It's not always influenza that kills
Scott McPherson
in influenza and infectious diseases
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1 Comment
While influenza hogs the world viral stage, adenovirus steals the show.
One thing I have learned after a twenty-one month immersion into the world of influenza research is that you'd better be ready to learn a whole lot more about other illnesses. That lesson could not be made clearer than this week, when I began to learn about the adenovirus.
Last week ,reports began to filter out of Mexico and Panama of a "mystery illness" that was killing scores of children.
As reported in the Miami Herald, edited by me:
Mystery disease strikes remote area of Panama
Posted on Tue, Oct. 02, 2007
BY ERIC JACKSON
Special to The Miami Herald
PANAMA CITY, Panama -- Local officials are reporting that 42 people have died, almost all of them children, in an outbreak of a still unidentified disease in the remote Ñurum district of Panama's indigenous Ngobe-Bugle region.
The ailment begins with a runny nose, coughing and fever, and when it gets deadly the victims present symptoms that look like bronchial pneumonia, according to a statement by Panama's Health Ministry.
The Health Ministry and the semi-automomous Gorgas Memorial Laboratory say they don't know the cause of the illness.
''We're studying it, and the Gorgas Lab is working on it, but to say anything now would be speculation,'' said a ministry official who asked for anonymity because he lacked authorization to comment on the case.
Word of a problem first got out in mid-September when local officials contacted the Health Ministry and then, alarmed by what they considered a lackadaisical response, took their story to the news media.
On September 23 Gladys Guerrero, the ministry's director of epidemiology, denied to a reporter for the tabloid El Siglo that there was any viral or bacterial pathogen at work, attributing the problem to complications of rainy season colds that are common in the area, especially because of its poor sanitary conditions.
Guerrero also said that local claims at the time of 10 deaths since late August were exaggerated. Within five days, Ngobe officials were reporting 40 deaths and many more sick. The La Prensa newspaper has reported that more than 30 children from Ñurum are being treated in various hospitals around the country.
The Health Ministry said in a Sept. 29 press release that the problem appears to be ''a known acute viral respiratory situation like influenza,'' but on Monday a ministry spokesman said that no flu or other virus had yet been identified.
The U.S. government has offered help, but as of Tuesday Panama had not asked for international assistance.
After news of the illness broke, President Martín Torrijos cut short a trip to the United States and flew into Ñurum with a team of some 60 healthcare workers. (bold mine)
Government officials fanned out to visit thousands of families and advise them to cooperate with health officials and that nobody evacuated to a city hospital would be left stranded -- a concern that had led some of the poor parents to refuse to let their children be taken to a hospital.
http://www.miamiherald.com/news/brea...ry/258274.html
So the president of panama ended his Washington visit with President Bush so he could take command of the situation. That is telling. Now, we have confirmation that the virus is none other than -- adenovirus. From today's FluTrackers forum (edits by me), and a huge hat-tip to poster Dutchy:
Minister confirms deaths of Panamanian natives by adenovirus
Panama, 10 oct (PL) the minister of Panamanian Health, Rosario Turner, today confirmed the death of 17 smaller indigenous children of five years, victims of curable respiratory diseases that proliferate in the isolated region Ngobe Buglé.
In an appearance before the Commission of Health and Social Security of the National Assembly, Turner said that 93 members of the community were hospitalized and of them 77 withdrew after receiving the corresponding treatments.
Turner declared that the respiratory deaths and serious pictures that appeared the last weeks in the community of Ñurum, in the referred region, must adenovirus and influenza, (bold Dutchy) in as much discarded all possibility of a mortal germ.
Communitarian leaders said days back that at least 40 minors and an adult passed away of the attacks of cough, fevers and diarreas, but as many were buried near their houses, far from health facilities.
The holder of Health expressed that the problem must to a virus that affects to children and adults with nutricionales problems and of anemia, but that the fast action of the unfolded medical personnel in the region avoided new deaths.
Turner said that the arisen respiratory diseases in the indigenous community are own of the rainy station in the country reason why it reiterated to maintain the measures of personal hygiene.
http://www.prensa-latina.cu/article....7d&language=ES
By itself, this article would not amount to too much. But let's seek context, and rewind two weeks ago to this report from Mexico, courtesy of WorldNetDaily:
Dozens in Mexican city ill with suspected avian flu
Raises concerns over international implications of epidemic
September 28, 2007
© 2007 WorldNetDaily.com
Dozens of people in a Mexican city are gravely ill with what is being treated as a possible outbreak of avian flu, according to a new report from a Spanish-language website.
According to El Universal, authorities in a neighborhood in Guanajuato say 45 patients have been given medical attention at the area's hospital after they reported symptoms including extreme headaches, stomachaches, vomiting and diarrhea.
The cases have developed over the last two weeks and "feel [like] death," according to Silvia Villalobos, one of the victims who spoke to El Universal correspondent Xochitl Alvarez in Spanish.
A spokesman for the regional general hospital, Ernesto Castle, said he does not know the cause of the problems, but officials are looking at an avian flu virus, which is transmitted by birds and is similar to botulism, as a source.
He reported at least 45 patients have been given emergency room medical attention, while others went to their private physicians for help.
One man reported his wife was hospitalized after the symptoms hit, waking her with fever and chills, before she fainted.
Guadalupe Gomez, a resident of the area, said her concern was that the epidemic was being carried by flies attracted by leather processed in the tanning industry, which includes leathers from other nations.
City spokesman Jose Eusebio Olague said officials have directed that barricades be set up so the sick do not spread the infections even further.
Traditional causes for fever and chills essentially have been ruled out by various tests, officials said. Sources in the air, water and other industries have been eliminated as a cause, officials said.
I will bet a dollar the Mexican virus is adenovirus.
Coincidentally, or perhaps serendipituously, a report was just issued this week on adenovirus 14 (oh, THAT adenovirus!).
IDSA: Outbreak of Severe Pneumonia Traced to Adenovirus 14
SAN DIEGO, Oct. 9 -- A potentially deadly form of community-acquired pneumonia linked to adenovirus type 14 has emerged in the Pacific northwest, according to a report presented here.First encountered in 2005 in Oregon, the viral pneumonia frequently leads to hospitalization and has a 20% fatality rate, (bold mine) Paul Lewis, M.D., of the Oregon State Public Health Department, said at the Infectious Diseases Society of America meeting.
"We recommend obtaining a viral culture in pneumonia patients who lack a specific etiology, especially those with severe disease," said Dr. Lewis. "If adenovirus 14 is detected, anticipate a stormy course. We encourage an infectious disease consultation to discuss the risks and benefits of any specific therapy that might be contemplated."
Recognition of the adenoviral pneumonia began with four patients hospitalized simultaneously at a Portland hospital. Upon comparing notes with physicians at area hospitals, Dr. Lewis and colleagues "almost fell out of our chairs because every hospital we called had recent severe and fatal cases of adenovirus disease."
(ditto) Investigators followed up the informal communication with a systematic review of all cases of adenovirus disease identified by Oregon clinical laboratories from November 2006 to April 2007. Six months of active surveillance revealed what appeared to be a winter-spring predominant adenovirus disease, as the number of reported cases increased from January through April.
Isolates from the sickest patients were sent to the CDC, which found that almost all the cases involved adenovirus 14, a serotype identified more than 50 years ago but rarely detected since then and never in association with outbreaks.
Dr. Lewis and colleagues at the state health department reviewed analyzed specimens dating back to 1993 and found a few cases of adenoviral disease almost every year. Beginning in 2005 adenovirus 14 was the predominant serotype identified.
Comparison of 31 patients with adenovirus 14 disease and 14 patients with other adenovirus serotypes showed that adenovirus 14 tended to infect older men (median age 52.9), and almost half the cases involved smokers. Most strikingly, adenovirus 14 was associated with a hospitalization odds ratio of 15.9 compared with other adenovirus serotypes.
The most common clinical features leading to diagnosis of adenovirus 14 disease were fever (~80%), tachypnea (75% to 80%), hypoxia (~50%), and hypotension (40% to 45%). Chest x-rays were abnormal in 23 of 24 cases. Radiographic progression was common, including single-lobe disease to multilobe in 55% of cases and lobar disease to adult respiratory distress syndrome in 45%.
All patients received broad-spectrum antibiotics. Dr. Lewis said 22 of the 31 patients with adenovirus 14 disease were hospitalized, and 16 required ICU care. Median hospital and ICU length of stay was seven days. Of the patients treated in the ICU, 13 required ventilatory support and eight had severe hypotension requiring pressor drugs. Seven patients (22%) died.
Risk factors for death or ICU care were a creatinine level greater than 1.2 mg/dL, lymphocyte count less than 100 µL, and coinfection with another pathogen. None of those factors remained statistically significant in multivariate analysis.
"This came out of nowhere in 2005 in Oregon," said Dr. Lewis. Acknowledging that almost all of the cases have involved severe illness, he agreed that the scope of the problem could be much larger and involve a broader spectrum of illness severity.
I don't know about where you live, but here in Tallahassee, we have been hit with what appears to be an epidemic of pneumonia. I personally know several people who were diagnosed with "viral pneumonia." I had a terrible cold with severe chest congestion last month that nearly sent me to the hospital and recently floored my wife as well. I am betting that where you live, you too had an experience similar to mine.
SARS was/is/will be again, a coronavirus that normally is associated with the common cold. Only in 2003, in China, this cold virus jumped species and mutated into a respiratory illness with a 10% case fatality rate. So what is to stop a mutant strain of adenovirus from growing in the jungles and rain forests of Central America and emerge on the world scene, as SARS emerged from the jungles of Southeast Asia?
Nothing. And, of course, there is no vaccine for adenovirus.
The CDC definition of adenovirus can be found at this link: http://www.cdc.gov/Ncidod/dvrd/revb/respiratory/eadfeat.htm . It says, in part:
Adenoviruses most commonly cause respiratory illness; however, depending on the infecting serotype, they may also cause various other illnesses, such as gastroenteritis, conjunctivitis, cystitis, and rash illness. Symptoms of respiratory illness caused by adenovirus infection range from the common cold syndrome to pneumonia, croup, and bronchitis. Patients with compromised immune systems are especially susceptible to severe complications of adenovirus infection. Acute respiratory disease (ARD), first recognized among military recruits during World War II, can be caused by adenovirus infections during conditions of crowding and stress. (bold mine).
Reader Comments (1)
is conjunctivitis realy cause by adenoviruses. I got suprised. Thanks for info.