential diagnosis include:
Many blistering skin disorders are autoimmune, such as various forms of pemphigoid and pemphigus. These autoimmune disorders usually do not occur in clusters of cases; however, an endemic form of pemphigus foliaceus, fogo selvagem, is seen in children, adolescents, and young adults in Brazil and other regions of South America, as well as North Africa, where it is thought to be initiated by the bite of a black fly (http://www.ncbi.nlm.nih.gov/pubmed/9206709). Photosensitivity is common in this disorder, and severe stinging or burning occurs with ultraviolet exposure. Some forms of autoimmune blistering disorders (e.g., mucous membrane pemphigoid and chronic bullous disease of childhood) involve scarring of the conjunctiva, which can lead to blindness. http://www.aafp.org/afp/2002/0501/p1861.html and http://www.ncbi.nlm.nih.gov/pubmed/3056993.
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin disease caused by toxigenic strains of _Staphylococcus aureus_. SSSS may originate from a focus of infection such as a purulent conjunctivitis, otitis media, or occult nasopharyngeal infection. A positive Nikolsky sign (slippage of the superficial layer of the epithelium on gentle pressure) can often be elicited. SSSS can occur in outbreaks. For example, large outbreaks in neonatal nurseries have been described.
Impetigo is a highly contagious afebrile, superficial bacterial skin infection, most common among children. The bullous form is primarily caused by _Staphylococcus aureus_, and _Streptococcus pyogenes_ commonly causes the nonbullous form. Blisters burst, leaving honey-colored crusts. Spread is by direct contact with lesions or with nasal carriers. However, impetigo is not usually serious, and only rarely causes potentially fatal complications.
Behcet disease (BD) is a chronic, multisystemic disease of unknown etiology that involves skin, mucous membranes, the eyes, cardiovascular, renal, gastrointestinal, pulmonary, urologic, and central nervous systems, as well as the joints, blood vessels, and lungs. However, it occurs mainly in the Mediterranean region.
Stevens Johnson syndrome and toxic epidermal necrolysis (TEN) are 2 forms of the same life-threatening skin disease that usually occurs 1-3 weeks after starting certain drugs and involves skin (with a positive Nikolsky sign) and mucous membranes of the oral cavity and eyes. Erythema multiforme is a similar acute skin condition associated with certain infections that include herpes simplex virus and _Mycoplasma_ infections.
Various zoonotic pox viruses (monkeypox, buffalopox, orf, and cowpox) can cause pustular lesions in humans. Most cases are occupational and sporadic and have few skin lesions with low morbidity, except for monkeypox, which produces an illness similar to smallpox, with significant morbidity and childhood mortality. Monkeypox virus is transmitted to people from a variety of wild animals with some human-to-human transmission. In the spring of 2003, monkeypox cases were confirmed in the midwestern United States, its first reported occurrence outside of the African continent: http://www.who.int/mediacentre/factsheets/fs161/en/ and http://whqlibdoc.who.int/smallpox/9241561106_chp29.pdf.
Buffalopox outbreaks have occurred in buffalo and in people in direct contact with the infected animals in India: http://www.oie.int/doc/ged/d3782.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125034/, and http://www.sciencedirect.com/science...67587711000870. People born after 1980, when smallpox vaccination ceased worldwide, are potentially susceptible to infection with buffalopox virus, a poxvirus closely related to vaccinia virus. In animal handlers, vesicular and pustular lesions develop on hands, arms, legs, feet and forehead, accompanied by fever that lasts about 3 days, lack of appetite, enlarged axillary lymph nodes and general malaise.
Orf virus, another pox virus, can cause infection in sheep or goats and their human handlers (http://www.cdc.gov/ncidod/dvrd/orf_virus/#whatis). Orf has been noted in India (http://www.ncbi.nlm.nih.gov/pubmed/24347045). People who come in contact with virus from an infected animal or contaminated equipment can get infected, usually developing painful sores on their fingers that heal over a period of several months without scarring. People do not infect other people. Cowpox has not been noted in India.
Chickenpox also produces mucosal lesions and skin blisters and pustules, which break open, followed by the formation of scabs. Chickenpox is a highly contagious disease caused by the initial infection with varicella zoster virus, a herpesvirus, not a pox virus. Chickenpox is infrequently serious in children, although secondary bacterial infection with _Staphylococcus aureus_ or _Streptococcus pyogenes_ may develop at sites that the patient has scratched.
More information on this outbreak would be appreciated from knowledgeable sources.
Chamarajanagar is the southernmost district in the state of Karnataka, India, bordering the states of Tamil Nadu and Kerala (http://en.wikipedia.org/wiki/Chamarajanagar_district). A map of Karnataka showing the location of Chamarajanagar can be found at (http://indhyan.in/states/karnataka/index.php). Karnataka is located in the western half of the Deccan plateau, a large plateau that makes up most of the southern part of the country. Hanur is a commercial center for many nearby villages such as Kuratti Hosur, where this outbreak is occurring, in Chamrajnagar district (http://en.wikipedia.org/wiki/Hanur). A map of India showing the location of the state of Karnataka can be found at http://www.worldofmaps.net/en/asia/m...ia-regions.htm. - Mod.ML
Published Date: 2015-03-24 11:38:29
Subject: PRO/EDR> Undiagnosed skin disease - India: (KA) fatal, children, blindness, RFI
Archive Number: 20150324.3247565
UNDIAGNOSED SKIN DISEASE - INDIA: (KARNATAKA), FATAL, CHILDREN, BLINDNESS, 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: Fri 20 Mar 2015
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/...s-disease.html
While 3 children have died of a mysterious disease at Kurattihosur village (a 16-year-old girl, a 13-year-old boy, and an 11-year-old girl), many other children have been suffering from the disease in the village over the last 6 months.
Initially, pimples are seen all over the body of the patients. They burst after some time, and this leads to wounds that do not heal with any treatment, posing a threat to the lives of the affected children. In some instances, the children have lost their sight.
A village resident said that the disease had so far claimed the lives of 10 children and that more were suffering from it, but no one from the Health department or any elected representative had visited Kurattihosur.
Dr Pandu Vijayan, the district health and family welfare officer, has promised to visit the village to take stock of the situation.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The news report above describes an outbreak of a generalized, non-healing blistering skin condition that has affected a relatively large number of mainly children (although the exact number of affected individuals and the age distribution are not given) in a village in southern Karnataka, India over a 6-month period. The illness has resulted in the deaths of at least 10 individuals and blindness in others.
The differential diagnosis for generalized blistering skin disorders is extensive. Although the description of the outbreak occurring in this Indian village is incomplete, some conditions to be included in the differential diagnosis include:
Many blistering skin disorders are autoimmune, such as various forms of pemphigoid and pemphigus. These autoimmune disorders usually do not occur in clusters of cases; however, an endemic form of pemphigus foliaceus, fogo selvagem, is seen in children, adolescents, and young adults in Brazil and other regions of South America, as well as North Africa, where it is thought to be initiated by the bite of a black fly (http://www.ncbi.nlm.nih.gov/pubmed/9206709). Photosensitivity is common in this disorder, and severe stinging or burning occurs with ultraviolet exposure. Some forms of autoimmune blistering disorders (e.g., mucous membrane pemphigoid and chronic bullous disease of childhood) involve scarring of the conjunctiva, which can lead to blindness. http://www.aafp.org/afp/2002/0501/p1861.html and http://www.ncbi.nlm.nih.gov/pubmed/3056993.
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin disease caused by toxigenic strains of _Staphylococcus aureus_. SSSS may originate from a focus of infection such as a purulent conjunctivitis, otitis media, or occult nasopharyngeal infection. A positive Nikolsky sign (slippage of the superficial layer of the epithelium on gentle pressure) can often be elicited. SSSS can occur in outbreaks. For example, large outbreaks in neonatal nurseries have been described.
Impetigo is a highly contagious afebrile, superficial bacterial skin infection, most common among children. The bullous form is primarily caused by _Staphylococcus aureus_, and _Streptococcus pyogenes_ commonly causes the nonbullous form. Blisters burst, leaving honey-colored crusts. Spread is by direct contact with lesions or with nasal carriers. However, impetigo is not usually serious, and only rarely causes potentially fatal complications.
Behcet disease (BD) is a chronic, multisystemic disease of unknown etiology that involves skin, mucous membranes, the eyes, cardiovascular, renal, gastrointestinal, pulmonary, urologic, and central nervous systems, as well as the joints, blood vessels, and lungs. However, it occurs mainly in the Mediterranean region.
Stevens Johnson syndrome and toxic epidermal necrolysis (TEN) are 2 forms of the same life-threatening skin disease that usually occurs 1-3 weeks after starting certain drugs and involves skin (with a positive Nikolsky sign) and mucous membranes of the oral cavity and eyes. Erythema multiforme is a similar acute skin condition associated with certain infections that include herpes simplex virus and _Mycoplasma_ infections.
Various zoonotic pox viruses (monkeypox, buffalopox, orf, and cowpox) can cause pustular lesions in humans. Most cases are occupational and sporadic and have few skin lesions with low morbidity, except for monkeypox, which produces an illness similar to smallpox, with significant morbidity and childhood mortality. Monkeypox virus is transmitted to people from a variety of wild animals with some human-to-human transmission. In the spring of 2003, monkeypox cases were confirmed in the midwestern United States, its first reported occurrence outside of the African continent: http://www.who.int/mediacentre/factsheets/fs161/en/ and http://whqlibdoc.who.int/smallpox/9241561106_chp29.pdf.
Buffalopox outbreaks have occurred in buffalo and in people in direct contact with the infected animals in India: http://www.oie.int/doc/ged/d3782.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125034/, and http://www.sciencedirect.com/science...67587711000870. People born after 1980, when smallpox vaccination ceased worldwide, are potentially susceptible to infection with buffalopox virus, a poxvirus closely related to vaccinia virus. In animal handlers, vesicular and pustular lesions develop on hands, arms, legs, feet and forehead, accompanied by fever that lasts about 3 days, lack of appetite, enlarged axillary lymph nodes and general malaise.
Orf virus, another pox virus, can cause infection in sheep or goats and their human handlers (http://www.cdc.gov/ncidod/dvrd/orf_virus/#whatis). Orf has been noted in India (http://www.ncbi.nlm.nih.gov/pubmed/24347045). People who come in contact with virus from an infected animal or contaminated equipment can get infected, usually developing painful sores on their fingers that heal over a period of several months without scarring. People do not infect other people. Cowpox has not been noted in India.
Chickenpox also produces mucosal lesions and skin blisters and pustules, which break open, followed by the formation of scabs. Chickenpox is a highly contagious disease caused by the initial infection with varicella zoster virus, a herpesvirus, not a pox virus. Chickenpox is infrequently serious in children, although secondary bacterial infection with _Staphylococcus aureus_ or _Streptococcus pyogenes_ may develop at sites that the patient has scratched.
More information on this outbreak would be appreciated from knowledgeable sources.
Chamarajanagar is the southernmost district in the state of Karnataka, India, bordering the states of Tamil Nadu and Kerala (http://en.wikipedia.org/wiki/Chamarajanagar_district). A map of Karnataka showing the location of Chamarajanagar can be found at (http://indhyan.in/states/karnataka/index.php). Karnataka is located in the western half of the Deccan plateau, a large plateau that makes up most of the southern part of the country. Hanur is a commercial center for many nearby villages such as Kuratti Hosur, where this outbreak is occurring, in Chamrajnagar district (http://en.wikipedia.org/wiki/Hanur). A map of India showing the location of the state of Karnataka can be found at http://www.worldofmaps.net/en/asia/m...ia-regions.htm. - Mod.ML