Published Date: 2005-05-07 23:50:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2005 (17)
Archive Number: 20050507.1261
CHOLERA, DIARRHEA & DYSENTERY UPDATE 2005 (17)
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A ProMED-mail post
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International Society for Infectious Diseases
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In these updates:
Asia
[1] Diarrhea, fatal - India (Tamil Nadu)
[2] Diarrhea - Malaysia (Sabah)
[3] Gastroenteritis - Kyrgyzstan (Batken)
[4] Cholera - Worldwide - WHO WER Notifications
*****
[1] Diarrhea, fatal - India (Tamil Nadu)
Date: Wed, 4 May 2005
From: ProMED-mail <promed@promedmail.org>
Source: New India Press [edited]
<http://www.newindpress.com/NewsItems.asp?ID=IET20050503122238&Page=T&Title=
Southern+News+-+Tamil+Nadu&Topic=0>
4 die of diarrhea in Krishnagiri
---------------------------------
4 persons, including 2 women, died of diarrhea in the last 5 days in
villages falling under Veppanapalli panchayat union in Krishnagiri district.
Several others suffering from acute diarrhea were admitted to the primary
health centers and Government Hospital.
Official sources said that the stool samples of the patients were sent to
Indian Vector Control (IVC), a Central Government Research Center in Hosur,
for cholera testing.
The residents of the villages, including Neralagiri, Seeranapalli,
Vallinagar, Kottaiyoor and Nachikuppan, had developed diarrhea in the last
15 days. It was said that the Village Health Nurses in the area had failed
to report to the district administration about the sudden outbreak of
diarrhea.
2 days ago, more than 25 persons at Vallinagar village in Veppanapalli
panchayat union were treated by the health department officials for
diarrhea. On Mon, 2 May 2005, over 15 persons were admitted to the primary
health center in Nachikuppam and some to Krishnagiri Government Hospital,
while several others took treatment in private hospitals.
[Fatal diarrheal illnesses in adults may well be cholera - Mod. LL]
*****
[2] Diarrhea - Malaysia (Sabah)
Date: Wed, 4 May 2005
From: ProMED-mail <promed@promedmail.org>
Source: The Star [edited]
http://thestar.com.my/news/story.asp?
file=/2005/5/4/nation/10853959&sec=nation>
Probe into outbreak of diarrhea
-------------------------------
Health officials hope to narrow down the possible causes of 150 children in
Sabah's Kota Belud district being struck with diarrhea and fever over the
past week.
Sabah Health Department deputy director Dr Mohd Yusof Ibrahim said although
health officials initially ruled out cholera and typhoid, they would carry
out tests on all samples for the diseases to cover all bases. The affected
children were from 20 villages in the district.
On Sat, 30 Apr 2005, 40 were admitted to the Kota Belud Hospital for
diarrhea while the others received outpatient treatment. As of yesterday,
18 were still inpatients. On Mon, 2 Apr 2005, 6 other people were given
outpatient treatment.
Health officers have collected more samples of piped water from the affected
areas. "We are looking at the quality of the water supply. We hope to know
more about the situation in a few days," Dr Mohd Yusof said on 3 May 2005.
Herbert Timbun Lagadan, the state assemblyman for Kedamaian, where most of
the cases were reported, said a possible factor was low chlorine content in
the water.
*****
[3] Gastroenteritis - Kyrgyzstan (Batken)
Date: Tue, 3 May 2005
From: ProMED-mail <promed@promedmail.org>
Source: Batken epidemiological surveillance center, [translated by NR]
[edited]
A serious outbreak of poisoning in Batken
-----------------------------------------
According to the chief of the Batken sanitary epidemiological surveillance
center, 353 people required medical assistance due to poisoning during the
period of 29 Apr to 2 May 2005. 30 of them were hospitalized. All of them
had similar symptoms of nausea, diarrhea, vomiting. Microbiological analysis
of patients' feces showed that they all had _Proteus vulgaris_.
The cause of outbreak was meat that was eaten during funeral ceremony and
later the remainder was distributed among the guests. The meat was put in
plastic bags and stored without refrigeration for 10-20 hours.
[see Moderator discussion below - Mod. LL]
*****
[4] Cholera - Worldwide - WHO WER Notifications
Date: Fri, 6 May 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Epidemiological Record, 6 May 2005 2005 [edited]
<http://www.who.int/wer/2005/wer8018/en>
Notifications of cholera received from 30 Apr to 5 May 2005
---------------------------------------------------
country / dates / cases / deaths
Africa
Cameroon / 14 Mar-24 Apr 2005 / 42 / 3
Equatorial Guinea / 4-24 Apr 2005 / 66/ -
Senegal / 18-24 Apr 2005 / 752 / 13
United Republic of Tanzania / 21 Feb-24 Apr 2005 / 932 /28
--
ProMED-mail
<promed@promedmail.org>
[The third posting above related to a cluster of gastroenteritis in
Kyrgyzstan ascribes the illness to be related to the isolation of _Proteus
vulgaris_ in the stool of the affected individuals. The role of
this organism, either _P. mirabilis_ or _P. vulgaris_, as a cause of
gastrointestinal illness is, for the most part, unclear. Although the
medical literature from 4-5 decades ago attributed some gastrointestinal
illness to _Proteus sp._, more modern clinical reports are sparse.
In a study of diarrheal illness in Ethiopia (1), however,
enteropathogenicity using the rabbit ileal loop, the rabbit skin test and
the Y-1 adrenal cell model did report enterotoxin-producing _Proteus sp._.
Similarly, some _Proteus sp._ isolates from children in Houston, TX, and
Mexico were felt to be enterotoxigenic using the adrenal cell model (2).
More recently, Brazilian strains of enteric bacilli including _Proteus sp._
were tested for Shiga-like toxin [but] other than _E. coli_, no positive
strains were found.
In a large study comparing the bacterial flora of asymptomatic people and
diarrheal cases from Germany (4), _Proteus mirabilis_ was isolated more
frequently from the symptomatic cohort but _P. vulgaris_ was not. Another
European study from the same author, however, did not find the association
between _P. mirabilis_ and diarrhea (5).
_Proteus sp._ are, however, common causes of urinary tract infections. One
relatively specific hint of their presence in the urine infection is the
urinanalysis pH. Proteus produces a urease which will act on urea to
produce ammonium ions. This makes the pH prominently alkaline, pH
8-8.5, instead of the usual neutral pH (7.0). - Mod. LL]
1. Wadstrom W, Aust-Kettis A, Habte D, et al: Enterotoxin-producing
bacteria and parasites in stools of Ethiopian children with diarrhoeal
disease. Arch Dis Child 1976; 51:865-70.
2. Pickering LK, Evans Jr DJ, Munoz O, et al: Prospective study of
enteropathogens in children with diarrhea in Houston and Mexico. J Pediatr.
1978; 93: 383-88.
3. Giraldi R, Guth BE, Trabulsi LR: Production of Shiga-like toxin among
_Escherichia coli_ strains and other bacteria isolated from diarrhea in Sao
Paulo, Brazil. J Clin Microbiol. 1990; 28: 1460-62.
4. Muller HE: Occurrence and pathogenic role of Morganella-Proteus-
Providencia group bacteria on human feces. J Clin Microbiol. 1986; 23: 404-
405.
5. Muller HE: The role of Protea in diarrhea. Zentralbl Bakteriol. 1989;
272:30-35.
See Also
Cholera, diarrhea & dysentery update 2005 (16) 20050502.1216Cholera, diarrhea & dysentery update 2005 (15) 20050422.1123
Cholera, diarrhea & dysentery update 2005 (14) 20050415.1083
Cholera, diarrhea & dysentery update 2005 (13) 20050408.1013
Cholera, diarrhea & dysentery update 2005 (12) 20050404.0966
Cholera, diarrhea & dysentery update 2005 (11) 20050328.0899
Cholera, diarrhea & dysentery update 2005 (10) 20050318.0789
Cholera, diarrhea & dysentery update 2005 (09) 20050311.0714
Cholera, diarrhea & dysentery update 2005 (08) 20050304.0662
Cholera, diarrhea & dysentery update 2005 (07) 20050225.0598
Cholera, diarrhea & dysentery update 2005 (06) 20050215.0512
Cholera, diarrhea & dysentery update 2005 (05) 20050204.0384
Cholera, diarrhea & dysentery update 2005 (04) 20050128.0308
Cholera, diarrhea & dysentery update 2005 (03) 20050123.0240
Cholera, diarrhea & dysentery update 2005 (02) 20050119.0174
Cholera, diarrhea & dysentery update 2005 (01) 20050108.0060
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