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Suspected Ebola case in Uganda (ex Sudan) tests negative

alert

Senior Moderator
http://www.newvision.co.ug/D/8/12/691810

Ebola suspect in Mbale
Wednesday, 19th August, 2009 E-mail article Print article


A nursing officer attending to an ebola suspect in the isolation room at Mbale Hospital


By Daniel Edyegu,/b>
in Mbale

Medical workers in Mbale Hospital have been put on high alert following the admission of a patient suspected to have Ebola.

Joseph (second name withheld) was referred to Mbale from Tororo Hospital at 11:00am on Tuesday after his condition deteriorated.

A senior nursing officer in Mbale Hospital said precautionary measures had been taken. The patient has been isolated and access to his room restricted.

“He has been bleeding from the nose, mouth and ears since admission. He also has blood in his stool and urine. We took laboratory tests and prescribed him on treatment for haemorrhagic fever,” said the medic yesterday.

The medical staff became concerned when the bleeding persisted, although they put him on five litres of intravenous fluids, blood transfusion and intensive treatment.

They said more blood samples were yesterday drawn from Joseph and taken to Entebbe viral institute for testing.

David Obol, the chief administrator, said the hospital had provided medical workers accessing the patient with protective gear and disinfectants while awaiting the results.

Yesterday, Joseph was in a pathetic state. He lay on the bed groaning, blood flowing from his mouth and nose. He was unable to talk.

“Though the patient has all symptoms of Ebola, we cannot make conclusive statements until we receive his results from the viral institute,” said the medic.

Joseph’s father narrated that his son was first treated for malaria in Sudan where he had been working as a casual labourer on a construction site.

“He first developed high fever and sweated profusely. He was put on malaria treatment. When he failed to respond to the treatment, friends contacted us and we brought him back home for additional treatment at Tororo Hospital.” He said they were immediately referred to Mbale Hospital.

Dr. Sam Zaramba of the Ministry of Health said last night that he had not yet received any report of the admission.

Ebola is a group of viruses that cause haemorrhagic fever for which there is no cure.

The various symptoms, that can appear suddenly, include diarrhoea, fever, fatigue, general pain and severe bleeding.

The cause of death is usually hypovolemic shock (inadequate blood) or organ failure. The virus spreads through contact with bodily fluids and tissue of infected people.

Ebola haemorrhagic fever has a high death rate, claiming between 50 and 90 percent of victims. The only way to stop or contain it is through prevention, rapid diagnosis and isolation of suspected cases.

The last outbreak of Ebola was reported in the western district of Bundibugyo in December 2007. The disease killed 16 people out of the 51 cases that were reported.

In the 2000 Ebola outbreak in Gulu, 428 people became infected, 173 of whom died.
 
Re: Suspected Ebola case in Uganda (ex Sudan)

Re: Suspected Ebola case in Uganda (ex Sudan)

Sudan is known for outbreaks of an other hemorraghic illness: Rift Valley fever.

Yesterday Saudi Arabia has lifted a temporary ban imposed on the import of all types of live animals from Sudan after an outbreak of Rift Valley fever.

http://www.sudantribune.com/spip.php?article32179
 
Re: Suspected Ebola case in Uganda (ex Sudan)

Re: Suspected Ebola case in Uganda (ex Sudan)

That is a good point. This could be a case of Rift Valley fever, or of Ebola Sudan. Depending on how long the case was in Sudan, and when the patient left Uganda, Marburg might also be in the list of potential diagnoses. Independent of timing, they also must consder possiblilites such as measles or typhoid, which are common in both Uganda and Sudan. Also, as there is (as of now) only one case, possiblilites such as trypansomiasis and spotted fever (both insect borne) should be considered as both are prevalent in Africa and could produce those symptoms in a severe and untreated case.

I am a little alarmed by the statement by the father that mentioned bringing him back home after he was ill. Hopefully, they didn't fly him out on a commercial jet, or things could get ugly if this is indeed contagious VHF. I can't imagine how else they would have transported him, though, as the patient is a laborer and unlikely to be able to afford a private craft.

We'll have to wait for results out of laboratory testing. This shouldn't take too long. Actually, I would be fairly surprised if Ebola was confirmed, as there is no known significant exposure (we're not reading things about eating bushmeat or being bitten by a bat).
 
Last edited:
Re: Suspected Ebola case in Uganda (ex Sudan)

Re: Suspected Ebola case in Uganda (ex Sudan)

And ProMed picks up the story with a posting based on post #1. What's notable here is the comments - there hasn't been a case of Ebola in humans in Sudan since 2004.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78890

EBOLA HEMORRHAGIC FEVER - UGANDA: (MBALE), SUSPECTED
****************************************************
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 19 Aug 2009
Source: The New Vision [edited]
<http://www.newvision.co.ug/D/8/12/691810>


Ebola haemorrhagic fever suspect in Mbale, Uganda
-------------------------------------------------
Medical workers in Mbale Hospital have been put on high alert
following the admission of a patient suspected to have Ebola
haemorrhagic fever. The suspect was referred to Mbale from Tororo
Hospital at 11:00 am on Tuesday [18 Aug 2009] after his condition
deteriorated. A senior nursing officer in Mbale Hospital said
precautionary measures had been taken. The patient has been isolated
and access to his room restricted.

The patient has been bleeding from the nose, mouth and ears since
admission. He also has blood in his stool and urine. "We took
laboratory tests and prescribed supportive treatment for haemorrhagic
fever," said the medic yesterday. The medical staff became concerned
when the bleeding persisted, although they put the patient on 5
litres of intravenous fluids, blood transfusion and intensive
treatment. They stated that more blood samples were taken yesterday
from the patient and sent to the Uganda Virus Research Institute in
Entebbe for testing. David Obol, the chief administrator, said the
hospital had provided medical workers [caring for] the patient with
protective gear and disinfectants while awaiting the results.

Yesterday [?18 Aug 2009], the patient was in a pathetic state. He lay
on bed groaning, blood flowing from his mouth and nose. He was unable
to talk."Though the patient has all symptoms of Ebola hemorrhagic
fever, we cannot make conclusive statements until we receive his
results from the Virus Institute," said the medic. The patient's
father narrated that his son was 1st treated for malaria in Sudan
where he had been working as a casual labourer on a construction
site. 'He 1st developed high fever and sweated profusely. He was put
on malaria treatment. When he failed to respond to the treatment,
friends contacted us and we brought him back home for additional
treatment at Tororo Hospital.' He said they were immediately referred
to Mbale Hospital. Dr. Sam Zaramba of the Ministry of Health said
last night [18 Aug 2009] that he had not yet received any report of
the admission.

Ebolavirus [belongs to a family of viruses, the _Filoviridae_] a
group of viruses that cause a haemorrhagic fever for which there is
no cure. The various symptoms, that can appear suddenly, include
diarrhoea, fever, fatigue, general pain and severe bleeding. The
cause of death is usually hypovolemic shock (inadequate blood) or
organ failure. The virus spreads through contact with bodily fluids
and tissue of infected people. Ebola haemorrhagic fever has a high
death rate, claiming between 50 and 90 percent of victims. The only
way to stop or contain it is through prevention, rapid diagnosis and
isolation of suspected cases.

The last outbreak of Ebola haemorrhagic fever was reported in the
western district of Bundibugyo [Uganda] in December 2007. The disease
killed 16 people out of the 51 cases that were reported. In an
ebolavirus outbreak in Gulu 2000, 428 people became infected, 173 of
whom died.

[Byline: Daniel Edyegu]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Uganda has had 2 outbreaks of Ebola haemorrhagic fevers in the past
with the 1st being in Gulu, northern Uganda, in 2000 and then
Bundibugyo district, western Uganda, in 2007. Both outbreaks were
characterized by delays in detecting and confirming the initial
cases, though both outbreaks were eventually successfully controlled.
Identification of the initial cases usually delays due to the
non-specific nature of the initial symptoms which include high fever
of sudden onset, profuse sweating, malaise, vomiting, diarrhoea, and
myalgia. There is therefore need for high index of suspicion among
the health care workers if Ebola haemrrhagic cases are to be detected
early enough. In the New Vision report the occurrence of bleeding and
information of travel to Sudan where the last Ebola haemorrhagic
fever outbreak was reported in Yambio in 2004, increases the degree
of suspicion.

There is however need for additional epidemiological information on
the occurrence of similar symptoms among the patient's co-workers or
neighbors in Sudan. Ccontact with wildlife should also be considered
in investigation of the source of the patient's infection.


For the interactive HealthMap/ProMED map of Mbale in Eastern Uganda see
<http://healthmap.org/r/00Ib>. - Mod.JFW]
 
Re: Suspected Ebola case in Uganda (ex Sudan)

Re: Suspected Ebola case in Uganda (ex Sudan)

Tested negative.

http://www.newvision.co.ug/D/8/13/692236

Tests rule out Ebola in Mbale
Sunday, 23rd August, 2009 E-mail article Print article

By Anne Mugisa and Raymond Baguma

BLOOD samples of the patient admitted in Mbale Hospital suspected of having Ebola have been found free of the virus, the Uganda Virus Research Institute has said.

The Ministry of Health spokesperson, Paul Kagwa, yesterday said the ministry was investigating other possible diseases the patient, whose name has been with held, might have.

?He is still in the hospital and he cannot be released until investigations are complete,? Kagwa said.

The man was admitted last week after he was referred from Tororo Hospital with suspected Ebola.

He bled from the mouth, nose, ears and passed blood in his stool and urine, which are all symptoms of the haemorrhagic fever.

On Friday, the director of clinical services, Dr. Kenya Mugisha, said not all bleeding is caused by Ebola.

A medical team was dispatched to Mbale to help handle the situation, Dr. Mugisha said.

He added that the patient was in a stable condition.

The patient?s relatives said he was first treated for malaria in Sudan where he worked as a casual labourer at a construction site.

Ebola has a high death rate. The only way to stop or contain it is through prevention, rapid diagnosis and isolation of suspected cases. The last outbreak of the disease was reported in Bundibugyo in 2007.

The disease killed 16 people out of the 51 cases that were reported.

In the 2000, an Ebola outbreak in Gulu claimed 173 people of the 428 people who were infected.
 
Re: Suspected Ebola case in Uganda (ex Sudan) - NOT

Re: Suspected Ebola case in Uganda (ex Sudan) - NOT

With the fact that the patient has been stabilized, and no contacts have been reported as ill, I think it is very likely that he will be negative for all forms of VHF. As we said earlier, there are many things that can look like VHF.

Someone please send the above article to ProMed.
 
Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

ProMed's East Africa division just posted the leading article in this thread with an RFI and the followign comments. Can someone please send the article that says the patient tested negative to ProMed?

http://eafr.promedmail.org/

[Uganda has had 2 outbreaks of Ebola hemorrhagic fever in the past,
the 1st in Gulu, northern Uganda in 2000 and the 2nd in Bundibugyo
district, western Uganda in 2007. Both outbreaks were characterized
by delays in detecting and confirming the initial cases, though both
outbreaks were eventually successfully controlled.

Identification of the initial cases is usually delayed because of the
non-specific nature of the initial symptoms, which include high fever
of sudden onset, profuse sweating, malaise, vomiting, diarrhoea, and
myalgia. There is therefore need for high index of suspicion among
the health care workers if cases of ebolavirus infection are to be
detected early enough.

In the newswire the occurrence of bleeding and information of
international travel to Sudan where the last ebolavirus disease
outbreak was reported in Yambio in 2004, increases the degree of
suspicion. Good enough that all precautionary measures have been
taken to limit nosocomial transmission and that the lab
investigations are already underway to confirm the disease. There is,
however, need for additional epidemiological information on the
occurrence of similar symptoms among the co-workers or neighbors in
Sudan; contact with wildlife or sick associates; and the current
plans for contact identification/follow-up and community sensitization.

Mbale, in Eastern Uganda, can be located on the HealthMap/ProMED-mail
interactive map at http://healthmap.org/r/00If. - Mod.JFW]

[see also:
Marburg virus, Egyptian fruit bat ? Uganda 20090802.201034]

[For additional background information on hemorrhagic fever,
available from the general ProMED-mail list, the postings below can
be found at
http://www.promedmail.org. - Mod.JFW]
 
Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

Thank you to whoever sent the negative result to ProMed. Promed has just issued this. While it doesn't cite FT directly, it is clear (at least to me) that it is FT that inspired this second posting. Two postings like this just hours apart is unusual for ProMed.

http://eafr.promedmail.org/

ProMED-EAFR:East Africa

Most Recent Alert
View printable version
Published Date
2009-08-25 10:46:30
Subject
PRO/EAFR> Ebola hemorrhagic fever - Uganda (02): (Mbale) NOT
Archive Number
20090825.201424
Full Text
EBOLA HEMORRHAGIC FEVER - UGANDA (02): (MBALE) NOT
**************************************************
Date: Sun 23 Aug 2009
Source: The New Vision (Uganda) [edited]
http://www.newvision.co.ug/D/8/13/692236


Tests rule out [ebolavirus] in Mbale, Uganda
--------------------------------------------
Blood samples of the patient admitted in Mbale Hospital suspected of
having an [ebolavirus infection] have been found free of the virus,
the Uganda Virus Research Institute has said.

The Ministry of Health spokesperson, Paul Kagwa, yesterday [22 Aug
2009] said the ministry was investigating other possible diseases the
patient, whose name has been withheld, might have. "He is still in
the hospital and he cannot be released until investigations are
complete," Kagwa said.

The man was admitted last week [week of 17 Aug 2009] after he was
referred from Tororo Hospital with suspected ebolavirus disease. He
bled from the mouth, nose, ears, and passed blood in his stool and
urine, which are all symptoms of the haemorrhagic fever.

On Friday [21 Aug 2009], the director of clinical services, Dr Kenya
Mugisha, said not all bleeding is caused by [ebolavirus].

A medical team was dispatched to Mbale to help handle the situation,
Dr Mugisha said. He added that the patient was in a stable condition.

The patient's relatives said he was first treated for malaria in
Sudan where he worked as a casual labourer at a construction site.

[Ebolavirus disease] has a high death rate. The only way to stop or
contain it is through prevention, rapid diagnosis, and isolation of
suspected cases. The last outbreak of the disease was reported in
Bundibugyo in 2007. The disease killed 16 people out of the 51 cases
that were reported.

In 2000, an Ebola disease outbreak in Gulu claimed the lives of 173
of the 428 people who were infected.

[Byline: Anne Mugisa, Raymond Baguma]

--
Communicated by:
ProMED-EAFR


[Following the lab investigations, which ruled out Ebola hemorrhagic
fever, there is need to investigate other possible causes.
Shigellosis and other bacterial enteric infections are possible.
Shigellosis patients usually present with fever and bloody mucoid
diarrhoea among other symptoms. A search for possible sites of
bacterial infection, together with cultures and blood smears, should
be made. Presence of leucocytosis distinguishes bacterial infections.

Typhoid fever is another possibility that can be confirmed by doing
blood and stool cultures. Blood smears for malaria parasites are
essential given that this is a malaria endemic area. Yellow fever and
other _Flaviviridae_ present with hemorrhagic complications. Virus
isolation and serological investigation serves to distinguish these
viruses. Other diseases like viral hepatitis, leptospirosis,
rheumatic fever, typhus, and mononucleosis produce signs and symptoms
that may be confused with ebolavirus disease in the early stages of infection.

For the interactive HealthMap/ProMED map of Mbale in Eastern Uganda
see http://healthmap.org/r/00If. - Mod.JFW]


[see also:
Ebola hemorrhagic fever - Uganda: (Mbale) RFI 20090825.201420
Marburg virus, Egyptian fruit bat - Uganda 20090802.201034


For additional background information on hemorrhagic fever, available
from the general ProMED-mail list, the postings below can be found at
http://www.promedmail.org. - Mod.JFW]


Undiagnosed fatalities - Congo DR: (BC), hem fever susp, RFI 20090626.2326
Ebola hemorrhagic fever - Congo DR (08): (KS), WHO 20090218.0668
Ebola hemorrhagic fever - Congo DR (07): (KS) 20090202.0462
Ebola hemorrhagic fever - Congo DR (06): (KS) 20090124.0315
Ebola hemorrhagic fever - Congo DR (05): (KS) 20090115.0173
Ebola hemorrhagic fever - Congo DR (04): (KS) 20090114.0159
Ebola hemorrhagic fever - Congo DR (03): (KS) 20090111.0113
Ebola hemorrhagic fever - Congo DR (02): (KS) 20090108.0082
Ebola hemorrhagic fever - Congo DR: (KS), WHO 20090102.0013
2008
----
Ebola hemorrhagic fever - Congo DR (03): (KS) 20081231.4133
Ebola hemorrhagic fever - Congo DR: (KS), WHO 20081227.4086
Undiagnosed illness - Congo DR (02): (KS), Ebola conf. 20081225.4068
Undiagnosed illness - Congo DR: (Kasai) RFI 20081222.4027
Undiagnosed illness - Congo DR: Kasai Occ, Ebola susp, RFI 20081009.3200
Hemorrhagic fever, fatal - Congo DR: (KA), RFI 20080823.2630
Ebola hemorrhagic fever, suspected - Congo DR (02) 20080702.2017
Ebola hemorrhagic fever - Congo DR: susp., corr. 20080604.1790
Ebola hemorrhagic fever - Congo DR: susp., corr. 20080604.1789
Ebola hemorrhagic fever - Congo DR: susp. 20080603.1779
Hemorrhagic fever, fatal - Congo DR: (KA), RFI 20080823.2630
2007
----
Ebola hemorrhagic fever - Congo DR (13): 20071121.3758
Ebola hemorrhagic fever - Congo DR 20070910.2996
Undiagnosed illness - Congo DR (Kasai Occidental): WHO, RFI 20070901.2882
Viral hemorrhagic fever - Congo DR (Kasai Occidental): susp. 20070829.2837
2006
----
Ebola, primates - Congo Rep.: 20061208.3462
Ebola hemorrhagic fever - Congo DR: susp. 20060315.0806
2005
---
Marburg hemorrhagic fever - Angola (54) 20051108.3269
Marburg Hemorrhagic fever - Angola: confirmed 20050322.0831
Undiagnosed hemorrhagic fever - Angola (05) 20050322.0827
Undiagnosed hemorrhagic fever - Angola: RFI 20050315.0751
2002
----
Marburg hemorrhagic fever - Congo, DR 20020322.3799
2001
----
Viral hemorrhagic fever, suspected - Congo, DR (03) 20011210.2991
2000
----
Marburg hemorrhagic fever - Congo, DR (06) 20000331.0477
Marburg hemorrhagic fever - Congo, DR 20000212.0194
1999
----
Marburg hemorrhagic fever - Congo, DR (04) 19991209.2137
Marburg hemorrhagic fever - Congo, DR 19990915.1641]
...................................jfw/mj/be

_______________________________________________
ProMED-EAFR mailing list
ProMED-EAFR@promedmail.org
http://eafr.promedmail.org/
 
Re: Suspected Ebola case in Uganda (ex Sudan) tests negative

And ProMed posting #2. Note the bold text. I think the moderator is a bit confused. Marburg virus is not endemic to Sudan, and there is no evidence the patient was in Uganda within three weeks of being ill.

Also, Marburg is spread the same way as Ebola, so there likely would have been other cases in contacts, something that did not occur (as far as we can tell).

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,79019

Archive Number 20090831.3061
Published Date 31-AUG-2009
Subject PRO/AH/EDR> Ebola hemorrhagic fever - Uganda (02): (ME), NOT, RFI


EBOLA HEMORRHAGIC FEVER - UGANDA (02): (MBALE), NOT, 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: Sun 23 Aug 2009 [the delay in posting is regretted - ProMED]
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/13/692236>


Tests rule out Ebola [hemorrhagic fever] in Mbale
-------------------------------------------------
Blood samples of the patient admitted to Mbale Hospital suspected of
having Ebola hemorrhagic fever have been found free of the virus, the
Uganda Virus Research Institute has reported [see ProMED-mail post
Ebola hemorrhagic fever - Uganda: (ME), susp. 20090821.2962].

The Ministry of Health spokesperson, Paul Kagwa, yesterday [22 Aug
2009] said the Ministry was investigating other possible diseases the
patient, whose name has been withheld, might have. "He is still in the
hospital and he cannot be released until investigations are complete,"
Kagwa said.

The man was admitted last week [week of 17 Aug 2009] after he was
referred from Tororo Hospital with suspected Ebola hemorrhagic fever.
He bled from the mouth, nose, ears and passed blood in his stool and
urine, which are all symptoms of hemorrhagic fever.

On Friday [21 Aug 2009], the director of clinical services, Dr Kenya
Mugisha, said not all bleeding is caused by ebolaviruses. A medical
team was dispatched to Mbale to help handle the situation, Dr Mugisha
said. He added that the patient was in a stable condition. The
patient's relatives said he was first treated for malaria in Sudan,
where he worked as a casual laborer at a construction site.

Ebola hemorrhagic fever has a high death rate. The only way to stop or
contain it is through prevention, rapid diagnosis, and isolation of
suspected cases. The last outbreak of the disease [in Uganda] was
reported in Bundibugyo in 2007 [see ProMED archives listed below]. The
disease killed 16 people out of the 51 cases that were reported. In
2000, an ebolavirus outbreak in Gulu claimed 173 people of the 428 who
were infected.

[Byline: Anne Mugisa, Raymond Baguma)

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[ProMED would be interested to know the final diagnosis. A likely
possibility is Marbug virus -- see ProMED refs. below.

A location map of Uganda is at:
<http://www.globaldiscipleship.net/uganda-map.jpg>
A map showing Mbale town & district on the Kenya border is at:
<http://www.richardsilverstein.com/tikun_olam/uganda%20map.gif>
- Mod.JW]

[see also:
Ebola hemorrhagic fever - Uganda: (ME), susp. 20090821.2962]
2008
----
Ebola hemorrhagic fever - Uganda (06): (Bundibugyo), new species 20081121.3675
Ebola hemorrhagic fever - Uganda (03): Arua, susp 20080122.0275
Ebola hemorrhagic fever - Uganda: (Bundibugyo) 20080104.0050
Marburg hemorrhagic fever - The Netherlands ex Uganda (02) 20080711.2115
Marburg hemorrhagic fever - The Netherlands ex Uganda 20080710.2107
Ebola hemorrhagic fever - Uganda (04): (Bundibugyo), WHO 20080221.0704
Ebola hemorrhagic fever - Uganda: (Bundibugyo) 20080104.0050
2007
----
Hemorrhagic fever - Uganda (02): (Bundibugyo), Marburg NOT 20071116.3718
Ebola hemorrhagic fever - Uganda (11): (Bundibugyo) 20071215.4031
Ebola hemorrhagic fever - Uganda: (Bundibugyo), WHO 20071130.3869
Hemorrhagic fever - Uganda (04): (Bundibugyo), Ebola confirmed 20071130.3859
Viral hemorrhagic fever - Uganda (Kamwenge): Marburg conf. 20070801.2490
........................................cp/mj/jw
 
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