#16,980
Over the past 24 hours reports of a cluster of unidentified pneumonia cases at a hospital in northern Argentina have lit up the internet (see Argentina: MOH Briefing On Unidentified Pneumonia Outbreak In Tucumán Hospital) - a scenario not unlike what we've seen in the past with the emergence of MERS-CoV in 2012, H7N9 in 2013, and COVID in late 2019 - raising concerns that a new public health threat may be at hand.
While we don't have enough information on this Argentinian cluster to make a valid threat assessment, public health agencies around the world are taking notice.
Overnight Sharon Sanders on FluTrackers posted a link to the following statement from PAHO (Pan-American Health Organization). You can follows FluTracker's coverage of this evolving situation at this LINK.
The machine translation of the PAHO statement follows:
(translation)
Informative note: cases of pneumonia Unknown cause Tucuman Argentina
September 1, 2022
Situation Summary
On August 30, 2022, the Ministry of Health of Argentina informed the Organization Pan American Health / World Health Organization (PAHO/WHO) of the notification by the Ministry of Public Health of the province of Tucumán, on the detection of a conglomerate of 6 cases of bilateral pneumonia without etiological identification until moment 1 .
The registered cases correspond to five health workers and a patient who is hospitalized in the intensive care service of a private sanatorium in the city of San Miguel of Tucumán, which began symptoms between August 18 and 22, presenting fever, myalgia, abdominal pain and dyspnea. The six cases presented bilateral pneumonia, two of them died, three are hospitalized and one is in home isolation in stable condition. All the cases are related to the same center of health care.
The samples were analyzed in the jurisdictional laboratory for respiratory viruses, other viral, bacterial and fungal agents, all with negative results so far. A
In turn, the samples have been sent to the National Administration of Laboratories and Institutes of Health (ANLIS) “Dr. Carlos Malbrán” to expand diagnostic studies 2 , including toxicological analyses, which are in progress.
On September 1, 2022, the Ministry of Public Health of Tucumán 3 reported on the identification of 3 additional patients, all health workers, who between 20 and 23 August presented symptoms similar to the 6 previously reported cases.
To date, 9 cases related to this conglomerate have been identified, including three deaths.
Official Communication Ministry of Public Health of the Government of Tucumán. The Ministry of Public Health reported that an outbreak of bilateral pneumonia has been detected in six patients, without having been able to find s origin and etiology.
Available at: https://msptucuman.gov.ar/comunicado-oficial-18/1
Press release Ministry of Health of Argentina, ANLIS-MALBRÁN analyzes the samples of the cases of pneumonia of unknown cause in Tucumán. Available at: https://www.argentina.gob.ar/noticias/anlis-malbran-analyzes-samples-from-cases-of-pneumonia-of-unknown-cause-in-tucuman
Official Communication Ministry of Public Health of the Government of Tucumán. The Ministry of Public Health reported on the health situation of the bilateral pneumonia outbreak. Available in:
https://msptucuman.gov.ar/el-ministerio-de-salud-informo-sobre-la-situacion-sanitaria-del-brote-de-neumonia-bilateral/
Preliminary investigation indicates that the deceased patients had some type of comorbidity The contacts of the cases are under permanent follow-up and even the date of preparation of this report have not presented symptoms.
Public health response
The Argentine Ministry of Health and provincial health authorities are working on to investigate the outbreak, as well as carrying out contact tracing and actions specific controls in the health center involved.
PAHO/WHO is monitoring this event together with the health authorities from Argentina.
Pan American Health Organization • www.paho.org• © PAHO/WHO, 2022
While some sort of (possibly novel) respiratory virus would seem the most likely culprit, it isn't the only possibility.
We've seen environmental outbreaks of bacterial pneumonia - particularly from gram negative bacteria like Legionella and Elizabethkingia - produce similar clusters in health care facilities (see Illinois Dept Of Health: Elizabethkingia Cases Grow To 11).
And sometimes, we've seen outbreaks where no cause can be identified.
Even with the full firepower of the CDC's labs, the specific cause of pneumonia infections often eludes us. A 2015 study published in the NEJM (see The CDC’s EPIC CA-Pneumonia Study) followed 2500 cases over 5 years and found that in the majority (62%) of cases no definitive pathogenic agent was identified.During the summer of 2019 we followed an outbreak of respiratory illness at a Fairfax, Virginia LTCF which resulted in at least 23 hospitalizations and 3 deaths, for which no causative pathogen could be identified (see Updating Respiratory Illness In Virginia LTCF).
Specifically, they found:The most commonly detected pathogens were:
- one or more viruses in 530 (23%) cases
- bacteria in 247 (11%) cases
- bacterial and viral pathogens in 59 (3%) cases
- and a fungal or mycobacterial pathogen in 17 (1%) of cases
- Human rhinovirus (in 9% of patients)
- Influenza virus (in 6%)
- and Streptococcus pneumoniae (in 5%).
Hopefully we won't draw a blank on this cluster, but we don't always get what we want.
Whether this outbreak turns out to be the next big thing - or merely a flash in the pan - this is a reminder that new public health challenges invariably lie ahead, and may emerge at any time, and with very little warning.
Stay tuned. And since this is National Preparedness Month, stay prepared as well.
