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UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (07): ARENAVIRUS
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International Society for Infectious Diseases
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Date: 12 Oct 2008
Source: The Mercury [edited]
<http://www.themercury.co.za/?fSectionId=3535&fArticleId=nw20081012152218513C975048>
The mystery viral hemorrhagic fever which killed 3 people in South
Africa has been provisionally identified as an arenavirus, the
National Institute for Communicable Diseases [NICD] and the
Department of Health said on Sunday [12 Oct 2008].
"The causative agent of the disease may be a rodent-born arenavirus
related to the Lassa fever virus of West Africa," NICD's Dr Lucille
Blumberg said at the Charlotte Maxexe Johannesburg Academic Hospital.
She said tests done by the NICD and the Centers for Disease Control
[CDC] in Atlanta, USA indicated that the disease seemed to be a kind
of arenavirus. The World Health Organisation has also been providing
technical assistance.
Arenaviruses cause chronic infections in multimammatic mice, a kind
of wild mouse, which excrete the virus in their urine, which can then
contaminate human food or house dust.
Viruses similar to the Lassa fever virus have been found in rodents
in Africa, but other than in West Africa have not been found to cause
diseases in humans.
She said there was no indication arenaviruses that could cause
disease in humans were present in South African rodents.
Blumberg said further tests still needed to be done. "It needs to be
determined whether it is a previously unrecognized member of the
arenaviruses and what its distribution is," she said.
The NICD's Robert Swanepoel said there were viruses of this family in
Southern Africa but that this could be an undiscovered kind. "Not
every country has been thoroughly searched," he said. He said the
kind of rodents that carried the virus were not generally found in
urban areas. "They are out there but attracted (to human dwellings)
if there is inadequate waste disposal." Crop disposal and animal feed
also sometimes attracted them, he said. He said the kinds of viruses
could range from causing mild fevers to being lethal. There were only
3 cases to work with for the kind of arenavirus now discovered, but
"it looks like it is very lethal," he said.
Head of the NICD's Special Pathogens Unit, Dr Janusz T Paweska, said
the arenavirus diagnosis came about after a number of tests.
[Biopsies] conducted on the last 2 victims in which infected tissues,
skin, liver and muscles were tested were critically important in
making a diagnosis. A blood sample obtained in Zambia from the 1st
victim also confirmed test results.
He said doctors were now waiting for the virus to grow in cell
culture to conduct further tests to identify what strain it was.
Gauteng health MEC [Brian Hlongwa?] said the 1st victim of the virus
was [a] 36-year-old [woman], who was airlifted from Zambia to the
Morningside Medi Clinic in Sandton on [12 Sep 2008] in a critical condition.
She is known to have lived in a smallholding on the outskirts of
Lusaka where she kept 3 horses, although the exact point of
contamination has never been discovered.
She fell ill on [8 Sep 2008] and was treated in 3 different hospitals
in Lusaka. Once in South Africa, she was treated for tick bite fever
and other potential infections but died 2 days later. She was not
tested for viral hemorrhagic fever.
On [27 Sep 2008], a Zambian paramedic who accompanied her into the
country was admitted to the hospital with similar flu-like symptoms,
fever and a skin rash, and viral hemorrhagic fever was queried.
He developed diarrhea, severe headaches, nausea and vomiting, and
although he initially seemed to respond to treatment, he died on [2
Oct 2008] at the clinic.
A 3rd victim of the virus was a nurse from Morningside Medi-Clinic
who attended [the 1st case]. She became ill with fever 18 days after
[the woman from Zambia] was admitted to the hospital, and consulted a
general practitioner, receiving intravenous therapy. She was then
referred to Robinson Hospital in Randfontein and was later
transferred due to a bedding shortage to Sir Albert Clinic. There,
she was treated for a suspected case of meningitis. Her condition
deteriorated, and she died last Sunday [5 Oct 2008].
A 4th person, a [37-year-old female] contract cleaner working at
Morningside Medi-clinic, died in Charlotte Maxeke Academic hospital.
Earlier this week, the health department said her death was not
related to viral hemorrhagic fever.
On Sunday [12 Oct 2008?], Blumberg said a female nurse and a male
paramedic were currently in isolation after they were in contact with
the deceased.
The paramedic had contact with [the 1st case, the female from
Zambia], and after developing flu-like symptoms and a fever was
admitted to Flora clinic. He was subsequently transferred to
Morningside Medi-clinic and diagnosed with kidney stones. On Sunday
[12 Oct 2008], Blumberg said it was "less likely" he had the virus.
The 2nd person in isolation is a nurse who had contact with a
paramedic that died [the 2nd patient, the male paramedic that
accompanied the 1st patient to South Africa]. She has developed
symptoms similar to the 3 deceased and is receiving anti-viral
medication called ribavirin. The department of health said she was
presently stable. Blumberg said she is "highly suspect" to have
contracted the virus and could not say further how her condition was
likely to progress.
This week, 3 other people who had been hospitalized after contact
with the deceased were discharged. On Friday morning [10 Oct 2008],
the 11-year-old son of the nursing sister who died [case number 3]
and his 23-year-old nanny were discharged [presumably discharged from
quarantine].
A cleaning supervisor at Morningside Medi-Clinic who had been
admitted to the Chris Hani Baragwanath Hospital on Monday [6 Oct
2008] with symptoms of viral hemorrhagic fever was also released. On
Sunday [12 Oct 2008], Hlongwa said she was currently "well."
All 3 continued to be monitored as part of the disease surveillance
system currently tracking 151 people who had contact with the deceased.
Blumberg said arenaviruses could cause a disease which spreads from
human to human through contact fluids. In hospital settings, special
precautions were needed when nursing patients.
People in contact with those who have contracted the virus must be
monitored for 21 days following their last contact with the patient.
Their body temperature is monitored, and those who develop fever or
illness are admitted to an isolation ward in the hospital.
Blumberg said there was a drug which showed promising results in
treating patients if their illness is recognized early.
Those who have been in contact with patients but are well do not
spread infection.
On Sunday [12 Oct 2008], Gauteng health MEC Brian Hlongwa said the
diagnosis of the virus was a step forward. "We are now a step further
because we know specifically what we are dealing with." However, it
was still vital to conduct more tests to find out what kind of
arenavirus it was, he said.
Director General Thami Mseleku cautioned South Africans not to now
fear that every mouse that came their way contained the virus.
Since the virus 1st broke out, medical officials have been at pains
to emphasize that the general public is not at risk, as only people
who were in direct contact with the bodily fluids of a person who had
a confirmed case of the virus could be infected.
--
Communicated by:
HealthMap Alert via
ProMED-mail <promed@promedmail.org>
[According to the above newswire, there has been a "preliminary"
identification of an arenavirus in specimens from the initial 3
fatalities felt to be associated in this cluster. Apparently, the
virus was identified in infected tissue of the 2nd and 3rd case (the
paramedic accompanying the 1st case during the medical transfer from
Zambia to South Africa and a nursing sister who cared for the 1st
case while hospitalized in South Africa) and further identified
through testing of blood from the original case (the 36-year-old
woman from Zambia.) We await further information on this from official sources.
Former viral disease moderator Prof. Charles H. Calisher had the
following to add: "There are at least 23 recognized arenaviruses
(family _Arenaviridae_, genus _Arenavirus_). The conventional
phylogeny of these viruses distinguishes "Old World" from "New World"
arenaviruses, i.e., based on geographic distribution. As are the
hantaviruses, each arenavirus is principally associated with rodents
of a single or a very few species, thus the basis for their
geographic distributions. An unusual exception may be Tacaribe
virus, which has been isolated from bats and mosquitoes. Most New
World arenaviruses are not known to cause human illnesses but others
cause severe illnesses: Machupo virus (Bolivian hemorrhagic fever),
Junin virus (Argentine hemorrhagic fever), Guanarito virus
(Venezuelan hemorrhagic fever), Sabia virus (Brazilian hemorrhagic
fever), and Chapare virus.
Lassa virus has been shown to cause severe, often fatal, hemorrhagic
fevers in human in a wide area of West Africa. It is now recognized
that this virus causes numerous illnesses each year. It will be
enlightening when we have news of the identity of the viruses causing
these illnesses in Zambia, and now in South Africa. The
investigations are in the hands of the world's most competent people
for such studies, Dr. Robert Swanepoel of South Africa's National
Institute for Communicable Diseases and collaborating investigators
at the U.S. Centers for Disease Control and Prevention. Therefore,
definitive information regarding whether this is a hitherto
unrecognized arenavirus or a variant of a recognized arenavirus
should be forthcoming relatively soon. Meanwhile, clinical practices
to control further spread should suffice."
If the etiologic agent is in fact an arenavirus, ribavirin is
presently used for the treatment of Lassa fever. This moderator would
like to thank Prof. C.J. Peters, a leading authority on
arenaviruses, for kindly providing the references listed below on
treatment modalities used for arenavirus infection.
References.
1. Barry, M., M. Russi, L. Armstrong, D. Geller, R. Tesh, L. Dembry,
J. P. Gonzalez, A. S. Khan, and C. J. Peters. 1995. Brief report:
treatment of a laboratory-acquired Sabia virus infection.[see
comment]. New England Journal of Medicine 333:294-296.
2. Enria, D. A., A. M. Briggiler, S. Levis, D. Vallejos, J. I.
Maiztegui, and P. G. Canonico. 1987. Tolerance and antiviral effect
of ribavirin in patients with Argentine hemorrhagic fever. Antiviral
Research 7:353-359.
3. Jahrling, P. B., R. A. Hesse, G. A. Eddy, K. M. Johnson, R. T.
Callis, and E. L. Stephen. 1980. Lassa virus infection of rhesus
monkeys: pathogenesis and treatment with ribavirin. Journal of
Infectious Diseases 141:580-589.
4. Kilgore, P. E., T. G. Ksiazek, P. E. Rollin, J. N. Mills, M. R.
Villagra, M. J. Montenegro, M. A. Costales, L. C. Paredes, and C. J.
Peters. 1997. Treatment of Bolivian hemorrhagic fever with
intravenous ribavirin. Clinical Infectious Diseases 24:718-722.
5. McCormick, J. B., I. J. King, P. A. Webb, C. L. Scribner, R. B.
Craven, K. M. Johnson, L. H. Elliott, and R. Belmont-Williams. 1986.
Lassa fever. Effective therapy with ribavirin. New England Journal of
Medicine 314:20-26.
6. Peters CJ. 2002. Arenaviruses, p. 949-969. In Richman DD, Whitely
RJ, and Hayden FG (eds.), Clinical Virology. ASM Press, Washington, DC.
7. Peters CJ, Zaki SR, and Rollin PE. 1997. Viral hemorrhagic fevers,
p. 10.l-10.26. In Mandell GL and Fekety R (eds.), Atlas of Infectious
Diseases, Vol. 8. Current Medicine, Philadelphia.
- Mod.MPP]
[see also:
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Human lymphocytic choriomeningitis virus - USA (03) 20080726.2276
Human lymphocytic choriomeningitis virus - USA (02) 20080516.1635
Human lymphocytic choriomeningitis virus - USA: organ donation 20080412.1339
Lassa fever - Nigeria (02) 20080611.1847
Lassa fever - Nigeria: (Ebonyi) 20080323.1100
Arenavirus hemorrhagic fever - Bolivia: (Chapare), new arenavirus 20080418.1387
2007
----
Arenavirus, organ transplants - Australia (VIC)(02) 20070430.1402
Arenavirus, organ transplants - Australia (VIC) 20070423.1325
Bolivian hemorrhagic fever - Bolivia (Beni)(02) 20070315.0914
2003
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Arenaviruses and rodent taxonomy (02) 20030412.0891
Arenaviruses and rodent taxonomy 20030411.0879
Lassa fever - Sierra Leone 20030409.0863
Lassa fever, imported - UK ex Sierra Leone 20030210.0360
2002
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Venezuelan hemorrhagic fever - Venezuela (02) 20020204.3479
Venezuelan hemorrhagic fever - Venezuela 20020203.3467
2001
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Argentinean hem. fever - Argentina (Buenos Aires Prov.) 20010404.0675
2000
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Arenavirus infection, human USA (CA): Confirmed (02) 20000813.1344
Arenavirus infections, human - USA (CA): Confirmed 20000804.1301
Arenavirus infection, human - USA (Calif.): comment (02) 20000708.1137
Arenavirus infection, human - USA (Calif.): comment 20000704.1110
Arenavirus infection, human - USA (California) 20000703.1104
Lassa virus, seroprevalence 20000119.0080
1996
----
List of recognized arenaviruses 19961218.2106]
...............................................mpp/msp/mpp/dk
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