Undiagnosed fatal illness in DRC: Not Hemorrhagic Fever

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http://www.reliefweb.int/rw/rwb.nsf/db900SID/VDUX-7TCSBU?OpenDocument

Suspected viral haemorrhagic fever reported between weeks 23 and 24 in areas of health and Boma Bangu-Boma (Bas Congo), 13 cases and 5 deaths (CFR 38.4%). Durant la m?me p?riode dans la zone de sant? de Djolu (Equateur), 6 cas et 5 d?c?s suspects de fi?vre h?morragique ont ?t? aussi notifi?s*. During the same period in the area of health Djolu (Ecuador), 6 cases and 5 deaths from suspected haemorrhagic fever have been reported *. L'OMS appuie l'?quipe d'investigation du Minist?re de la sant? et des ?chantillons ont ?t? pr?lev?s pour la confirmation de laboratoire. WHO supports the investigation team of the Ministry of Health and samples were collected for laboratory confirmation. Elle appuie aussi le renforcement du syst?me de surveillance. It also supports the strengthening of the surveillance system.

 

[alert]

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,78112

UNDIAGNOSED FATALITIES - DEMOCRATIC REPUBLIC OF THE CONGO: (BAS
CONGO), HEMORRHAGIC FEVER SUSPECTED, 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: Mon 22 Jun 2009
Source: Agence Centrafrique Presse, Xiinhua News Agency report
[in French, trans. Mod.MPP, edited]
<http://www.acap-cf.info/RDC-Une-maladie-non-identifiee-tue-cinq-personnes-dans-la-province-du-Bas-Congo_a2364.html>


An unidentified disease killed 5 people in the province of Bas-Congo,
DRC [Democratic Republic of the Congo]
----------------------------------
5 people out of almost a dozen ill individuals have died within a few
days from an as yet unidentified disease in the village of Mangala,
located some 30 kilometers [19 mi] from the city of Boma, the capital
of the province of Bas-Congo [Kongo Central] in the west of the
Democratic Republic of the Congo (DRC).

The chief medical officer of the Boma health district, Dr Lawrence
Kiphunda Nlandu, who informed the press, reported that 5 cases, of
which only one has survived so far, a man of 35 years, have been
detected in the rural health zone of Boma Bungu, considered the
epicenter of the epidemic, while the other 5 cases were recorded in
the area of health Boma. He mentioned that 2 men, a woman, and a young
man of 14 years of age are currently hospitalized in a local medical
facility and a child of 4 years who succumbed to the disease
[referring to the 2nd cluster mentioned above].

Dr Kiphunda did not provide the incubation period of the disease,
however he mentioned that it is characterized by vomiting of blood
[hematemesis] accompanied by bloody diarrhea [melena or hematochezia]
and blood flow from the nostrils [epistaxis].

Pending assistance from the central government and external partners,
a regimen consisting of a combination of antibiotics, antacids, and
other tonics, as well as transfusion and rehydration was developed,
said the source, adding that samples of blood and stool have been sent
to the INRB (National Institute for Biomedical Research) in Kinshasa.

This disease, whose symptoms are similar to those seen with Ebola
haemorrhagic fever, has created a panic among the population of Boma.

In the DRC, Ebola haemorrhagic fever has already occurred in the
provinces of Equateur in 1976 and 1977 (West), in Bandundu in 1995
(West), in Orientale in 1999 and 2000 (Northeast), and in Kasai
Occidental in 2007 and 2008 (Center).

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

[The differential diagnosis for a hemorrhagic fever in the Democratic
Republic of the Congo (DRC) would include more "common" etiologies
such as leptospirosis, yellow fever, malaria, Crimean Congo
hemorrhagic fever and dengue hemorrhagic fever, among others.

The more "exotic" viral hemorrhagic fevers such as Ebola, Lassa &
Marburg, while they not been reported from the Bas Congo region of the
DRC, have been reported from elsewhere in the DRC, and from
neighboring Angola. During 2004-2005, there was a major epidemic of
Marburg hemorrhagic fever in Angola. Geographically Boma, DRC is just
at the border with Angola, and the outbreak of Marburg hemorrhagic
fever began in Uige, Angola, which is in the north of the country,
near to the border with the DRC. Outbreaks of Ebola hemorrhagic fever
have been reported in the DRC: in Kasai Occidental province in
2008-2009, in Equateur Province in 2008, in Kasai Occidental province
in 2007, in Bandundu Province (Kikwit) in 1995, in the then Haut Zaire
province (Tandala) 1977, and Equateur province (Yambuku) 1996.
Outbreaks of Marburg hemorrhagic fever have occurred in the DRC: in
Orientale (Watsa) in 2002, and in Orientale Province (Durba) in
1998-2000.

The newswire mentions that patients are being treated with a
"combination of antibiotics, antacids and other tonics, as well as
transfusion and rehydration" suggesting that possible bacterial
etiologies are being considered. More information on this outbreak
and results of epidemiologic and laboratory investigations would be
appreciated.

For a map of the Democratic Republic of the Congo, see
<http://www.lib.utexas.edu/maps/africa/congo_demrep_pol98.jpg>. For
the interactive HealthMap/ProMED-mail map showing Boma, DRC with links
to other recent outbreaks reported on ProMED-mail in neighboring
countries, see <http://healthmap.org/r/00uC>. - Mod.MPP]

 

[alert]

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Actually, the first article mentions two outbreaks; one in Boma described in ProMed pst #2, and one in Djolu, described here. The mention of "Ecuador" is a region in the DRC - not the country by the same name:

http://www.reliefweb.int/rw/rwb.nsf/db900SID/JBRN-7TDDM9?OpenDocument

DR Congo / Ecuador: 4 dead, assessment of an epidemic of haemorrhagic fever Djolu
Source: Radio Okapi Source: Radio Okapi

Date: 26 Jun 2009 Date: 26 Jun 2009


RDC | 26 Juin 2009 à 08:45:49 RDC | 26 June 2009 08:45:49

Huit cas de fièvre hémorragique ont été enregistrés depuis le mois de mai dans la zone de santé de Djolu. Eight cases of haemorrhagic fever have been reported since May in the area of health Djolu. Selon le médecin inspecteur provincial de l'Equateur, quatre décès sont déjà signalés parmi les personnes atteintes, rapporte radiookapi.net According to the provincial medical inspector of Ecuador, four deaths have already been reported among persons with reported radiookapi.net

Les malades présentent les mêmes signes : un état de fièvre avec hémorragie par le nez et l'anus ainsi que des vomissements accompagnés du sang. Patients have the same signs: a state of fever with bleeding from the nose and anus and vomiting with blood. Mais d'après le Docteur Augustin Makaya, médecin inspecteur provincial, l'on ne connaît pas encore jusqu'à présent le virus causal de cette maladie. But according to Dr. Augustine Makaya, provincial medical inspector, is not yet known so far the virus causing the disease. Des échantillons de sang prélevés mercredi dernier sur les malades par une équipe de Médecins sans frontière venue de Kisangani, ont été envoyés le même jour à Kinshasa, par avion. Blood samples taken last Wednesday on patients by a team from Doctors Without Borders in Kisangani, were sent on the same day in Kinshasa by plane.

Pending the identification of this virus, the provincial branch of WHO / Ecuador has made available to the health Djolu a lot of drugs, said the same source, to monitor and carers family members who were in contact with patients.

Copyright Radio Okapi Copyright Radio Okapi

 

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Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

And more information about the outbreak in Boma:

http://www.casafree.com/modules/news/article.php?storyid=34463

Health: DR Congo: An unidentified disease killed five people in the province of Bas Congo
Cinq personnes sur une dizaine atteintes d'une maladie non encore identifi?e jusqu'? pr?sent sont d?c?d?es en l'espace de quelques jours dans la localit? de Mangala, situ?e ? une trentaine de kilom?tres de la ville de Boma, chef-lieu de la province du Bas-Congo, dans l'ouest de la R?publique d?mocratique du Congo (RDC). Five people on a dozen illnesses not yet identified so far have died within a few days in the village of Mangala, located some thirty kilometers from the town of Boma, the capital of the province Bas-Congo in the west of the Democratic Republic of Congo (DRC).

Le m?decin-chef du district sanitaire de Boma, Dr Laurent Kiphunda Nlandu, qui l'a d?clar? ? la presse, a fait savoir que cinq cas, dont un seul a surv?cu jusqu'? pr?sent. The chief medical officer of health district Boma, Dr. Lawrence Kiphunda Nlandu, who told the press, reported that five cases, only one has survived so far.

Un homme de 35 ans, ont ?t? d?tect?s dans la zone de sant? rurale de Boma Bungu, consid?r?e comme l'?picentre de l'?pid?mie ; tandis que cinq autres cas ont ?t? enregistr?s dans la zone de sant? de Boma. A man aged 35, were detected in the rural health zone of Boma Bungu, considered the epicenter of the epidemic, while the other five cases were recorded in the area of health Boma. Il s'agit de deux hommes, d'une femme et d'un jeune gar?on de 14 ans qui sont actuellement intern?s dans une formation m?dicale locale ainsi que d'un enfant de quatre ans qui a succomb? ? la maladie. These two men, a woman and a young boy of 14 who are being interned in a local medical training and a child of four years who succumbed to the disease.

Le Dr Kiphunda qui n'a pas pr?cis? la p?riode d'incubation de cette maladie, a cependant fait savoir qu'elle se caract?rise par des vomissements du sang accompagn? de diarrh?es sanguinolentes et d'?coulements de sang aux narines. Dr. Kiphunda did not state that the incubation period of this disease, however, that it is characterized by vomiting of blood accompanied by bloody diarrhea and blood flow to the nostrils.

En attendant des secours en provenance du gouvernement central et des partenaires ext?rieurs, un sch?ma th?rapeutique constitu? d'une combinaison d'antibiotiques, d'antiacides et d'autres fortifiants ainsi que de transfusion et de r?hydratation a ?t? mis au point, pr?cise la source, ajoutant que des ?chantillons de sang et de selles ont d?j? ?t? envoy?s ? l'INRB (Institut national de recherches biom?dicales) ? Kinshasa. Pending relief from the central government and external partners, a regimen consisting of a combination of antibiotics, antacids and other tonics, as well as transfusion and rehydration was developed, said the source , adding that samples of blood and stool have been sent to the INRB (National Institute for Biomedical Research) in Kinshasa.

Cette maladie, dont les sympt?mes s'apparente avec la fi?vre h?morragique ? virus Ebola, cr?e une panique au sein de la population bomotracienne. This disease, with symptoms similar to the Ebola haemorrhagic fever, has created a panic among the population bomotracienne.

En RDC, la fi?vre h?morragique ? virus Ebola s'?tait d?j? d?clar? dans les provinces de l'Equateur en 1976 et 1977 (Ouest), du Bandundu en 1995 (Ouest), Orientale en 1999 et 2000 (Nord-Est) et du Kasa? Occidental en 2007 et en 2008 (Centre). In DRC, the Ebola haemorrhagic fever had already declared in the provinces of Ecuador in 1976 and 1977 (West), Bandundu in 1995 (West), Eastern in 1999 and 2000 (Northeast) and Kasai Occidental in 2007 and 2008 (Center).

Xinhua Xinhua

 

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Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

This was posted almost a week ago, but I just found it. I take it that means negative for BOTH Ebola and Marburg (and maybe Lassa and Lujo too). Typhoid and malaria cases both can resemble VHF, and both those illnesses are common in DRC. I wish this source had said what the working diagnosis was, but it is nice to see that VHF is unlikely. I don't expect to read anything further on any of these "clusters".

Something I noticed here - when a village is reporting only a handful of suspect VHF cases, unless there is some clear epidemological link (i.e. all in the same family or all went hunting together), VHF is unlikely.

I think we need a "- NOT" on the title of this thread.

http://www.reliefweb.int/rw/rwb.nsf/db900SID/EGUA-7TJP2B?OpenDocument

Suspect Hemorrhagic Fever cases notified between week 23 and 24 in Bas Congo and Equateur, the lab result is negative.

 

[Giuseppe]

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Sometimes measles was misdiagnosed as viral hemorrhagic fever in Africa, since one of its complication is hemorrhages.

 

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Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Re: Undiagnosed fatal illness in DRC; Viral Hemorrhagic Fever Suspected

Another good point. If one is really looking for VHF symptoms, a lot of diseases can look like VHF. I believe, as someone said in another context here on FT, "when you're a hammer, a lot of things look like nails".

 

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Re: Undiagnosed fatal illness in DRC: Not Hemorrhagic Fever

This was posted on 7/8/09, but I just found it today. It doesn't seem to have any more information (and importantly no increase in case counts) than the first postings on 6/26, but doesn't mention VHF being ruled out. This could very easily be an "echo" story from mid-June, but I figured I'd post it anyway. Again, eight scattered cases in several villages is not the pattern one typically sees with a VHF outbreak. I wonder if CCHF could be the culprit.

http://www.translate.google.com/tra...S4MT?OpenDocument&sl=fr&tl=en&history_state0=

DR Congo: Epidemic bloody to Ecuador
Source: Le Potentiel Source: Le Potentiel

Date: 08 Jul 2009 Date: 08 Jul 2009


Par Raymonde Senga Kosi By Raymonde Senga Kosi

La population congolaise a été informée de l'apparition d'une épidémie sanguinolente accompagnée de fièvre et de vomissements dans les villages du groupement Lotulo, territoire de Djolu, district de la Tshuapa, province de l'Equateur. The Congolese population has been informed of the outbreak of a bloody epidemic with fever and vomiting in the villages of the group Lotulo Territory Djolu, Tshuapa the district, province of Ecuador. L'épidémie en question vient de causer quatre morts parmi les huit cas recensés par les autorités sanitaires de la province de l'Equateur. The epidemic in question has caused four deaths among the eight cases identified by health authorities in the province of Ecuador.

Longtemps considéré par les acteurs humanitaires comme un no man's land à cause de l'enclavement et de l'inaccessibilité, la Zone de santé de Djolu (ZS) est l'une des structures sanitaires située dans le territoire de Djolu sur une superficie de 8500 km² avec une population estimée à 165.000 habitants. Long regarded by humanitarian actors as a no man's land because of isolation and inaccessibility, the Area Health Djolu (ZS) is one of the health facilities in the territory of Djolu over an area of 8500 km ² with a population estimated at 165,000 inhabitants. Le paludisme, les infections respiratoires, la diarrhée simple, infections sexuellement transmissibles et VIH, les anémies d'origines diverses, la malnutrition, l'onchocercose, la tuberculose, etc sont les principales causes de mortalité et de morbidité. Malaria, respiratory infections, diarrhea, simple, sexually transmitted infections and HIV, anemia of various origins, malnutrition, onchocerciasis, tuberculosis, etc. are the main causes of mortality and morbidity.

Les données recueillies auprès du bureau Central de la ZS de Djolu pour l'année 2007, le nombre de cas de pathologie pendant l'année se présente de la manière suivante : 12.801 cas de paludisme, 2360 cas de IRA, 1469 cas de diarrhée, 807 cas de IST, 455 cas d'anémie, 296 cas de filariose, 172 cas de tuberculose, etc. The data collected from the Central Office of the ZS Djolu for the year 2007, the number of cases of disease during the year is as follows: 12,801 cases of malaria, 2360 cases of ARI, 1469 cases of diarrhea, IST 807 cases, 455 cases of anemia, 296 cases of filariasis, 172 cases of tuberculosis, etc. La carte de vaccination de routine est de 102 % pour BGC, 82% VP03, 70 % VAR, 98 % VAA, 102 VAT2+. The map routine immunization is 102% for GCA, 82% VP03, 70% VAR, 98% VAA, 102 TT2 +. La ZS de Djolu a un taux de mortalité hospitalière de 4% et le taux d'occupation de lit de 66%. The ZS Djolu of a hospital mortality rate of 4% and the rate of bed occupancy of 66%.

Sur ce tableau sombre on constate que les infrastructures sanitaires sont dans un état de délabrement avancé, les lits dégarnis, le personnel sanitaire démotivé à cause de la modicité des salaires et les détournements répétés par les autorités supérieures, l'appui inexistant en dépit de la présence du programme PARSS qui, en principe, avait été mis en place pour construire, réhabiliter, équiper et renforcer les capacités du personnel sanitaire. On this gloomy picture there is that health facilities are in a state of disrepair, the bare beds, health personnel demotivated because of low salaries and diversion repeated by higher authorities, no support despite the PARSS presence of which in principle had been established to build, rehabilitate, equip and build capacity of health personnel. L'Hôpital Général de Référence de Djolu est à ce jour comparable à un mouroir, les jeunes médecins affectés pour sauver de vie sont confrontés à beaucoup de réalités et contraintes qui méritent une attention particulière des tenants du pouvoir. Hôpital Général de Référence de Djolu to date is comparable to a mouroir, young physicians assigned to save lives face many realities and constraints that deserve special attention of those in power.

Avec l'apparition de l'épidémie dans la ZS de Djolu, le pire est à craindre. With the advent of the epidemic in the ZS of Djolu, the worst is feared. Initiative Locale pour le Développement Intégré (ILDI) interpelle le gouvernement congolais pour les sommes prévues dans le cadre du budget « d'investissements sur transferts aux Entités Administratives Décentralisées (ETD) » exercice 2009 pour la province de l'Equateur dont l'enveloppe évaluée à 1.189.000.000 Fc, soit 2.032.478,63 $USD ne soit pas considérée des simples intentions, mais traduite en action pour sauver de milliers de vie. Local Initiative for Integrated Development (ildi) appeals to the Congolese government for the money under the budget on investment transfers to decentralized administrative entities (ETD) "year 2009 for the Province of Ecuador which is the estimated Fc to 1,189,000,000, or $ 2,032,478.63 USD will not be considered mere intentions, but translated into action to save thousands of lives. En plus de l'appui budgétaire, la société civile de la Tshuapa réclame la visibilité du projet PARSS (Projet d'Appui à la Réhabilitation du Secteur de Santé) financé par la Banque mondiale pour augmenter l'accès aux services de santé essentiels à la population des douze ZS du district de la Tshuapa. In addition to budget support, civil society in the Tshuapa requires visibility PARSS Project (Projet d'Appui à la Réhabilitation du Secteur de Santé), funded by the World Bank to increase access to essential health services to ZS twelve people of the District of Tshuapa. Le projet souffre d'une bureaucratie et maque de visibilité alors que des projets similaires comme le Fonds Mondial enregistre de succès dans leur rayon d'action. The project suffers from bureaucracy and maque visibility while similar projects like the Global Fund has recorded success in their outreach.