Infectious disease with life threatening complications and at least 3 deaths reported

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Was the patient tested for kala azar?

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

There was no evidence of significant renal and hepatic complications.
said Dr V W Jagath Vasanthathilaka.
I suppose the patient wasn't " yellow", and that ALAT or ASAT was OK

it was a "peripheric " pancytopenia ( not in bone marrow ).. ( I don't know the right english term , escuse me.. )

a lot of mosquitoes ( flooding )

it's not leptospirosis
it's not dengue or chikungunya ( or false negatives)


did you take special protection measures like gloves or mask ?



http://www.un.org/Depts/Cartographic...e/srilanka.pdf

The area which we have described is "Kekirawa" according to the http://www.un.org/Depts/Cartographic...e/srilanka.pdf pdf document.

According to the Sri Lanka Map - Sri Lanka Satellite Image http://geology.com/world/sri-lanka-s...te-image.shtml this particular area is situated in the north central province. North of Matale , west of Polonnaruwa, towards east of Maho and south of Anuradhapura exactly around the Kalawewa ( Ancient man made reservoir) from where the Kalaoya waterway ( River) begins. Three deaths were reported from this area and the patient who recovered after fever and pancytopenia was also from the same area in the north central province. We can see the blue color wedge shaped massive reservoir on the map which was filled to the full capacity during the rainy season in early January 2008 , and there was flooding.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Was the patient tested for kala azar?

This patient was not tested for Kalar azar; this possibly is also always there, with several man made reservoirs located around this area. Kalar azar was rare in Sri Lanka, however there have been cases reported recently and there are patients presenting with skin manifestations presenting occasionally to the dermatology units. We do not routinely test for Kalar azar as it was rare, however we can always further investigate for this possibility if the patient develops additional clinical clues. As we considered earlier the differential diagnosis is wide and open.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

The area which we have described is "Kekirawa" according to the http://www.un.org/Depts/Cartographic...e/srilanka.pdf pdf document.

According to the Sri Lanka Map - Sri Lanka Satellite Image http://geology.com/world/sri-lanka-s...te-image.shtml this particular area is situated in the north central province. North of Matale , west of Polonnaruwa, towards east of Maho and south of Anuradhapura exactly around the Kalawewa ( Ancient man made reservoir) from where the Kalaoya waterway ( River) begins. Three deaths were reported from this area and the patient who recovered after fever and pancytopenia was also from the same area in the north central province. We can see the blue color wedge shaped massive reservoir on the map which was filled to the full capacity during the rainy season in early January 2008 , and there was flooding.

We still do not know whether we are dealing with the same disease where there were three or four deaths in the same area and the patient with pacytopenia wether it is an unrelated different kind of a presentation coincidentally found from the same area. We keep all those options and possibilities open until we find more information.

[Vibrant62]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

To eliminate the possibility of an unusual flu presentation, such as H5N1, has a rapid test for flu A been conducted? The possibility could perhaps be excluded by running such a test on this and other patients from their blood samples? It is unlikely, but perhaps is a good one to cross off the list, especially bearing in mind the high levels of infections in birds that have been cropping up in many countries, although the risk and likelihood may be very low indeed.

Thank you for keeping us informed.

[Anne]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

I m trying to find the location with google map.
It seems to me there is a lot of green at satellite view.
Is there a lot of forest in this region? ( mosquitoes, bats ? )

you said this illness is periodical ? ( 10 years ago.. )

how do your patient feels : after effects?

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Today, Monday EST, I have checked some of the newspapers in the area and did not find any new fever reports.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

[/IMG][/IMG]

I m trying to find the location with google map.
It seems to me there is a lot of green at satellite view.
Is there a lot of forest in this region? ( mosquitoes, bats ? )

you said this illness is periodical ? ( 10 years ago.. )

how do your patient feels : after effects?

This area is green, trees found among paddy fields. Mostly villages and small towns found along the main roads.

http://img206.imageshack.us/my.php?image=1kekirawadsc00149yt2.jpg

Kekirawa on 15th January 2008 sunny after heavy rain one week ago


This image shows the reservoir Kalawewa ( Wedge shaped area on the google earth) on 15th January 2008 filled to the maximum capacity http://img179.imageshack.us/my.php?i...sc00143oq9.jpg

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Today, Monday EST, I have checked some of the newspapers in the area and did not find any new fever reports.

Thank you very much indeed regarding your update. We did not come across any new patients. Rain has stopped. It is now sunny around the north central province.

http://profile.imageshack.us/user/drjagathv/images/detail/#179/7kalawewadsc00129zy1.jpg

http://img179.imageshack.us/my.php?image=8kalawewadsc00143oq9.jpg

That was the view while traveling over bund of the Kalawewa reservoir in the North central province on 15th January 2008.

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

Thank you Dr. Vasanthathilaka. We are monitoring. I will perform another news scan today.


S.

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

I am not seeing any new reports of the fever.


S.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

I am not seeing any new reports of the fever.


S.

Patient presented to us with fever and pancytopenia has now completely recovered from this illness except for an on and off headache, blood counts have returned to normal. Public health authorities in the affected areas have taken strict preventive measures. Public have been advised not to swim in the rivers in the affected areas. There is no flooding for the last two weeks, and it is sunny. Those patients who died of this febrile illness were otherwise young and healthy individuals, they also had fever weakness and joint pains. They were all residents living near the waterways, no more deaths reported thereafter.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

I am not seeing any new reports of the fever.


S.

We visited the area affected and awaiting any new information. Please keep us informed on any new information. We informed the our regular follow up patients to seek immediate medical treatment if the develop any febrile illnesses.
Dr V W Jagath Vasanthathilaka.

[drjagathv]

Re: Infectious disease with life threatening complications and at least 3 deaths repo

We visited the area affected and awaiting any new information. Please keep us informed on any new information. We informed the our regular follow up patients to seek immediate medical treatment if the develop any febrile illnesses.
Dr V W Jagath Vasanthathilaka.

Three weeks after initial reports of fever and 3 deaths, we do not hear about any new case reports of unusual febrile illnesses from that region or elsewhere.

Dr. V W Jagath Vasanthathilaka.

[sharon sanders]

Re: Infectious disease with life threatening complications and at least 3 deaths reported

Thank you Dr. Vasanthathilaka for all of your work.