Mystery illness: Another patient sickens

MAIL & GUARDIAN ONLINE REPORTER AND AGENCIES
JOHANNESBURG, SOUTH AFRICA - Oct 07 2008 12:18

A 51-year-old woman has been admitted to the Chris-Hani Baragwanath Hospital with symptoms of a killer disease, suspected to be haemorrhagic fever.

The disease has so far claimed three lives in South Africa, the Gauteng Health Department said on Tuesday.

Spokesperson Zanele Mngadi said the department had confirmed that Maria Stuurman, who was admitted to the hospital, was a cleaning supervisor at Morningside Medi-Clinic.

Stuurman was admitted on Monday with flu-like symptoms.

"She is in isolation and tests are being done to confirm her illness. Ms Stuurman is stable and there is a chance of her being discharged today or soon," Mngadi said.

A health official said on Tuesday the disease was suspected to be Crimean-Congo haemorrhagic fever (CCHF).

"We suspect that it may be Congo haemorrhagic fever but we have not made a diagnosis yet," said Frew Benson, the South African Health Department's deputy director of communicable diseases.

South African health officials said on Monday they were closely monitoring the illness, which causes external and internal bleeding, but called on the public not to panic.

Health authorities were due to send blood samples to the United States Centres for Disease Control and Prevention in Atlanta on Tuesday, Benson said.

Fatalities
The first fatality was Cecilia Van Deventer (36), a reservations manager for Wilderness Safaris in Lusaka. After falling ill, Van Deventer was taken to three different hospitals before being flown to South Africa. She was admitted to the Morningside Medi-Clinic on September 12 and treated for tick-bite fever, but died two days later.

Hannes Els (33), a paramedic who accompanied Els, also displayed similar symptoms and was admitted to the same hospital on September 27 and was dead by October 2.

Two others who worked at the hospital have also died. Maria Mokubung (37), a cleaner, died on October 5 and Gladys Mthembu (34), a nurse, died on October 4.

Morningside Medi-Clinic's regional marketing manager Melinda Pelser said Mokubung did not die from the viral disease.

"She died of a neurological illness. It has been established that she was not near the patient," said Pelser.

Dr Simon Miti, the permanent secretary in the Zambian Health Ministry, said that no other cases had been reported.

"It is still quiet here. We have checked all the places the woman [Van Deventer] passed through and no one has presented with any of the symptoms or died with similar condition. Out of the 12-million Zambians no one has presented with these symptoms," Miti said.

Meanwhile, private and public hospitals were urged by the National Education Health and Allied Workers' Union (Nehawu) to take precautionary measures and isolate patients who were vomiting and suffering from diarrhoea.

"This outbreak has put lives of many South Africans at risk and the authorities have a duty to investigate if negligence is to blame for this serious health hazard," said Nehawu spokesperson Sizwe Pamla.

CCHF is carried by domestic animals and can be transmitted by ticks. It is found in Africa, Eastern Europe and Asia.

Treatement possible
CCHF first appeared in Crimea in 1944 and was later identified in 1956 as the cause of an illness in what is now the Democratic Republic of Congo.

Cases have been recorded in Kosovo, Albania, Iran, Pakistan and South Africa. Symptoms include headaches, back pains, vomiting, severe bruising and nose bleeds.

According to the World Health Organisation, CCHF can be treated but recovery is slow. If treatment is not provided in time, death can occur in the second week of illness.

There are several other strains of haemorrhagic fever, including Ebola and Marburg, which have killed hundreds of people in outbreaks in Africa. These diseases cause bleeding from multiple sites and can have very high death rates.

Ebola is rare, but there is no known cure and the virus usually kills between 50% and 90% of its victims.

It is spread through contact with bodily fluids of a patient. As with other haemorrhagic fevers, patients die from dehydration, bleeding, and shock.

The latest outbreak, which ended in February in Uganda, was unusually mild, killing 37 people out of 149 infected.

Article at: http://www.mg.co.za/article/2008-10-07-mystery-illness-another-patient-sickens

Sounds more like Ebola - ....

Explanation of Congo Hemorrhagic Fever from the CDC below:

What is Crimean-Congo hemorrhagic fever?

Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. The disease was first characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease.

Where is the disease found?

Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union. It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

How is CCHF spread and how do humans become infected?

The Hyalomma tick

Ixodid (hard) ticks, especially those of the genus, Hyalomma, are both a reservoir and a vector for the CCHF virus. Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus. Transmission to humans occurs through contact with infected animal blood or ticks. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. Documented spread of CCHF has also occurred in hospitals due to improper sterilization of medical equipment, reuse of injection needles, and contamination of medical supplies.

What are the symptoms of Crimean-Congo hemorrhagic fever?

The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception. As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

How is Crimean-Congo hemorrhagic fever diagnosed?

Laboratory tests that are used to diagnose CCHF include antigen-capture enzyme-linked immunosorbent assay (ELISA), real time polymerase chain reaction (RT-PCR), virus isolation attempts, and detection of antibody by ELISA (IgG and IgM). Laboratory diagnosis of a patient with a clinical history compatible with CCHF can be made during the acute phase of the disease by using the combination of detection of the viral antigen (ELISA antigen capture), viral RNA sequence (RT-PCR) in the blood or in tissues collected from a fatal case and virus isolation. Immunohistochemical staining can also show evidence of viral antigen in formalin-fixed tissues. Later in the course of the disease, in people surviving, antibodies can be found in the blood. But antigen, viral RNA and virus are no more present and detectable

Are there complications after recovery?

The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow.

Is the disease ever fatal?

In documented outbreaks of CCHF, fatality rates in hospitalized patients have ranged from 9% to as high as 50%.

How is Crimean-Congo hemorrhagic fever treated?

Treatment for CCHF is primarily supportive. Care should include careful attention to fluid balance and correction of electrolyte abnormalities, oxygenation and hemodynamic support, and appropriate treatment of secondary infections. The virus is sensitive in vitro to the antiviral drug ribavirin. It has been used in the treatment of CCHF patients reportedly with some benefit.

Who is at risk for the disease?

Animal herders, livestock workers, and slaughter houses in endemic areas are at risk of CCHF. Healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids. Individuals and international travelers with contact to livestock in endemic regions may also be exposed.

How is the disease prevented?

Agricultural workers and others working with animals should use insect repellent on exposed skin and clothing. Insect repellants containing DEET (N, N-diethyl-m-toluamide) are the most effective in warding off ticks. Wearing gloves and other protective clothing is recommended. Individuals should also avoid contact with the blood and body fluids of livestock or humans who show symptoms of infection. It is important for healthcare workers to use proper infection control precautions to prevent occupational exposure.

An inactivated, mouse-brain derived vaccine against CCHF has been developed and is used on a small scale in Eastern Europe. However, there is no safe and effective vaccine widely available for human use.

What needs to be done to address the threat of Crimean-Congo hemorrhagic fever?

Prevalence needs to be measured in animals and in at-risk humans in endemic areas; and a useful animal model needs to be developed. Further research is needed to determine the efficacy of specific treatment with ribavirin and other antiviral drugs, and develop a safe and effective vaccine for human use.