Mysterious Outbreak In Pakistan - 10 Deaths to Date

[Reasonable Rascal]

Date: 21 May 2002 11:54:04
From: ProMED-mail <promed@promedmail.org>
Source: Pak News [edited]
<http://paknews.com/main.php?id=10&date1=2002-05-21>


Mysterious deadly outbreak claims lives of 10
---------------------------------------------
MORO, May 21 (PNS): Ten have died, including 4 children from the same family, and 25 others have been admitted to hospital as a result of a
widespread mysterious life threatening epidemic in a village near the river Indus.

Doctors have been unable to diagnose or stop the spread of this disease. The inhabitants of village Malik situated 10 km from Moro near Indus River
have been suffering from this deadly disease for the last week.

The first sign of this deadly disease is that the patient's hands and feet become black. The face then swells up. This is followed by a severe fever, which may be followed by death of the patient.

The inhabitants have said that they were using water from a tap installed in their village.

A 10 member team headed by ADO Noshehra Feroz has reached the village and taken a water sample, which has been sent to Karachi for further laboratory tests.

[Reasonable Rascal]

Date: Tue, 28 May 2002 06:46:36 -0400

Historically speaking, the "classic" causes of epidemic gangrenous lesions are ergotism and typhus. The Serbian typhus epidemic of World War I caused large numbers of cases of gangrene, sometimes symmetrical, and typically on the extremities and distal areas. I wonder also, lacking full information, whether toxic alimentary aleukia is a possibility, although that should be
easy to rule out epidemiologically, and would seem doubtful given the locale and season.

--
DMM, MD
National Institute of Allergy and Infectious Diseases
National Institutes of Health

[The only description of the current illness available to us from a newswire report is an illness characterized by blackening of the hands and feet followed by high fever and death. Dave's correlation of epidemic gangrene with outbreaks of typhus and ergotism are on target.

The mention of alimentary toxic aleukia (ATA) is an interesting hypothesis. ATA is a disease characterized by nausea, vomiting, and hemorrhagic
phenomenon associated with bone marrow suppression and ultimate aplastic anemic (total bone marrow failure) associated with fungal contamination of
grain resulting in the production of a T-2 mycotoxin. Mycotoxins are naturally occurring substances produced by fungi as a secondary metabolite. Many of these toxins are pathogenic to animals and humans. The T-2 mycotoxin (a trichothecene mycotoxin) is elaborated from the fusarial species of fungus. The T-2 mycotoxin has been used as a biological weapon.

An outbreak of ATA occurred in the Orenburg district of Russia during World War II. As most men in the village were fighting in the war, the wheat crop was left unharvested, resulting in the crop remaining in the fields over the winter. It was harvested in the spring and eaten, causing an outbreak of ATA, with reported mortality rates from 10 to 60 per cent. Of note, ProMED-mail posted a concern about fungal contamination of wheat in Pakistan in 2001 - additional food for thought here.

At this point we are left with speculations...
--------------------------------------------------
Provided under Fair Use for Education doctrine.