Wednesday, September 17, 2014

`Mystery Diseases’ In Hard To Verify Places




# 9085


A day scarcely goes by where the dedicated volunteers at FluTrackers, the Flu Wiki, or ProMed Mail don’t come across a media report of an `unidentified disease’ raging in some remote part of the world.  Often initial news reports are either highly speculative, or just downright wrong, and so I approach these stories with caution.


Fever is, by the way, the most common presenting symptom of an infection, and FUO (Fever of Undetermined Origin) is one of the most common admitting diagnoses on the planet.  But, like with most UFO reports and magic tricks, given a little time and some investigative skills, FUOs are usually found to be far less mysterious than originally thought.


India seems particularly fond of reporting outbreaks of `mystery fevers’ -  to the point where it has almost become an easily recognizable meme in the papers.


These usually turn out to be due to vector borne diseases like Dengue, Chikungunya, or Japanese Encephalitis - but sometimes the diagnosis remains elusive for years thanks to a massive population, a plethora of pathogens, and relatively few testing facilities (see Times of India Mysterious fever grips part of Kolkata).


Whenever public health is being hyper vigilant over an emerging threat – like MERSEbola, or Bird Flu – local media often latch onto that as a likely explanation – mostly, I suppose, because it sells papers -  even though the facts may not fit the narrative. 


We saw that earlier this summer with reports of `hemorrhagic’ fever in Sudan, which in turn gave rise to some highly speculative news reports  like  - Sudan: Port Sudan Hit by Unknown Virus, MERS Suspected - despite the fact that little about the reports matched MERS. 


After a week of confusion, we finally saw Dengue, Not MERS, In Red Sea State (Sudan).


We aren’t exactly immune in this country, as some headline writers are still referring to the EV-D68 virus as a `mystery virus’, despite it having been identified by the CDC two weeks ago.


Last December, we saw a bit of a media furor over reports of four deaths from an as-yet unidentified flu-like illness in Texas (see Texas: MCHD On Deaths From Unidentified `Flu-like’ Illness) which turned out to be seasonal H1N1 flu, and in May of 2013 Dothan, Alabama was hit by an unusual cluster of severe respiratory illness which after three days was resolved (see Dothan Respiratory Illness – No Unusual Pathogens).


Of course, sometimes reports of a strange disease outbreak really does indicate something new, or at least, unusual. 


That’s how the Ebola outbreak in West Africa (in a region not  previously known for having Ebola) was initially described; as `a mysterious hemorrhagic fever’.  


And it was just two years ago when the first MERS case was described in a letter to ProMed Mail by Professor Zaki (see VDU Blog Happy 2nd birthday Middle East respiratory syndrome coronavirus (MERS-CoV)...).


The list goes on. 


The first inkling of the  2009 H1N1 pandemic began with an uptick of  unidentified respiratory cases in Mexico.  H5N1 bird flu outbreaks in Indonesia, Turkey, and Egypt were often first identified by the media as a `mystery outbreak’, as were the first reports of three unknown pneumonia cases in China that turned out to be H7N9.


While most of these reports turn out to be due to something relatively common, every once in awhile . . . .


Which bring us to reports out of Venezuela over the past six days suggesting some sort of `hemorrhagic fever’ that has claimed the lives 8 or more people (reports varied).  Not surprisingly, local media and social media outlets immediately evoked the `E’ word, but there is little reason to suspect Ebola in South America.

Flutrackers has diligently collected and translated scores of newspaper articles over the past week in their thread Venezuela - Deaths in Maracay Central Hospital and elsewhere by unidentified illness(es?) - one case meningococcal disease confirmed.  


Between blanket government denials and attempts to censor reports, a lack of testing, and a tendency for the media to try to both sensationalize the story and lump all `suspicious’ deaths into the same outbreak, we are left with more confusion than clarity.  This `mystery outbreak’ could turn out to be anything, or perhaps nothing.


The usual suspects that immediately come to mind in this part of the world include Hemorrhagic Dengue, Venezuelan hemorrhagic fever (Guanarito virus (GTOV)), one of the South American Hantaviruses, or perhaps Leptospirosis

Other etiological agents, including toxins, or something `new’ cannot be excluded.


The newshounds at FluTrackers will continue to watch developments in Venezuela, and I’ll report any significant announcements.   Whatever is behind this outbreak, I suspect will eventually be known.


Those interested in either this outbreak – or in the process used by these dedicated newshounds – will want to check in on the FT thread for more frequent updates.

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