Eight Israelis Found Suffering from Virus- Typhoid

[Shiloh]

Source: http://www.israelnationalnews.com/News/Flash.aspx/172322

Sixth Israeli Backpacker Found Suffering from Virus

Reported: 13:18 PM - Oct/11/09
Follow Israel news briefs on Twitter and Facebook.

(IsraelNN.com)

An Israeli who returned from a trip to Nepal was found to be suffering from a serious stomach ailment, doctors said Sunday. The 30 year old woman was taken for treatment to a hospital in Tiberias after complaining of severe stomach pains. She is in stable condition, doctors said.

She is the sixth person to be diagnosed with the same stomach virus in since last Friday. Two others are being examined at hospitals after showing the same symptoms, although doctors have not yet fully concluded that they are suffering from the same virus. All the victims returned from Nepal in the past few weeks. Doctors are trying to determine if they contracted the disease in the same place, or if the phenomenon is more widespread.

 

[Shiloh]

Re: Sixth Israeli Backpacker Found Suffering from Virus- Typhoid

Re: Sixth Israeli Backpacker Found Suffering from Virus- Typhoid

Source: http://www.israelnationalnews.com/News/News.aspx/133789

Israelis Return from Nepal with Typhoid

by Zalman Nelson
Follow Israel news on Twitter and Facebook.

(IsraelNN.com) Five Israelis travelers have been hospitalized and are undergoing treatment for typhoid at the Sheba Medical Center in Tel Hashomer following recent trips to Nepal. A sixth is hospitalized in Tiberias.

Hospital officials said that all six are suffering from fever and are being treated with intravenous antibiotic. Following investigation, it was discovered that all of them had eaten at two Chabad centers in Nepal, including meals during the recent holiday period. The possibility that that the disease was transferred to their food by one of the local employees is being considered.

Because of the potential connection to the Nepal centers, Health Ministry officials suspect that there are additional cases of as-yet-undiagnosed infection. Israelis who were in Nepal over the past month and who have experienced a fever are asked to immediately seek medical attention and be tested.

On Sunday, an Israeli woman who returned from a trip to Nepal was was taken for treatment to a hospital in Tiberias after complaining of severe stomach pains. She is in stable condition, said doctors who diagnosed her as the sixth traveller suffering from a typhoid infection.

Stomach typhoid is caused by the salmonella virus, which is ingested in food or drink, entering the digestive system and then the circulatory system. It is characterized by a severe, sustained fever, and carries the risk of death if not treated in time. The accepted treatment for typhoid, also known as typhoid fever, involves two weeks of intravenous medication.

The Health Ministry said that it is investigating the source of the infection, as well as attempting to track down additional infected patients.

World health officials handling several recent natural disasters acknowledged that they are worried about possible outbreaks of such flood-borne diseases like typhoid, cholera, leptospirosis, A/H1N1 flu virus, and hepatitis A.

 

[Shiloh]

Re: Eight Israelis Found Suffering from Virus- Typhoid

Source: http://www.israelnationalnews.com/News/Flash.aspx/172364

Three More Cases of Typhoid from Nepal at Sheba

Reported: 22:28 PM - Oct/11/09


(IsraelNN.com) Three more cases of typhoid fever were discovered Sunday evening at Sheba hospital near Tel Aviv, bringing the total diagnosed with virus to eight. Another patient is being treated for symptoms of the disease at a hotpital in Tiberias.

The Health Department reports that all of the victims had been at the Chabad House in Fukra Nepal. The ministry has asked all those who visited the facility and have symptoms of the virus to contact their physician.

 

[Slithers]

Re: Eight Israelis Found Suffering from Virus- Typhoid

I wonder why they knew that typhoid fever was caused by a species of salmonella but not that salmonella is a bacteria rather than a virus. I know that reporters are not scientists but you would think those two facts would be together wherever one looked it up.

 

[alert]

Re: Eight Israelis Found Suffering from Virus- Typhoid

And the outbreak continues. Perhaps the case count (eight) should be removed from the thread title, as there are over 40 cases in this posting alone, and the word virus should definitely be removed as typhoid is bacterial. I vote for something like "Israelis contract Typhoid in Nepal".

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80872

Archive Number 20100111.0125
Published Date 11-JAN-2010
Subject PRO/EDR> Typhoid fever update 2010 (01): tourists, Nepal


TYPHOID FEVER UPDATE 2010 (01): TOURISTS, NEPAL
***********************************************
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: Thu 6 Jan 2010
Source: News agency Cursor [trans. Mod.ATS, edited]
<http://cursorinfo.co.il/news/novosti/2010/01/06/pokhara/>


Israeli travelers - Russian Far East ex Nepal

40 Israeli travelers who were traveling in the [Russian] Far East
became ill with enteric fever. This news came from the news agency NRG
on 6 Jan 2009. The source of the outbreak probably was the canteen at
the Jewish Center Beit-Khabat in the city of Pokhara in Nepal. All the
travelers had been there before going to the [Russian] Far East. The
chairman of epidemiological control of tropical diseases in Israel,
Professor Eli Schwarz, mentioned that none of these cases became
infected by enteric fever from exposures within Israel. All the
patients had been hospitalized, properly treated and then returned to
Israel. "There is no threat for the spread of enteric fever within
Israel," the professor said.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Where in Asia the travelers were hospitalized and treated is not
stated in the posting.

Enteric fever (caused by _Salmonella enterica_ serotypes Typhi or
Paratyphi serogroups A-C) has a totally different presentation than
the more common kinds of salmonellosis. Vomiting and diarrhea are
typically absent; indeed, constipation is frequently reported. As it
is a systemic illness, blood cultures are at least as likely to be
positive as stool in enteric fever, particularly early in the course
of the infection, and bone marrow cultures may be the most sensitive.

Initial symptoms typically include fever, anorexia, lethargy, malaise,
dull continuous headache, non-productive cough, vague abdominal pain,
and constipation. Despite the often high fever, the pulse is often
only slightly elevated. During the 2nd week of the illness, there is
protracted fever and mental dullness [classically called coma vigil -
Mod.LL]. Diarrhea may develop, but usually does not. Many patients
develop hepatosplenomegaly. After the 1st week or so, many cases
develop a maculopapular rash on the upper abdomen. These lesions
("rose spots") are about 2 cm in diameter and blanch on pressure. They
persist for 2-4 days and may come and go. Mild and atypical infections
are common.

As many as 10 percent of untreated infections may be fatal, and
relapses are not uncommon. The illnesses caused by Paratyphoid
serotypes are generally milder. The specific organism or organisms
related to this report are not stated.

The development of enteric fever in Israeli travelers going to Nepal
is well known (1) and was reported to be higher than in other
travelers, possibly due to the low vaccination rate for typhoid in the
Israeli travelers. More recently, there was a significant increase in
the percentage of cases related to Paratyphoid, which is not a
vaccine-preventable infection (2,3). Of note, the Paratyphoid serotype
cases were observed not to be any milder than the typhoid serotype
cases.

1. Schwartz E, Shlim DR: Enteric fever among Israeli travelers in
Nepal: the need for typhoid vaccination. Isr J Med Sci. 1990;26:
325-327.
2. Meltzer E, Yossepowitch O, Sadik C, Dan M, Schwartz E: Epidemiology
and clinical aspects of enteric fever in Israel. Am J Trop Med Hyg.
2006;74: 540-545.
3. Meltzer E, Sadik C, Schwartz E: Enteric fever in Israeli travelers:
a nationwide study. J Travel Med. 2005;12: 275-281.

Pokhara is located in the Kaski District in the Western Region of
Nepal and can be found on a map at:
<http://ncthakur.itgo.com/map04.htm>. - Mod.LL]

[see also:
2009
----
Typhoid fever update 2009 (01) 20090710.2472
Typhoid fever - USA: (TN) cluster 20090608.2120
2008
----
Typhoid fever update 2008 (08) 20081229.4095
Typhoid fever update 2008 (06): Canada (BC) ex India, alert 20081026.3386
Undiagnosed illness, fatal - Uganda: (KS), typhoid susp. 20080814.2524
Typhoid fever update 2008 (05): Philippines 20080312.0999
Typhoid fever update 2008 (02): Philippines, Fiji 20080204.0450
Typhoid fever update 2008 (01) 20080128.0358

2007
----
Typhoid fever update 2007 (10) 20070627.2072
2006
----
Typhoid fever update 2006 (07) 20061121.3315
Typhoid fever update 2006 (06) 20061106.3188
2004
----
Paratyphoid fever - Israel ex India 20041019.2840
1999
----
Salmonella paratyphi B - Europe ex Turkey (03) 19990916.1656
Salmonella paratyphi B - Europe ex Turkey 19990904.1553
Paratyphoid - India (New Delhi): increasing 19990715.1187]
..............................................ba/ats/nr/ll/msp/jw
*##########################################################*

 

[alert]

Re: Eight Israelis Found Suffering from Virus- Typhoid

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80914

Archive Number 20100113.0156
Published Date 13-JAN-2010
Subject PRO/EDR> Typhoid fever update 2010 (02): tourists, Nepal


TYPHOID FEVER UPDATE 2010 (02): TOURISTS, NEPAL
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 13 Jan 2010
From: Buddha Basnyat <rishibas@wlink.com.np>


I would like to comment on the post written on Thu 6 Jan 2010 (Typhoid
fever update 2010 (01): tourists, Nepal).

First of all, without the results of proper investigation, testing and
diagnosis, it may be premature to suggest that one particular Jewish
canteen in Pokhara, Nepal is the cause for this disease. Enteric fever
is rampant in Nepal, and without a thorough investigation, it may be
unfair to label one center as the source.

Secondly, I would like to comment on some of the statements made.
Constipation used to be thought as more common in enteric fever than
diarrhea. This may no longer be accepted on the basis of a large case
series, including work from South and Southeast Asia, including our
own data. A recent report from our group based on a large cohort of
over 600 culture proven patients studied in Nepal showed that diarrhea
is a common presentation in enteric fever. The same large study also
showed (contrary to what is stated in one part of the write up) that
paratyphoid is not any less aggressive than typhoid fever. In our
report and in other reports, it is becoming clear that there is an
enormous overlap between the clinical syndromes caused by typhoid and
paratyphoid fever. Paratyphoid fever should no longer be considered a
more mild form of enteric fever.

--
Dr. Buddha Basnyat
Oxford University Clinical Research Unit
Patan Hospital
Kathmandu, Nepal
<rishibas@wlink.com.np>

******
[2]
Date: Mon 11 Jan 2010
From: Henry Wilde <wildehenry@yahoo.com>


The presence of paratyphi A in Nepal, India, Indonesia and China,
representing up to 50 percent of enteric fever cases, is now well
documented and was 1st publicized as far back as 1995. We have seen
several cases of paratyphoid A enteric fever that have been evacuated
to Bangkok hospitals from Nepal who had current _S._ Typhi vaccines.
Also, it has been our impression that Israeli tourists are usually
vaccinated with Ty21 or Vi vaccines before leaving home. It would be
very interesting to know what salmonellae were identified in the
patients reported recently.

--
Henry Wilde, MD, FACP
Professor of Medicine
Division of Research Affairs
WHO-CC for Research and Training in Emerging Zoonoses
Faculty of Medicine, Chulalongkorn University
Bangkok, Thailand
<wildehenry@yahoo.com>

[ProMED thanks Drs. Basnyat and Wilde for their comments as well as
their continued interest in ProMED. - Mod.LL]

[see also:
Typhoid fever update 2010 (01): tourists, Nepal 20100111.0125
2009
----
Typhoid fever update 2009 (01) 20090710.2472
Typhoid fever - USA: (TN) cluster 20090608.2120
2008
----
Typhoid fever update 2008 (08) 20081229.4095
Typhoid fever update 2008 (06): Canada (BC) ex India, alert 20081026.3386
Undiagnosed illness, fatal - Uganda: (KS), typhoid susp. 20080814.2524
Typhoid fever update 2008 (05): Philippines 20080312.0999
Typhoid fever update 2008 (02): Philippines, Fiji 20080204.0450
Typhoid fever update 2008 (01) 20080128.0358]
..................................................ll/msp/jw