Mix of pathogens caused mystery illness in Cambodia, doctors say

 

http://cnn.com/video/#/video/world/2012/07/11/bpr-gupta-cambodia-mystery-disease.cnn 

July 11, 2012 By Dr. Sanjay Gupta and Danielle Dellorto, CNN

STORY HIGHLIGHTS

• Doctors say the inappropriate use of steroids worsened many cases
• No new cases of the condition have been confirmed since last Saturday
• The pathogens include enterovirus 71, streptococcus suis and dengue
• Most of the patients have come from southern Cambodia

Phnom Penh, Cambodia (CNN) -- The World Health Organization, in conjunction with the Cambodian Ministry of Health, will conclude that a combination of pathogens is to blame for the mysterious illness that has claimed the lives of more than 60 children in Cambodia, medical doctors familiar with the investigation told CNN on Wednesday.

The pathogens include enterovirus 71, streptococcus suis and dengue, the medical sources said. Additionally, the inappropriate use of steroids, which can suppress the immune system, worsened the illness in a majority of the patients, they said.

The sources did not want to be identified because the results of the health organization's investigation have not yet been made public.

Dr. Beat Richner, head of Kantha Bopha Children's Hospitals -- which cared for 66 patients affected by the illness, 64 of whom died -- said that no new cases had been confirmed since last Saturday.

Possible breakthrough in mystery illness The World Health Organization (WHO) is also expected to advise health care workers to refrain from using steroids in patients with signs and symptoms of the infection, which include severe fever, encephalitis, and breathing difficulties.

Over the past four months, doctors at Kantha Bopha in Phnom Penh have been faced with the mysterious syndrome, which kills children so fast that nearly all of those infected with it die within a day or two of being admitted to the hospital.

In the last hours of their life, the children experienced a "total destruction of the alveola(e) in the lungs," Richner said. The patients also suffered from encephalitis, which is inflammation of the brain, he said.

Other hospitals in the country have also reported similar cases, but far fewer than the children's hospital in the capital, which is the most popular.

Most of the children who have contracted the illness have come from the south of the country, though health officials cannot find what is known as a cluster -- a lot of cases coming from one specific area.

By June 29, the WHO had been contacted and Cambodian officials were scrambling to instruct health providers across the country to spread the message to the masses as quickly as possible.

The WHO and the Cambodian authorities' announcement of the situation drew criticism from Richner, the head of the children's hospital, that they were "causing unnecessary panic."

The WHO said the unexplained nature of the outbreak obliged it to communicate the information.

Over the weekend, lab tests linked enterovirus 71 (EV71), which is known to cause neurological disease, to some of the cases. But it didn't solve the whole puzzle and health officials continued their investigations, noting the detection of other elements like streptococcus suis and dengue.

The rainy season in Cambodia, which lasts from May to October, is a key problem in trying to control diseases like dengue, which are transmitted by mosquitoes.

Because of a lack of indoor plumbing in many homes, people collect rainwater in vats, potential breeding grounds for mosquitoes.

In Cambodia, as with many places around the world, parents first try treating their child at home. If that doesn't work then they go to their local clinic, with a trip to the nearest hospital the last resort as it often involves a long trip.

CNN's Sara Sidner and Tim Schwarz contributed to this report.