Published Date: 2005-03-03 23:50:00
Subject: PRO/AH/EDR> Leptospirosis, fatal - Venezuela (Carabobo): susp.
Archive Number: 20050303.0655

LEPTOSPIROSIS, FATAL - VENEZUELA (CARABOBO): SUSPECTED
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[1]
Date: Wed, 2 Mar 2005
From: ProMED-mail <promed@promedmail.org>
Source: El Universal Digital, Venezuela 1 Mar 2005 [in Spanish, translated]
[edited]
<http://buscador.eluniversal.com/2005/02/28/suc_ava_28A536755.shtml>

4 persons have died in Puerto Cabello, a city on the central [Caribbean]
coast of the state of Carabobo, from a possible outbreak of leptospirosis, a
disease transmitted through contact with the urine of infected animals,
according to ABN [Agencia Bolivariana de Noticias, or Bolivar News Agency.
Simon Bolivar (1783-1830) was a Venezuelan general who helped win
independence from Spain for Bolivia, Panama, Colombia, Ecuador, Peru, and
Venezuela].
This information was distributed by the new Director of Civil Safety
of Carabobo, Ricardo Hernandez Lanz, who traveled to that city to
assess the situation. He indicated that among the fatalities were 2
adolescents, both 14 years old, who presented with vomiting,
diarrhea, high fever, respiratory difficulty, and jaundice. He also
referred to 13 persons who presented with the same clinical history
who are currently in isolation in the Jose Francisco Molina Sierra
and Adolfo Prince Lara hospitals, the latter affiliated with the
Venezuelan Institute of Society Security (IVSS), and both located in
Puerto Cabello. For this reason, the Director has declared a state
of alert regarding the possible spread of this disease.
Hernandez pointed out that, according to medical personnel studying
these cases, the deaths had resulted from contact with infected
animals, presumably rats. He also indicated that the patients
hospitalized in Puerto Cabello have been isolated to avoid the spread
of the disease.
The official confirmed that a program of fumigation had been carried
out in the Santa Cruz and Jesus de Nazaret sectors of the city, where
the cases had come from, as well as the neighboring sectors to avoid
others being infected.
******
[2]
Date: 2 Mar 2005
From: Alfonso Rodriguez <ajrm_msds@yahoo.es>
Source: Epidemiologic Alert, Venezuelan Health Ministry, Week No.7,
13-19 Feb 2005 [in Spanish, translated] [edited]
<http://www.msds.gov.ve/msds/Boletines/Alertas/2005/Alerta07.zip>

Regional Coordination of Zoonosis of Aragua State [sic: Puerto
Cabello is in Carabobo State], report for Week 7: 15 probable cases
were reported from the following municipalities:
Federal entity / municipality / parish / total cases
Carabobo / Carlos Arvelo / Belen / 11
Carabobo / Carlos Arvelo / Guigue / 1
Carabobo / Juan Jose Mora / Moron / 1
Carabobo / Valencia / Miguel Pena / 1
Carabobo / Libertador / Independencia / 1
Total / 15
Source: Direccion de Vigilancia Epidemiologico. Coordinacion Nacional
de Zoonosis, Programa de Vigilancia de Leptospirosis [Epidemiologic
Surveillance Authority, National Coordination for Zoonoses,
Surveillance Program for Leptospirosis]
--
ProMED-mail
<promed@promedmail.org>
[Leptospirosis is a spirochetal infection that is distributed widely
throughout the world with the major risk factor being exposure to
water (as noted above) -- no matter how pristine-looking -- that has
been contaminated with infected rodent urine. Because of its varied
manifestations, particularly in clusters -- as occurred earlier in
2004 in western Kenya -- many different diseases including viral
hemorrhagic fever and hantavirus need to be considered in the
differential diagnosis.
Leptospire infection has protean manifestations. As a result, it is
frequently misdiagnosed. Approximately 15-40 percent of patients who were
exposed but did not become ill show serologic evidence of past infection.
The incubation period is usually 7-12 days, with a range of 2-20 days.
Approximately 90 percent of patients manifest a mild anicteric [without
jaundice] form of the disease, and approximately 5-10 percent have the severe
form with jaundice, otherwise known as Weil's disease. Severe disease can
also manifest with respiratory symptoms, and this has been described
associated with pulmonary hemorrhage in Argentina (1). The treatment of
choice is tetracycline.
Leptospirosis is often a 2-phase illness. During the 1st stage, which lasts
4-7 days, the patient develops a nonspecific flu-like illness of varying
severity. It is characterized by fever, chills, weakness, and myalgias,
primarily affecting the calfs, back, and abdomen. Other symptoms are sore
throat, cough, chest pain, hemoptysis [coughing up blood], rash, frontal
headache, or other symptoms of meningitis. Because of the abrupt nature of
the onset, the patient often can tell exactly when the symptoms started.
During a 1-3 day period of improvement that follows the 1st stage,
the patient may become afebrile and relatively asymptomatic. The
fever then recurs, indicating the onset of the 2nd stage. Disease
referable to specific organs is seen, including the meninges, liver,
eyes, and kidney.
Many patients experience headache that is intense and poorly controlled by
analgesics; this often heralds the onset of meningitis. In anicteric disease,
aseptic meningitis is the most important clinical syndrome, usually lasting a
few days, but occasionally for 1-2 weeks. Mortality is extremely rare in the
anicteric cases. In icteric disease, abdominal pain with diarrhea or
constipation, hepatosplenomegaly, nausea, vomiting, and anorexia also are
seen.
1. Seijo A, Coto H, San Juan J, et al: Lethal leptospiral pulmonary
hemorrhage: an emerging disease in Buenos Aires, Argentina. Emerg
Infect Dis 2002; 8:1004-1005.
<http://www.cdc.gov/ncidod/EID/vol8no8/01-0499.htm>
- Mod.LL]

See Also

Leptospirosis - Guyana (coastal)(04) 20050302.0642
Leptospirosis, fatal - Guyana (coastal) 20050204.0379
2004
----
Leptospirosis - India (South Gujarat)(02) 20040908.2509
Leptospirosis - India (South Gujarat) 20040902.2441
Leptospirosis, fatal - USA (AS) 20040820.2307
Leptospirosis, fatal - Argentina (Entre Rios) (04) 20040811.2222
Leptospirosis, fatal - Argentina (Entre Rios) 20040805.2141
Leptospirosis - Kenya (Western Districts) (04) 20040713.1879
Leptospirosis, fatal - USA (HI) 20040411.0987
.................................jt/ll/pg/jw
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