Not mold, but interesting outbreak of illness, Panama

October 7, 2006

UNDIAGNOSED DEATHS - PANAMA (02): REQUEST FOR INFORMATION

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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: 5 Oct 2006

From: Doyle, PhD <dr_p_doyle@...>

Source: Reuters AlertNet [edited]

<http://www.alertnet.org/thenews/newsdesk/N04273.htm>

The death toll from a mystery illness in Panama has risen to at least

17, with 10 others still suffering but recovering from fever, diarrhea

and partial paralysis, the Health Ministry said on Wednesday [4 Oct

2006].

Doctors do not know the cause but say the disease progresses rapidly

to the renal system and causes neurological damage.

Two more people suffering from the unidentified illness died on

Wednesday, health minister Camilo Alleyne told reporters. He also

bumped up the number of people fighting the mystery disease to 10 from

7.

Up to Tuesday [3 Oct 2006] the disease had killed 15 over the last

month, the ministry said.

The ministry declared a national epidemic alert on Tuesday.

The dead were all over 60 years of age and most were already suffering

from high blood pressure, diabetes and kidney problems.

The illness does not seem to be contagious and dengue fever,

influenza, West Nile virus and other illnesses have been ruled out.

******

Date: 5 Oct 2006

Source: La Prensa [trans. by Mod.MPP; edited]

<http://www.prensa.com/hoy/panorama/756606.html>

The official number of deaths increased to 17 yesterday with 27 total

cases affected by an as yet unknown syndrome which appeared in Panama

in the month of September, according to reports from the Ministry of

Health.

The 2 new deaths had been hospitalized in the Dr. Arnulfo Arias Madrid

hospital complex, but more details on the course of their disease were

not provided.

The minister, Camilo Alleyne, who on Tuesday [3 Oct 2006] afternoon

said there were no new cases, confirmed that there were 5 new cases.

He indicated that the investigations thus far into the etiology of the

syndrome have eliminated bacteria such as _E. coli_ and

_Campylobacter_ and viruses such as those responsible for West Nile

fever, dengue, influenza A or B, equine encephalitis and enterovirus,

as well as poisoning by substances such as arsenic.

Yesterday he explained that there had been 3 ambulatory cases

reported, that there are 4 patients hospitalized in stable condition

and that another 3 patients were in the intensive care unit, where the

area has been isolated.

The infectious disease specialist Nestor Sosa said that in the Santo

Tomas hospital there were 2 patients in serious condition. He said

that there are patients under observation to determine if they had the

same syndrome, and that the 2 new fatal cases had similar

characteristics in terms of age and symptomatology.

The Director General of Health, Cirilo Lawson, talked about the

investigations into the origins of this disease. " We are open to the

possibility that this disease is either of infectious or toxic

etiology " . [Of note... there are a number of infectious agents that

are known to produce toxins, so it is possible the etiology is both of

infectious and toxic origins. - Mod.MPP]

Lawson clarified that pharmacologic agents [medicines] are included

among possible toxicologic exposures and confirmed that investigations

into this possibility are currently underway.

Authorities were awaiting the arrival of 4 experts from the Center for

Disease Control and Prevention [CDC] from Atlanta, Georgia [uSA], who

will work together with the Pan American Health Organization [PAHO]

and the Ministry of Health to determine the cause of this lethal

syndrome.

[byline: Urania Cecilia Molina]

--

ProMED-mail <promed@...>

[upon review of the updated information, this moderator has not

significantly changed her opinion on the possible etiologies of this

outbreak. The moderator comment included in the 1st posting of this

thread is reproduced below.

" From the description given in the article from the local press in

Panama, there appears to be " confidence " on the part of the Ministry

that the outbreak does not appear to be " contagious, " so that

person-to-person transmission seems to be ruled out by the

epidemiologic studies. Obvious questions include what is the common

exposure on the part of the patients; the mention that they are all

older individuals with pre-existing medical problems could be an

indication of an exposure that, in most cases, is relatively benign,

but when a compromised individual is exposed, then problems are seen.

Or it may be an indication of an exposure that is occurring in the

health care environment where these individuals may have a common

exposure. And a key question is whether this exposure is to an

infectious agent or a toxin.

Clearly, more information on the epidemiologic studies conducted on

this outbreak would be very much appreciated. - Mod.MPP "

According to the latest newswires, the more common infectious agents

that might be associated with a similar clinical picture have been

ruled out (such as _E. coli_, campylobacter, enteroviruses, dengue,

West Nile virus, equine encephalitis viruses). The common denominator

seems to remain somewhat older individuals with pre-existing medical

problems... leading one to ask whether some exposure in the health

care environment might be responsible for their illness. The Ministry

of Health clearly states they are investigating medications,

suggesting that these patients may have been exposed to a common

medication.

We await further information. - Mod.MPP]

............................mpp/pg/dk

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UNDIAGNOSED DEATHS - PANAMA: REQUEST FOR INFORMATION

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Date: 3 Oct 2006

From: Montgomery <LMonty911@...>

Source: Reuters Alertnet [edited]

<http://www.alertnet.org/thenews/newsdesk/N03219590.htm>

Mystery illness kills at least 6 in Panama

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Panama's Health Ministry declared a national epidemic alert on Tuesday

[3 Oct 2006] after a mystery illness killed at least 6 people and left

others suffering with fever, diarrhea and partial paralysis.

Doctors do not know the cause but say the disease progresses rapidly

to the renal system and causes neurological damage. Another 6 people

may have died from it in the last month [september 2006].

" These symptoms are completely unusual, and have not been detected

before in our country, " Panama's health director, Cirilo Lawson, told

Reuters.

Ten more people have been stricken but survived.

Doctors in the central Panama and Cocle provinces are taking samples

from the affected people and seeking advice from abroad.

--

******

Date: 3 Oct 2006

Source: La Prensa [trans. by Mod. MPP, edited]

<http://mensual.prensa.com/mensual/contenido/2006/10/03/hoy/panorama/754539.ht

ml>

While the Ministry confirmed 6 deaths, medical sources are speaking of

17 [deaths]; Alert for lethal syndrome

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

Authorities have not been able to identify the cause of a syndrome

that has already affected 22 persons. There is no evidence of direct

contagion with this syndrome, which begins with severe diarrhea.

An " epidemiologic alert " has been issued by the Ministry of Health.

The cause is an " aggressive, acute syndrome, whose origin is unknown,

that has led to the deaths of at least 7 of the 22 [persons] who were

treated in the Dr. Arnulfo Arias Madrid Hospital Complex of Social

Security (CSS) and in the Santo Tomas Hospital.

The patients presented with a clinical picture that, in the lethal

cases, developed over the course of one week, beginning with fever and

severe diarrhea and progressed to renal failure and neurological

deficits in the extremities.

The Minister of Health, Camilo Alleyne, reported last night [2 Oct

2006] the deaths of 6 people by cardio-respiratory arrest, but medical

sources said that there were already 17 fatalities in the complex.

The problem began one and a half months ago, although it wasn't until

the end of September [2006] that the authorities considered it to be

an " unusual " occurrence.

In the CSS Complex, for example, the Department of Epidemiology issued

a memorandum on 27 Sep [2006] in which it requested that all medical

personnel give notification immediately of any " renal syndrome with

neurologic manifestations. "

In addition, it was known that the Minister and the Director General

of Health, Cirilo Lawson, had met various times with investigators of

the Gorgas Institute and medical specialists to study the medical

records of the deceased patients in order to rule out possible causes.

In fact, the Gorgas Institute conducted studies in order to determine

the causes and also sent specimens from the deceased to the Center for

Disease Control and Prevention in the United States.

Alleyne explained that " there [was] no evidence encountered of direct

contagion, " and that all of the patients were persons greater than 60

years of age, with predisposing diabetes, renal disease or

hypertension. Nevertheless, medical sources reported that the patients

were between 40 and 80 years of age. The cases presented in the

metropolitan area, west Panama, San ito and Cocle Province.

[byline: Ana ]

--

ProMED-mail <promed@...>

[From the description given in the article from the local press in