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Go Back   FluTrackers > South America > Seasonal Flu 2009 - 2013 1/2 including H1N1 pandemic 2009 > Brazil

Brazil Announcements, strategies & resources for dealing with a pandemic

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  #1  
Old December 4th, 2012, 04:48 AM
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Default Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

02/12/2012

Respiratory syndrome patients are transferred from Bethlehem to Curuçá

From the newsroom
Para News Agency


The State Department of Public Health (Sespa) decided to transfer to Bethlehem five patients with clinical gentler, who were admitted to the Hospital Municipal Curuçá with symptoms of acute respiratory syndrome because as yet undefined.

The aim is to ensure better care of the sick, whose cases are still being investigated by the Epidemiological Monitoring of Sespa in conjunction with the 3rd Regional Center for Health in Castlebay, the Municipal Health Curuçá, Central Laboratory of the State (Lacen), Centre Skill Scientific Renato Chaves (CPC) and Instituto Evandro Chagas.

Patients transferred to the capital will be admitted to the Unit Diagnosis of Meningitis (UDM), the University Hospital João de Barros Barreto, under monitoring of infectious disease. In addition to these five people, 14 more showed symptoms of the disease since the beginning of the outbreak in Curuçá Municipal Hospital, where a 17-year-old died in the ICU of the Holy House, on the evening of Saturday, 01.

The case of the young man is being investigated because she was a resident of Curuçá and press a technique Nursing Municipal Hospital, which is also showing symptoms of the disease. She was pregnant and lost her baby after being infected. Although the body was released for burial and taken to Curuçá, Team Sespa contacted the family and asked permission for an autopsy, which will take place at the Center for Scientific Skills in Bethlehem

The initial suspicion was that the patients had been victims of radioactive contamination and then by chemical product used in radiographic revelation, which was dismissed on the basis of the same symptoms - fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate) and hemorrhagic manifestations in the digestive system, among others. Now the Sespa works with the chances of infection by viruses, bacteria and fungus.

To discover the causative agent of the disease samples were collected nasal and pharyngeal patients, as well as blood to a series of laboratory tests that are underway in Lacen and Evandro Chagas Institute, including, blood culture and research of various viruses, H1N1 and as Hantavirus. And even without the test results, patients were treated with Ciprofloxacin Tamiflu, not showing, but no improvement.

The Lacen also collected samples of the water supply of the City Hospital Curuçá because it is suspected that the causative agent is present in the medium. According to the director of the Health Surveillance Sespa, Rosian Noble, plus research and medical care to patients, it was necessary to provide assistance to families and professionals supposedly exposed, as well as disinfect the Municipal Hospital to eliminate possible sources of infection and meet Curuçá with the municipality of medicines, supplies and personal protective equipment (PPE).

She said she is also being developed to guide the work of population Curuçá Hospital professionals and families about preventive measures to avoid the emergence of new cases pending laboratory results and the identification of more specific measures for disease prevention. "

Governo do Para'
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Old December 4th, 2012, 10:33 AM
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Default Re: Brazil: unknown respiratory disease

thanks to Mike Coston

Sai result today on infection in hospital

Monday, 03/12/2012, 1:47 a.m.

The State Department of Health (SESPA) has no information about what the real focus of the contamination in Unit Joint Health Dr. Henrique Alves de Christo, located in the municipality of Curuçá, northeastern state. The complaint made by the hospital staff said that about 10 employees were contaminated by alleged leakage of a chemical used to make dental x-ray. Some employees are hospitalized in Curuçá and others were taken to Bethlehem for treatment.

Since last week the SESPA became aware of the case and is investigating the complaint on two lines of research. One is that the symptoms reported by employees can be caused by bacteria or a respiratory virus.

Laboratory technicians Central State (Lacen) and Epidemiological Surveillance investigating the case. The result of tests performed by teams due out today (Monday).

(Continue . . . )
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  #3  
Old December 4th, 2012, 11:16 AM
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Default Re: Brazil: unknown respiratory disease

Has not been discovered because of contamination
Tuesday, 04/12/2012, 10:07:33 - Updated 04/12/2012, 10:07:33


It may take another week for it to be released the final report on the contamination of patients and staff of the Municipal Hospital Curuçá - Mixed Health Unit Dr. Henrique Alves de Christo. The estimate is the Directorate of Environmental Monitoring, the State Department of Health (Sespa), who requested the analysis of biological materials, patients, and chemical unit.
Until yesterday afternoon, the Instituto Evandro Chagas (IEC) had not completed the tests performed in patients.

Among the 19 people suspected of contamination, five were transferred to the University Hospital João de Barros Barreto (HUJBB) and died on Saturday, 1 , ICU, Santa Casa. It was a young pregnant woman, aged 17, who went by the hospital. The suspicion is that it was the first fatality of the contamination. Those in HUJBB showed a small improvement in the clinical picture. "The prognosis is good of them. Some symptoms improved. The fever passed and also the lack of air. We are now taking care of these patients hydration and applying medications that can be used to directly act on the symptoms, "said the hospital's director Barros Barreto, Eduardo Leitão, They had high fever, shortness of breath, oliguria (reduced urine volume) , hypotension (low blood pressure), hypoglycemia, bradycardia (slow heart rate) and hemorrhagic manifestations. The other patients remain in Castlebay. Some remain in the hospital for Curuçá.

Samples of nasal secretions were collected and the pharynx so that, by means of laboratory tests, are discovered causative agent of the problem. The Central Laboratory (Lacen) and IEC also collected blood from patients. The water consumed in the hospital was also subjected to analysis. According to the technical advisor for Health Surveillance and Environmental Sespa, Amiraldo Pinheiro, ruled out the possibility that the Municipal Hospital Curuçá be closed until it is clear the case. "First it is expensive to close or prohibit a public hospital and secondly because the contamination occurred between 23 and 25 November. Since then, no new cases were reported, "he said.

's body patient who died of suspected contamination, will undergo an autopsy by the Center for Scientific Skills Renato Chaves. Amiraldo Pinheiro reported that the teenager was a resident of Curuçá and passed the hospital. She was a cousin of one of the techniques in nursing who is hospitalized with suspected contamination. advice of the Instituto Evandro Chagas reported that tests the patients were not completed and when ready will be delivered to patients and their families. But the Director of Barros Barreto expects to receive diagnoses today.

PATIENTS Press one of the patients infected in Curuçá, Viviane Araujo, says the family is distressed. After duty as a technique in nursing at the hospital, on the last day 27, Wanna Cardoso began to feel ill and in the second, 29, with the aggravation of the framework, had to be hospitalized in Castlebay. The family fears the delay in diagnosis. "She is evil. There are people worse. It's been over a week and nobody even knows what it is. It's strange all this because everyone needs to be isolated and are now being spread. We understand that this is a serious case and therefore should be treated in Bethlehem because that's where there are more resources ", says Viviane.,"

No joke what's happening in Curuç. My cousin got sick and has no doctor to attend. To this day no one knows the level of contamination of the hospital. Until masks are required, we who are buying. We need an immediate response, "complains Viviane.
According to the secretary of the municipal health Curuçá, Rui Carvalho, despite the diagnosis still undefined, the people must be quiet. He also denied any negligence in assisting contaminated. "Right now, where no one knows for sure the origin of the contamination, we can not say much because everything is speculation. We are in contact with the families and with the population in order to reassure them. It is not time to despair. We are awaiting the results of laboratory tests performed for an accurate diagnosis, but people are being treated and monitored properly, "said the secretary. Two patients remain hospitalized in Castlebay and four in Curuçá. According to the secretary: "These are patients who are stable and awaiting the release of the State of beds to be transferred to Bethlehem As a preventive measure, the hospital is only Curuçá with contaminated patients.http://www.diarioonline.com.br/notic...taminacao.html
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  #4  
Old December 4th, 2012, 11:17 AM
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Default Re: Brazil: unknown respiratory disease

Curuçá

The five patients have stable, according to hospital director

The s five women who are sick due to the use of a chemical used as a fixative for dental x-rays at the Hospital Municipal de Christo Henrique Alves in Curuçá, and who exhibited more severe disease,
length of hospital stay following João de Barros Barreto (HJUBB) given application made ​​by the holder of the State Department of Health (Sespa), Helio Franco.
The picture of them is stable and there was considerable improvement in the early hours of yesterday after symptomatic medication. "Today (yesterday), most of them have symptoms such as low fever and breathing difficulties, but all are lucid and interact seamlessly with the medical staff. Can say that compared to the picture they had when they arrived, there was considerable improvement in all symptoms, "said the director of HUJBB, Eduardo Leitão.

The patients are in isolation in the Diagnostic Unit in meningitis, however, according to the director, it does not mean a confirmation of high contagiousness of disease. "The hospital wards are full at the moment, but we set out to fulfill the request of Sespa. Such was the way found to accommodate them," he argued.

Some of the 20 patients who had symptoms were in Bethlehem, the Instituto Evandro Chagas, for collection of biological material and exams more specific, seeking to identify the causes of the disease. The result should be published by the institute this week.




To view the full article subscribe to The Digital Liberal.http://www.orm.com.br/projetos/olibe...&codigo=620891
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Old December 4th, 2012, 11:48 AM
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Default Re: Brazil: unknown respiratory disease

Published Date: 2012-12-04 11:18:09
Subject: PRO/AH/EDR> Undiagnosed respiratory disease - Brazil: (PA) RFI
Archive Number: 20121204.1436678
UNDIAGNOSED RESPIRATORY DISEASE - BRAZIL: (PARA) REQUEST FOR INFORMATION
************************************************** **********************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sun 2 Dec 2012

Source: Para Government press release [in Portuguese, trans. Mod.MPP, edited]

http://www.pa.gov.br/noticia_interna.asp?id_ver=113000





Patients with respiratory syndrome are transferred from Curuca to Belem


----------------------------------------------------------------------


The State Department of Public Health (Sespa) decided to transfer 5 patients in serious clinical condition from Curuca Municipal Hospital to Belem, with symptoms of an acute respiratory syndrome with as yet undiagnosed etiology. The purpose of the transfer is to assure better care of the patients, cases which are still under investigation by the Sespa Epidemiologic Surveillance unit in conjunction with the 3rd Regional Center for Health in Castanhal, the Curuca Municipal Health Secretariat, the State Central Laboratory (Lacen), the Renato Chaves Center of Scientific Expertise (CPC), and the Evandro Chagas Institute.



The patients that were transferred to the capital [Belem is the capital of Para State] will be admitted to the Meningitis Diagnostic Unit (UDM), of the Joao de Barros Barreto University Hospital, under the care [monitoring] of the Infectious Disease physicians. In addition to these 5 people, another 14 [individuals] showed symptoms of the disease since the beginning of the outbreak in the Municipal Hospital of Curuca, where a 17 year old female died in the ICU of Santa Casa, on the evening of Sat 1 Dec 2012.



The case of the young woman [the 17 year old] is being investigated because she was a resident of Curuca and a cousin of a nursing technician in the Municipal Hospital, who also presented with symptoms of this disease. The young woman was pregnant and lost the baby after being infected. Although the body was released for burial and taken to Curuca, the Sespa team contacted the family and asked permission for an autopsy, which will be performed at the Center for Scientific Expertise in Belem.



The initial suspicion was that the patients had been victims of radioactive contamination and then by a chemical product used in developing the radiographs. [This hypothesis] was discarded as a function of the presenting symptoms -- low fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate), and hemorrhagic manifestations in the digestive system, among others. The working hypothesis of Sespa is now a viral, bacterial, or fungal infection.



To discover the causative agent of the disease nasopharyngeal secretions of the patients were collected, as well as blood for a series of laboratory tests that are underway in Lacen [State Laboratory] and the Evandro Chagas Institute, including, blood cultures and studies for various viruses, including H1N1 and hantavirus. The patients were [empirically] treated with ciprofloxacin and Tamiflu even in the absence of test results, but they did not show any improvement.



The State Laboratory also collected samples of the water supply of Curuca City Hospital because of a suspicion that the causative agent might me found there. According to the director of the Sespa Health Surveillance Unit, Rosiana Nobre, in addition to the investigation and medical attention of the patients, it was necessary to provide assistance to the families and professionals supposedly exposed [to the source of the infection], as well as to disinfect the Municipal Hospital in order to eliminate the possible sources of infection and provide the Municipal Hospital of Curuca with medicines, supplies, and personal protective equipment (PPE).



Nobre also said they were developing an orientation guide for the Curuca population, hospital workers, and family members on preventive measures to avoid the emergence of new cases pending laboratory results and the identification of more specific measures for disease prevention.



[Byline: Roberta Vilanova, Sespa]



--

Communicated by:

ProMED-mail



[An initial reaction one has upon reading the introductory paragraphs describing the outbreak of an acute severe respiratory illness associated with reduced urinary output was to wonder if this might be another new location for a nosocomial outbreak of the novel coronavirus described in the Eastern Mediterranean countries of Saudi Arabia, Jordan, and Qatar. As one reads more of the official announcement, this seems to be less and less a possible explanation for this outbreak.



A curious symptom described in the clinical presentations above is the relative bradycardia. Usually when there is respiratory distress (due to hypoxia -- low blood oxygen concentrations) or when there is a fever, it is often accompanied by a tachycardia (fast heart beat). Diseases that are known to present with a relative bradycardia (slow heart beat in the face of other symptoms) include typhoid fever, legionnaires' disease, psittacosis, typhus, leptospirosis, malaria, babesiosis, dengue fever, and viral hemorrhagic fevers (see refs 1,2,3 below). With respect to the presentation of hypoglycemia, Mod. ML mentioned that hyperglycemia is the most common blood glucose abnormality seen early in the course of bacterial sepsis. Profound hypoglycemia may occur late in the course of sepsis. Hypoglycemia with cardiovascular collapse is seen in patients with adrenal insufficiency.



In another newswire, there is mention there had been 19 cases with respiratory symptoms reported from the Hospital in Curuca during the period 23-24 Nov 2012. Further investigation revealed a predominance of hypoglycemia, bradycardia, and gastrointestinal hemorrhagic symptoms (see http://g1.globo.com/pa/para/noticia/...ara-belem.html in Portuguese).



When one reads the paragraphs towards the end of the press release discussing the concerns that there was exposure to the etiologic agent through a water source of the hospital, this moderator wondered about legionellosis as one of the diseases under suspicion.



There is clearly much room for speculation, with many questions -- what is the apparent transmission? Is a common source exposure suspected? (while the newswire mentions that 19 cases were reported during a 24-48 hour period, it doesn't mention if that reflected the dates of onset of the illnesses, but does seem to suggest there may have been a common source exposure, as did the initial working hypothesis of a possible radiation exposure). What is the suspected incubation period? Is there evidence for person-to-person transmission? What does the epidemic curve look like? (number of cases by date of onset of illness). What is the distribution of the symptom complex (what is the frequency of the symptoms in the affected group of individuals)?



More information on the results of the investigations to date as well as laboratory results when available would be greatly appreciated.



For a map of the state of Para in Brazil, see http://www.v-brazil.com/graphics/para.gif. Belem is to the northeast of the state, with Castanhal to the northeast of Belem.

For a map of Brazil showing the location of Curuca, see http://www.maplandia.com/brazil/para/curuca/. It is further northeast of both Castanhal and Belem.

For the HealthMap/ProMED-mail interactive map of Brazil see http://healthmap.org/r/4oYc.
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  #6  
Old December 4th, 2012, 12:10 PM
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Default Re: Brazil: unknown respiratory disease

Hypotension is among ARS symptoms.

See this, for example:

http://journals.lww.com/smajournalon...nt_and.13.aspx

Southern Medical Journal:
June 2010 - Volume 103 - Issue 6 - pp 541-546
doi: 10.1097/SMJ.0b013e3181ddd571
CME Topics, Questions, Submission Forms


Acute Radiation Syndrome: Assessment and Management

Donnelly, Elizabeth H. CHP, ME; Nemhauser, Jeffrey B. MD; Smith, James M. PhD; Kazzi, Ziad N. MD; Farfán, Eduardo B. PhD; Chang, Arthur S. MD; Naeem, Syed F. MS

Continued Medical Education



Abstract


Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time to onset of ARS is dependent on the dose received, but even at the lowest doses capable of causing illness, this will occur within a matter of hours to days. This article describes the clinical manifestations of ARS, provides guidelines for assessing its severity, and makes recommendations for managing ARS victims.


© 2010 Southern Medical Association


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Old December 4th, 2012, 08:19 PM
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Default Re: Brazil: unknown respiratory disease

Sespa disclose within 15 days the results of tests done on patients Curuçá
04/12/2012 at 18:53

Bernardo Cardoso (c) told reporters that tests ruled out contamination by influenza viruses, including influenza A (H1N1)

The State Department of Public Health (Sespa) continues to investigate the cause of the disease that affects 19 people, residents of the city of Curuçá in northeastern Pará, and stipulated a deadline of 15 days to disseminate the results of all tests that are being performed by Instituto Evandro Chagas (IEC) and the Central Laboratory of the State (Lacen). In an interview on the afternoon of Tuesday (4), the director of the Department of Endemic Disease Control, Bernardo Cardoso, said that the tests were negative for common viruses like Influenza, including Influenza A (H1N1). However, several tests are still being conducted by the IEC and Lacen.

The main symptoms of the patients are fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate) and hemorrhagic manifestations in the digestive system. Therefore, samples were taken from nasal and pharyngeal secretions of patients as well as blood for a series of laboratory tests such as blood culture and research of several viruses.

Bernardo Cardoso said the Sespa currently works with the following assumptions: poisoning and contamination by bacteria, viruses and fungus. For investigation of possible poisoning, the Department will work with the Toxicology Laboratory of the Federal University of Pará (UFPA), which examine the spilled accidentally in Curuçá Municipal Hospital, originally named as causing the problem.

The director emphasized that the state government, through Sespa, intensified work to discover the cause of the disease, "it remains unclear to doctors, specialists and researchers."

The director of Lacen, Licinius Lira, explained that laboratory investigations require time, because you have to wait for the possible cause of the disease to proliferate in the laboratory and can be identified. The Lacen also is analyzing samples of water that supplies the Hospital Curuçá.

The director of the Health Surveillance Sespa, Nobre Guimarães Rosa, said at the time, 14 patients remain hospitalized, including five in the University Hospital João de Barros Barreto, a Hospital in Port-day, two in the Women's Health Hospital, and six in Curuçá . She also said that the 3rd Regional Health Center is providing Sespa beds in Castlebay (municipality northeast region) to receive patients from Curuçá to the local hospital can be completely disinfected.

As Nobre Guimarães Rosa, technical areas of Epidemiology and Health Surveillance continue working in the municipality, to reassure the population.http://www.agenciapara.com.br/noticia.asp?id_ver=113178
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Old December 4th, 2012, 08:25 PM
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Default Re: Brazil: unknown respiratory disease

Patients in Curuçá be transferred to Castlebay
Updated 04/12/2012 20h19

Municipal Hospital Curuçá will undergo disinfection after death.
Causes of the disease is remaining unknown.


Six employees of the Municipal Hospital Curuçá who are hospitalized in the city will be transferred on Wednesday (5) to Castlebay, northeast of the state. They are hospitalized since last Nov. 23, after they began to exhibit symptoms such as fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate) and hemorrhagic manifestations in the digestive system.
According to the State Department of Health (Sespa), the transfer will occur so that the hospital Curuçá be disinfected. Still no confirmation on the exact disease that affects 19 employees. A 17 year old died in the ICU of Santa House on the evening of Saturday (01). The results of tests performed on patients must leave in 15 days.

Only test results for common viruses like Influenza, including Influenza A (H1N1), was released. The analysis was negative.

Samples were collected nasal and pharyngeal patients, as well as blood to a series of laboratory tests such as blood culture and research of various viruses.
According to director of the Department of Endemic Disease Control, Bernardo Cardoso, is likely to be patients with poisoning and contamination by bacteria, viruses and fungus. For investigation of possible intoxication, Toxicology Laboratory, Federal University of Pará (UFPA) examine spilled accidentally in Curuçá Municipal Hospital, originally named as causing the problem.

The cases are being followed up by the Epidemiological Monitoring of Sespa in conjunction with the 3rd Regional Center for Health in Castlebay, the Municipal Health Curuçá, Central Laboratory of the State (Lacen), Centre for Skills Scientific Renato Chaves (CPC) and Instituto Evandro Chagas.
Last Sunday (2), five other patients who have symptoms more delicate were transferred to Bethlehem Patients are admitted to the unit of Meningitis Diagnosis (UDM), the University Hospital João de Barros Barreto, under monitoring of infectious disease.
Understand the case
Between 23 and 24 November, 19 people were diagnosed with respiratory syndrome in Curuçá Municipal Hospital. According to Sespa at first was suspected contamination by radioactive material.

As the evolution of the process of investigation, however, the main suspicion is that employees are with an infection caused by viruses, bacteria or fungus.
The investigations and assistance to patients and families is being coordinated by Sespa (Central and Regional Level) with the participation of the Municipal Health Department, Instituto Evandro Chagas and Scientific Skills Center Renato Chaves.http://g1.globo.com/pa/para/noticia/...castanhal.html
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Old December 5th, 2012, 07:47 AM
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Default Re: Brazil: unknown respiratory disease - tests negative for influenza

Contamination is not by any influenza virus

Tests done by the Instituto Evandro Chagas to see if the contamination occurred for some sort of flu viruses, including H1N1, came back negative - in 19 people infected in Curuçá Municipal Hospital in northeast Pará. But still no diagnosis to confirm the cause of the contamination.

Yesterday, the Municipal Health Curuçá asked the State to transfer the six patients who remain hospitalized in the unit where the contamination happened, to be made ​​a new disinfection in hospital. A State Department of Health (Sespa) reported that three patients who were hospitalized were discharged. These are two women who were at St. Joseph Hospital in Castlebay, and another who was referred to a private clinic in Bethlehem and that there was no need to be hospitalized. A feeling of being at risk has left the population Curuçá startled.

The evil that affected 19 people may have contributed to the death of a 17 year old first name of Jennifer. Admitted to the Hospital Barros Barreto, along with three other nursing techniques and more secretary of the Municipal Hospital, isolated technique in nursing Cordovil Edna Cristina said that compared to the period when he reached the hospital, the picture has improved, but the oscillating symptoms still remain.
"I feel better, but there are times when we feel bad, we are well another time. I still feel dizzy, pain in the chest and neck,
"he said. Surveillance in Health Sespa still awaiting the autopsy report of a girl who died pregnant. http://www.diariodopara.com.br/N-163...DE+GRIPE+.html
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Old December 5th, 2012, 05:09 PM
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http://g1.globo.com/pa/para/noticia/...adiologia.html

04/12/2012 23h13 - 23h13 Updated 04/12/2012
Hospital Curuçá, PA, goes through inspection of the Board of Radiology
Surveys began after the outbreak of unknown disease in employees.
Is suspected of poisoning, but the case is still being investigated.
G1 PA

Comment agoraO Curuçá Municipal Hospital, in the northeastern state, went through an inspection of the Board of Radiology, Tuesday (4). The objective was to examine whether there was leakage of radiation or some chemical. The State Department of Health (Sespa) Epidemiological and also participated in the action.

The chairperson of the division of health surveillance Sespa, Amiraldo Pinheiro, said that the hospital is able to make calls. "We need to tell the people that the hospital has conditions. Risk has passed," he said.

But the representative of the prefecture Curuçá, Adilson Lima, said he is trying to transfer patients to the capital. "We are expecting the central release of beds for us lacrarmos unit mixed to make disinfection of the hospital," he said.

The other patients are admitted to a private hospital and the Hospital Barros Barreto, both in Bethlehem, and St. Joseph Hospital in Castlebay.

According to Sespa, three of 19 patients were discharged on Tuesday (4). "Two patients in Castlebay and one in Bethlehem What we can say is that they are evolving for the better," said Roseane Nore, Director of Health Surveillance Sespa.

Patients, who are employees of the Hospital Curuçá complain of body pain, eye irritation and fatigue. What caused the symptoms is still a mystery.

The possibility of contamination by respiratory virus has been ruled by Sespa. It is being investigated whether patients contracted a bacteria or were intoxicated, as some employees would come into contact with chemical fixative used as X-ray plate.

"What is common among patients who work in the hospital is the product that was spilled, the fastener. Released by The ammonium salt this material may have caused the lack of air, but this is transitory," said Bernardo Cardoso, department endemics of Sespa.

The prediction is that the test results be disclosed within 15 days. "A survey of bacteria or fungus you need to sow among cultures, expect growth to be able to do after the identification, like a incubation period of the disease," said Sebastian Licício, director of the Central Laboratory of the State (Lacen) .
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Old December 6th, 2012, 12:19 PM
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Default Re: Brazil: unknown respiratory disease - tests negative for influenza

- Updated 6/12/2012 9:36 a.m.
Regional Nursing Council visit hospital Curuçá, PA
Entity accompanying research on health problems in hospital.
town Hospital will undergo a disinfection.


The Regional Nursing Council was on the afternoon of Wednesday (5) until Curuçá in northeastern Pará, to monitor the investigation into the health problems that affected employees of the city hospital. A committee of nurses attended a meeting with the Health Department of the municipality and health surveillance.

All patients who were admitted to the hospital Curuçá already been transferred to the building undergo a disinfection, but the state health department has not disclosed when it will happen.
The seven patients at the Hospital Barros Barreto, in Bethlehem, showed improvement in clinical status, according to the latest medical bulletin, but will remain in hospital. Other patients are in private hospitals in the capital.
video
http://g1.globo.com/pa/para/noticia/...curuca-pa.html
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Old December 6th, 2012, 05:45 PM
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http://www.jornalfloripa.com.br/bras...oripa&id=30020

06/12/2012 at 09:48 - Updated 06/12/2012 at 09:48


Hospital employees in PA are hospitalized with suspected contamination


An unknown disease, suspected to have been caused by a chemical spill, reached 19 employees of a hospital within the Pará



People infected, all employees of the Municipal Hospital Curuçá (to 129 miles from Bethlehem), began to experience similar symptoms last week.



Had fever, shortness of breath, decreased pressure, low pulse rate, volume of urine and less bleeding in the digestive system.



After being admitted to the hospital where they defiled, they were transferred to health facilities in Bethlehem and in Castlebay (74 km from the capital).



The hospital was closed yesterday Curuçá to undergo cleaning and sanitizing.



According to Sespa (Department of Health Pará), 14 patients remain hospitalized and five were already [discharged].



Besides the 19, there is another suspected case: a 17-year-old who was pregnant and was a cousin of one of the employees infected, died last Saturday (29). Exams assess whether the teenager was a victim of the same disease.



The Sespa must complete in 15 days with infected exams and investigates the possible causes. Chances are contaminated by bacteria, virus, fungus or chemical poisoning.



It was initially suspected of contamination by radioactivity of an x-ray apparatus, but the possibility was ruled out.



According to the Secretary of Health Curuçá, Rui Carvalho, a chemical used as a fixative for the x-ray machine leaked in late October, when a glass broke.



"In November, began appearing frames of a respiratory syndrome among our employees, all very similar," he said. "People [in the city] are apprehensive, nervous, scared."Undo edits
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Old December 12th, 2012, 06:30 AM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - tests negative for influenza - possible chemical poisoning

Still undiagnosed (and not completely recovering), but no new cases.

http://g1.globo.com/pa/para/noticia/...curuca-pa.html

11/12/2012 23h47 - Updated 12/12/2012 8:27 a.m.
Demonstrators protest by improvements in health Curuçá, PA
Residents and technical Municipal Hospital organized the protest.
A house is being utilized for implementation of health care.
G1 PA

Review of agoraMoradores Curuçá, in the northeastern state, officials and the Municipal Hospital staged a protest on Tuesday (11) by the lack of support from the municipality to patients who had not yet identified a disease and also to collect improvements in health. The city hospital is prohibited by termpo undetermined.

Five nursing techniques that were discharged last week participated in the demonstration. They say they still suffer from the same symptoms of the disease. "I feel fatigue, dyspnea, irritation by the body, fainting, sleep.'ve Also had vomiting, not for anything in my stomach," says Edna Cordovil, technical nursing.

Two victims of the disease reported the case to prosecutors. They seek appropriate medical care, new tests and reimbursement of expenses they have had with medicines and treatment.

"The costs that patients had to be borne by the municipality. Expect that to happen administratively, without the need to resort to juduciário" says Ney Franco Tapajós, prosecutor.

Medical care
As the Municipal Hospital is paralyzed, all medical care to the residents was moved to a house, where he runs a health clinic.

The student Thais Sena, which is the seventh month of pregnancy, the post sought to continue the prenatal period, but found the door of the clinic closed. "I was pregnant and a few other children who also need care, but there was nobody. Told us to return next week to reschedule attendance for January," he said.

The hospital staff want better working conditions to meet people and denounce the structure mounted resicência is not sufficient to meet patients. "The structure of the post you can not attend. If you get someone to do a suture, fine, but if we get an accident victim has no way to do anything," says Neila Fields, a nurse.

The City of Curuçá said the demonstration was a political act. The State Department of Health (Sespa) has not yet released the results of tests done to identify what caused the symptoms in the patients. Only one of the 19 infected remains hospitalized in a private hospital in Bethlehem.
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Old December 13th, 2012, 05:49 PM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - tests negative for influenza - possible chemical poisoning

http://g1.globo.com/pa/para/noticia/...de-curuca.html

13/12/2012 15h12 - 15h19 Updated 13/12/2012
Sespa announces award of examinations of hospital employees Curuçá
According to tests, servers experienced an infection chemistry.
Secretary of Health ensures that there is no possibility of transmission.
G1 PA

Comment agoraA State Department of Public Health (Sespa) announced on Thursday (13) the results of tests performed in the municipal hospital officials Curuçá in northeast Pará. According to the official report, they had a chemical poisoning.

According to the examinations made by Sespa, the possibility of infection was discarded either by virus, fungus or bacterium. Thirty-two patients underwent blood tests, stool and urine in last November. The result of the tests, made by Instituto Evandro Chagas and the Central Laboratory of the Federal University of Pará (UFPA), indicated the presence of ammonium thiocyanate in the body of patients, which, according to Sespa, indicates a condition of intoxication chemistry.

"The hospital staff of Curuçá had contact with a chemical, which was has expired and he was content with leaking the bottle. Furthermore, [the officials] were in a room administrative inadequate, with administrative roles where staff used these papers to routine use of labor, "explains the infecciologista Sespa, Helena Drive.

The state secretary of health, Helio Franco, also ensures that there is no possibility of transmitting intoxication.


read more

Patients may be Curuçá with bacteria or viruses, says SespaConselho Regional Nursing hospital visit in Curuçá, PAManifestantes protesting for health improvements in Curuçá, PADesde the end of November, the county hospital servers and relatives of employees showed symptoms such as pain body, eye irritation, bleeding, and tiredness. The Sespa recognized the severity of the patient's symptoms and said that everyone will receive treatment.

"There is an antidote, where we will begin the administration of these drugs, so that they become available for use by patients, but there is no need for all patients taking the medication. They will be evaluated by a rigorous criterion for the good of all of them, "says the infecciologista Helena.

Also according to the Sespa, the hospital reopened Curuçá on Thursday (13), but a team of the secretariat remains in the county to do a reassessment of the physical structure of the building. All 32 employees who had already contracted the intoxication high.

Understand the case
On 26 November, a report by Liberal TV showed that two servers Hospital Curuçá were already hospitalized and another 10 have had symptoms such as body aches, eye irritation and malaise. They complained that they felt ill after contact with a chemical used in x-ray machines. The Health Department of the State dismissed the suspicion of contamination by radioactive material.

There are reports that the material used for x-rays would have spilled in a room, there was a cleaning with a damp cloth and even that would have been used in other wards of the hospital. "This product is very important, it contains thiosulphate and thiocyanate ammonia etchant, toxic. He may have caused this respiratory and hemorrhagic, "explains infectious Helena Brígido.

Three days later, five nursing techniques Hospital Curuçá to Bethlehem were taking blood samples. Investigations pointed to the possibility of contamination by viruses, among them the H1N1. The test results have not yet been disclosed.

On Friday (30), the picture of some patients worsened. Two patients were transferred to Bethlehem One felt a lot of pain and was another stunted fingers and said he could not feel his legs. On Sunday, a relative of one of these patients reported that he received the medical information of the two had already made improvements.
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Old December 13th, 2012, 05:51 PM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - tests negative for influenza - possible chemical poisoning

Please send to ProMED.

http://www.agenciapara.com.br/noticia.asp?id_ver=113876

Exams dismiss infection by viruses, bacteria or fungi in patients Curuçá

The Health Secretary, Helio Franco, said tests in patients Curuçá ruled out infection by viruses, bacteria or fungus
. The newsroom
Para News Agency
Updated on 13/12/2012 at 14:25
The Secretary of State for Public Health, Helio Franco, reported on Thursday, 13, at a news conference that the servers and patients of the Hospital Municipal Curuçá were victims of poisoning by ammonium thiocyanate, a chemical component of the fixer radiography, which damaged packaging allowed the liquid leaked and spread by the hospital environment. Helio explained that inadequate cleaning of the environment, using bleach and alcohol caused the substance to become volatile and be inhaled by people in the hospital.



With test results in hand, Helio Franco said is totally ruled out infection by viruses, bacteria or fungus. Tests on samples of blood and urine of patients were performed by the Central Laboratory of the State (Lacen), Instituto Evandro Chagas (IEC) and another lab outside the state. "It is not virus, not fungus, not bacteria," emphasized Helio Franco. "This is an episode restricted to hospital and there is no risk of transmission from one person to another," he said.



According Helio Franco, normal is that the human organism load up 4mg/litro ammonium thiocyanate. Among smokers, the rate doubles up. However, people are not affected in Curuçá smokers and some had high rates of substance, varying according to the time of exposure to the chemical.



It was also informed by the clerk that the patient's death Jhenyffer Roberta Abreu dos Passos, held at the Santa Casa de Misericordia of Pará, has no relation to the case of Curuçá, although she spent there. According to report of the Center for Scientific Skills Renato Chaves, she died of generalized infection, which began with a urinary tract infection, which is common in pregnant women, but can affect the kidneys if not treated appropriately. An examination of the IEC also pointed out that it was dengue.



About the victims of intoxication, Helio Franco said they will continue to be monitored and receiving all the support Sespa. "It is important that they are monitored their kidney function, liver and respiratory diseases," he said. The infectious disease doctor and epidemiologist Helen Brigido, the Sespa, explained that the human body thiocyanate ammonia turns into cyanide, and removes iron from hemoglobin, impairing their function oxygenation of the body, which explains the symptoms like shortness of breath , vaginal bleeding and Digestive and tingling in hands and feet.



The antidote of thiocyanate is an injectable drug called Hidroxocobalina. "The drug binds to cyanide, which prevents it from attaching and remove iron from hemoglobin and is eliminated in the urine," said Helena. The drug is only used in part of the 32 patients affected by intoxication, especially in those with higher levels of thiocyanate. Those with low rates are eliminating the substance in the urine.



Initially, as the doctor, patients will be treated with the drug for ten days and will be reassessed on whether or not to continue treatment, since it can also produce side effects. Helena said, finally, that these people should remain under the control and monitoring interdicted by time, to reduce the risk of pulmonary and neurologic sequelae.



The secretary Helio Franco said the Municipal Hospital Curuçá was sanitized by a specialized company and will be reopened from this Thursday, with support from Sespa, who provided some equipment, medicines and supplies to improve the service. He said the hospital needs to be reclassified, because its structure is out of the current technical standards of the Health Surveillance Agency (ANVISA).



The Health Secretary took the opportunity to advise people to avoid making cleaning environments, including home, using different chemicals, it is not known which can result in a mixture of these substances. He suggests that they be used only soap and water and that the environments are kept fresh. "It's always good to let the wind and sun come in, because in dry environment, the bacteria die," he said.



Franco warned, though, about the care that health professionals should take with chemicals and the proper disposal of these products as well as medicines and hospital supplies. It is therefore important that all hospitals have committees Infection Control. "If the case had been Curuçá immediately reported to the Health Surveillance, the consequences would have been lower," he noted.
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Old December 14th, 2012, 06:44 AM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

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Old December 14th, 2012, 06:48 AM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

Thank you Gert.
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Old December 15th, 2012, 08:38 PM
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Default Re: Brazil: 19 HCW affected by unknown respiratory disease - ammonium thiocyanate poisoning confirmed

Published Date: 2012-12-15 13:15:44
Subject: PRO/EDR> Undiagnosed respiratory disease - Brazil (02): (PA) resolved
Archive Number: 20121215.1452878

UNDIAGNOSED RESPIRATORY DISEASE - BRAZIL (02): (PARA) RESOLVED
************************************************** ************
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Date: 13 Dec 2012
Source: Flutrackers.com [edited[
http://www.flutrackers.com/forum/sho...php?t=3D195884
via machine translation:
http://www.agenciapara.com.br/notici...d_ver=3D113876


Exams dismiss infection by viruses, bacteria or fungi in patients
-----------------------------------------------------------------
The Secretary of State for Public Health, Helio Franco, reported on Thursday, 13 Dec 2012, at a news conference that the servers and patients of the Curuca Municipal Hospital were victims of poisoning by ammonium thiocyanate, a chemical component of the radiography fixer, where damaged packaging allowed the liquid to leak and spread by the hospital environment. Franco explained that inadequate cleaning of the environment, using bleach and alcohol caused the substance to become volatile and be inhaled by people in the hospital.

With test results in hand, Helio Franco said it totally ruled out infection by viruses, bacteria or fungus. Tests on samples of blood and urine of patients were performed by the Central Laboratory of the State (Lacen), Instituto Evandro Chagas (IEC) and another lab outside the state. "It is not virus, not fungus, not bacteria," emphasized Helio Franco. "This is an episode restricted to hospital and there is no risk of transmission from one person to another," he said.

--
Communicated by:
Gert van der Hoek


[As a reminder the original report of this outbreak was on 4 Dec 2012 (see prior posting: Undiagnosed respiratory disease - Brazil: (PA) RFI 20121204.1436678) when the newswires mentioned 5 patients being transferred from Curuca Hospital to a hospital in Belem, the capital of Para State. In addition to these 5 patients, there were another 14 patients, including a 17-year-old female who died. Symptoms at that time were described as: "low fever, shortness of breath, oliguria (reduced urine volume), hypotension, hypoglycemia, bradycardia (slow heart rate), and hemorrhagic manifestations in the digestive system, among others." Initial hypotheses included radiation poisoning, then exposure to chemicals used to develop radiographic films, and finally, when the patients were being transferred to Belem, the hypothesis was this was of infectious origin. From the above newswire, it appears as though the 2nd hypothesis -- exposure to chemicals used to develop radiographic films was correct after all. One wonders what the sequence of events were that led to the varied hypotheses in the beginning. - Mod.MPP

Generally we see ammonium thiocyanate as a component of herbicides herbicides, or a component of thiourea. This chemical is also found in artificial resins. It has also been found in matches and rustproofing products. Ammonium thiocyanate has been used to stabilize some photographic developing reagents. Other uses include textile dying, printing and tracer components for locating leaks in the oil field industry.

Acute effects may occur by inhalation. While the product is not necessarily reactive with other products, bleach may be toxic in its own right. Fumes from bleach are irritating to the respiratory system and to mucous membranes.

According to a Material Safety Data Sheet (MSDS):
Acute Potential Health Effects: Skin: Causes skin irritation
Eyes: Causes eye irritation Inhalation:
Causes respiratory tract and mucous membrane irritation.
Ingestion: May cause gastrointestinal tract irritation with nausea and vomiting.
May affect: Behavior, Central Nervous System (hallucinations, distorted perceptions, personality and mood changes, mania, disorientation, weakness, seizures), metabolism.
Chronic Potential Health Effects: Prolonged exposure may affect the thyroid gland and blood cells, and cause personality and mood changes.

Therefore it seems possible that irritating bleach fumes and irritating ammonium thoicyanate may have an additive effect at irritating the respiratory system.

For a map of the state of Para in Brazil, see http://www.v-brazil.com/graphics/para.gif. Belem is to the northeast of the state, with Castanhal to the northeast of Belem.
For a map of Brazil showing the location of Curuca, see http://www.maplandia.com/brazil/para/curuca/. It is further northeast of both Castanhal and Belem.
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