Viet Nam - Quang Ngai: Undiagnosed illness, 26 fatalities since April 2011

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Hat-tip Pathfinder.

http://www.futura-sciences.com/fr/n...e-na-pas-encore-livre-tous-ses-secrets_38890/

The Vietnamese strange disease has not yet revealed all its secrets
Janlou by Chaput, Futura-Sciences joliprintPDF Share Share on Vietnam is hit by an upsurge in cases of an unknown disease, involving the skin, appetite and liver. National authorities, supported by WHO and the Centers for Disease Control and Disease Prevention American, have not been able to positively identify its origin, but still have new information. Futura-Sciences following the case closely, via Timothy O'Leary, a spokesman for the WHO.
A month ago, there was concern of a mysterious skin disease reappeared in Vietnam. At the time, 19 victims had been found for 170 people affected. The figures are mounted to 21 on 205 patients died. The track was considered pesticides as herbicides were being applied to fields of cassava. Since then, biological and physicochemical analyzes have yielded new information: the situation clears up slightly, although the blur still reigns.
Timothy O'Leary, spokesman for the World Health Organization (WHO) in the region of the western Pacific, entrusts Futura-Sciences we still do not know "what makes people sick. But whatever the cause, nothing makes us think that it is transmitted from human to human. " Blood tests conducted by Japanese biologists have revealed no evidence of infection. A first reassuring news, which allows specialists to exclude viral or bacterial cause. The trail of insects and other arthropod vectors of disease is not considered.
Pesticides exonerated
"There is also no evidence supporting the idea that the disease is caused by heavy metals or chemicals used in agriculture," Timothy O'Leary resumes. Indeed, the physicochemical analysis of water, soil and rice, constituting the bulk of their diet, do not reveal the presence of pollutants beyond acceptable doses. Look elsewhere.

The epidemic is concentrated on only five municipalities around Ba To, in central Vietnam. ? Ide
But not too far, because the solution is on site. As noted by the spokesman for WHO, "the disease is localized and involves only five municipalities in a particular district of Quang Ngai province."
Aflatoxin in the heart of the Vietnamese strange disease?
Part of the problem may still have been resolved. In the unbleached rice, very popular in the region, traces of aflatoxin, a molecule produced by fungi, were detected in amounts five times higher than in milled rice. However, the risk of reporting symptoms are 4.8 times higher for those who swallow rice unbleached.
Aflatoxin is known to cause liver problems, which can lead to cirrhosis include or liver cancer. Consumption at high doses is fatal within hours or days. Indeed, patients experiencing liver problems. But this would not explain the observed skin ulcers in patients.
There must be something else. But what? It remains undetermined. Seventy experts in dermatology came to lend strong hand to local doctors. "The investigations continue. We are monitoring the situation closely, "concluded Timothy O'Leary. In parallel, of course, the authorities try to minimize the spread of the epidemic and treat the most patients. The mystery is not yet fully resolved. Following the next episode.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI - multiple etiologies suspected

Not good. Why hasn't the WHO been called in yet?

The mention of a "blood infection" here might suggest either a co-infection, or perhaps a typhus case.

http://www.thanhniennews.com/index/...ondition-infects-more-in-central-vietnam.aspx

HCMC treats first skin victim as more infected in central Vietnam
Last Updated: Tuesday, May 22, 2012 03:20:00


A boy is examined for a strange skin disease that has killed dozens in the central province of Quang Ngai since last April.

A child afflicted by the skin condition that has plagued an ethnic minority community in central Vietnam for more than a year was admitted to Ho Chi Minh City's Children's Hosptial No. 1 in critical condition on Saturday.

Doctors at a hospital in Binh Dinh Province had failed to stabilize the deteriorating condition of the 9-year-old patient Pham Van Thach of Ba To District in Quang Ngai Province, north of Binh Dinh.

Thach was admitted to Children's Hospital 1 suffering from severe liver damage and a blood infection, according to doctors at the city hospital.

Health experts say the condition begins with blisters on hands and feet and can quickly lead to organ failure.

On Tuesday, Doctor Le Bich Lien, deputy director of the hospital, said the cause of the condition remains unknown and physicians are treating the child through a process known as "blood filtering."

Three other members of T.’s family are also suffering from the disease, doctors said.

Health minister Nguyen Thi Kim Tien has ordered hospitals to provide free treatment to patients suffering from the condition. Tien asked the hospitals to cover 5 percent of the treatment cost, and leave the rest for government health insurance.

The first cases of the symptoms were reported last April. The condition died out by the beginning of 2012, but flared up again in late March.

After a year of dispatching multiple teams of researchers and epidemiologists to the two afflicted districts, health officials remain baffled as to the cause of the illness, which continues to spread.

Meanwhile, the World Health Organization maintains that it has not been asked to assist Vietnam's healthcare officials in determining the cause.

Dang Thi Phuong, the medical center director of the plagued Ba To District, said the number of recorded cases rose to 209 this past week from 200 on May 8.

A tally conducted by Tuoi Tre showed that the number of cases closer to 240--including 21 deaths as of May 7.

The figure is only expected to grow, officials say, since blood tests show that over 28 percent of people in the district, which is home to mostly H’re ethnic people, are exhibiting abnormally high levels of liver enzymes--which usually precedes the other symptoms.

Health officials had previously suspected that the illness had been brought on by the practice of deliberately eating fungus-covered rice--a traditional food for the tribe. But the fungus has been ruled out as a cause--though health officials have imported clean rice as a better alternative.

Health officials have also issued new sleeping mats to residents of the affected area and incinerated their old bedding.

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[Just a novel thought here as most of the suggested diagnoses seem to be either insufficient or are being ruled out. Is it possible that this illness might be the result of a novel, vector-borne agent? This thread seems vaguely similar to the situation over the past few years in parts of China (http://www.flutrackers.com/forum/showthread.php?p=373777) leading up to the discovery of a novel tick-borne virus there. That would explain the seasonality of the illness, and would also explain the high proportion of patients that tested positive for a rickettsial agent as well; it would simply have also been transmitted by the same bite. - alert]

 

[Emily]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI

Acquired Palmoplantar Keratoderma

Authors: Patel, Shaily1; Zirwas, Matthew2; English, Joseph C.1

Source: American Journal of Clinical Dermatology, Volume 8, Number 1, 2007 , pp. 1-11(11)

Publisher: Adis International

Palmoplantar keratodermas (PPKs) are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. Traditionally they have been classified as either hereditary or acquired and are distinguished from each other on the basis of mode of inheritance, presence of transgrediens (defined as contiguous extension of hyperkeratosis beyond the palmar and/or plantar skin), co-morbidities with other symptoms, and extent of epidermal involvement, namely diffuse, focal, and punctate. As the terms hyperkeratosis and keratoderma have been used interchangeably throughout the literature, we define acquired keratoderma as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves ≥50% of the surface of involved acral areas and that may or may not be associated with clinical and histologic inflammation.

Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task. To facilitate such evaluations, this review categorizes the acquired PPKs as: keratoderma climactericum, drug related, malnutrition associated, chemically induced, systemic disease related, malignancy associated, dermatoses related, infectious, and idiopathic...

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

Same commune as well. Not sure if this is related:

http://english.vietnamnet.vn/en/society/22873/angry-with-his-wife--man-poison-community-wells.html

Angry with his wife, man poison community wells
VietNamNet Bridge ? Tens of families in Nui Ngang hamlet in Ba To district of the central province of Quang Ngai were very worried because many wells in the hamlet smelled like insecticide.




A well poisoned by Ty.



Mr. Pham Van Lia and his wife were the first who detected the strange phenomenon. ?After I pumped water from the well into a tank, my wife used the water to wash the rice. She found out that the water bubbled up and smelt like insecticide,?

This well is used by six families, totaling more than 20 people.

Mr. Lia reported to the local authorities. Experts were sent to collect water sample for testing. They concluded that the well is poisoned with insecticide.

The water tank of Mr. Pham Van Ngan, a local official, was in similar situation. ?It is very lucky that we early detected insecticide in the tank. We have bought water to temporary use,? Ngan said.

According to the local authorities, four wells and tanks of 12 families, totaling 40 people, are poisoned with insecticide.





Pham Van Ty.


Police suspected that someone tried to poison local residents and they investigated. The culprit was determined shortly. It was a man named Pham Van Ty, 35, from a neighboring hamlet.

Ty declared that he was angry with his wife, Ms. Pham Thi Lan, who left him to return to her parents in Nui Ngang hamlet. The man bought insecticide to poison wells and tanks in this hamlet, in order to kill his wife?s family and relatives.

Consequently, Ty?s wife was allergic after having bath with poisoned water. Pigs of a family in the hamlet had died of poisoning.

Local people have to dig new wells.

Ty was arrested and prosecuted.

 

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Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

http://www.saigon-gpdaily.com.vn/Health/2012/5/101416/

Monday, May 28, 2012, Posted at: 12:10(GMT+7)

Medics add nutritious food supplements to tackle mysterious skin disease
Medical workers in Ba To District in Quang Ngai Province have come to the conclusion that most of the indigenous ethnic minority groups suffering from the mysterious and as yet unidentified skin disease also suffer from acute malnutrition, hence are supplementing their diet with more nutritious foods.



Although many medical teams have come and gone from the district, the unidentified skin disease plaguing Ba To District in the central province of Quang Ngai continues to elude Vietnam?s public health officials and medical researchers.

However, one unanimous conclusion is that the skin disease could be cured by better nutrition.

Accordingly the National Institute of Nutrition in coordination with Pasteur Institute in Nha Trang in the south-central province of Khanh Hoa and the Department of Health in Quang Ngai Province have distributed nutritious food supplements to all residents in Ba Dien, Ba Ngac and Ba To Communes.

Children below the age of five will receive confectionary, frog protein flour while adults and children above the age of five will be given multi-vitamin tablets and other nutritious food products.

Apart from this, patients already suffering from the skin disease will be provided additional and special nutritional products, which are expected to help strengthen the body's defenses within two months, said Dr. Nguyen Thi Lam, deputy director of the National Institute of Nutrition.

According to the latest statistics from the Department of Health, the number of afflicted skin disease patients number more than 230, most of who are Ba Dien Commune residents.

At present, the ministry is struggling to contain the number of patients affected by this baffling skin disease. Food samples tested by medics found mouldy fungus and Aflatoxin in rice which was nearly five times higher than in other areas.

Aflatoxin, a toxic fungus, is recorded in medical documents in the world for causing chronic and acute liver damage. In addition, test results of samples of spring water and soil taken from the commune in Son Ha District showed contamination of ?Glyphosate?, a broad-spectrum herbicide used to kill weeds.

 

[Ronan Kelly]

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 21 fatalities since April 2011 - Viet Nam: Quang Ngai

Tuesday, May 29, 2012, Posted at: 14:28(GMT+7)
9-year-old boy succumbs to unidentified skin disease
By A. Vinh, H. Minh - Translated by Nha Tran

A 9-year-old boy succumbed to the mysterious skin disease that has been plaguing residents in the central province of Quang Ngai, after undergoing treatment for seven days in Children Hospital No.1 in Ho Chi Minh City, bringing the death toll to 22, said a gov?t official on May 25.

Pham Van But, chairman of Ba Dien Commune in Ba To District in the central province of Quang Ngai, announced that Pham Van Thach, 9, son of Pham Van Thoat from Reu Village had died after seven days of treatment in Children Hospital No.1 in HCMC.

Thach?s death is the third in Reu village from the unknown skin disease in just one month, bringing the total death toll from the disease to 22 victims.
...
http://www.saigon-gpdaily.com.vn/Health/2012/5/101439/

 

[Treyfish]

Re: Undiagnosed illness, 22 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 22 fatalities since April 2011 - Viet Nam: Quang Ngai

Consecutive cases appear more strange deaths from the disease

|​

8:04 PM Wednesday, May 30, 2012 -

-​

On the afternoon of 30/5, Pham Van Pen, president of CPC Ba Dien (Ba To, Quang Ngai), said Pham Thi Trieu (1979) Mosses village resident, Ba Dien Commune, who died at hospital Quang Ngai Department at about 10 am the same day.

She Korea suffered "strange disease" from early 2012, then go in and out of hospitals to treat the province but no less severe disease but increasing.
Then she was transferred to Korea General Hospital of Quang Ngai and dialysis treatment three times. However, Korea's health weakened and died. In the morning of 30/5, her family moved in Korea for local burial.
<TABLE border=0 cellSpacing=1 cellPadding=1 width=200 align=center><TBODY><TR><TD>

</TD></TR><TR><TD class=pCaption>Health workers are taking blood samples for children in Ba Dien Commune </TD></TR></TBODY></TABLE>

.​

Afternoon 30/5, Ms. Dang Thi Phuong, director of the district health center Ba - Quang Ngai, said her unit had moved three questions "strange disease" Children's Hospital 2, TP.

HCM để điều trị.​

City for treatment.
It is the children Pham Thi On (born 1998); Pham Dinh Hieu (born 2007) and Pham Quoc Bao (b. 2003).

Cả ba em đều ở x? Ba Điền, huyện Ba Tơ.​

All three children are in Ba Dien Commune, Ba district.
Thus, in the village three days from 28-30/5 Moss had two deaths due to "unknown disease", bringing the total number of deaths from the disease to 23 cases with 241 cases of "unknown disease". :tiphat:http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=vi&tl=en&u=http://www.tinmoi.vn/lien-tiep-xuat-hien-them-truong-hop-tu-vong-vi-benh-la-05915281.html&usg=ALkJrhhGon5_PAiltgUdN7t6daFTAonWPQ

 

[Ronan Kelly]

Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Two more die of unknown skin disease in Quang Ngai
TUOI TRE
Updated : Thu, May 31, 2012,12:12 PM (GMT+0700)

While health authorities have yet to identify the cause of the mysterious skin disease in central Quang Ngai Province, two more people died in Ba To District in the past 3 days, taking the death toll to 23 so far.

34-year-old woman, Pham Thi Trieu, in Reu Hamlet, Ba Dien Commune, died at 10 am on May 30 at the provincial General Hospital while 9-year-old boy, Pham Van T, died on May 28 in the same hamlet.

Luong Ngoc Khue, head of the Health Ministry?s Department of Medical Examination and Treatment, said the hair samples taken from the boy contained arsenic at a level 100 times higher than the country?s acceptable limit.
...
http://www.tuoitrenews.vn/cmlink/tu...of-unknown-skin-disease-in-quang-ngai-1.74181
...

 

[Ronan Kelly]

Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Woman hospitalised for unknown disease
VNS
QUANG NGAI ? A 34-year-old woman with breathing difficulties and skin peeling off the palms of her hands has been taken to a healthcare centre in central Quang Ngai Province.
Dinh Van Bum, head of the Son Ky Commune's communal health care centre said that It was suspected the woman had been in contact with a herbicide when she worked in the field three days before.
...
http://vietnamnews.vnagency.com.vn/social-issues/225535/woman-hospitalised-for-unknown-disease.html

 

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Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Re: Undiagnosed illness, 23 fatalities since April 2011 - Viet Nam: Quang Ngai

Woman hospitalised for unknown disease
VNS
QUANG NGAI — A 34-year-old woman with breathing difficulties and skin peeling off the palms of her hands has been taken to a healthcare centre in central Quang Ngai Province.
Dinh Van Bum, head of the Son Ky Commune's communal health care centre said that It was suspected the woman had been in contact with a herbicide when she worked in the field three days before.
...
http://vietnamnews.vnagency.com.vn/social-issues/225535/woman-hospitalised-for-unknown-disease.html

Interesting. Son Ky commune is NOT the commune where the main undiagnosed outbreak is occurring, but the symptoms here do seem similar enough to those in Ba To to suggest the two outbreaks might be related. If they are, the total number of fatalities seems to be 27, as the article states there have been four such fatalities in Son Ky. That said, the outbreak at Son Ky seems to have "breathing difficulties" as a symptom, something that has not been reported in most of the descriptions from Ba To. Also, Son Ky has had 4 fatalities in 15 cases, a much higher ratio than the 23 fatalities in 240 or so cases in Ba To.

The herbicide Kanup 480SL which some articles have suspected as the cause of the outbreak in Son Ky has been excluded as the cause of the illness in Ba To because the illness began before the start of the use of that product. If the two outbreaks are connected, the herbicide would also not be the cause of the outbreak in Son Ky.

 

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Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://www.promedmail.org/

Published Date: 2012-06-01 20:02:05
Subject: PRO/EDR> Undiagnosed illness - Viet Nam (06): (QG) toxin susp. RFI
Archive Number: 20120601.1153587

UNDIAGNOSED ILLNESS - VIET NAM (06): (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: Thu 31 May 2012
Source: tuoitrenews.vn [edited]
http://tuoitrenews.vn/cmlink/tuoitr...of-unknown-skin-disease-in-quang-ngai-1.74181


While health authorities have yet to identify the cause of the mysterious skin disease in central Quang Ngai Province, 2 more people died in Ba To District in the past 3 days, taking the death toll to 23 so far.

A 34-year-old woman in Reu Hamlet, Ba Dien Commune, died at 10 am on 30 May 2012 at the provincial General Hospital while 9-year-old boy died on 28 May 2012 in the same hamlet. Luong Ngoc Khue, head of the Health Ministry's Department of Medical Examination and Treatment, said the hair samples taken from the boy contained arsenic at a level 100 times higher than the country's acceptable limit.

The disease has so far spread to 5 communes in Ba To district, including Ba Dien, Ba Ngac, Ba Xa, Ba Vinh and Ba To, of which Ba Dien is leading with the most cases.

The mysterious skin disease that 1st occurred in the district on 19 Apr 2011 is characterized by thickened skin (keratosis) over the palms and soles, causing stiffness in the limbs and ulcers on victims' hands and feet that look like burns.

There has been no disease in the world so far that is exactly identical to the strange syndrome in Quang Ngai, Health Deputy Minister Nguyen Thanh Long said at recent conference. Most of the patients have elevated liver enzymes, but they do not suffer from infectious diseases since no symptoms of infection have been found, according to the results of patient blood tests made by Japan's Nagasaki University, he said.

Health workers have found more than 200 species of insects, including mites, ticks and fleas, in disease-impacted areas, but no evidence has been found to link them with the disease.

According to some scientific councils, the strange syndrome might be caused by toxic substances that affect malnourished people with low immunity.


--
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 [Some of the articles dispute this claim. - alert] 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. The death toll in 2012 was previously reported to be 27, but the news report above says that number is 23. [The discrepancy is likely the four deaths in Son Ky. - alert]

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 of the affected Vietnamese villagers 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 current news report above says that the hair samples taken from a 9-year-old boy who died contained arsenic at a level 100 times higher than the country's acceptable limit. Arsenic exposure can lead to skin pigment changes and multiple, irregular, warty keratotic lesions on the palms and soles, alone or in combination with nodules usually symmetrically distributed. These skin lesions typically occur after chronic arsenic ingestion, as mentioned in the ProMED-mail moderator's comments in Undiagnosed illness - Viet Nam (03): (QG) RFI Archive Number: 20120423.1110507.

Chronic arsenic toxicity also produces varied systemic manifestations, such as chronic lung disease (e.g., chronic bronchitis, chronic obstructive pulmonary disease and bronchiectasis), liver disease (e.g., non cirrhotic portal fibrosis) and other diseases (e.g., polyneuropathy, peripheral vascular disease, hypertension and ischemic heart disease, diabetes mellitus, non-pitting edema of feet/ hands, weakness and anemia), as well as cancer of skin and different internal organs (e.g., lung and urinary bladder). Pictures of the skin lesions of chronic arsenic toxicity can be seen at http://icmr.nic.in/ijmr/2008/october/1007.pdf. Elevated concentration of arsenic in hair (> 1 mg/kg of hair) or in nail clippings (> 1.5 mg/kg of nail) serves as presumptive evidence of elevated arsenic exposure within the preceding nine months (WHO, A field guide for detection, management and surveillance of arsenicosis cases. Caussy D, editor. Technical Publication No 30. New Delhi: WHO, SEARO; 2005. p. 5- 18. Available at http://www.searo.who.int/LinkFiles/Publications_seaTP30.pdf).

Humans are exposed to arsenic primarily from air, food and water. Drinking water may be contaminated with arsenic from arsenical pesticide, natural mineral deposits or improperly disposed arsenical chemicals. However, elevated arsenic level in drinking water is the major cause of arsenic toxicity in the world.

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]

 

[Ronan Kelly]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

US helps Vietnam identify mysterious disease
TUOI TRE
Updated : Sat, June 2, 2012,10:16 AM (GMT+0700)


A medical expert from the US Center for Disease Control and Prevention (CDC) will arrive in Vietnam tomorrow to help discover the cause of a bizarre skin syndrome that has killed 23 people in Quang Ngai Province, Vietnam's Health Ministry said yesterday.

The US expert will help Vietnamese health workers classify samples taken from the disease?s victims and then send a number of typical samples to CDC?s laboratories for testing.
...
http://www.tuoitrenews.vn/cmlink/tu...s-vietnam-identify-mysterious-disease-1.74452

 

[Emily]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://magazine.sina.com/bg/xinminweekly/17/20120508/1837118112.html
Google translation.

Vietnam fatal skin disease secretive obscure Xinmin Weekly

中文版報價及研究

Intern Han Xuewei

Some people even believe that this is a disease caused by the toxic substances left over from the United States during the Vietnam War.

So far, the Vietnam outbreak of mysterious skin disease has taken away the lives of 19 people, the scientists of this disease is poorly understood, but unknown exacerbated people's fears.

Mysterious skin disease strikes

4-year-old boy Thuan eventually failed to survive the torment of the disease, left this world in early January, he was the first patients with the disease died this year. Thuan's home in Quang Ngai province of Vietnam's central mountainous area (Quang, Ngai), Aberdeen Village, of Basi County of (Ba To) (Ba of Dien), the end of last year, he had a strange skin disease. His hands and feet, inflammation of the skin to a single sitting, and soon the horny and hard as ulceration, with exacerbations of liver dysfunction, his physical condition worsened. December 31, 2011, Thuan was taken to the generalized General Hospital for treatment, January 2, 2012, transferred to Da Nang General Hospital. Unfortunately, in the dawn of this new year, Thuan end of his brief life journey.

Thuan is the second disease died in the province, he was a less than 10-year-old child. They have the deadly abnormal by the Vietnamese Ministry of Health named the "hand, foot and skin horny thickening of inflammation" (hereinafter referred to as the "skin disease"). As of April 25, Quang Ngai province reported a total of 176 patients infected with skin diseases, eight of whom died in a medical clinic, 11 people died at her home.

The the Basi County People's Committee Chairman Li Han Wind (Le Han, Phong), recalled that the disease from the mountain popular in the central Quang Ngai province in April last year and continued until December, the epidemic gradually subsided, the health sector did not able to determine this what kind of disease. The resurgence of disease in the central region in March this year, and menacing. Within a short span of 10 days of March 27 to April 5, alone diagnosed 68 cases, 8 patients died. At present, nearly 100 people receiving treatment in hospital, patients with mild symptoms in isolation at home, to accept the doctor's onsite inspection.

Li Han Feng, the initial illness, the patient will be high fever, loss of appetite, hand, foot rash, swelling, itching and other symptoms; 4 - 7 days in patients with skin stiff as horny like or cracking. Did not receive timely treatment of patients with respiratory system may be affected, and could easily lead to eye diseases, abortion, liver dysfunction, or even multiple organ failure and other serious consequences. Condition is detected, the sooner, the more timely treatment, the better the patient recovered. However, there are 29 patients cured after re-infection, a high recurrence rate. In short, the disease deteriorated rapidly cure is not easy. There is no effective treatment to control the disease, generalized Provincial Health Bureau deputy director Nguyen Xuan Men, recently said health officials have proposed a new treatment program.

Nguyen Xuan Men, mainly children and young people infected with skin diseases, of which 73% are farmers, 20 percent are students. 60% of patients with recurrence, and significantly higher than during the rainy season, the prevalence of the dry season. Incidence are concentrated in central Vietnam Basi County Aberdeen Village, which is one of the poorest regions of the Quang Ngai province, the minority Hre ethnic ghettos.

The number of patients is increasing, and cast a haze to the local knowledge of the skin so that people know what to do and fear. Vietnam, "Labor Daily" reported that a villager deaths because of skin disease, the village only a few people attended the funeral, other people are afraid of infectious diseases is hiding in the home. At school, the children go to class dwindling, and some people left the area to escape this bizarre skin.

Panic among local residents to take some common preventive measures to try this Black Death in the door. Aboriginal Pham, Van Tray explain, "To prohibit the patients are out of transmission of infection, we have to block the road, because do not know the reasons for the sick, and only rely on traditional ceremonies and prayers." Residents to the housing of patients. placed on the road branches, such as roadblocks and sacrifice buffalo medical treatment is the ancient custom of the Hre tribe.

Reu village chiefs, the epidemic center the Pha mVan Dang, suggested that people looking for a more scientific sanitation and epidemic prevention method. "I said to them, if you are sick, do not stay at home, but should go to the hospital to seek treatment. If we want to keep their homes clean and sanitary. Any one of the bereaved families should get the help of young people."

Pathogens so far is a mystery

In order to find the root causes of the disease-causing, the Vietnamese Ministry of Health in October last year and April this year to send experts to conduct investigations to Basi County. They collect the water, soil and variety of food, the patient's blood and hair samples were collected, but some research down to the end with nothing.

April 18, the Vietnamese Ministry of Health held a meeting on the prevention and cure skin diseases, many medical experts and relevant departments are recommended to the World Health Organization for help. Vietnam's disease examination and treatment agencies Vice Chairman Nguyen Trong Khoa said that they have decided to seek support to the World Health Organization and the United States Center for Disease Control; international experts is very interested in this disease are also willing to Vietnam in April 19 lend a helping hand.

Vietnamese Ministry of Health for disease research continues. Ministry of Health for the cause of the disease and the professional organizations of Vietnam National Dermatology Hospital carried out field investigations are ongoing. The experts were divided into four areas of expertise, are skin-related diseases, intestinal health, food hygiene and general safety. The investigation will focus primarily on environmental factors, and selectivity in the local residents to take blood, skin and hair samples for analysis. So far, however, they did not find any localized source of infection.

While struggling with Vietnam because of a mysterious skin disease, the close neighbor of Thailand, the people it is difficult to remain calm. In late April, a 6-year-old Thai girl because hands and feet, legs covered with red spots to Chachoengsao hospital, suspected of being infected with a mysterious skin disease in Vietnam, causing local people to panic, worried that the disease will spread from Vietnam Thailand. Later, after further diagnosis, the doctor to assess the girl had to purpura, rather than a skin disease in Vietnam.

World Health Organization spokesman, Hartl said the disease is always in the same area, and never spread to elsewhere, worry about international spread too early, especially in other provinces and regions of Vietnam, there is no such condition appears circumstances.

After a series of survey analysis, the disease first emerged. Vietnamese media quoted the generalized Provincial Health Director of the Bureau the Fan Hongfang (Mr.Pham Hong Phuong,) on the 25th saying that the submission of 26 patients blood samples of 14 samples positive for Rickettsia's lanes. Rickettsia is the characteristics of both bacteria and virus characteristics of a class of micro-organisms, usually in the in vivo survival of ticks, mites, fleas, lice can be transmitted by biting insects giving. The diseases caused by Rickettsia, including typhus, spotted fever.

However, local experts do not believe that Rickettsia is the root that causes the disease, and think it's just a pathogenic factor.

Some medical experts suspect that the patient is infected with a chemical herbicide poisoning, because many patients in the cassava to spray herbicides soon after the emergence of the disease. The provincial health administrative department can not determine the cause, but that the application of this chemical herbicides contaminated local water resources. Kanup 480 SL, the American brand of herbicide called Viet Thang Company imports and sales. Local water sources, cassava soil and herbicide packaging have been collected to carry out laboratory tests. The provincial preventive medicine center also reminded local residents do not continue to use existing sources of water, once the symptoms to drink sugar water and promptly to a medical center for examination. More part of people believe that this is a disease caused by the toxic substances left over from the United States during the Vietnam War.

Emory University School of Medicine and a professor of public health, the former Chairman of the American Society for Infectious Diseases, Dr. Hughes said: "There on the disease to explain, it may be contagious, perhaps caused by some kind of toxin in the local environment. "infected area concentrated in the poorer areas of Vietnam, there may be a relatively poor water quality, poor health conditions, which may cause infection." Hughes believes that the disease may not be very widespread, but will not go away. He said it depends on what is the cause of the infection.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://vietnamnews.vnagency.com.vn/...rt-to-assist-in-study-on-disease-control.html

International expert to assist in study on disease control

An American expert from the US-based Centre for Disease Control and Prevention (CDC) in Thailand will arrive in Viet Nam today to assist local scientists in their study of a mysterious skin disease that has affected 240 people, killing 22, in Ba To District in the central province of Quang Ngai.
Experts from the Ministry of Health have collected and tested 1,940 samples of soil, water, hair and fingernails. It is expected that the CDC expert will send samples to CDC's laboratory in the US.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://www.promedmail.org/mbds

Published Date: 2012-06-04 23:09:59
Subject: PRO/MBDS> Undiagnosed illness - Viet Nam (11): Quang Ngai, update, RFI
Archive Number: 20120604.1259

UNDIAGNOSED ILLNESS - VIET NAM (11): QUANG NGAI,UPDATE, 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 31 May 2012Source: Thanh Nien News [edited]http://www.thanhniennews.com/index/pages/20120531-central-vietnam-skin-condition-kills-woman-raises-toll-to-23.aspx


Central Viet Nam skin condition kills woman, raises toll to 23
--------------------------------------------------------------
A mysterious skin condition plaguing Ba To District in the central
province of Quang Ngai claimed another life Wednesday morning [30 May
2012], 2 days after a young boy from the district died of the condition
in Ho Chi Minh City. A 33-year-old woman died at Quang Ngai General
Hospital despite 3 blood transfusions, raising the death toll to 23
since the 1st case was reported in April last year [2011].

On Sunday night [27 May 2012], a 9-year-old boy died after 8 days at
HCMC Children's Hospital No.1.

Le Huy, chief of staff at the Quang Ngai Health Department, said 3 more
Ba To children with the condition, ages 5, 6, and 14, have been sent to
HCMC Children's Hospital No.2.

The condition begins with blisters on the hands and feet and loss of
appetite, and then becomes fatal due to organ failures, starting with
the liver. Most patients have had enzyme levels 4-20 times the norm.

At least 214 people from the district have the condition.

The Heath Ministry has sent officials to study Ba To several times, but
no conclusions have been released.

The World Health Organization said it has not received an official
request for help from the ministry.

[Byline: Hien Cu]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[The number of deaths due to the strange disease in Ba To and Quang Ngai
has reached 23 since April 2011. The etiological agent for this disease
has not yet been identified. In contradiction to previous media
coverage, this news release says that WHO has not received an official
request for help from the Ministry of Health.

PRO/MBDS would appreciate further information from knowledgeable sources
regarding this undiagnosed illness in Quang Ngai province, Viet Nam.

For a map of Viet Nam with provinces, see
http://upload.wikimedia.org/wikipedia/commons/f/f0/VietnameseProvincesMap.png.
For the interactive HealthMap/ProMED-mail map with direct links to other
outbreaks in Viet Nam and surrounding countries reported on ProMED-mail
and PRO/MBDS, see http://healthmap.org/r/1f3d. - Mod.QCN]

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://vietnamnews.vnagency.com.vn/...mystery-disease-may-be-arsenic-poisoning.html

Updated June, 07 2012 09:05:48

Mystery disease may be arsenic poisoning

Doctors at the HCM Paediatrics Hospital No 2 speculate that the mystery skin disease afflicting people in Quang Ngai Province may be caused by arsenic or dioxin poisoning.
But a final conclusion awaits the results of tests done on three children admitted there a week ago.

Dr Ho Thi Kim Thoa said the preliminary diagnosis was that the patients were poisoned. Besides causing liver defects, the disease also affected other organs like heart and kidney.

Today the Ministry of Health will organise a conference to discuss the cause of the disease at Hospital C in Da Nang.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://www.thanhniennews.com/index/...ir-of-central-vietnam-fatal-skin-patient.aspx

Arsenic found in hair of fatal skin patient in central Vietnam
Last Updated: Sunday, June 03, 2012 04:05:00


Pham Van Thach at HCMC Children?s Hospital No.1 before he died May 27. His hair tested postive for high levels of arsenic.


Hair samples of the boy who died of a mysterious skin condition in central Vietnam?s Quang Ngai Province showed elevated levels of arsenic, doctors said.

Tang Chi Thuong, director of Ho Chi Minh City Children?s Hospital No.1 where the boy died May 27, said arsenic can cause skin inflammation, the first and most common symptoms among all patients suffering from the condition so far, according to a Sunday report by news website VnExpress.

However, Thuong said a lot more patients must be tested, and at different laboratories, before an official conclusion should be drawn about the skin condition which has been plaguing Quang Ngai?s Ba To District since April last year.

Thach was transferred to the hospital on May 20 after falling sick in March.

The arsenic level in one of his hair samples was 100 higher than normal while several others showed negative results.

Environmental surveys in 2011 found arsenic in groundwater in many places in northern and central Vietnam, VnExpress said.

The Health Ministry is prepared to conduct more tests on more patients.

At least 214 people from Ba To District have been infected with the unknown skin ailment and 23 have died, including the most recent casualty, a 33-year-old woman who expired on May 30.

Health officials have visited the district many times but remain puzzled as to the cause of the condition, which can quickly turn lethal by causing multiple organs to fail, beginning with the liver.

The World Health Organization said they have not received an official request for help with the situation.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

A large number of Vietnamese language articles have just come out. A sample:

http://tuoitre.vn/Chinh-tri-xa-hoi/...-“la”-o-Quang-Ngai-dioxin-vao-“tam-ngam”.html

Friday, 06.08.2012, 04:01 (GMT +7) disease "strange" in Quang Ngai: dioxin on the "radar"

TT - Seminar Diagnosis and treatment of dermatitis thick horn hands, feet by the Administration clinics (MOH) held in Da Nang 7-6.

The experts say you should test to find dioxin causes.

Diseases >> "strange" in Quang Ngai
Quang Ngai >> strange disease: still deadlocked



Patients, "stranger" treatment at Health Centers Ba district - Photo: UNION STRENGTH



The latest information is Assoc. Dr. Tran Hau Khang - Director of Central Hospital of Dermatology and chairman of the board of the Ministry of Health professional - 7-6 for light, Asian Association of Dermatology in touch with him, ask if the Assembly will need to experts to help understand the disease "strange". However, by days 6-6 Ministry of Health has worked with the Centers for Disease Control and Disease Prevention (CDC) and the World Health Organization (WHO) does not need to participate.

Mr. Luong Ngoc Khue (Director of Administration medical) that may cause illness or school tomorrow to find out any resistance.

Dioxin can be found in plant protection drugs


Expeditiously at the

At the session of Congress on 7-6 on the economic situation - social, deputies Nguyen Cao Phuc (Quang Ngai) is very frustrating when the treatment regimen as well as the recommendations of the Ministry of Health were local timely implementation but not effective, patients still die. "I would propose to the Government directed the Ministry of Health should use all resources and all organizations that can, promptly invited the World Health Organization in early research to find effective solutions to save lives "- fierce Phuc.

Sues

Experts were aware of the source patient "strange" is due to poisoning. At the same time the experts suggest to put dioxin into the "sights". According to Prof. Kang, in all the tests have not done that a dioxin, and dioxin exposure may be related to the use of plant protection agents in agriculture.

Dr. Pham Due - anti-director of the Center (Bach Mai Hospital) - frank proposal to put dioxin into doubt by factors caused by dioxin has long been overlooked. He also agreed with the conclusions derived high disease from chronic poisoning syndrome lead to liver damage and skin thick horn hands, feet.

"I suspect dioxin-related diseases, but funding is not so large that testing be done. For years we thought dioxin is due to the war but not really, it was found in plant protection drugs "- Dr. Due said.

The same point, Dr. Hoang Van Minh - University Hospital Medical City - also said to focus on determining what toxic substances and so can not remove dioxin.

Administration health care provider about testing for dioxin, the WHO and CDC will monitor the situation and specific plans.

"Need to relocate displaced people will soon"

Mr. Nguyen Xuan Men - deputy director of Quang Ngai Health Department - pressing for that most diarrhea cases "strange" that dialysis will lead to death. He added that leaders of Quang Ngai province awaiting comments from the Ministry of Health. If the water is poisoned by saying the province will build water plants for people. Needed for displaced people in three provinces Fill it would move immediately.

At the workshop, the Ministry of Health has announced plans to reduce mortality by intervention patients, "stranger" in Ba from May to December. Ministry of Health focal implement this plan are 14 hospitals and medical facilities nationwide.

The plan was implemented in two phases. Phase 1 focus on improving the technical capacity for Quang Ngai province and referral treatment of severe cases. The severe cases are transferred and a tertiary treatment such as Hue Central Hospital, Cho Ray Hospital, Bach Mai Hospital, Children's Hospital 1, 2 ... Phase 2 will develop local treatment: the treatment of mild disease in the Medical Center of Ba To district, they taken seriously Hospital of Quang Ngai province.

Answer questions when critically ill patients transferred to hospitals at end of treatment still die, now back to the hospital in Quang Ngai province has nearly as much if not, Assoc. Dr. Tran Hau Khang said briefly: "The Ministry will strengthen the experienced professionals to help treat and train local doctors. With the added manpower, facilities, techniques for Quang Ngai. "

UNION STRENGTH


The first symposium

Calculated from the patients appear "strange" first (19-4-2011), this is the second official conference on the disease organized by the Health Ministry (1st workshop was held in April -2012 in Quang Ngai, with the participation of the Minister of Health Nguyen Thi Kim Tien and Deputy Minister Nguyen Thanh Long). But this is a symposium on treatment for patients with "strange" first.

According to the Ministry of Health, has had two tours of the Central Hospital of Dermatology in 2011, two inter-hospital survey team. 1st from 25 to 28-4 with 35 members and the 2 month 5-2012 with 70 members, not to mention the other sporadic trips.
.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

http://vov.vn/Home/Bo-Y-te-van-chua-tim-duoc--nguyen-nhan-benh-la/20126/212215.vov

Health has not found a reason unknown disease
(VNA) - Ba To district, Quang Ngai Province had 215 people with thick horn syndrome dermatitis palms, feet, 43 relapse cases and 23 deaths.
Morning of 7/6, in Da Nang, medical Administration Ministry of Health organized a workshop diagnosis and treatment of skin inflammatory syndrome horns thick palms, feet. Attending the seminar were the leading experts of Dermatology, the Dermatology Hospital, Hue Central Hospital and the provincial departments of Health central city area. Many treatments, consultations, preventing the syndrome has been tabled. But still have not found the cause of gastritis horn syndrome palms feet.

Dr Nguyen Minh Tuyen, Deputy Head of resuscitation, a Children's Hospital, said after being taken from patients in Quang Ngai, the hospital has treated the direction of anti-infective, liver support. The patient improved very well but then relapse and death. The hospital just stop at treating symptoms.



Patients treated strangers.

Central Hospital Dermatology Quy Hoa, Ministry of Health said last year to now, the hospital has treated over 100 patients, all cured, but when returning to the disease relapse rate recurrence up to 76%. Mr Nguyen Thanh Tan, Director of Central Hospital Dermatology Quy Hoa, Ministry of Health stated that the characteristics of this syndrome is very persistent treatment, but progress was slow when there was very unfavorable surprises hospitals should be monitored closely.

Information at the conference, said the health sector have removed many factors that cause diseases such as allergic dermatitis due to the location, exposed to infection by fungal, bacterial, viral, allergic dermatitis drugs, toxic heavy metals. The Health Ministry has also implemented measures to examine the clinical epidemiology and community epidemiology and has removed all these factors. Because no cause is found should lead to health sector reform recommended further environmental screening to enable early detection in order to have timely treatment to people, the same time allocating drugs, vitamins and micronutrients regimen of health.

Associate Professor, Dr. Tran Hau Khang, Director of the Central Hospital of Dermatology, chairman of the dermatology specialist Ministry of Health recommends:

If not, only liver lesions treated with topical anti-inflammatory, anti-horns thick, anti-psoriasis. When the liver has to put up hospitals for treatment, there must be consultation of experienced staff

The experts World Health Organization has arrived in Vietnam, yesterday undertook to work with professional institutes of the Ministry of Health to find out the situation, then the actual survey, find the cause and provide appropriate treatment.

As of today 7/6, in the district of Ba To, Quang Ngai Province had 215 people with dermatitis syndrome horns thick palms, feet, of which, 43 recurrent cases and 23 deaths. Particularly in the last two days, District Health Centers Ba To, Quang Ngai province received 13 cases the presence of thick horn syndrome dermatitis palms, feet.

 

[alert]

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

Re: Viet Nam - Quang Ngai: Undiagnosed illness, 23 fatalities since April 2011 in Ba To commune, 4 in Son Ky

The mention of dioxin in an herbicide here is odd. The herbicide that has been used here is Kanup 480SL, which is glyphosphate, which is used worldwide, including elsewhere in Vietnam, without producing these symptoms and was not used here until after the start of the outbreak. I don't think it even has dioxin in it. Could they have been using a second herbicide that has not been identified? Or is the mention of dioxin a masked attempt to link these illnesses to the war 40 years ago?