Unexplained Deaths & Critical Illnesses: DBMD


Article title: Unexplained Deaths & Critical Illnesses: DBMD
Conditions: Unexplained Illness
Source: DBMD

Unexplained Deaths & Critical Illnesses

Clinical Features Critical illness or death from a potentially infectious cause occurring in previously healthy persons. No etiology identified on initial testing.
Etiologic Agents Multiple. Results of primary and secondary testing provided evidence of presumed etiologies in 28% of cases including disease due to the following pathogens: Neisseria meningitidis (5), Mycoplasma pneumoniae (5), Enterovirus (4), Chlamydia pneumoniae (3), Bartonella sp. (3), Adenovirus (2), Influenza (2), Legionella sp. (2), Streptococcus pneumoniae (2), Hantavirus (1), Yellow fever virus (1), Tropheryma whippelii (1), Burkholderia pseudomallei (1).
Incidence At least 0.5 cases per 100,000 persons 1-49 years of age. Most common clinical syndromes are central nervous system (meningitis, encephalitis) (29%), respiratory (26%), cardiac (20%), sepsis/multiorgan failure (13%), hepatic (7%).
Sequelae Overall, 32% of cases are fatal; of these, 73% had autopsies.
Transmission Varied. Unknown mode of transmission for unexplained cases.
Risk Groups General population.
Surveillance Active population-based surveillance through coroners and medical examiners in four Emerging Infections Program (EIP) sites with total population of 6.7 million 1-39 year olds. Institution-based protocols are performed at individual EIP sites to identify and evaluate selected infectious disease syndromes, including central nervous system infection, acute liver failure, acute pulmonary syndrome, and myocarditis. National and international surveillance is passive for clusters of unexplained deaths and illnesses.
Trends Efforts to more readily identify emerging pathogens will depend on both advances in diagnostic tests and modifications in public health surveillance. Bioterrorism preparedness requires the capacity to detect and evaluate cases or clusters of unexplained deaths or critical illnesses.
Challenges Simplify the case-finding methods; improve collaboration between clinicians, pathologists and public health practitioners; enhance the quality of clinical specimens available for testing; systematically evaluate role and utility of new techniques for identifying infectious pathogens.
Opportunities Build an infrastructure to evaluate cases of unexplained infectious disease; respond to clusters of unexplained illness in the United States and abroad; detect emerging pathogens or possible acts of biologic terrorism by challenging the limits of our diagnostic capabilities.

December 2001


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