ProMED-mail |

Published Date: 2005-07-25 23:50:00
Subject: PRO/EDR> Undiagnosed deaths - China (Sichuan) (03)
Archive Number: 20050725.2153

UNDIAGNOSED DEATHS - CHINA (SICHUAN) (03)
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Sponsored in part by Elsevier, publisher of
Principles and Practice of Infectious Diseases Online, 6th edition
<http://tinyurl.com/7sfzw>
Date: Mon 25 Jul 2005
From: ProMED-mail <promed@promedmail.org>
Source: China View, Xinhua News Agency, Mon 25 Jul 2005 [edited]
<http://news.xinhuanet.com/english/2005-07/25/content_3262105.htm>

China: Strange Disease Kills 17 in Sichuan Province
--------------------------------------------------
Investigations are under way after a mysterious disease killed 17 farm
workers and left at least 12 in a critical condition in hospital in
Southwest China's Sichuan Province.
Zeng Huajin, a senior official with the provincial health department, said
the deadly illness was "probably" caused by _Streptococcus suis_, a
bacterium usually spread among pigs. "I can assure you that the disease is
absolutely not SARS (severe acute respiratory syndrome), anthrax or avian
influenza," the official said last night. "If it is caused by
_Streptococcus suis_, we still need further research," he added.
An initial 20 farm workers who handled sick or dead pigs and sheep in 12
towns and 15 villages in Jianyang city and Ziyang city's Yanjiang district
suffered from high fever, nausea, vomiting and haemorrhaging. But more
cases were reported as health workers began to search villages for the
sick. "By noon on Saturday [23 Jul 2005], 58 people suspected of having the
disease had been reported in Ziyang and (neighbouring) Neijiang," according
to a statement last night from the provincial health department. "2 people
(of those 58) have been released from hospital while 27 of them are
recovering," the statement said.
The statement said that the patients were from 49 villages of 23 townships
in Sichuan and they were not related to each other. Zeng said the disease
could not spread among humans, and normally only those with a weak immune
system became ill. The Ministry of Health and Ministry of Agriculture last
week sent a special team to Sichuan to assist in the investigation,
treatment and control of the outbreak. The 2 departments were not available
for comment yesterday. "This is a good job of disease surveillance, and
shows China has vastly improved its system since the SARS period in 2003,"
World Health Organization spokesman Bob Dietz was quoted by Bloomberg as
saying.
A physician with Ziyang No 1 People's Hospital said yesterday that people
could quickly become ill and doctors were busy carrying out emergency
treatment. All patients were reportedly being treated at 3 hospitals in
Ziyang. Yesterday, Hong Kong put out an alert relating to the disease.
Frozen pork from Sichuan is safe to eat, the Secretary for Health, Welfare
and Food York Chow told the Hong Kong public. He confirmed that no live
pigs are imported from the province into the territory. He said frozen pork
imports come via designated companies with permits from the Hong Kong
health authorities.
--
ProMED-mail
<promed@promedmail.org>
[This outbreak appears to be more extensive than originally reported, with
another 58 people under observation with similar symptoms. Our previous
suggestion that the common factors of the sporadic nature of the cases, the
limitation to farmers tending pigs and sheep, and the late development of
haemorrhagic symptoms might suggest involvement of Crimean-Congo
haemorrhagic fever (CCHF) virus probably no longer applies. This suggestion
is not compatible with the reported sickness and death of the pigs and
sheep in the care of the affected farmers. CCHF virus infection does not
normally produce symptoms in domestic animals. The disease bears no
resemblance to avian influenza and a bacterial infection is now the locally
preferred diagnosis. - Mod.CP]
[_Streptoccossus suis_ is a commensal organism in pigs that can cause
invasive disease. The Gram-positive coccus can also cause disease in
man. Usually individuals at risk are those with exposure to pigs or pork
(pig farmers, slaughterhouse personnel, butchers). The most common
manifestation of human _S. suis_ infection is meningitis, and although _S.
suis_ infection is relatively rare in the West, it has been reported to be
the 2nd most common cause of pyogenic meningitis in Hong Kong
(1). Although most reports are from Asia, the infection in humans has been
reported in many countries in Europe as well. Early hearing loss in these
cases is a common feature (2). Additionally the infection may be more
virulent and recurrent in those who are asplenic or functionally
hyposplenic (3). Primary bacteremia, septic arthritis, pneumonia, and
endocarditis have also been reported (4).
The infection is generally sporadic in man, and since overt meningitis is
not described in the current cases, it appears that _S. suis_ is less
likely to be the etiology of this outbreak in China.
1. Gui ACF, Ng KC, Tong PY, et al: Bacterial meningitis in Hong
Kong:10-years' experience. Clin Neurol Neurosurg 2005;107:366-70.
2. Donsakul DK, Dejthevaporn C, Witoonpanich R: Southeast Asian J Trop Med
Public Health 2003; 34:154-58.
3. Francois B, Gissot V, Ploy MC, Vignon P: Recurrent septic shock due to
_Streptococcus suis_. J Clin Microbiol 1998; 36:2395.
4. Kay R, Cheng AF, Tse CY: _Streptococcus suis_ infection in Hong Kong.
QJM 1995p;88:39-47.
- Mod.LL]

See Also