Mystery Respiratory Disease Kills two

UNDIAGNOSED RESPIRATORY DISEASE, FATAL - BRAZIL: SAO PAULO


On 2 Apr 2008, the Secretariat for Health Surveillance (SVS)/Ministry
of Health (MS), through the Center for Epidemiological Surveillance
(CVE)/Coordination Control of Diseases of Sao Paulo, was notified of
the occurrence of cases of respiratory disease in the municipality of
Santos, state of Sao Paulo. Epidemiological surveillance is being
carried out jointly by city, state, and federal health authorities.

The 4 cases initially reported belonged to the same family, with
signs and symptoms of low fever, coryza, throat pain, cough, earache
(3 cases), and otorrhea with purulent exudate from the ears (2
cases); 2 cases had severe clinical evolution and died for reasons
that are being investigated.

Dengue virus and hantaviruses were excluded in all 4 cases and
seasonal influenza and avian influenza viruses, respiratory syncytial
virus, adenovirus, and parainfluenza virus excluded in samples
processed from 3 cases. In 2 cases secretion from the nasopharynx
showed suggestive electron microscopy images of a picornavirus,
agents, which are normally associated with the common cold. Analyses
for other viral agents using the techniques of molecular biology and
virus isolation are being carried out at the Institute Adolfo Lutz.

Besides the family cases, a symptomatic case with an epidemiological
connection to the family was found, who recovered with negative
immunofluorescence tests for respiratory viruses.

A municipal surveillance team is carrying out an active search for
new cases among household and close contacts, as well as a
retrospective review of hospitalizations and deaths from atypical
pneumonia of acute evolution.

The guidelines for precautionary measures directed against contact,
droplets, and aerosols, washing hands, and organizing the flow of
care for possible cases, were strengthened.

The system of municipal surveillance is on alert for the
identification of new cases through the monitoring of contacts
already identified.

[It may be just a coincidence, but the presence of otitis and
intra-family transmission recalls infection with _Mycoplasma_ or
_Moraxella_. - Mod.LJS

The etiology of this illness in which it appears that 2 of 4 members
of the family died is not clear. As suggested above, _Mycoplasma
pneumoniae_ can be associated with ear disease, generally bullous
myringitis, which does not usually cause a purulent otorrhea.

Fatalities from mycoplasmosis can occur but 2 in one family seems
extraordinary. As well, _Moraxella catarrhalis_ can cause otitis media

and pneumonia, but not usually in the same patient and again,
fatalities in otherwise well individuals are uncommon.

It would be of interest to know more about the epidemiology including
the ages of those afflicted, pets at home, travel, visitors from
elsewhere, and the living conditions.



Sources:

-A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
-Ministry of Health, Secretariat for Health Surveillance [in
Portuguese, trans. & summ. Mod.JW,edited]
http://portal.saude.gov.br/portal/arquivos/pdf/nota_doenca_respiratoria0904.pdf