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
http://www.promedmail.org/
Published Date: 2012-05-02 21:34:27
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (05): (QG) toxin susp. RFI
Archive Number: 20120502.1120880
UNDIAGNOSED ILLNESS - VIET NAM (05): (QUANG NGAI), TOXIN 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: Tue 1 May 2012
Source: VnnNews.net [edited]
http://www.vnnnews.net/rice-mold-added-to-list-of-suspects-in-vietnam-fatal-skin-condition
Villagers do not want to be disturbed while chasing away a ghost they believe is causing a skin condition that has killed at least 19 people.
Viet Nam health officers are adding rice mold to the list of suspects as they try to solve the mystery of a fatal skin condition in a district in the central region. At a Saturday [28 Apr 2012] meeting between the Health Ministry and authorities in Quang Ngai province, it was said that many of the patients in Ba To district had eaten rice covered with fungus, the Nguoi Lao Dong newspaper reported. Nguyen Thi Kim Tien, the health minister, said at the meeting that the ministry has ruled out microorganisms as the cause and narrowed the suspects to poisons transmitted through external contact or eating. She said the condition is not contagious.
The ministry is studying the moldy rice as well as other toxin suspects and will try to reach a final conclusion in the next 10 days. Otherwise, the ministry will seek help from the World Health Organization, Tien said.
The ministry's experts last week found the flea-carried _Rickettsia_ in half of the blood samples taken from the district on 12-13 Apr 2012 but then said the typhus bacterium did not cause the condition.
The skin condition begins with a high fever, loss of appetite and causes inflamed, thickened skin on the palms and feet. It has thus far claimed the lives of 19 people among 179 affected in the district, including 2 new cases on 28 Apr 2012, a man and a woman, both 35 years old.
Doctor Tran Hau Khang, director of the Viet Nam National Dermatology Hospital, said infected people, most of them children and young people, have their liver enzyme levels increase by 4-20 times the normal.
Le Han Phong, chairman of the district People's Committee, said the illness responds well to treatment, but patients who are not treated early can suffer liver problems and multi-organ failure.
The 1st infections in the district were reported last April [2011]. The condition died out by the year-end, but has returned, with 8 deaths between 27 Mar and 5 Apr this year [2012]. At least 29 people have been re-infected.
Last week, the Ministry of Defense collected soil, water, and air samples from the district to check whether toxins left from the Viet Nam war are causing the skin condition.
Meanwhile, many of the district's frightened residents have chosen to isolate themselves from outsiders, spooked by the visits of officials. Reu and Go Nghenh villages, home to the patients, are not allowing outsiders to visit because the residents want to be undisturbed as they "make offerings to drive away the ghost causing the disease," said Pham Van Vong, head of Go Nghenh village. Pham Van Dang, the head of Reu village, was reluctant to open the gate to health experts. "If they can get rid of the disease, they'd better do it. The more they came, the more people here have gotten sick. We are very scared now," Dang told the Nguoi Lao Dong newspaper.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The news article above concerns an outbreak in several villages in the Bo To district of Quang Ngai province, Viet Nam, on which ProMED-mail has previously reported. 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 described as "palmoplantar keratoderma," (http://emedicine.medscape.com/article/1108406-overview#aw2aab6b) accompanied by liver dysfunction and, in some patients, by multi-organ failure and death. Ulcers on the hands, feet, mouth, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage are also described. Mainly children and young adults have been affected.
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 179, with 27 deaths in 2012.
Early "treatment" is said to effective, but exactly what this treatment consists of has not been 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.
The diagnosis of a rickettsial etiology, initially said to have been made on the basis of a positive blood test in half of the blood samples, is now said to have been ruled out. The Weil-Felix test, which is inexpensive, easy to perform, and although 1st developed in 1916, still remains an important way to the diagnosis rickettsial diseases in resource-limited settings and was likely used in this outbreak. However, the Weil-Felix test lacks specificity and sensitivity. In any case, the clinical picture in this outbreak does not fit well with a rickettsial disease.
A better fit would be exposure to a toxin, and Vietnamese officials are now suspecting "molded rice" as well as other toxins as a cause of the outbreak.
Exposure to certain toxic 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 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 in the poisoning of president Viktor Yushchenko of Ukraine in 2004.
Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km (549 miles) south of Hanoi and 838 km (521 miles) 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]
Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI
http://www.promedmail.org/
Published Date: 2012-05-02 21:34:27
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (05): (QG) toxin susp. RFI
Archive Number: 20120502.1120880
UNDIAGNOSED ILLNESS - VIET NAM (05): (QUANG NGAI), TOXIN 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: Tue 1 May 2012
Source: VnnNews.net [edited]
http://www.vnnnews.net/rice-mold-added-to-list-of-suspects-in-vietnam-fatal-skin-condition
Villagers do not want to be disturbed while chasing away a ghost they believe is causing a skin condition that has killed at least 19 people.
Viet Nam health officers are adding rice mold to the list of suspects as they try to solve the mystery of a fatal skin condition in a district in the central region. At a Saturday [28 Apr 2012] meeting between the Health Ministry and authorities in Quang Ngai province, it was said that many of the patients in Ba To district had eaten rice covered with fungus, the Nguoi Lao Dong newspaper reported. Nguyen Thi Kim Tien, the health minister, said at the meeting that the ministry has ruled out microorganisms as the cause and narrowed the suspects to poisons transmitted through external contact or eating. She said the condition is not contagious.
The ministry is studying the moldy rice as well as other toxin suspects and will try to reach a final conclusion in the next 10 days. Otherwise, the ministry will seek help from the World Health Organization, Tien said.
The ministry's experts last week found the flea-carried _Rickettsia_ in half of the blood samples taken from the district on 12-13 Apr 2012 but then said the typhus bacterium did not cause the condition.
The skin condition begins with a high fever, loss of appetite and causes inflamed, thickened skin on the palms and feet. It has thus far claimed the lives of 19 people among 179 affected in the district, including 2 new cases on 28 Apr 2012, a man and a woman, both 35 years old.
Doctor Tran Hau Khang, director of the Viet Nam National Dermatology Hospital, said infected people, most of them children and young people, have their liver enzyme levels increase by 4-20 times the normal.
Le Han Phong, chairman of the district People's Committee, said the illness responds well to treatment, but patients who are not treated early can suffer liver problems and multi-organ failure.
The 1st infections in the district were reported last April [2011]. The condition died out by the year-end, but has returned, with 8 deaths between 27 Mar and 5 Apr this year [2012]. At least 29 people have been re-infected.
Last week, the Ministry of Defense collected soil, water, and air samples from the district to check whether toxins left from the Viet Nam war are causing the skin condition.
Meanwhile, many of the district's frightened residents have chosen to isolate themselves from outsiders, spooked by the visits of officials. Reu and Go Nghenh villages, home to the patients, are not allowing outsiders to visit because the residents want to be undisturbed as they "make offerings to drive away the ghost causing the disease," said Pham Van Vong, head of Go Nghenh village. Pham Van Dang, the head of Reu village, was reluctant to open the gate to health experts. "If they can get rid of the disease, they'd better do it. The more they came, the more people here have gotten sick. We are very scared now," Dang told the Nguoi Lao Dong newspaper.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The news article above concerns an outbreak in several villages in the Bo To district of Quang Ngai province, Viet Nam, on which ProMED-mail has previously reported. 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 described as "palmoplantar keratoderma," (http://emedicine.medscape.com/article/1108406-overview#aw2aab6b) accompanied by liver dysfunction and, in some patients, by multi-organ failure and death. Ulcers on the hands, feet, mouth, back, and abdomen, eye disease, stiffness of the limbs, and miscarriage are also described. Mainly children and young adults have been affected.
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 179, with 27 deaths in 2012.
Early "treatment" is said to effective, but exactly what this treatment consists of has not been 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.
The diagnosis of a rickettsial etiology, initially said to have been made on the basis of a positive blood test in half of the blood samples, is now said to have been ruled out. The Weil-Felix test, which is inexpensive, easy to perform, and although 1st developed in 1916, still remains an important way to the diagnosis rickettsial diseases in resource-limited settings and was likely used in this outbreak. However, the Weil-Felix test lacks specificity and sensitivity. In any case, the clinical picture in this outbreak does not fit well with a rickettsial disease.
A better fit would be exposure to a toxin, and Vietnamese officials are now suspecting "molded rice" as well as other toxins as a cause of the outbreak.
Exposure to certain toxic 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 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 in the poisoning of president Viktor Yushchenko of Ukraine in 2004.
Quang Ngai is a Vietnamese province located in the South Central Coastal region along the South China Sea, 883 km (549 miles) south of Hanoi and 838 km (521 miles) 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]
I hadn't heard about pink disease before. It sounds like they are testing for several toxins but maybe the range will expand, since now it looks like rickettsial etiology isn't strongly suspected.