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Mysterious Deaths Of Young
Western Tourists In Thailand
Was It A Mystery Disease? Foul Play?

Patricia A. Doyle DVM, PhD
Hello Jeff - Thus far, there have been SIX strange deaths of tourists staying at the SAME hotel in Thailand The tourists have been young women mostly of European and North American ethnicity. The exception was the strange death of a retired couple.
I started to research deaths of European and American tourists in Thailand and stumbled upon a case in 2009. Two young women, one American and one Norwegian died the same weekend while they were staying at the same resort in Thailand.
Both cases are mentioned below. I do, however, suspect that the cause of death in both the 2009 and the recent case in 2011 were both foul play.
Right now, other people looking into the cases and reporting on the latest case feel as I do, however, and don't want to offend the investigators in Thailand who are pursuing this as a 'disease' investigation and are not mentioning any suspicion of foul play.  (Bad for business...)
Source - Phuketwan Tourism News (edited)
Young French Tourist's Death No. 6 in Chiang Mai
By Alan Morison
The revelation of a 6th death and the results of an investigation by Thailand's Department of Disease Control has shed new light on the series of mysterious fatalities in Chiang Mai.
The 6th death involved a Frenchwoman -- one of 2 who fell sick, a media release from the department says. It highlighted the exceptional nature of a complaint that appears to have struck down 6 young women aged 23-33 between 9 Jan 2011 and 4 Feb 2011, killing 3 of them.
These 3 deaths -- the unnamed Frenchwoman, a New Zealand woman also 23, and an American, aged 33 -- have been linked by the media to 3 other deaths, 2 British pensioners, a man and a woman and a 47-year-old Thai guide.
The joint investigation by the department with the Chiang Mai Provincial Health Office found 4 clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another 2 patients with mild symptoms.
"These 6 patients were among 3 separate groups of tourists visiting Chiang Mai, Thailand, between 9 Jan 2011 and 4 Feb 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3)." 5 of the 6 women "became ill while visiting Chiang Mai and one developed symptoms 3 days before arriving there." However, an extensive epidemiological investigation "has not revealed any common exposures across the 3 groups."
The media release says autopsies on 2 of the dead patients (American and French) were done by forensic medical experts from Chiang Mai University. The joint investigation team found 4 clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another 2 patients with mild symptoms. "The autopsies found nothing abnormal except for inflammation of the heart muscle," it says.
"The Department of Disease Control has shared this information with the World Health Organisation and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation focal points of France and the European Community." The report carefully distinguishes between the cases involving the 6 young women and the other cases.
"In a separate episode, since 3 Feb 2011, there were 3 other deaths in the same hotel where the 3 New Zealanders stayed," it says. "This included an elderly British couple and a 47-year-old Thai woman. As these 3 deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the 2 elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death."
One recent report on the Chiang Mai cases also claimed there had been 50 "unexplained deaths" among expats on Phuket in an 8-month period last year [2010]. Germany's honorary consul for Phuket, Dirk Naumann, said today: "That's absolute rubbish. If it was true, all the honorary consuls would have been up in arms about it."
Neither of the online sites that carried the misleading article -- Asia Sentinel or Irrawaddy -- has responded to requests that they correct the falsehood.
Two young women -- a 22-year-old Norwegian and a 27-year-old American -- died within hours of falling sick at a guest house on the holiday island of Phi Phi, off Phuket, in May 2009 in a baffling case that failed to produce a cause for their deaths.
-- Communicated by ProMED-mail  promded@promedmail.org
Chiang Mai is located in the mountainous north of Thailand and is a favourite destination for tourists, attracting backpackers as well as a more upmarket clientele of all ages. The hotel involved has been rated a 2/3 star establishment. The HealthMap/ProMED-mail interactive map of Thailand can be accessed at: <http://healthmap.org/r/00cC>.
Myocarditis can be caused by a variety of infections (mainly viral), and by immune diseases (such as systemic lupus, etc.), pregnancy, and other ill-defined conditions. The commonest cause of myocarditis is viral infection of heart muscle resulting in local inflammation. Enteroviruses are the agents most commonly associated with myocarditis. After the initial infection subsides, the body's immune system may continue to inflict inflammatory damage to the heart muscle prolonging the myocarditis. This circumstance may make it difficult to attribute the condition to any particular virus. Enteroviral infections are prevalent where living conditions and hygiene are inadequate.
While it is feasible to attribute the the Chiang Mai incident to viral infection, no positive evidence has been advanced to confirm this possibility and other circumstances, other than fortuitous coincidence, should be considered - Mod.CP
How suspicious that so many deaths are linked to the same hotel and the same city. It would seem unlikely that food poisoning is the source of the situation. We are not told if the victim that died in the city had any association with the hotel. However, I might be willing to consider an herbal preparation or seasoning that is popular in this area and is not prepared properly, or has been mistakenly identified and is a toxic plant.
There are vegetation and herbs that may cause cardiac issues, but for surgery to correct it seems a bit odd. An additional oddity is that this myocarditis has come on quickly enough to kill these people. This had to be something very potent. Things like _Nerium oleander_ come to mind, and may possibly be used in food preparation, such as a fuel source for cooking, or a stick to place the food on. A pancake type of food on a stick is popular in Thailand. I am not suggesting this is the cause but rather speculating as these cases seem to have baffled the investigators.
The strong connection between the hotel and the majority of the victims may also make me think of perhaps a chemical in the air handling system, or on the beds perhaps.
It is odd that most of the victims are women. While women may be vulnerable in many ways, as are the aged couple, this is still rather unsettling. - Mod.TG
see also:Undiagnosed deaths - Thailand: (CM) RFI 20110312.0802
I found a similar case in 2009  
(CNN) -- The family of a Seattle, Washington, woman is searching for answers after her mysterious death at a resort hotel in Thailand. Jill St. Onge, 27, died last week on a Thai island while on a trip with her fiancé.
Jill St. Onge, 27, died Saturday while at a hotel on Thailand's Phi Phi island. She became ill and died before her fiancé, Ryan Kells, could get her to a hospital, according to CNN affiliate KOMO-TV in Seattle.
St. Onge's relatives have said they have had a hard time getting answers about her death.
"It's really bad. It's about the worst thing any of us have ever gone through," Robert St. Onge, Jill's brother, told KOMO. Video Watch the fiancé talk about the sudden illness »
Another tourist, a 22-year-old Norwegian woman, died at the same resort the same weekend, according to the U.S. Embassy in Thailand.
Norwegian media reported that the woman could have been a victim of food poisoning. Papers in Thailand have questioned whether both women were poisoned.
The U.S. Embassy in Thailand has been working with the St. Onge family on a daily basis.
"We are in contact with police who are investigating this," said embassy spokesman Michael Turner. "The police know we are concerned about this, but as with any investigation, it could take some time."
The results of an autopsy performed overseas are expected in several months, KOMO reported.
Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies Please visit my "Emerging Diseases" message board at:http://www.emergingdisease.org/phpbb/index.php Also my new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa Go with God and in Good Health
Benjamin Franklin said, "They that  can give up essential liberty to obtain a little temporary safety deserve  neither liberty nor safety." 
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