Re: US, Texas: Unidentified Illness (fatal) - 2 died, 1 critical
Re: US, Texas: Unidentified Illness (fatal) - 2 died, 1 critical
And a ProMED post (with some more possible etiologies, but no mention of influenza):
Published Date: 2013-05-12 17:34:34
Subject: PRO/EDR> Undiagnosed deaths - USA: (TX) teenager, RFI
Archive Number: 20130512.1707679
UNDIAGNOSED DEATHS - USA: (TEXAS) TEENAGER, 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: Thu 9 May 2013
Source: Houston Chronicle [edited]
http://blog.chron.com/healthzone/20...ndition-from-unknown-disease-in-houston-area/
Health officials have reported that an unidentified illness has taken the lives of 2 high school students from Montgomery and Liberty counties [2 counties that are part of the Houston-Sugar Land-Baytown metropolitan area, that is, Greater Houston, in Southeast Texas with a population of over 2 million residents in 2010], according to KHOU Channel 11.
Officials said that all 3 had pneumonia-like symptoms, fever, coughing and then went into seizures and respiratory failure.
[A 17-year-old male] was the 1st case when he got sick in February [2013] and died on [10 Mar 2013]. A teenage girl in Montgomery County died on [29 Apr 2013] and a teenage boy with similar symptoms is currently in critical condition. The results of the autopsies won't be available for several months.
Health experts are working together to figure out what is behind it all.
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
******
[2]
Date: Sat 11 May 2013
Source: Houston Chronicle [summ., edited]
http://www.houstonchronicle.com/new...llness-linked-to-2-deaths-doctors-4507149.php
A month ago, [the boy's mother] started making Internet postings to express her utter grief and frustration over not knowing what killed her athletic 17-year-old son, in a matter of weeks. The healthy junior who attended a tiny Liberty County high school died [10 Mar 2013], just 3 weeks after contracting a mysterious illness that Houston doctors have yet to identify. It started with flu-like body aches and fever, progressing to seizures, medically induced coma, and death. [His mother] says he loved football, hunting, and horseback riding.
The mystery deepened when someone attached an article to [the mother's] post about a 17-year-old [girl], a softball player at Kingwood Park High School, who died under similar baffling circumstances 60 miles [97 km] to the west on [29 Apr 2013]. The mother contacted the girl's family and sent a copy of her son's Memorial Hermann Hospital medical file to the Texas Children's Hospital doctors who had treated her. Their ailments were almost identical.
The 3rd link in the mystery was another 17-year-old, a male student at New Caney High School to the north, whose name was not released. He remains in critical condition at Texas Children's after getting the illness a few weeks ago. His condition also started with a fever, but hasn't developed to seizures. He had severe stomach pains that led to vomiting and diarrhea.
Now Montgomery County epidemiologist Dr Syed Ibrahim is leading an inquiry into whether there's a link between these 3 cases. "This sort of thing, where we don't know the cause, is very rare," said Ibrahim. The hospitals have run scores of tests, ruling out usual suspects such as meningitis or botulism. Doctors have been stumped as to whether the teens contracted the same fast-moving illness or each has something entirely different.
So far the 17-year-olds appear to have never had any close contact with each other before getting sick. [The girl] once attended the same junior high in Porter as the hospitalized teen, but they were never close friends before she switched districts and began attending Humble ISD's Kingwood Park, said her aunt.
[The mother] said: "All kinds of people have been close to these kids and nobody else has gotten sick. Nobody thinks what they contracted is contagious."
An unusual factor in these cases, Ibrahim said, is that the symptoms can sometimes appear to dissipate and then reappear with a vengeance. [The boy] was sent home from school with a fever. After taking antibiotics for a couple of days, he appeared to get well. But the next day, he suddenly relapsed and his family found him collapsed on the floor, experiencing uncontrollable seizures. He had earlier tested positive for mononucleosis, but it's not supposed to swell the brain to twice its size as it did, she said.
[The 2 dead teenager's families are] waiting on autopsy reports to be completed.
"[The girl's] symptoms were very similar to [the boy's]. But we don't see any connection to the 3rd case. It presented very differently. He never had any seizures," said [the girl's] aunt, who is also a nurse. The girl contracted her fever [15 Apr 2013]. She, too, seemed to get better after a few days before digressing again into massive seizures and dying 14 days after her symptoms began.
The infectious disease team has worked tirelessly to discover what made these teens so ill, said [the girl's aunt]. The US Centers for Disease Control and Prevention is monitoring the cases, but declined comment.
[Byline: Cindy Horswell]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The news reports above describe a flu-like illness with fever, body aches, coughing, progressing to seizures and respiratory failure in 2 teenagers over a several-week period of time that terminated in their deaths, one in March 2013 and the other a month later. After taking antibiotics initially for a couple of days, both appeared to get well, and then relapsed with uncontrollable seizures.
A 3rd teenager remains hospitalized in critical condition, with reportedly a different illness: he had fever, severe abdominal pain, vomiting, and diarrhea, without ever having developed seizures. The 3 lived in the Greater Houston, Texas area, but are said not to have had any contact with one another. There are also said to be no secondary cases among their contacts. Little additional detail is given, except one of the teenagers who died was said to be a hunter and horseback rider; he also had a positive test for Epstein-Barr virus (EBV) infection. However, we are not told which type of test was used, heterophile, EBV-specific immunoassay, or both. Also we are not told if the other 2 teenagers had these serologies done.
EBV usually infects people who are under 30 years old. In immunocompetent patients, primary infection is usually asymptomatic or presents as infectious mononucleosis. Infectious mononucleosis, an acute infectious disease, is characterized by fever, pharyngitis, generalized lymphadenopathy, and splenomegaly. In patients with the typical clinical findings of infectious mononucleosis, a complete blood cell count and a test for heterophile antibodies can usually establish the diagnosis of an EBV infection.
The presence of heterophile antibodies is highly specific for infectious mononucleosis, but false-positive results have been rarely reported for several conditions, including leukemia, rubella, malaria, systemic lupus erythematosus, pancreatic carcinoma, viral hepatitis, and human immunodeficiency virus infection (1), which should have been ruled in the patient's extensive work-up. Using EBV-specific immunoassays, the specificity of the blood tests for infectious mononucleosis approaches 100 percent (2). A rare immunodeficiency syndrome associated with EBV infection in young boys is X-linked lymphoproliferative (XLP) syndrome, which often leads to death from bone marrow failure, irreversible hepatitis, and malignant lymphoma, which were not described in this patient (
http://emedicine.medscape.com/article/203780-overview).
However, EBV infection itself in an immunocompetent patient can cause acute viral encephalomyelitis, as well as post-infectious acute disseminated encephalomyelitis (ADEM) (3). ADEM is an immune-mediated inflammatory demyelinating disease of the brain that usually occurs following a viral infection, but may follow vaccination, such as, brain tissue-based rabies vaccine. Viral infections, in addition to EBV infection, thought to induce ADEM include infections due to influenza virus, enterovirus, measles, mumps, rubella, varicella zoster, cytomegalovirus, herpes simplex virus, hepatitis A, and coxsackievirus (
http://emedicine.medscape.com/article/1147044-clinical). Some bacterial infections implicated include infections due to _Mycoplasma pneumoniae_, _Borrelia burgdorferi_, and _Leptospira_ (4). There is usually a clearly defined phase of afebrile improvement lasting 1-20 days or more before onset of neurologic findings. The diagnosis of ADEM is based on clinical features and neuroimaging, such as, MRI findings.
In addition, the 2 Houston teenagers who died were said to have respiratory symptoms and respiratory failure. Severe pneumonitis is a rare complication of EBV infection in immunocompetent individuals, although several cases have been reported in the literature (
http://cid.oxfordjournals.org/content/21/1/206.abstract).
Other unusual pathogens that can cause a febrile illness with pneumonitis and encephalitis in the Houston area are rickettsial and rickettsial-like diseases, such murine typhus (_Rickettsia typhi_) (
http://cid.oxfordjournals.org/content/46/6/913.full), Rocky Mountain spotted fever (_Rickettsia rickettsii_) (
http://www.cdc.gov/rmsf/symptoms/), and human monocytic ehrlichiosis (_Ehrlichia chaffeensis_) (
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC145301/), as well as leptospirosis (_Leptospira_ spp.).
References
----------
1. van Essen GG, Lieverse AG, Sprenger HG, et al: False-positive Paul-Bunnell test in HIV seroconversion. Lancet 1988; 2(8613): 747-8.
2. Gerber MA, Shapiro ED, Ryan RW, Bell GL: Evaluations of enzyme-linked immunosorbent assay procedure for determining specific Epstein-Barr Virus serology and of rapid test kits for diagnosis of infectious mononucleosis. J Clin Microbiol. 1996; 34(12): 3240-1; available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC229495/.
3. Bahadori HR, Williams VC, Turner RP, et al: Acute disseminated encephalomyelitis following infectious mononucleosis. J Child Neurol 2007; 22(3): 324-8; abstract available at
http://jcn.sagepub.com/content/22/3/324.long.
4. Tenembaum S, Chitnis T, Ness J, Hahn JS; International Pediatric MS Study Group: Acute disseminated encephalomyelitis. Neurology 2007; 68(16 Suppl 2): S23-36; abstract available at
http://www.ncbi.nlm.nih.gov/pubmed/17438235.
ProMED-mail would greatly appreciate more information on these cases along with results of ongoing investigations.
Houston can be located on the HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/276D. - Mod.ML]
[There is no evidence that the condition is transmissible. - Mod.CP]
[It is ProMED's policy not to identify individuals by name even when they are identified in media reports. - Mod.LM]]
See Also
2012
----
Murine typhus - USA: (TX) fatal 20120526.1145817
2011
----
Murine typhus - USA (04): background 20110918.2841
Murine typhus - USA (02): (TX) 20110701.2000
Murine typhus - USA: (TX) 20110607.1734
2009
----
Murine typhus - USA (04): (TX) 2008-2009 20091120.3995
Murine typhus - USA (02): (TX) 20090617.2240
Murine typhus - USA: (TX) 20090616.2228
2007
----
Ehrlichiosis, fatal - USA (MO) 20070607.1849
Rocky Mountain spotted fever, fatal - USA (NC) (02) 20070606.1835
Rocky Mountain spotted fever, fatal - USA (NC) 20070604.1807
2004
----
Leptospirosis, human, canine - USA (TX)(03) 20040911.2527
Leptospirosis, human, canine - USA (TX)(02) 20040907.2499
Leptospirosis, human, canine - USA (TX) 20040904.2472
Leptospirosis, fatal - USA (AS) 20040820.2307
.................................................sb/ml/mj/lm
