A New Infectious Disease or a Health Care-Induced Disease?
Headlines and news pundits have been submitting various stories about a "mystery illness" causing deaths of young children in Cambodia. Some statistics quoted are shocking (over a 90% death rate), parents are panicked and bringing their small children to Cambodian hospitals. We do not know what is causing the deaths. Within two days, the alveoli in their lungs (the small air sacs that are critical for oxygen-carbon dioxide exchange) are destroyed and the child dies. In this age of the Internet and global TV coverage, such statements have touched off major waves of anxiety in parents of children worldwide, wondering if their toddler could be next to get the disease.
I don't like medical mysteries because until they are solved, many people can become ill and even die while others may take inappropriate or dangerous actions based on conclusions or beliefs they base on incorrect, faulty, or partial information; some may act on belief alone without any supportive information.
My view of this mystery illness is to first look at the discovered and proven "facts" (or clues). What clues are available to date (and to keep in mind that as time progresses, these clues may be changed and/or additional ones may arise), and do they provide insight into the mystery? They are put into a sequence as they were discovered and are as follows:
- Since April, about 64 of 66 children (most under the age of three) admitted to area hospitals in Cambodia have died from an illness that initially resembled hand, foot, and mouth disease (HFMD).
- The children died of neurological and lung symptoms (autopsy evidence of alveolar destruction), but in true HFMD, complications like lung destruction and death are rare.
- Many of these children tested "positive" for enterovirus 71, a virus known to cause more severe symptoms of HFMD.
- Other children had, according to investigators, evidence of infection with Streptococcus suis, a bacterial pathogen that may cause HFMD-like symptoms.
- Still others had evidence of dengue fever, a disease caused by a virus that can mimic HFMD symptoms.
- Most of the children who died received steroids during their hospital stay.
- There have been no new cases since Sat., July 8, 2012.
The above clues lead people to think (or believe) that a new strain of virulent enterovirus 71 caused the disease. Then others thought that coinfection with two or more pathogens (even if two were not detected together) may cause the disease. Others thought that all three pathogens, enterovirus 71, Streptococcus suis, or dengue virus, each caused deaths in hospitalized children that initially developed HFMD-like initial symptoms, and most recently, it was discovered that the large majority of children that died were treated with steroids. This lead some to conclude that treatment of hospitalized children with HFMD-like symptoms caused suppression of the children's immune response and the pathogen(s) then simply were uninhibited by the children's depressed immune system and rapidly multiplied enough to kill them by destroying their lung tissue. The advice to stop treatment of HFMD-like symptoms in hospitalized children with steroids was given and pursued by doctors. The last clue (remember, to date) is that suddenly children's deaths from the "mystery illness" is in rapid retreat.
Is the mystery solved? Maybe, but time and additional clues (data) will tell; we need to keep an open mind and continue to ask questions and think about what the data (clues) may be telling us.
When more data (clues) are forthcoming, I plan to add them to this article so you (and I) can understand how this mystery is solved over time.
CNN Wire Staff. "Officials Make Break in Baffling Disease Killing Cambodian Children." CNN.com. July 8, 2012. <http://articles.cnn.com/2012-07-08/asia/world_asia_cambodia-children-disease_1_ev71-sick-children-foot-and-mouth-disease?_s=PM:ASIA>.
Gupta, Sanjay, and Danielle Dellorto. "Mix of Pathogens Caused Mystery Illness in Cambodia, Doctors Say." CNN.com. July 10, 2012. <http://articles.cnn.com/2012-07-10/asia/world_asia_cambodia-children-disease_1_mystery-illness-cambodian-ministry-pathogens>.
Mersch, John. "Hand Foot and Mouth (HFM) Disease." MedicineNet.com. Aug. 23, 2010. <https://www.medicinenet.com/hand-foot-and-mouth_syndrome/article.htm>.