H5N1

Tanzania on high alert after strange disease kills five

Via The Citizen: Tanzania on high alert after strange disease kills five.

Tanzania’s ministry of health has issued a public notice about an unknown disease that has so far killed 5 people in Bukoba, Kagera Region.  

The notice comes after 7 people were reported to have fallen ill, showing symptoms of fever, vomiting, bleeding, and kidney failure.  

The ministry has called on the general public to remain alert and advised that anyone who shows signs of nausea, weakness, bleeding, diarrhea, or fever to report to the nearest health centre. 

“Anyone who sees someone with the aforementioned symptoms should alert authorities by calling a toll-free number (199).”  

It is believed that the disease is infectious and samples from the dead bodies have been taken to determine what type of disease it is.  

The ministry also said that a rapid response team has been dispatched to the affected areas.

Bilateral pneumonia outbreak in Tucumán, Argentina

Thanks to Giuseppe Michieli for tagging me in a tweet about this news release from the Ministry of Public Health in the province of Tucumán, Argentina: El ministerio de Salud Pública informó sobre la situación sanitaria del brote de neumonía bilateral (Ministry of Public Health reports on the health situation of the outbreak of bilateral pneumonia). Excerpt from the Google translation, lightly edited:

In a new press conference, the head of the Health Portfolio, Dr. Luis Medina Ruiz, reported the death of a 70-year-old patient and the identification of 3 employees of the sanatorium experiencing the same outbreak.

In this regard, the minister announced: “The sanatorium informed us of the death of a 70-year-old patient who was hospitalized there, we needed the family to know first to be able to communicate it. In addition, we identified 3 more employees of the private agent who began with symptoms around August 20 to 23 (that is, they correspond to the same outbreak and place of contagion in principle). That is why at this moment 3 more people are added to the 6 initial patients”.

Regarding the 70-year-old patient who died today, the minister stated: “She was hospitalized and she underwent surgery for a gallbladder problem. She was re-operated twice. From then on, an infectious pulmonary disease took place, the date of which coincides with the onset of symptoms in the other patients, around August 20. Although it is not yet clear which came first, at first she was considered patient zero, but she is under study based on the deepening of the analyses that are being carried out”.

At the same time he added: “We informed about the 3 identified employees. One of them is a 40-year-old pharmacy assistant and she was hospitalized a few days ago in a public hospital with a fever. In the active search that we are carrying out, especially in health personnel, we detected that it is a person who has non-severe bilateral pneumonia with an oxygen requirement under study. The other person is a 44-year-old nurse; she is at her home and we are following her evolution, since her clinical condition does not warrant hospitalization. The third case is a 30-year-old nurse with comorbidities, who was admitted to hospital this morning. His symptoms began around the same days and on the date he was present to be evaluated, at which time we decided to hospitalize him."

Following this line, the official explained that these three people have bilateral pneumonia as a clinical characteristic and have in common the origin of the focus, the epidemiological link with the 6 initial patients. The criterion of incorporating them as suspected patients to the outbreak in principle is based on the employment relationship with the sanatorium, bilateral pneumonia and that with all the study panels its etiology has not yet been found.

“Last night and this morning we had information from the Malbrán Institute and so far all the studies that we had as negative -for Covid, Hantavirus and some strains of Legionella- are also giving negative results there. We continue to carry out the research protocol for blood cultures, sputum cultures, urine cultures and all the viruses and bacteria that we have available in the province. We are in direct communication with Minister Carla Vizzotti, who is available, as well as all the epidemiology and infectious disease teams of the Nation, we are working as a large medical board in which we all participate with the information we have, there are hypotheses of the etiology that are being put on the table, although what we have specifically is the common origin and evolution of the disease”, he added.

Tanzania moves to contain nosebleed disease

Via allAfrica.com, a Tanzania Daily News report: Tanzania: Govt Moves to Contain Nosebleed Disease. Excerpt:

Preliminary specimens taken from patients suffering nosebleed disease in Lindi Region have tested negative for Ebola, Marburg and Covid-19, as the government intensifies measures to contain the contagion, Chief Medical Officer Dr AifelloSichalwe confirmed.  

Dr Sichalwe told reporters in the capital city, Dodoma, on Wednesday that the government had dispatched a team of health experts to Lindi region after receiving a report on the strange disease from Lindi Regional Medical officer.  

The team comprised experts from Emergency Medicine Department, Department of Epidemiology, Chief Government Chemist, National Institute for Medical Research (NMRI), Muhimbili University of Health and Allied Sciences (MUHAS) and Muhimbili National Hospital and Lindi Regional team which involved Veterinary Department.  

The disease was announced to the public by President Samia Suluhu Hassan on Tuesday while gracing the official opening of the 20th Plenary Assembly of Association of Member Episcopal Conferences in Eastern Africa (AMECEA), which was held in Dar es Salaam.  

And briefing the media on Wednesday on the preliminary samples which were tested at the National Public Health Laboratory, Dr Sichalwe said further epidemiological and medical investigations will be conducted while waiting for results from the medical and veterinary laboratories and Chief Government Chemist Laboratory.  

He said until July 12, this year a total of 13 patients were reported to have contracted the disease, with three succumbing to the illness and two patients isolated at Mbekenyera Health Centre were discharged after showing positive recovery.  

Dr Sichalwe further said that other five patients have isolated themselves at Naungo division, Nanjilinji ward in Kilwa District while one patient who has fully recovered was proceeding with his daily routine.  

"The government is also monitoring people who made contact with those who suffered from the unknown disease... so far, there is no one who has shown similar symptoms," he said.

What was the plague of Athens?

In February I'll be teaching a 4-session course for our local ElderCollege: Perspectives on Pandemics. The first session will deal with outbreaks we know of in antiquity, and one of the most momentous of those was the plague of Athens. While it was not a pandemic, its focus on Athens weakened the city's military strength, demoralized and divided the population, and killed its leader Pericles; Athens and its empire never recovered, and eventually lost the war to Sparta and its allies. 

Background: In the second year of the Peloponnesian War (430 BCE), Sparta's army invaded Attica. Pericles adopted a defensive strategy, bringing rural residents into Athens. These tended to crowd into Piraeus, the harbour district, living in shacks and huts. Meanwhile, Pericles focused on building up the Athenian navy. His policies were unpopular, especially with wealthy landowners whose farms were now ravaged by the Spartans, and he was even ousted from power on a charge of embezzlement. Later he was re-elected to power, but he and members of his family contracted the plague also, and he died of it. 

Could it have been the ancestor of some modern disease, or an early variant of a modern disease? Or is it more likely a one-off that mercifully died out? Here are the symptoms as described by Thucydides (who survived it) in the Penguin Books edition translated by Rex Warner, 1954. 

“At the beginning the doctors were quite incapable of treating the disease because of their ignorance of the right methods. In fact mortality among the doctors was the highest of all, since they cam more frequently in contact with the sick.”

Origins: Ethiopia to Egypt, Libya, and much of Persia. Appeared suddenly in Athen in Piraeus (which was crowded with rural refugees who lacked adequate housing); then in upper city. That year saw no other serious outbreaks, but all who had any kind of previous illness caught the plague.

“In other cases, however, there seemed to be no reason for the attacks. People in perfect health began to have burning feelings in the head; their eyes became red and inflamed; inside their mouths there was bleeding from the throat and tongue, and the breath became unnatural and unpleasant.

“The next symptoms were sneezing and hoarseness of voice, and before long the pain settled on the chest and was accompanied by coughing. Next the stomach was afflicted with stomaches aches and with vomitings of every kind of bile that has been given a name by the medical profession, all this being accompanied by great pain and difficulty. In most cases there were attacks of ineffectual retching, producing violent spasms; this sometimes ended with this stage of the disease, but sometimes continued long afterwards.

“Externally the body was not very hot to the touch, no was there any pallor; the skin was rather reddish and livid, breaking out into small pustules and ulcers. But inside there was a feeling of burning, so that people could not bear the touch even of the lightest lien clothing, but wanted to be completely naked, and indeed most of all would have liked to plunge into cold water. Many of the sick who were uncared for actually did so, plunging into the water-tanks in an effort to relieve a thirst which was unquenchable …. Then all the time they were afflicted with insomnia and the desperate feeling of not being able to keep still.

“In the period when the disease was at its height, the body, so far from wasting away, showed surprising powers of resistance to all the agony, so that there was still some strength left on the seventh or eighth day, which was the time when, in most cases, death came from the internal fever. But if people survived this critical period, then the disease descended to the bowels, producing violent ulcerations and uncontrollable diarrhea, so that most of them died later as a result of the weakness caused by this.

“For the disease, first setting in the head, went on to affect every part of the body in turn, and even when people escaped its worst effects, it still left its trace on them by fastening upon the extremities of the body. It affected the genitals, the fingers, and the toes, and many of those who recovered lost the use of these members; some, too, went blind. There were some also who, when they first began to get better, suffered from a total loss of memory, not knowing who they were themselves and being unable to recognize their friends.”

Psychological effects: “The most terrible thing of all was the despair into which people fell when they realized that they had caught the plague; for they would immediately adopt an attitude of utter hopelessness, and by giving in in this way, would lose their powers of resistance. Terrible, too, was the sight of people dying like sheep through having caught the disease as a result of nursing others.”

Kwilu: 286 children died in 3 months from an unknown disease

Kwilu province, DR Congo. Gungu is in the south-central part of the province. Google Maps.

Thanks to @BojoBodean for alerting me to this Radio Okapi report: Kwilu: 286 children died in 3 months from an unknown disease. The Google translation:

The head of the provincial health division of Kwilu, Dr Jean-Pierre Basake, told Radio Okapi on Monday, November 8 that two hundred and forty-six children whose age varies between 0 and 5 years had died since the end of the month. of August 2021 of an illness of unknown origin, in the health zone of Mukedi, in the territory of Gungu, in the province of Kwilu.  

According to him, this figure was drawn from the cumulative amount of 4,881 cases including 286 registered deaths. "The cases are still there. Children have a fever with abdominal pain, vomiting, some lead to a picture of anemia. We are at 4,481 cases and 286 cumulative deaths," said Dr Basake.  

He also said that the province and some partners had provided material and financial support to strengthen the response:  

"We brought in medical, material and technical support. The drugs we used did not have the right active principle. We nevertheless obtained the support of the provincial government on the recommendation of the provincial assembly, five million francs. Congolese (US $ 2,450) taken out of the provincial fund and drugs. The partners also made available antimalarials, therefore ACTs and inputs of nearly US $28 to 29,000. From the weekend to this day, this 'was $33 to 34,000 USD. Drugs and inputs. We have with us here a biologist technician who takes the samples, we will send nationally to the INRB."

DR Congo: In less than two months, nearly 90 children aged 0 to 5 died from an unknown disease in Gungu (Kwilu)

Via Actualite.cd: DRC: in less than two months, nearly 90 children aged 0 to 5 died from an unknown disease in Gungu (Kwilu). The Google translation:

Nearly 90 children aged 0 to 5 have died since the end of August as a result of a hitherto undetermined illness, authorities alert. According to the head of the provincial health division in Kwilu, Jean-Pierre Basake, the affected children show signs of fever causing anemia. He indicates that the health authorities were not seized of the matter in time.

“In places, like in Lonzo Munene village, two to three children die. It already dates from the end of August. And when we add up, we are around 90 children. The team was not warned in time because the families were going to the private community more, the state structures were not informed. It is malaria with fevers that reduce blood hemoglobin, so that by lack of transfusion and good management to minimize fevers, there is anemia,” said Jean-Pierre Basake. 

He adds: “Also because of their habits and customs, we don't like transfusing. Now is the time for us to see how we can combine actions to have a possibility of installing the blood bank in large cities.”  

In society, these numerous cases of child deaths call for an investigation to determine the nature of the disease.  

“Children die every day, especially in the rural commune of Mukedi and the surrounding villages. There is fever, loss of blood, there is also diarrhea which manifests itself especially in children from 0 to 5 years old who are targeted by this epidemic which still lacks a name. We ask that there be a descent of a team of health experts who can come to the aid, to see if it is exactly what,” pleaded journalist René Kinenga, director of programs at Radio Fraternité by Mukedi.  

According to information collected from some residents, this is the third time that these repeated deaths have been observed for three years, still at the start of the rainy season.

What can a medical mystery from Guam teach New Brunswick about its own strange, deadly disease?

Via The Globe and Mail: What can a medical mystery from Guam teach New Brunswick about its own strange, deadly disease? Excerpt:

They called it lytico-bodig. As the Second World War drew to a close, U.S. military doctors stationed on Guam noticed many of the Pacific island’s Chamorro people were suffering from a baffling and devastating illness. 

The local name for the progressive and fatal disease – said to have come from the Spanish “paralytico” – provided a label for what Islanders described as an illness that disconnects one from one’s family. It captured a constellation of symptoms, including muscle wasting, paralysis, muscle rigidity, shaking, confusion and memory loss. Doctors and researchers observed this strange illness shared characteristics of amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), Parkinson’s disease and Alzheimer’s disease, and they clamoured to try to understand it, with the hope it would shed light on other neurodegenerative disorders. 

In a collection of case reports published in 1961, early investigators documented the deterioration over 12 years of their first patient, whom they described as a “Chamorro housewife.” Her initial chief complaint was of weakness in both her hands. “When last observed in August, 1960, the patient was helpless, bedridden, almost immobile and in a terminal state,” the authors wrote. 

The disease was still a mystery when Canadian chemist Susan Murch travelled to Guam as a postdoctoral fellow in 2003 to study a neurotoxin researchers believed might hold the key to solving the puzzle. What she and the scientists she worked with discovered there provided not only what they considered a possible source of the illness, but may also offer clues to a new medical mystery in New Brunswick, where dozens of people have developed unexplained neurological symptoms. 

Dr. Murch, working with principal investigator Paul Cox, a U.S. ethnobotanist, found that a toxin produced by blue-green algae called beta-methylamino-L-alanine, or BMAA, was present in cycad trees, a source of food for the island’s residents. They found the same toxin in the animals residents consumed, such as pigs, deer and bats that ate the seeds, fruit and other parts of the cycad plants. And they also found it in the brain tissue of several Chamorro patients who died of the mysterious disease. 

Dr. Cox, together with famed British neurologist Oliver Sacks, hypothesized that neurotoxic BMAA, the amounts of which were magnified as people consumed animals at higher levels of the food chain, might offer a long-sought explanation for what was causing damage to people’s bodies and brains. Today, that hypothesis is still debated. But investigators of the new illness in New Brunswick are revisiting the work of Dr. Murch and her colleagues. 

As of mid-July, 48 cases of an unknown neurological syndrome, including six deaths, have been reported in the province, mostly in the Moncton area and the Acadian peninsula. Doctors and researchers investigating the illness say they are looking into various potential causes – among them, BMAA or an algal toxin like it.

In New Brunswick, experts try to figure out why dozens have been affected by a mystery brain disease

Via The Globe and Mail: In New Brunswick, experts try to figure out why dozens have been affected by a mystery brain disease. Excerpt:

It typically starts with uncharacteristic irritability, anxiety and depression. Then comes pain, along with insomnia, and a constellation of other devastating symptoms, including terrifying hallucinations, a loss of balance and co-ordination, and in a few cases, Capgras delusion – the irrational belief that family members or other familiar people have been replaced by imposters. 

By now, Dr. Alier Marrero knows what a mysterious brain illness that has sickened dozens of New Brunswickers looks like. 

But what he can’t tell you is how to best help these patients – or how to prevent others from suffering the same fate. Because before Dr. Marrero can tackle these questions, he must find the answer to another, more basic one: What has made all these people in his province ill in the first place? 

Without knowing the cause, “it’s very difficult to go out there and shoot in the dark,” said Dr. Marrero, a neurologist at Dr. Georges-L.-Dumont University Hospital Centre in Moncton, explaining the best he and his team can do for the patients is to treat their symptoms. “But still, the puzzle is not solved.” 

Dr. Marrero is leading an investigation into this unknown brain disease that has affected residents mostly in the Moncton area and the Acadian Peninsula, and has attracted the attention of scientists around the world. As of Friday, there have been 47 cases, including six patients who have died, and more possible cases are being investigated. 

Working in the shadow of a global pandemic, he and his colleagues are looking for clues in a hunt that leads down multiple potential paths. One line of pursuit suggests what they’re seeing may be akin to Creutzfeldt-Jakob disease, the human form of mad cow disease. Another hints at a possible environmental toxin, similar to a 1987 outbreak that sickened more than 100 Canadians who ate contaminated Atlantic shellfish. And yet another suggests answers may be found by revisiting a mysterious neurological disease that was detected in the Pacific island of Guam in the 1940s. 

“In many ways, it’s the worst thing that could happen, to have this happen in the middle of COVID-19, because what you need are boots on the ground,” said Michael Strong, professor of neurology at Western University and president of the Canadian Institutes of Health Research. 

Dr. Strong, an expert in neurodegenerative diseases, explained investigating potential environmental toxins would require going into communities and individual households to look for commonalities between cases, including examining things such as water supply, fishing and hunting habits. It also requires taking soil and water samples, and studying them back in the lab. 

“If the worse-case scenario is that this is something new that we haven’t seen before, then truly bringing the whole of the government response that’s working on this now and bringing the academic community to bear on this ... it’s what we’ve got to do,” he said. 

Since the first case in 2015, the illness has shown up in more individuals over the past three years, ranging in age from 18 to 86. And researchers say they are a long way from solving the mystery.

Mystery brain disorder baffles Canadian medicine

Via The Guardian: Mystery brain disorder baffles Canadian medicine. Excerpt:

Doctors in Canada are concerned they could be dealing with a previously unknown brain disease amid a string of cases involving memory loss, hallucinations and muscle atrophy. 

Politicians in the province of New Brunswick have demanded answers, but with so few cases, experts say there are far more questions than answers and have urged the public not to panic. 

For more than a year public health officials have been tracking a “cluster” of 43 cases of suspected neurological disease in the province with no known cause. 

Residents first learned of the investigation last week after a leaked memo from the province’s public health agency asked physicians to be on the lookout for symptoms similar to Creutzfeldt-Jakob disease – a rare, fatal brain disease caused by misformed proteins known as prions. 

“We are collaborating with different national groups and experts; however, no clear cause has been identified at this time,” said the memo. 

A number of the symptoms including memory loss, vision problems and abnormal jerking movements triggered an alert with Canada’s CJD surveillance network. Despite the initial similarities, screening produced no confirmed cases of CJD. 

“We don’t have evidence to suggest it’s a prion disease,” said Dr Alier Marrero, the neurologist leading New Brunswick’s investigation. 

Now a team of researchers, including federal scientists, are racing to determine if they are dealing with a previously unknown neurological syndrome, or a series of unrelated, but previously known – and even treatable – ailments. 

 Marrero says patients initially complained of unexplained pains, spasms and behavioural changes – all symptoms that could be easily diagnosed as anxiety or depression. 

But over 18 to 36 months they began developing cognitive decline, muscle wasting, drooling and teeth chattering. A number of patients also began experiencing frightening hallucinations, including the feeling of insects crawling on their skin. 

In order for a new case to be included in the New Brunswick “cluster”, Marrero and his team conduct an extensive study of the patient’s history, as well as a battery of tests including brain imaging, metabolic and toxicology tests and spinal taps, to rule out other possible illnesses like dementia, neurodegenerative disorders, autoimmune disorders and possible infections. 

Only a single suspected case was recorded in 2015, but in 2019 there were 11 cases and 24 in 2020. Researchers believe five people have died from the illness. 

“We have not seen over the last 20-plus years a cluster of diagnosis-resistant neurological disease like this one,” said Michael Coulthart, head of Canada’s CJD surveillance network.

What's causing New Brunswick's mystery neurological disease? Worried residents want answers

Via CBC News: What's causing N.B.'s mystery neurological disease? Worried residents want answers Excerpt:.

News this week that a cluster of more than 40 cases of an unknown neurological disease have been identified and found only in New Brunswick has residents of several communities on edge. 

The mystery illness has similarities to Creutzfeldt-Jakob disease, a rare and fatal brain disease. 

First diagnosed in 2015, according to an internal Public Health memo sent this month to medical professionals, the disease affects all age groups and appears to be concentrated in the Acadian Peninsula in northeast New Brunswick and the Moncton region in the southeast. 

Forty-three cases have been identified, and five people have died. Since that news was reported on Wednesday, people in those communities have been wondering how alarmed they should be.   

 "People are wondering, what is it? Why is it only here? We are hoping that somebody will tell us," Anita Savoie Robichaud, the mayor of Shippagan, a town on the peninsula, said Friday. 

Yvon Godin, the mayor of Bertrand, a village further north on the peninsula, who also chairs the Forum of Acadian Peninsula Mayors, agrees. 

"We are very, very worried about it," Godin said. "Residents are anxious, they're asking 'Is it moose meat? Is it deer? Is it contagious?' We need to know, as fast as possible, what is causing this disease." 

Dr. Neil Cashman understands the concern. Cashman, a professor in the University of British Columbia's faculty of medicine, is a neurologist with a special expertise in prion diseases — a group of neurodegenerative diseases caused by proteinaceous infectious particles, or prions — including Creutzfeldt-Jakob disease. 

When Cashman first heard about the cases in New Brunswick, he says his first thought was, "We have a problem on our hands."