Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI
Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI
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Published Date: 2012-04-23 02:39:31
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (03): (QG) RFI
Archive Number: 20120423.1110507
UNDIAGNOSED ILLNESS - VIET NAM (03): (QUANG NGAI) REQUEST FOR INFORMATION
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[1]Date: Fri 6 Jan 2012
Source: eyedrd.org [edited]
http://www.eyedrd.org/2012/01/second-child-dies-from-skin-disease-of-unknown-etiology.html
A 4 year old died in Quang Ngai Province on Monday [2 Jan 2012] after suffering palmoplantar keratoderma, which is characterized by an even, thick, symmetric hyperkeratosis over the whole of the palm and sole.
Following a similar case that happened to a [child less than 10 years old] last year [2011], the 4 year old was the 2nd child in the province to have died of the skin disease for which doctors have yet to find the cause, VnExpress newswire quoted Nguyen Xuan Men, deputy director of the provincial Health Department, as saying.
The boy, of Ba Dien Commune, mountainous Ba To District, was admitted to Quang Ngai General Hospital on 31 Dec 2011 after developing palmoplantar keratoderma, ulcers on the hands and feet, and serious liver function disorder, doctors said. On 2 Jan 2012, the boy was transferred to the Da Nang General Hospital but he died after one day of treatment.
As of 4 Jan 2012, 98 people, including 25 children, have suffered from the skin disease, the department reported. In December 2011 alone, 11 children under 10 were hospitalized with ulcers in their hands, feet, mouths, backs, and abdomens. Most of them were in poor health condition and suffered from liver function disorder.
The department has ordered the Ba To Health Center to treat patients in accordance with the instructions from the Quy Hoa National Leprosy Dermatology Hospital in Binh Dinh Province. The center must transfer all patients in critical condition to that hospital or the Quang Ngai General Hospital, where they will be given free meals, the department said.
On 26-27 Dec 2011, the Quang Ngai health authorities have given medical checkups and provided medicines to 300 people in Ba Dien Commune, where the skin disease broke out. Medical workers also sprayed antiseptic chemicals in the commune.
"Though the health sector has yet to identify the cause of the skin disease, everybody should not worry excessively. We are continuing with our investigation and discovering some factors that might give rise to the disease, such as pesticide, fertilizer, and chemicals that are being used locally," Dr Tran Hau Khang, director of the National Hospital of Dermatology and Venereology, told VnExpress.
Doctors should continue treating patients under the hospital's instructions, including requesting patients to spend more time for resting, prescribing them with vitamins of the B group, zinc supplements, suitable ointment, liver tonics, or applying transfusion to patients with liver injuries, he said.
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[2]
Date: Fri 20 Apr 2012
Source: eyedrd.org [edited]
http://www.eyedrd.org/2012/04/break...-has-claimed-27-lives-in-central-vietnam.html
Viet Nam has asked international health experts to help investigate a mystery illness that has killed 27 people and sickened 171 others in an impoverished district in central Viet Nam, an official said on Friday [20 Apr 2012].
More people are reported suffering from stiffness of the limbs, respiratory problems, and miscarriages, caused by a peculiar and unidentified skin ulceration that has plagued the central province of Quang Ngai since April [2011], said medical authorities from the province.
The infection has mostly affected children and young people. It begins with a high fever, loss of appetite, and a rash that covers the hands and feet. Patients who are not treated early can develop liver problems and eventually multiorgan failure, said Le Han Phong, chairman of the People's Committee in Ba To District in Quang Ngai province.
Nearly 100 people remain hospitalized, including 10 in critical condition. Patients with milder symptoms are being treated at home. The illness responds well to treatment if detected early, but 29 patients have been reinfected, Phong said.
Medical experts suspect the victims are suffering from poisoning from chemical herbicides, as they were affected soon after spraying the chemical in cassava fields. The provincial health authorities have yet to determine the cause of the deaths, but believe use of high contents of chemical herbicides have polluted the water sources in the commune.
Residents in these communes use an American brand herbicide named Kanup 480 SL, imported by the Viet Thang Company in the northern province of Bac Giang. The chemical was offered for sale on the company's catalog on 5 Nov 2011.
Samples of water, soil from cassava fields, and herbicide packages have been collected for testing. Preventive medicine centres in the province have warned people not to use the present water source but find an alternative source. Farmers must eat meals before spraying on fields and drink sugar water when experiencing symptoms and visit a medical centre immediately.
The Ministry of Health's missions paid visits to Ba To district twice last October [2011] and in April 2012 to collect water and soil samples, as well as blood and hair of patients for testing, but until now they have not defined the cause of the strange skin disease. The ministry has since asked the World Health Organization and the US Centers for Disease Control and Prevention to help investigate.
The ailment was first detected last April [2011], but the number of cases had died down by October. A fresh spate of infections started last month [March 2012], with 68 cases and 8 deaths reported between 27 Mar and 5 Apr 2012, Phong said.
Most of the patients are from Ba Dien village in Ba To. It is one of the poorest districts in the province and home to many of the Hre ethnic minority group. According to the Quang Ngai Department of Health, 166 people have been infected with this disease, 8 of them died. However, Ba To district reports up to 19 dead patients.
"We have decided to ask the Ministry of Health to ask assistance from the WHO and the US Disease Control Agency to research the bizarre skin disease. International experts are very interested in this disease and they are willing to help Viet Nam," says Mr Nguyen Trong Khoa, vice chief of the Agency for Disease Examination and Treatment.
Experts from the Ministry of Health say that patients were poisoned because they suffered from skin wounds and viscera failure, particularly liver failure. Local residents are panicked because of the strange disease.
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[3]
Date: Fri 20 Apr 2012
Source: Saigon Giai Phong (SGGP) [edited]
http://www.saigon-gpdaily.com.vn/Health/2012/4/100820/
Viet Nam is to seek WHO help to diagnose strange skin disease. At a meeting with the Ministry of Health in the central province of Quang Ngai on [18 Apr 2012], medical experts suggested that Viet Nam should now turn to the World Health Organisation to identify the strange skin disease plaguing the people in this region.
A team of medical experts from the Ministry of Health had gone to Ba Dien Commune on 13 Apr 2012 to study the causes and development of the strange and unidentified skin disease. They took samples of soil, hair, skin, and various foods, to ascertain causes of the disease but all efforts proved futile.
Consequently, relevant agencies proposed to the Ministry of Health to seek help from WHO and the [US] CDC, at a meeting with the ministry on 18 Apr 2012 to discuss preventive measures and quick eradication of the disease. As of now, the Department of Health in the province needs to increase the number of medics and equip the general hospital with blood filtering facilities for treatment. The Department of Agriculture and Rural Development has been ordered to provide clean water and other assistance, while the education sector has been asked to encourage students to attend schools.
According to the latest report from the health sector, the province has reported 171 infected cases and 19 fatalities. Since beginning of this year [2012], 63 people are being treated at the Quy Hoa National Leprosy Dermatology Hospital, 10 of whom are in critical condition.
Last year [2011] the province had recorded more than 150 people with similar symptoms.
[byline: H Minh]
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[4]
Date: Sat 21 Apr 2012
Source: BBC News Asia [edited]
http://www.bbc.co.uk/news/world-asia-17799053
Viet Nam says it will ask for international help to find out what is causing a skin infection that has already killed 19 people. More than 170 people in the country's central province of Quang Ngai have reported symptoms.
The disease begins with a rash on the hands and feet: it can progress to liver problems and multiple organ failure. Vietnamese health ministry tests have failed to pinpoint the cause.
The mystery illness was first reported between April and December 2011 and then subsided, but broke out again last month [March 2012]. Health workers say it responds well to early intervention but is difficult to treat once established.
Frightened residents of Reu village in an impoverished, mountainous part of Quang Ngai, have laid branches across the path to the houses of infected people to try to isolate the outbreak. "We have to block the entrances here to stop patients from getting out and spreading the disease," one resident told Vietnamese TV. "Since we don't know what caused the disease, we will have to rely on our rituals and prayers."
Vietnamese media quoted officials in Quang Ngai as saying that the condition might be caused by chemicals. But the health ministry said it had yet to draw conclusions from its own tests: it hoped to have preliminary results within 10 days.
Dozens of people are being treated at a leprosy hospital in the neighbouring province of Binh Dinh. The government has said it will ask WHO and the US CDC to join its investigation. Those organisations have yet to comment on the disease: a WHO spokesman told the Associated Press news agency it had not yet received a request from Viet Nam for help.
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[The news articles above describe an outbreak mainly in the Bo To district of Quang Ngai province, Viet Nam. Those affected are reported to have developed an acute febrile illness with loss of appetite and respiratory symptoms followed by a rash on the hands and feet, with liver dysfunction, and in some patients multiorgan failure and death. Ulcers on the hands, feet, mouths, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage are also described. The disease is said to affect mainly children and young adults. The disease is said to have started in April 2011, subsided somewhat between November 2011 and February 2012, and picked up pace again in March and April 2012. The numbers of patients affected vary in the news reports, but may be as high as a total of 150 in 2011 and a total of 171, with 27 deaths in 2012.
Early "treatment" is said to effective, but exactly what this treatment consists of is not specified. However, some patients are said to relapse after an initial response to therapy. Pictures of the rash on the hands and feet are available at
http://www.saigon-gpdaily.com.vn/Health/2012/4/100698 and
http://www.eyedrd.org/2012/04/break...-has-claimed-27-lives-in-central-vietnam.html.
At one point the lesions of the hands and feet are described as "palmoplantar keratoderma", that is, an increased keratin layer on the skin (hyperkeratosis) of the palms and soles; (see
http://emedicine.medscape.com/article/1108406-overview#aw2aab6b). Palmoplantar keratoderma may be inherited or acquired. Conditions that can lead to acquired palmoplantar keratoderma include inflammatory and reactive dermatoses such as Reiter's syndrome (arthritis, conjunctivitis or uveitis, and urethritis that follow dysentery or chlamydial or gonococcal genital infection) and infections, such as those due to human papillomavirus, _Treponema pallidum_ (the bacterium that causes syphilis), _Mycobacterium tuberculosis_, and _Mycobacterium leprae_. Encrusted scabies may progress to hyperkeratotic and/or crusted lesions on palmar surfaces. Painful keratotic plaques that involved the skin surrounding the ears, the nose, and the soles in association with polyarthritis has been described in patients with HIV infection (
http://www.nejm.org/doi/full/10.1056/NEJM200312113492425) and keratoderma of the palms and soles has been seen in glucan-treated patients with AIDS (
http://www.ncbi.nlm.nih.gov/pubmed/2953313).
Arsenic exposure can lead to multiple, irregular, warty keratotic lesions on the palms and soles, typically decades after chronic arsenic ingestion. Exposure to certain chemicals, namely chloracnegens, has been reported to present as palmoplantar keratoderma (Patel S, Zirwas M, English JC. Acquired palmoplantar keratoderma. Am J Clin Dermatol. 2007; 8(1): 1-11; abstract available at
http://www.ncbi.nlm.nih.gov/pubmed/17298101). Chloracnegens are halogenated aromatic compounds, such as chlorinated dioxins and polychlorinated biphenyls (PCBs). Chloracne is an acne-like eruption of blackheads, cysts, and pustules on the face and neck, associated with overexposure to halogenated aromatic compounds, such as chlorinated dioxins.
The news articles say that exposure to a herbicide is suspected as the cause of this outbreak, as the patients were affected soon after spraying herbicides in cassava fields. The most toxic dioxin, 2,3,7,8-tetrachlorodibenzo-p-dioxin, became well known as a contaminant of Agent Orange, a herbicide used in the Viet Nam war. Dioxins were incriminated to have poisoned president Viktor Yushchenko of Ukraine in 2004.
Exposure to a toxin such as a dioxin seems a more likely cause of this large outbreak that is occurring in the Ba To district than any of the infections mentioned above.
The population of the Ba To district is predominantly the Hre ethnic group (
http://en.wikipedia.org/wiki/H're_people), which may have a genetic predisposition to palmoplantar keratoderma. We await more information on this outbreak.
Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km south (549 mi) of Hanoi and 838 km (521) north of Ho Chi Minh City (
http://en.wikipedia.org/wiki/Quang_Ngai_province). The province has a large plain along the coast and in the center of the province and has mountains and hills in the west. Ba To is a rural district of Quang Ngai province with a population of 47 268 in 2003 (
http://en.wikipedia.org/wiki/Ba_To_District).
A map of Viet Nam provinces can be seen at
http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png. Viet Nam may also be found on the interactive HealthMap/ProMED-mail map at
http://healthmap.org/r/2bxT. - Mod.ML]
