Ebola In VZ Kills 8 In
| Hello, Jeff - I have to wonder if Ebola has made its way
to Latin American. I have suspected that we would see cases along
Coastal South America, specifically Brazil and Venezuela. If this
is yet, another virus, and NOT Ebola, will we see this one popping up along
the US border and into the Mid West as we have with Whooping Cough, Scabies,
TB, Chagas, and Enterovirus 68 to name a few.
We really need to get volunteers into Africa to stop the Ebola outbreak. The CDC is offering a course in Alabama for health care workers who would then deploy to W Africa.
One thing that I feel we could do is send over some Navy hospital ships to care for Ebola victims. Specifically, we could save many children and young mothers if we could treat them quickly and in better surroundings. That would free up beds in the Ebola field hospitals for men and adolescent young men.
Sending troops and military police, as I fear Obama will do, does little to help the patients with the virus or prevent those who do not have Ebola from contracting it.
There is a state of the art ship that can house 5,000+
patients. It has three operating rooms. It was scheduled to go to W Africa when it was cancelled as Ebola was too risky for the crew whose accommodations were deemed too close to the Ebola patients. So, now the ship sits in water off the Canary Islands.
If it cannot be made to house isolation patients *which I think it can house isolation patients with a bit of refitting) then send the ship and allow it to treat Malaria, HIV etc patients. This would free up field hospitals to treat more Ebola patients.
In any event, forget the soldiers who have military experience, police with police experience and get help, medical and veterinary research people into ships and send them S T A T! If not, will will be fighting Ebola on our own turf.
UNDIAGNOSED HEMORRHAGIC FEVER - VENEZUELA: (ARAGUA) FATAL, REQUEST FOR INFORMATION
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 11 Sep 2014
Source: La Patilla [in Spanish, trans. Mod.MPP, edited]
El Carabobeno [a news media source] reports that on Thu 11 Sep 2014, Angel Sarmiento, President of the Physician's College of the state of Aragua, noted that in the last 72 hours 8 people have died in the Maracay Central Hospital from an unidentified illness.
At the press conference, the doctor stated that they had treated 4 adults and 4 children, who presented with generalized malaise, fever, spots on the body, which then became blisters and internal hemorrhages.
Sarmiento said in a Union Radio program that specimens have already been sent to the National Institute of Health in Caracas in order to determine the disease that is responsible for the death[s]. He denied that the Maracay Central Hospital was quarantined.
He rejected information that has been circulating on social networks about a possible isolation of the health center for this reason. He said that early in the morning there was an incident on the 1st floor, caused by the same patients, but it was not a formal decision taken by the health authorities.
He said that in the next few hours the Aragua Health Corporation (Corposalud) will issue a statement to confirm the 8 deaths and it is expected to provide more details of what happened and the investigations being carried out to clarify the causes of the deaths.
Earlier, the President of the Aragua Physician's College [CMA], Angel Sarmiento, gave a press conference in order to [report] the sudden deaths of children, adults, and adolescents that were admitted to the Maracay Central Hospital in the last few hours, according to El Aragueno [a media source].
Sarmiento said that, so far, the diagnosis of patients who have died is unknown. He explained that this presented as an "acute hemorrhagic fever syndrome" that resulted in an abrupt death within a period not exceeding 72 hours."
He reported that the patients reached the Maracay hospital with symptoms, coming from other municipalities and remote sectors.
"So far, there have been 8 deaths in adults and children," he said.
The president of the CMA said they were waiting for results from the National Institute of Health on [the specimens from] these cases in order to determine the diagnosis of this "rare" disease with unfamiliar details. He called for calm among the public at large, and, for the present time, he recommended that people not visit the Maracay Central Hospital because, in his opinion, "even visitors may be affected."
[Byline: Ysa Rodriguez]
Date: Thu 11 Sep 2014
Source: El Universal [in Spanish, trans. Mod.MPP, edited]
The Physician's College of Aragua declared an alarm following the deaths of 8 people during the last several hours in the Central Hospital of Maracay (HCM), due to a virus or bacterium, which has not as yet been identified.
The information was confirmed on Thursday [11 Sep 2014] by the President of the College, Angel Sarmiento, who explained that the 8 victims, 4 adults and an equal number of children, presented the same symptoms, leading to death within 72 hours. He indicated that they presented with a clinical picture of fever up to 40 deg C [104 deg F], generalized malaise, and skin eruptions that progressed into blisters. Furthermore, they presented with sepsis, leading to multiorgan failure, disseminated intravascular coagulation, bleeding from the ears and nose, and leading to generalized collapse [and death].
Sarmiento indicated that there have not been prior cases admitted [to the hospital] with the same symptoms, mentioning that the clinical histories of each patient were compatible with an acute hemorrhagic fever.
The diagnoses of Ebola virus disease or meningococcemia, as were rumored on social media networks, were discarded. He also mentioned that chikungunya or dengue fever were discarded as well. He indicated that they are waiting for results from specimens taken from the bodies of the victims to determine whether they are dealing with a viral or bacterial disease.
The representative of the [Physician's College] mentioned that 2 of the patients came from the state of Carabobo, and the rest came from the municipalities of Francisco Linares Alcantara (La Morita), Mario Briceno Iragorry (El Limon), and Santos Michelena (Las Tejerias) in the state of Aragua. He also mentioned that there was not any contamination in the HCM.
The route of transmission of this disease is not known.
[Byline: Erika Guillen]
Date: Thu 11 Sep 2014
Source: El Universal [edited]
Tareck El Aissami, ruling party Governor of Aragua state, north Venezuela, dismissed reports about an "alleged (deadly) bacteria at Maracay Central Hospital." Via his twitter account, the governor said the reports spread via digital networks about the alleged bacteria were not true at all.
El Aissami did not confirm, though, the death of 8 people at the central hospital, as reported by the president of the Aragua State Medical Association, Angel Sarmiento.
"It is no surprise that the president of the Aragua State Medical Association, a member of Accion Democratica (Democratic Action) party, has been heading this campaign of rumors and terrorism," the governor twitted.
[So, following the 3rd media report () above, the question that comes to mind is whether this is all hype for political motivation or is there something real going on, with initial denial? Clearly there is a need for more information to clarify the actual situation.
Speculating on the possible etiology of the described deaths, from the brief description of the clinical presentation, it appears as though there may be cases of either a viral hemorrhagic fever (VHF) or some as yet unidentified bacterial infection leading to sepsis with disseminated intravascular coagulation that have occurred in individuals from the states of Aragua and Carabobo.
From the 2nd media report above (in  above), 2 of the cases have come from the State of Carabobo, and the other 6 cases were from 3 different municipalities in the state of Aragua: Francisco Linares Alcantara (La Morita), Mario Briceno Iragorry (El Limon), and Santos Michelena (Las Tejerias). It is unclear whether these are 8 unrelated cases that were transferred to the State (Aragua) capital city Maracay for treatment or whether one or more of these cases were related in some way so that there was similar exposure to the as yet unidentified pathogen responsible for their illness. Clearly, more information from knowledgeable sources is needed and would be greatly appreciated.
The media reports mention the onset of panic in the general public, as rumors surrounding these cases are spreading exponentially through social media platforms. Given the media attention to the ongoing Ebola outbreaks in West Africa and the Democratic Republic of the Congo, this is not surprising.
While the media report mentions that the President of the Aragua College of Physicians stated that Ebola virus disease, meningococcemia, dengue, and chikungunya virus infections have been ruled out as possible diagnoses, specific information on the laboratory tests performed has not been provided.
Venezuelan hemorrhagic fever, caused by Guanarito virus, a member of the Tacaribe complex of the _Arenaviridae_ family, is an RNA virus that was first identified in 1989. Implicated rodents for transmission include _Sigmodon alstoni_, the cotton rat (see image at http://www.planet-mammiferes.org/Photos/Rongeur/Myomo/Sigmod/SigmAls2.gif) and _Zygodontomys brevicauda_, the cane mouse (see image at http://animaldiversity.ummz.umich.edu/site/resources/Heideman_Paul/Zygod_brevicauda/medium.jpg). Other viruses previously described in Venezuela include another arenavirus identified in the same geographical area, Pirital virus (not felt to be pathogenic in humans), and the Cano Delgadito virus (not previously identified as a human pathogen), a hantavirus from the _Bunyaviridae_ family.
Borrowing from Mod.TY's comment in ProMED post Venezuelan hemorrhagic fever - Venezuela: susp, RFI 20140317.2336965, "Guanarito virus is an arenavirus related to 3 other South American arenaviruses that are of significant public health concern: Machupo virus (Bolivian hemorrhagic fever), Junin virus (Argentinian hemorrhagic fever), and Sabia virus (Brazilian hemorrhagic fever)."
A description of clinical presentations of Venezuelan hemorrhagic fever includes "fever, toxicity, headache, arthralgia, diarrhoea, conjunctivitis, pharyngitis, leucopenia, thrombocytopenia, and haemorrhagic manifestations. Other features include facial oedema, cervical lymphadenopathy, nausea/vomiting, cough, chest or abdominal pain, and convulsions" (see ref. 3). Cases of Venezuelan hemorrhagic fever have occurred in the states of Portuguesa and Barinas in the central western part of Venezuela but have not been reported outside of this area (see prior ProMED-mail posts referenced below). The media descriptions of the clinical course mentions a rash progressing to blisters -- not something usually seen with Venezuelan hemorrhagic fever, and makes one wonder if there might be one of the pox virus diseases.
We await more information from knowledgeable sources in the region.
A HealthMap/ProMED-mail map of Venezuela can be accessed at http://healthmap.org/promed/p/7377. For a map of Venezuela showing the states, see http://www.ephotopix.com/image/south_america/venezuela_political_map.gif. The state of Aragua is located to the west of Caracas and borders with the state of Carabobo to its immediate west. They are both in the north, northeast of Portuguesa and Barinas, where the cases of Venezuelan hemorrhagic fever have been identified.
1. de Manzione N, Salas RA, Paredes H, et al: Venezuelan hemorrhagic fever: clinical and epidemiological studies of 165 cases. Clin Infect Dis. 1998; 26(2): 308-13 (full article available at http://cid.oxfordjournals.org/content/26/2/308.long).
2. Salas RA, de Manzione N, Tesh R: [Venezuelan hemorrhagic fever: eight years of observation]. Acta Cient Venez. 1998; 49 Suppl 1: 46-51 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10030054).
3. Salas R, de Manzione N, Tesh RB, et al: Venezuelan haemorrhagic fever. Lancet. 1991; 338(8774): 1033-6 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1681354).
4. Tesh RB, Wilson ML, Salas R, et al: Field studies on the epidemiology of Venezuelan hemorrhagic fever: implication of the cotton rat _Sigmodon alstoni_ as the probable rodent reservoir. Am J Trop Med Hyg. 1993; 49(2): 227-35 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8395143).
5. Vainrub B, Salas R: Latin American hemorrhagic fever. Infect Dis Clin North Am. 1994; 8(1): 47-59 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8021448).
6. Tesh RB, Jahrling PB, Salas R, Shope RE: Description of Guanarito virus (_Arenaviridae_: Arenavirus), the etiologic agent of Venezuelan hemorrhagic fever. Am J Trop Med Hyg. 1994; 50(4): 452-9 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8166352).
7. Fulhorst CE, Bowen MD, Salas RA, et al: Isolation and characterization of Pirital virus, a newly discovered South American arenavirus. Am J Trop Med Hyg. 1997; 56(5): 548-53 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9180606).
8. Fulhorst CF, Monroe MC, Salas RA, et al: Isolation, characterization and geographic distribution of Cano Delgadito virus, a newly discovered South American hantavirus (family _Bunyaviridae_). Virus Res. 1997; 51(2): 159-71 (abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9498614).
9. Weaver SC, Salas RA, de Manzione N, et al: Guanarito virus (_Arenaviridae_) isolates from endemic and outlying localities in Venezuela: sequence comparisons among and within strains isolated from Venezuelan hemorrhagic fever patients and rodents. Virology. 2000; 266(1): 189-95 (full article available at http://tinyurl.com/ldynkcg).
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