Undiagnosed Respiratory Disease - Cambodia

May 8, 2003

Source: The State.com (USA) 8 May 2003 [edited] <http://www.thestate.com/mld/thestate/news/world/5811661.htm

New Illness Raises Alarm in Cambodia ------------------------- BORGHOK, Cambodia - In a remote Cambodian jungle hamlet, a tribal chief chanted prayers, to fight a mystery illness - with symptoms similar to SARS - that was sweeping his community. After weeks of investigations, Western and Cambodian doctors have ruled out severe acute respiratory syndrome. But the unknown disease has killed 7 of the 392 people infected in the villages of Borghok and Ping in northeastern Cambodia.

The illness serves as a reminder to the global medical community - already reeling under the shock of SARS - of the many unknown diseases lurking in various parts of the world. It also highlights the plight of areas untouched by the modern world, where even common diseases such as the flu can be life-threatening.

Doctors visiting Borghok and Ping said the disease was like nothing they had seen before. The symptoms included fever, coughing, breathing problems - all signs of SARS. But the victims also suffered from diarrhea and maintained normal white blood cell counts, something not usually found in SARS patients.

The outbreak began on 2 Mar 2003, baffling the illiterate and poor residents of the 2 villages. The communities about 200 miles northeast of the capital, Phnom Penh, have no paved roads, and the nearest hospital is a 3-hour trek through hilly forest. Associated Press journalists visiting Borghok recently were told that 6 residents died within 4 days of the outbreak, some within 24 hours of falling ill.

Dr. Prudence Hamade of Health Unlimited, a British non-governmental organization, was the first Western doctor to reach the villages on 10 Mar 2003. She tended to suffering patients and distributed antibiotics. When she traveled a few days later to Phnom Penh for a conference she learned of SARS for the first time and became alarmed. "The symptoms were almost identical," she recalled. She described the mystery illness as a form of pneumonia preying on people perpetually in poor health.

Cambodia is one of the few countries in Asia without a confirmed SARS case. The disease has claimed some 500 lives worldwide, most of them in China and Hong Kong. Representatives of the World Health Organization and the Cambodian government visited Borghok and Ping on 19--21 Mar 2003. When it appeared that patients responded to antibiotics, health officials felt confident enough to rule out SARS.

"There is no evidence that this outbreak is in any way linked to SARS," said the joint mission's report.

But the bad news is doctors still don't know much more about the disease. "A spate of deaths like this caused by an illness we cannot determine by tests is unusual," said Dr. Severin Xylander, a German doctor and the only World Health Organization representative to visit the area.

The village chief, doesn't care. He says he brought the disease under control with rituals he conducted on 20 Mar 2003, witnessed by about 200 villagers. "It stopped tormenting us after the big ceremony. I know, because people stopped dying and didn't get sick anymore," he said.

[By: Chris Decherd]

-- ProMED-mail <promed@promedmail.org

[Rather than try to speculate on the etiology of this outbreak it seems more prudent to request more information from informed sources as to the nature and outcome of this outbreak. From the limited description given above, it appears as though this outbreak ended in late March albeit confirmation of this would be appreciated. In addition, the apparent response to antibiotics (if true) suggests there may have been either a primary bacterial illness or a primary viral illness with a secondary bacterial infection that lead to the fatalities. Of note, if the numbers are correct, there was an observed case fatality rate of 1.8 percent. Given the ongoing outbreak of SARS, there is an environment of heightened concern for new foci, albeit the article suggests that this was considered in the initial investigation. We've included a selection of "unknown respiratory outbreak" RFIs in the see also's below. Many of these have turned out to be influenza with secondary bacterial pneumonia, in more remote areas with lower health quality and reduced access to medical care. Clearly we would appreciate more information from official sources. Perhaps our colleagues at WHO have information on the investigation conducted in March 2003. - Mod.MPP]

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