Published Date: 2008-10-02 15:07:15
Subject: PRO/MBDS> Acute resp distress syndrome - Thailand (02): leptospirosis conf.
Archive Number: 20081002.3110
ACUTE RESPIRATORY DISTRESS SYNDROME - THAILAND (02): LEPTOSPIROSIS CONFIRMED
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 2 Oct 2008 03:40:34 -0400 (EDT)
From: Kumnuan Ungchusak <firstname.lastname@example.org>
[Re: PRO/MBDS> Acute resp. distress syndrome - Thailand: AI susp.
We got the respiratory specimens from both the father and the son and
tested them twice by PCR [polymerase chain reaction] for influenza
virus, both at the regional and the central levels. All tests are
negative for influenza A and B. The veterinary team from the
Department of Livestock took 12 cloacal swabs from the ducks and all
tested negative for avian influenza virus by PCR.
Our clinical expert has reviewed the chart and visited the boy. The
clinical picture matches leptospirosis because both cases (the father
and the son) have renal involvement and the father died from
septicemic shock not respiratory failure [as reported in the media].
The rapid test for _Leptospira_ is also positive for the boy. In
conclusion, we can exclude these 2 cases as not being infected with
the H5N1 avian influenza virus.
Bureau of Epidemiology and International Health Regulation (IHR) Focal Point
Department of Diseases Control
Ministry of Public Health
Tivanonda Road, Nonthaburi 11000
[PRO/MBDS would like to thank Dr Kumnuan Ungchusak for his rapid
follow-up to the PRO/MBDS posting "Acute resp. distress syndrome -
Thailand: AI susp." (archive number 20081001.3093). As can be seen
from the information provided above, the final diagnosis for the
human cases is leptospirosis.
The rapid coordinated response on the parts of the Ministry of Public
Health and Department of Livestock are clear demonstrations of the
importance of a coordinated effort between human and animal health
sectors -- one of the key strategies of the MBDS initiative.
Leptospirosis is a zoonotic disease caused by a spirochete and can be
transmitted through contact with water or soil contaminated with
urine from infected animals, predominantly rodents. Transmission of
the disease is potentiated during the rainy season (due to large
areas with standing water contaminated by infected animal urine).
"Symptoms include fever, headache, chills, muscle aches, vomiting,
jaundice, anemia, and sometimes a rash. The incubation period usually
is 7 days, with a range of 2-29 days. If not treated, the patient
could develop kidney damage, meningitis, liver failure, and
respiratory distress. In rare cases, death occurs...... Clinical
course is highly variable. The serious icteric form (Weil's disease)
is not common, but hemorrhage, hepatomegaly, pulmonary hemorrhage,
ARDS (acute respiratory distress syndrome), and jaundice are among
the severe features. Case fatality rate is 1 to 5 percent." (from the
CDC [US Centers for Disease Control and Prevention] technical
information sheet available at
Note that respiratory distress can be seen in severe cases,
consistent with the clinical picture of the fatal case (the father)
in this present report.
According to the Thai Ministry of Public Health surveillance data,
during the period 1 Jan 2008 through 1 Oct 2008, there have been a
total of 1918 cases and 43 deaths (with a case fatality rate of 2.2
percent) attributable to leptospirosis reported countrywide (see
<http://18.104.22.168/surdata/disease.php?ds=43> for data for 2008 and
follow link to 2551).
In the earlier PRO/MBDS posting on leptospirosis in Thailand, in the
period 1 Jan 2008 through 1 Jul 2008 there had been a total of 715
cases and 16 deaths (with a case fatality rate of 2.2 percent)
attributable to leptospirosis reported countrywide (see Leptospirosis
- Thailand 20080708.2065), representing a 2.68-fold increase in
reported cases and in reported deaths. Of note, Phichit province (the
location of residence of these cases) is in Zone 3 of the Northern
Region in Thailand. According to the data available on the Ministry
of Public Health website thus far this year (2008) there have been 3
cases of leptospirosis reported from Phichit province and 21 cases
reported from Zone 3 of the Northern Region.
At present, we do not have a final diagnosis for the reported deaths
in the ducks owned by the family of these cases other than ruling out
avian influenza virus circulation in surviving ducks through cloacal
swabs that tested negative for avian influenza by PCR testing.
In 2007, there was a PRO/MBDS report of a 26-year-old man from Hong
Kong who had a recent travel history to Thailand and who was
diagnosed as having leptospirosis upon return to Hong Kong (see
PRO/MBDS posting Leptospirosis - China (Hong Kong) ex Thailand: RFI
For more detailed background information on leptospirosis in Thailand
with references, see PRO/MBDS posting Leptospirosis - Thailand
20080708.2065 available at the PRO/MBDS website (go to
<http://www.promedmail.org> and click on the MBDS logo on the right
side of the page).
For a map of Thailand showing the geographic regions, see
For the interactive HealthMap/ProMED map with links to other recent
ProMED-mail postings in Thailand and neighboring countries, see
<http://healthmap.org/promed?v=15.1,101,5>. - Mod.MPP]