# 4585
If you blog about medical stories - particularly disease outbreaks - for very long you discover that quite often stories emerge, hang around for awhile, and then quietly disappear without a resolution.
It’s a big world, with 7 billion inhabitants. Outbreaks of `mysterious fevers’ and clusters of unexplained deaths are reported somewhere nearly every week.
When it happens in some remote corner of the world, like interior China, northern India, or perhaps Indonesia or Vietnam, you tend to chalk it up to limited surveillance, poor sample collections, or inadequate lab facilities.
And I’m sure that fairly often, that is the answer.
But sometimes even the combined efforts of the Centers for Disease Control here in the United States are unable to immediately pinpoint the cause of a disease outbreak.
This is not a slam against the CDC, it is simply an acknowledgement of the limits to our technology.
We’ve become accustomed to believing – mainly from their portrayal on TV shows like CSI, NCIS, Bones, etc. - that forensic and medical testing laboratories can find just about anything from the smallest tissue or evidence sample.
It’s a nice fantasy, but it isn’t quite that easy.
Most tests are specific to a type of pathogen. If you don’t know what you are looking for, it becomes very difficult to test for it.
In recent weeks we’ve seen several (as yet) unresolved outbreak stories; notably one in Canada, one in Louisiana, and now one in Vietnam.
A quick tour, therefore, of these three stories.
Late last April we began to hear of a series of deaths at a long-term care facility in British Columbia ( Investigating A Viral Outbreak In Vancouver).
Within a couple of weeks, after 10 deaths among an elderly and frail population, and more than 20 infections (including 3 hospital staff members), the outbreak had been declared over.
But the cause has not been identified.
Tests for Influenza A and B, and legionnaire's disease – considered to be the most likely suspects - were negative. Other tests have failed to turn up a definitive cause.
Unless some new breakthrough in this investigation occurs, we may never know the cause of this outbreak.
Here in the states earlier this month there was an outbreak of suspected `food poisoning’ at a state hospital in Louisiana. Before it was over 40 people were sickened and 3 people had died.
Initially, speculation centered around the hospital cafeteria, as reported by the AP on May 9th.
Food poisoning suspected in 3 La. hospital deaths
(AP) – May 9, 2010
PINEVILLE, La. — A health official says food poisoning perhaps from an ingredient in chicken salad could be what killed three Louisiana mental health hospital patients and sickened 40 others.
Officials say patients at Pineville's Central State Hospital showed signs of gastrointestinal stress beginning Friday morning. The three deaths — a 43-year-old woman, 41-year-old man and 52-year-old man — happened late Friday night or early Saturday morning.
A day or two later norovirus became the prime suspect, and indeed, some of the victims apparently tested positive for the virus. But not all of them. And while norovirus can leave you temporarily wanting to die, it is rarely fatal.
This from Thetowntalk.com, a local media site for the region, this report as of May 18th.
Federal health officials investigating 3 deaths at hospital in Pineville; new cause suspected
(Excerpt)
CDC inspectors collected samples, re-interviewed patients and staff members, re-examined medical records and re-analyzed epidemiological data, Holcombe said.
"We identified norovirus, the agent that causes nausea, vomiting and diarrhea -- all the symptoms these folks had," he said. "You would expect the vast majority of stool samples would come back positive for the agent. And while we had some that were positive, we felt it was not an adequate explanation for the whole thing."
New samples will be sent off to be tested for even more agents along with samples of all of the food in the kitchen that had been carefully saved and preserved, Holcombe said.
While the investigation continues, and a root cause may yet be identified, this illustrates that even two weeks after an outbreak in a hospital here in the United States, the cause can remain elusive.
Which brings us to a fresh story out of Vietnam of an unidentified pneumonia that has put three pregnant women into acute respiratory distress.
This first report comes via Sally Furniss of FluTrackers, the entire translation appearing in the FT thread here. You’ll find more than a half dozen additional media reports, from other newshounds, translated there as well.
Wednesday, 19/05/2010 - 15:01
Pregnant women infected with pneumonia "strange" not to find out the root cause
(AP) - In the past week, three pregnant women have been transferred to hospital from heat illness in severe lung inflammation. Suspected lung damage caused by viruses, doctors conducted tests of influenza A/H5N1 virus, H1N1, H3N2, but the results were negative.
A severe pneumonia patients are being treated in isolation room pressure center, a tropical disease hospital INVESTMENT
Critical illness of unknown cause
Nguyen Thi My Linh patients (22 years old, native of Duc Hoa, Soc Son, Hanoi) is 34 weeks pregnant a sudden high fever suddenly, two days after the fever began breathing difficulties should be taken directly to family illness central institute of tropical diseases.
When hospitalized, the patient was in coma, doctors had to open the windpipe and mechanical ventilation for patients. At the same time, samples of patients Spirit also conducted the test, find the cause but were negative for the virus and the doctor could not find a root cause patients with severe pneumonia.
Once again, these cases are still under investigation, and a cause may yet be determined. But there are a lot of pathogenic players out there . . . many that we know about, and some that we don’t.
This may simply turn out to be one of those outbreak blips that shows up briefly, never goes anywhere, then disappears without leaving much of a trace. That happens fairly often.
But atypical pneumonias . . . particularly when they occur in south east Asia, tend to capture our attention. It was not so far away, in Guangdong Province of China, that SARS erupted in much the same fashion 8 years ago.
So we will watch this story, and any others like it, to see if they escalate into a wider public health threat.
Most, admittedly, won’t.
As we do, we have to accept that some of these medical mysteries will simply never be solved. Or media interest will fade by the time that a cause is determined and we may simply never hear about it.
While many of these stories sound alarming, most will fade into obscurity. Even if the cause is never identified, they will remain localized tragedies that affect a handful of people.
Rest assured that there are a great many watchful eyes upon these stories, and if conditions should escalate, we’ll hear about it.
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