UNDIAGNOSED FATAL ILLNESS - INDIA (UTTAR PRADESH):

UNDIAGNOSED FATAL ILLNESS - INDIA (UTTAR PRADESH): 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: 1 Apr 2008
Source: DDI news India [edited]
<http://www.ddinews.gov.in/Homepage/32+die+of+mysterious+disease.htm>


Children die of mysterious disease in Western UP
------------------------------------------------
A total of 32 children have died of a mysterious disease over the
last 2 days while several others have been admitted to various
hospitals in parts of western Uttar Pradesh, official sources said.

More than 100 children with complaints of severe headache, fever and
vomiting were brought to health-care centers and government hospitals
in Meerut, Baghpat, Muzaffarnagar and Garhmukteshwar districts,
sources informed.

So far, as many as 14 children have died in Khekra town in Baghpat
district, 8 in Muzaffarnagar and 10 in Saharanpur, due to this
disease which has symptoms similar to that of encephalitis,
meningitis and cholera.

The disease, mostly prevalent among those residing in unhygienic
conditions, is a result of inflammation of the brain membranes and
patients generally vomit blood, informed S K Arora, Director of
Health, Meerut Division.

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

[The statement that the illness is "a result of inflammation of the
brain membranes" suggest a meningitis, either viral or bacterial, or
an encephalitis. Certainly Japanese encephalitis occurs in the area.
It is curious that these deaths are reported to have occurred in a
short period of time (48 hours) somewhat suggesting a possible common
source type outbreak, (if the above provided information is
correct). The additional symptom of hematemesis (vomiting blood) has
one wondering if the hematemesis is mechanically related to active
vomiting and retching or is a primary hemorrhagic phenomenon. ProMED
would greatly appreciate more information about this outbreak of
fatal illness from knowledgeable sources in the region.

An interactive map of the states of India that show the districts in
Uttar Pradesh can be accessed at:
<http://www.mapsofindia.com/maps/india/india-political-map.htm>. - Mods.LL/MPP]

[see also:
Japanese encephalitis - India (02) (Uttar Pradesh) 20071026.3486
Japanese encephalitis - India (Uttar Pradesh) 20070930.3233
2006
----
Japanese encephalitis - India (Uttar Pradesh)(03): vaccine
safety 20061222.3583
2005
----
Undiagnosed deaths - India (Uttar Pradesh) (02) 20051115.3342
Undiagnosed deaths - India (Uttar Pradesh): RFI 20051113.3322
Japanese encephalitis - India (Uttar Pradesh) (13) 20051105.3237
Encephalitis, coxsackievirus - India (Uttar Pradesh) 20051025.3115
Japanese encephalitis - India (Uttar Pradesh) (12) 20051019.3045
Japanese encephalitis - India (Uttar Pradesh) (11) 20051011.2964
Japanese encephalitis - India (Uttar Pradesh) (10) 20051001.2869
Japanese encephalitis - India (Uttar Pradesh) (09) 20050926.2835
Japanese encephalitis - India (Uttar Pradesh) (08) 20050921.2788
Japanese encephalitis - India (Uttar Pradesh) (07) 20050913.2713
Japanese encephalitis - India (Uttar Pradesh) (06) 20050909.2674
Japanese encephalitis - India (Uttar Pradesh) (05) 20050903.2610
Japanese encephalitis - India (Uttar Pradesh) (04): conf 20050825.2514
Japanese encephalitis - India (Uttar Pradesh) (03): susp., RFI 20050823.2485
Japanese encephalitis - India (Uttar Pradesh) (02): susp., RFI 20050821.2454
Japanese encephalitis - India (Uttar Pradesh): susp., RFI 20050818.2421]
...................mpp/ll/ejp/mpp

The plot thickens



The mysterious death of 90 gharials in the Chambal waters has set the alarm bells ringing. Kirtiman Awasthi reports.


The mystery of gharial deaths in the Chambal waters continues to elude scientists. More than 90 of the critically endangered species have died since early December, all within a stretch of about 25 km of the river flowing along the Uttar Pradesh-Madhya Pradesh border. Nobody seems to know the reason. In a January 28 meeting of the Crisis Management Group, set up by the Union Government to look into possible causes and draw an action plan, veterinarians and conservationists could not pinpoint the causes of deaths.

The Society for Conservation of Nature, an Etawah-based NGO, reported the first death in the first week of December 2007. By the end of the month, 40 gharials had died. Alarmed, the Forest Department sent samples of viscera and water to the Indian Veterinary Research Institute (IVRI) in Bareilly for testing toxins.









Though most of the gharial carcasses found were partially decomposed, on-the-spot post-mortems revealed liver cirrhosis, as indicated by scarred and damaged liver. “After death, the carcass first sinks and then surfaces after a few days; by then it is partially decomposed,” says Dhruva J Basu, gharial conservation coordinator at WWF India.

IVRI scientists suspect a protozoan parasite found in viscera analysis damaged the liver and kidney in gharials. But crocodile experts rule out this possibility.

“Protozoan and other parasites are common in crocodiles and other aquatic reptiles, and do not cause mortalities,” says F W Huchzermeyer, a veterinary consultant and co-chair of veterinary science with the World Conservation Union’s Crocodile Specialist Group. R J Rao, gharial researcher at Jiwaji University in Gwalior, echoed his views.

The IVRI report also showed high levels of lead in gharials. It can’t be said for certain if these levels (0.7-1.4 ppm) are fatal. “At this level, lead can act as an immunosuppressant but cannot cause mortality,” says D Swarup, scientist at IVRI. There is another problem: absence of baseline data for comparison, even after 30 years of conservation. Gharials are found only in India and Nepal. The only comparison for lead levels right now is with Chinese alligators.

Conservationists say high levels of lead in gharials could be from eating contaminated fish. The lead and protozoan hypotheses debunked, Brian Stacy, veterinary pathologist at the University of Florida, USA, who carried out an on-the-spot postmortem of a gharial, says there are indications of gout in gharials, possibly due to kidney failure.

Huchzermeyer says if this is so, it is shocking because kidney infection, and hence gout, is very rare in gharials.
Lala A K Singh, gharial expert of the Orissa Forest Department, says though gout is uncommon in natural crocodilian populations, it is common in captive-bred animals. He recalls a 1977 incident when most of the 400 gharial hatchlings brought from Nepal died. The symptoms were similar. Even then, the cause of deaths remained inconclusive.

Again, lack of baseline data comes in the way. Huchzermeyer says he wants to study a live, healthy gharial but the Wildlife Protection Act, 1972, does not allow this as gharial is a Schedule I species.
For the time being, scientists are focusing their investigation on diseases. Members of the Crisis Management Group have ruled out human interference and are not looking at the possibilities of poaching and reduced prey base.

The dead gharials had no signs of external injury and post-mortem results indicated that deaths were not due to drowning in fishing nets, a common cause of death. Scientists also rule out poisoning of the river because fish and other aquatic animals had not died.

Huchzermeyer has another hypothesis: “The deaths may have been caused by pansteatitis, a condition caused by the consumption of rotten fish.” It has killed South African crocodiles in the past.

While scientists are busy explaining the disease, villagers have a different explanation. “They are dying of starvation. Extensive illegal fishing has reduced fish in the river to such an extent that big gharials are not getting enough food,” says a resident of Sahnso village in Etawah. The Forest Department has confiscated fishing nets in the region. “I have reports of people blasting underwater to kill and catch fish in large numbers,” says Rajeev Chauhan, secretary general of the Society for Conservation of Nature: “Gharials might have eaten leftover dead and rotten fish,” he explained. This dovetails with Huchzermeyer’s hypothesis.

IVRI scientists also found that in most cases the gharial’s stomach was empty. But conservationists rule out starvation, saying there is enough prey base in the river for gharials. Filmmaker Naresh Bedi, who made the first documentary on gharials, says this claim is not based on studies of the prey base.

It is worth noting that all the deaths occurred between the bridge at Sahnso and Udi village in Etawah. This stretch is part of the 400 km of the river protected under the National Chambal Sanctuary. “The stretch has a high density of gharials. Due to illegal fishing and continuous human presence, there is a possibility that gharials are not getting enough time for basking,” says Rom Whitaker, chairman of the Gharial Conservation Alliance, an independent international mission.

Before this episode, less than 200 breeding gharials were estimated in the wild. Basu points out that all dead gharials were longer than two metres — mostly breeding animals. Ten were males; gharial populations are skewed in favour of females, and a small reduction of males can bring them to the brink.

Forest officials stress that all the deaths occurred in the ‘natural population’, as opposed to captive-bred animals released into the wild. Bedi doubts if there is a survey to ascertain the number of captive-bred gharials surviving in the wild.

The gharial was on the verge of extinction in the 1970s. Since the inception of Project Crocodile in 1975, which included captive breeding, several thousand captive-bred gharials were released into the wild. Only a few survived. The present crisis questions the knowledge and conservation approach of the Union Ministry of Environment and Forests, which is again planning to launch a project to conserve gharials, which are on the IUCN Red List.

“This time we will focus on the gharial in its natural habitat rather than going for captive-breeding,” promises Pramod Krishnan, joint director, wildlife, at the ministry.

Another old article: 

Bird Flu Virus Crosses Species Barrier to Kill Dogs, Study Says

By Jason Gale

April 2 (Bloomberg) -- A bird flu virus killed dogs in South Korea, showing that a pure avian strain of influenza is capable of crossing a species barrier and causing outbreaks of severe disease in mammals, a new study found.

A cocker spaniel and a miniature schnauzer were among dozens of dogs in South Korea sickened by an H3N2 strain from birds, researchers said in a study published in the May issue of Emerging Infectious Diseases journal. Viruses taken from the sick canines were used in an experiment later to see if pathogens were capable of spreading from dog to dog.

The findings add to scientific understanding of how flu viruses evolve in animals and the risks they pose to humans. Previous studies showed that the H5N1 bird flu strain, a type-A influenza that's killed at least 236 people worldwide, can infect dogs, cats and other mammals. The H5N1 virus, which isn't known to transmit efficiently in non-bird species, would become more dangerous to people if it achieved that feat.

``Transmission of avian influenza A virus to a new mammalian species is of great concern because it potentially allows the virus to adapt to a new mammalian host, cross new species barriers, and acquire pandemic potential,'' the Korean researchers said.

The study, led by Daesub Song, Bokyu Kang and Chulseung Lee of the Green Cross Veterinary Products Co. and Daewoong Pharmaceutical Co. at Yong-in, outside Seoul, followed cases of severe respiratory disease last year in dogs at three veterinary clinics in Kyunggi province.

Tests on specimens collected from three of the dogs showed they were infected with H3N2 viruses closely resembling those found in chickens and doves in South Korea in 2003. The pathogens may have been transmitted from birds to dogs fed raw, minced meat from infected ducks and chickens, the authors said.

Dog Farms

``In South Korea, untreated duck and chicken meats, including internal organs and heads, have been widely used to feed dogs for fattening in local canine farms or kennels,'' they said.

Dog is regarded by some Koreans as a delicacy. Seoul city officials will ask the national government to include the animal in the legal definition of livestock, the Chosun Ilbo newspaper reported last week.

A variant of the H3N2 virus causes seasonal flu in humans. A canine strain was linked to an outbreak among 13 dogs at an animal hospital and later reported at a kennel in Jeolla province, where as many as 52 canines were infected, most likely as the virus spread from dog to dog, the Korean researchers said.

Seal, Dogs

Avian flu viruses are known to transmit to unrelated mammalian species only rarely, the researchers said. Bird- derived H7 and H4 flu viruses were reported in seals in the early 1980s, and the H5N1 bird-flu strain was found in a dog that fed on a duck infected with the virus in Thailand in 2004, according to the study.

Large cats, including tigers and leopards, kept in capacity and fed on infected poultry carcasses, have also been infected and developed severe disease.

``This is an important and interesting study because previous avian-to-mammal influenza infection by H5 or H7 were not efficient in subsequent human-to-human or cat-to-cat transmission, whereas this study shows an outbreak of 13 dogs in addition to sporadic cases,'' said Yuen Kwok-yung, a microbiology professor at the University of Hong Kong.

``Efficient mammal-to-mammal transmission'' of H3N2 viruses isn't unexpected since variations of the strain regularly infect humans and pigs, Yuen said in an interview today.

Dogs may be more susceptible to flu strains carried by birds because both canines and birds share a specific type of virus-binding site in their respiratory systems which is less common in humans.

The bird-like H3N2 virus may be capable of spreading between dogs because it was excreted in nasal discharges of experimentally infected Beagle puppies, the study found.

Evidence of avian flu in pet dogs ``raises the concern that dogs may be become a new source of transmission of novel influenza viruses, especially where avian influenza viruses are circulating or have been detected,'' the authors said.

To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net

Last Updated: April 2, 2008 03:44 EDT

I pray these 32 children did not die in pain.  The symptoms mentioned in the article are cruel, evil, torturous and inhumane symptoms.  H5N1 terroism. 

India has a huge population problem and this kind of thing makes any virus more prone to mutate, infect and could certainly trigger a pandemic.  Flights must stop at once.

[QUOTE=Albert]

Bird flu in humans may be going undiagnosed

DETECTING the start of a pandemic caused by a new form of the H5N1 bird flu virus might be even harder than experts feared. Two children in Vietnam who died of diarrhoea and brain inflammation have been discovered to have had bird flu, suggesting that doctors watching only for the fever and cough typical of normal flu may miss cases.

The news is particularly worrying because diseases that cause gastrointestinal symptoms and brain inflammation (encephalitis) are common in south-east Asia. If H5N1 evolves into a form that is easily transmitted from person to person it could spread widely before anyone notices the unusual number of cases, reducing the chances of preventing a wider outbreak.

The World Health Organization is analysing blood samples from people in areas affected by H5N1 to see how many carry antibodies to the virus. This will give an idea of how many cases have gone unnoticed ...

Volume 13, Number 12–December 2007 - CDC -

A/chicken/Vietnam/14/2005 (H5N1) Challenge

Twenty-eight days after pre-exposure to British Columbia/05, birds in the pre-exposure and naïve groups were challenged with Vietnam/05. Juvenile birds were estimated to be 13 weeks of age at this time. Adult birds in the British Columbia/05 pre-exposure group exhibited mild decreases in feed consumption and mild depression 5–7 dpc. Except for 1 bird with a positive oropharyngeal swab sample at 6 dpc, oropharyngeal and cloacal swab specimens for the adults tested real-time RT-PCR negative at 2, 3, and 6 dpc. Juvenile birds in the British Columbia/05 pre-exposure group exhibited clinical signs similar to those of the adults with the addition of transient nervous signs manifested as repetitive jerking head movements. Viral shedding, as determined by real-time RT-PCR and confirmed by isolation, was detected at 3 dpc in oropharyngeal swab samples in 3 of 5 birds and in a cloacal swab sample in 1 of 5 birds. Complete necropsies showed no gross lesions in juvenile or adult birds at 3, 6, 11, and 21 dpc. The cerebrum, brain stem, and spinal cord of juvenile birds exhibited low levels of viral nucleic acid at 11 and 21 dpc (Appendix Table). Other organs were weakly positive by real-time RT-PCR to varying degrees.

In contrast, juvenile birds in the naïve group showed 100% morbidity after Vietnam/05 challenge; clinical signs included severe depression, inappetence, bright yellow diarrhea, ruffled feathers, hunched posture, repetitive jerking head movements, weakness, staggering gait, distressed vocalization, wing droop, and terminal coma. All birds died or were humanely euthanized by 5 dpc. Viral nucleic acid was detected in the oropharyngeal swab specimens collected at all time points before euthanasia or death; cloacal swab specimens were not as consistently positive. Adult birds also showed 100% morbidity but with clinical signs and viral shedding less pronounced than that observed in juveniles. Necropsies were performed on 2 adults on days 3 and 5; the remaining 3 birds survived until 20 dpc.

Gross pathologic lesions included congestion of the mucosal surface of the trachea, edema and multifocal pinpoint hemorrhages on the serosal surface of the pancreas, splenomegaly, hemorrhage within the ceca, conjunctivitis, congestion of the meninges and cerebral blood vessels, and hemorrhages on the surface of the brain. Virtually all tissues collected from juvenile birds in the naïve group were real-time RT-PCR positive; heaviest viral loads were found in cerebrum, brain stem, and spinal cord. Adult bird 841S/41Y, which required euthanasia at 5 dpi, also had levels of viral nucleic acid in the central nervous system (CNS) comparable to those found in naïve juveniles. This was one of the adult birds with no pre-existing NP antibodies at the beginning of the acclimation period (Table 1). Viral nucleic acid was found in the CNS of a second adult (840S/40Y), euthanized at 20 dpc, but at levels that were 5–7 logs lower than those found in juveniles or the adult bird euthanized at 5 dpc.

http://www.cdc.gov/eid/content/13/12/1821.htm
also:

The most consistently affected tissues were the brain, spinal cord, parasympathetic ganglia of the gastrointestinal tract, heart, and pancreas (Figures 1, 2). Within the small intestine and cecum, the strongest and most consistent immunolabeling involved the parasympathetic ganglia of the submucosal and myenteric plexi