Published Date: 2003-09-22 23:50:00
Subject: PRO/EDR> Undiagnosed deaths - India (Himachal Pradesh) (03)
Archive Number: 20030922.2385

UNDIAGNOSED DEATHS - INDIA (HIMACHAL PRADESH) (03)
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[1]
Date: 20 Sep 2003
From: ProMED-mail <promed@promedmail.org>
Source: NDTV.com [edited]
<http://www.ndtv.com/template/template.asp?template=Health&slug=NICD+probes+Himachal%92s+mysterious+fever&id=12786&callid=0&category=National>


NICD probes Himachal's mysterious fever
--------------------------------------------
A high-level team of doctors from the National Institute of
Communicable Diseases (NICD) and Institute of Virology, Pune is
visiting Himachal Pradesh to try and identify a mystery disease which
has killed 10 people and caused serious illness to at least 60 people.

The doctors are travelling to Bilaspur, Hamirpur, Kinnaur and Rohru
-- the areas which have reported this mysterious illness.

"The symptoms can't be categorised. That's why we are calling it
fever or pyrexia of an unknown region or a mysterious disease," said
Dr Avdhesh Kumar, member of the NICD team.

The disease has been recurring over the past 3 years during the
monsoon season. While several people have succumbed to this disease,
so far doctors have not been able to find a diagnosis.

Symptoms

Its symptoms include high-grade fever, acute body ache, and headache.
A patient becomes unconscious before eventually succumbing to
multiple organ failure.

More than 30 people are being treated at the Indira Gandhi Medical
College (IGMC) hospital in Shimla. Some of them are responding well
to treatment.

"She first had fever, we gave her a lot of medicines and then got her
here from Kinnaur," said Ratan Singh, a patient's father.

"She has had fever for the past 10 to 12 days. We got her here from
Hamirpur. She's not eating anything. We can't understand what has
happened," said Amar Nath, a patient's relative.

A team of medical experts has visited Himachal Pradesh each time the
state has reported this mysterious disease. But an understanding of
the root of the problem has eluded them so far.

[By: Swati Maheshwari]

--
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Fri, 19 Sep 2003 07:35:41 +0200
From: Dr. S. Berger <mberger@post.tau.ac.il>
Source: GIDEON [edited]


[In the first posting there was a brief mention that one of the local
physicians suspected typhus might be the etiology of this outbreak.
Dr. Steve Berger has submitted the following background on Typhus in
India. - Mod.MPP]


GIDEON identifies 5 rickettsial diseases in India, with notes as follows:

Spotted fever: The local infection is known as Indian tick typhus,
and caused by _Rickettsia conorii_ (strain ITT). The etiologic agent
has never been isolated from patients in India; however, a spotted
fever group rickettsia was isolated in 1950 from a brown dog tick
(_Rhipicephalus sanguineus_). Spotted fever in India differs from the
Mediterranean form in that the rash is often purpuric, and an
inoculation eschar at the bite site is rarely found. The clinical
course is mild to moderately severe. Infection was diagnosed in a
French tourist returning from India in 1999.

Epidemic typhus Cases of epidemic typhus were previously reported
from hilly areas in the northwest. In 1968, a case of typhus was
reported in a traveler who returned to England from India. The
disease has not been reported in recent years.

North Asian tick typhus, Q fever and Endemic typhus are also thought
to occur in India. Epidemics of scrub typhus were previously reported
among troops stationed in the north and east, but have not been
encountered in recent years.

--
Dr. S. Berger
<mberger@post.tau.ac.il>

[Of note is the mention that this disease has been recurring in this
region for the past 3 years, each time in the monsoon season. The
clinical description is still rather vague, but the list of
possibilities would also include leptospirosis. We await more
information from authoritative sources. - Mod.MPP]

See Also

Undiagnosed deaths - India (Himachal Pradesh): RFI 20030918.2364
Undiagnosed deaths - India (Himachal Pradesh)(02) 20030920.2381
...................mpp/pg/lm

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