Rash Has Officials Scratching Their Heads... (First Case Of Small Pox???)?

Washington Post ^ | Washington Post

[The Magical Mischief Tour]

Follow the link due to posting restrictions... I posted this under Breaking News just incase. I appologize if it's jumping the gun. ...

[vannrox]

"...What doctors are seeing on many of the Marsteller students is a rash made up of little red bumps..."

Penetration is usually through the respiratory tract and local lymph nodes and then the virus enters the blood (primary viremia).


Internal organs are infected; then the virus reenters the blood (secondary viremia) and spreads to the skin. (As a rash).


These events occur during the incubation period, when the patient is still well.


Smallpox is characterised in its classical form by the sudden onset of fever, headache, backache, vomiting, marked prostration and even delirium. At this early stage the patient may be very ill and compelled to take to his bed. Early in the illness there may appear in about 10% of patients a fleeting rash in the form of a reddening of the skin, not unlike the rash of German Measles. This is the so-called prodromal rash and, in the absence of a history of exposure to a source of infection, there is nothing about htis rash to arouse suspicion of smallpox. The incubation period from exposure to the onset of this feverish illness is nearly always 12 days with very little variation either way.


About two to three days after the onset of illness the true smallpox rash appears. At this time any prodromal rash will be fading. This true or so-called focal rash is normally diagnostic of smallpox and is characteristic both in its evolution and distribution on the body. It begins as tiny discrete pink spots, macules, which enlarge and become slightly raised papules. Each of these progresses by the third day to become a tense blister, vesicle, 6mm in diameter, deep in the skin. After two more days the fluid inside becomes turbid and the lesions are not described as pustules or by the older term of pocks. In the following days these shrink and dry up to become hard lentil-like crusts ni the skin. Eventually they separate leaving a sunken scar. The hard material which comes away contains smallpox virus in its substance


The distribution of this focal rash is characteristic, affecting the head and extremeties much more than the trunk. These features make classical smallpox easy to diagnose clinically when once the thought of the disease has entered the mind.


Mild smallpox naturally occuring - or more likely modified in this direction by residual immunity resulting from an old vaccination - also presents great difficulties in clinical diagnosis, so much so that it was described by one witness as "the clinicians nightmare". For example, a patient with only a single skin lesion on the wrist caused an outbreak of smallpox involving some 40 patients and several deaths in 1973. The extreme form of this modification is known as variola sine eruptione in which no rash follows the onset of illness. Even those patients may very occasionally be infectious through droplets from the mouth.


There is no treatment recognised as effective once the illness has started. Depending on the strain, 1% - 30% mortality is likely.

[The Magical Mischief Tour]

Manassas VA.

[PennsylvaniaMom]

There was another thread about this, and I will throw my thoughts into the diagnosis theories. What about Cox-Sackie. It has been a warm fall. CS comes from canine feces decaying in soil. Symptoms include a rash, fever, malaise. The article is not clear...does the rash represent itself in the same child after the child returns to school? If so, then environmental factors, cafeteria items, soaps in the restrooms, etc. need all be examined.

[SarahW]

This sounds EXACTLY like what my son and I had around halloween.

THe doctor thought MAYBE fifth disease, but the rash wasn't "right". My son had a high fever, tummy trouble, and developed a rash on his cheeks and chest and arms. I had a lower fever, tummy trouble, and a very pronounced rash on my face - the rash for both of us was not "flat and lacy" but looked more like contact dermatitis; i.e. little red bumps, some of them weepy.

FWIW I am in Richmond, not so far away from these folks.

No fever in my child has ever scared me more - smallpox was looming large in my mind at the time.

[SarahW]

BTW, the pediatrician thought an enterovirus the most likely culprit, with fifth disease another possibility.

[deport]

A few other articles on the subject over the past few days..... ALL FROM HERE....

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WJLA  

Tuesday November 20 07:00 PM EST

Classes Cancelled After Skin Irritation Hits Students

Students at Marsteller Middle School will get an extended Thanksgiving holiday, after a strange incident today.

Prince William County school authorities say about 30 kids at the Manassas school had skin irritation, itching and redness. All were treated at the school and none went to the hospital. But just what caused the problem remains a mystery.

So tomorrow, the 940 students, plus their teachers, are being given the day off, while tests are done to try and figure out the cause. However, school system spokeswoman Irene Cromer says they don't think there is anything in the building.

Twelve-month employees at Marsteller will have to work tomorrow, unless they had previously arranged leave.

Copyright 2001 ABC 7 WJLA-TV

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WJLA  

Tuesday November 27 08:05 PM EST

Mystery Skin Irritation Strikes Again

A mysterious skin irritation has once again hit a school in Manassas.

Today, 114 students and four staffers at Marsteller Middle School were affected. The symptoms -- irritation, itching and redness -- are very similar to what happened last Tuesday, when about 30 youths were affected.

Marsteller will be closed to students tomorrow, though faculty and staff should report to work.

Prince William County Public Schools spokeswoman Irene Cromer says one student was confirmed to have Fifth Disease. The Centers for Disease Control says that is a mild rash that occurs most commonly in children, and is often preceded by a cold or low-grade fever.

No one had to be hospitalized today.

More tests will be done at the school tomorrow, in addition to the ones performed last week.

Copyright 2001 ABC 7 WJLA-TV 

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WJLA  

Thursday November 29 09:37 AM EST

Classes To Resume at Rash-Stricken School

Classes will resume tomorrow at a Manassas school where more than a hundred people have come down with a mysterious skin irritation.

Students at Marsteller Middle School were told to stay home today after the mystery ailment turned up yesterday for the third time in eight days. Irene Cromer with the Prince William County Public Schools says there's still no word on what's causing the problems.

Marsteller has 950 students and about 90 teachers and other staffers.

Principal Karen Poindexter says no one has been hospitalized, and everyone's symptoms are mild and are being treated with ointments and antihistamines.

Copyright 2001 ABC 7 WJLA-TV

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[aristeides]

Fortunately this disease doesn't sound particularly serious, but schools are one of the classic ways for infectious diseases to spread. Another reason for home schooling.

[operation clinton cleanup]

Sorry, I have not read all the posts.

[xm177e2]

something is wrong here...very wrong.

Something is very weird, but it looks totally unrelated to terrorism. It's actually probably quite exciting for the scientists, they might even discover a new disease!

The symptoms flares up only when the students are in the school itself, which means something in the school is triggering the symptoms.

It could be that bacteria or fungi or virus particles are all over the school, being spread by something inside it, but that they have very low survival capabilities after they start attacking someone. In that case, the disease (or whatever it is) would not leave the school, and would die out after the scientists go to work.

It could be that some sort of agent like bacteria or a fungus is producing some nasty chemicals, which cause a rash in some of the students.

It doesn't seem like it would be any kind of dangerous disease or virus, because it isn't really hurting anyone and it isn't spreading outside of the school. I wouldn't get worried about it.

[bluefish]

Article said they changed the filters while the school was shut down. This of course allows more smaller particles behind the filter to get through initially I believe. So if the source is on the pre-filter side and still present, changing the filters is likely to allow more through. If the source was a one time event, changing them would be a good idea. Perhaps the filters should have been sent to a lab of some sort for a very thorough examination. They should have been sent to the CDC, who would probably appreciate an opportunity to inspect it and probably has all kinds of experts who would know what to look for.

[Nita Nupress]

There's no way this is smallpox. Smallpox rash doesn't "come and go" like this seems to be doing. And the rash appears on the oral mucosa, not just on the skin.

[Nita Nupress]

Also, antibodies can be detected in the blood by the sixth day of rash. You CAN'T tell me that none of these students have been tested for it by now.

[The Magical Mischief Tour]

Article said that none had gone to the doctor they were all treated at school..

I may be wrong...

[vannrox]

December 08, 1989 / 38(48);831-832,837-838

Ebola Virus Infection in Imported Primates -- Virginia, 1989

In late November 1989, Ebola virus was isolated from cynomolgus monkeys (Macaca fascicularis) imported into the United States from the Philippines via Amsterdam and New York. During quarantine in a primate facility in Virginia, numerous macaques died, some with findings consistent with simian hemorrhagic fever (SHF). The U.S. Army Medical Research Institute of Infectious Diseases tested 10 animals and, from three, isolated SHF from tissues and serum; however, five other animals of the 10 tested were positive for Ebola virus. Monkeys from a later shipment quarantined in a second room also had unusually high mortality and were tested by a rapid antigen detection enzyme-linked immunosorbent assay. Ebola viral antigen was detected in serum and/or tissues from seven of these monkeys. Primary liver material from animals in both rooms exhibited particles with typical filovirus morphology by electron microscopy and Ebola virus antigen by immunohistochemistry.

All persons who might have come in contact with the monkeys or with tissue or blood specimens from them have been identified and will be under surveillance by the Virginia State Department of Health for 3 weeks after the last possible exposure for each contact. As of December 6, no evidence of infection has appeared in any of the exposed persons. Any person with symptoms compatible with Ebola infection will be admitted to a local hospital and cared for under CDC guidelines for suspected cases of viral hemorrhagic fevers (1). Appropriate guidelines for management of newly imported primates have been sent to all U.S. primate importation and quarantine facilities, and surveillance for hemorrhagic disease in staff members and in recently imported primates is being instituted. An investigation is under way by CDC, in cooperation with foreign health officials, to identify the source of infection in the monkeys. Reported by: D Dalgard, DVM, Hazelton Research Products, Inc, Reston; JY Baumgardner, MAS, CW Armstrong, MD, SR Jenkins, VMD, CD Woolard, MPH, GB Miller, Jr, MD, State Epidemiologist, Virginia State Dept of Health. PB Jahrling, PhD, TG Ksiazekdum, PhD, EO Johnson, PhD, CJ Peters, MD, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland. Div of Quarantine, Center for Prevention Svcs; Div of Viral and Rickettsial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Unlike SHF virus, which does not cause clinical illness in humans, Ebola virus can cause severe disease in humans. This report describes the first isolation of Ebola virus in the United States.

Ebola hemorrhagic fever was first recognized in 1976, when two epidemics occurred in southern Sudan and in Zaire (2). A subsequent outbreak occurred in 1979 in Sudan (3). All three outbreaks were associated with high case-fatality rates in humans. In these epidemics, nosocomial transmission (often by contaminated needles) was followed by person-to-person transmission to household members in close contact with blood or secretions from seriously ill patients.

The ecology, natural history, and mode of transmission in nature of Ebola virus and the related Marburg virus are unknown. Before this incident, no monkey had ever been found to be naturally infected with Ebola virus. The incubation period for Ebola virus is 5-9 days (range: 2-15 days) but can be shorter with parenteral transmission. Disease onset is abrupt and characterized by severe malaise, headache, high fever, myalgia, joint pains, and sore throat. The disease course is rapid and includes pharyngitis, conjunctivitis, diarrhea, abdominal pain, and occasionally facial edema and jaundice. Severe thrombocytopenia can occur, and hemorrhagic manifestations include petechiae and frank bleeding. Death occurs primarily as a result of hypovolemic shock and its consequences. There is no specific therapy (1), and patient management is usually directed at supportive measures.

The only previous documentation of transmission of this family of virus from primates to humans occurred in 1967, when African monkeys infected with Marburg virus were imported into Europe (4). In that outbreak, human infection occurred in 25 workers handling blood and tissues from infected monkeys, and six secondary (person-to-person transmission) cases occurred; seven persons died. Animal caretakers did not become infected.

As a result of the 1967 Marburg virus outbreak, the United States and several other countries instituted a 31-day quarantine for imported monkeys. The facility in the Virginia outbreak routinely has used a 45-day quarantine. In addition to quarantine measures, the use of universal precautions in handling animals or their specimens minimizes the risk for human infections. Suspected cases of illness in potentially exposed persons should be promptly reported through state health departments to the Special Pathogens Branch, Division of Viral and Rickettsial Diseases, Center for Infectious Diseases, CDC.

References

1. CDC. Management of patients with suspected viral hemorrhagic fever. MMWR 1988;37 (no. S-3):1-16.

2. World Health Organization. Ebola hemorrhagic fever in Sudan, 1976: report of a WHO/International Study Team. Bull WHO 1978;56:247-70.

3. Baron RC, McCormick JB, Zubeir OA. Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread. Bull WHO 1983;61:997-1003.

4. Martini GA, Siegert R, eds. Marburg virus disease. Berlin: Springer-Verlag, 1971.

[meridia]

Indexing

[The Magical Mischief Tour]

Oh man I need a drink...

[July 4th]

Charter pipeline sucks. I can't get washington post to come up

Guess what? It will suck even more tomorrow. Tonight, all of Charter's subscribers who use the @home service will likely get bumped over to Pipeline. I'm expecting slower download speeds come tomorrow. Or as Tony Blair says, toomorrow.

[The Magical Mischief Tour]

Better make that a double...

[Salvation]

Allergies? I know one of the schools in my town has mold in it. Teachers and students get sick every winter.

[rwt60]

It could be fungal. Several fungal strains are quite contagious if people are sharing showers, towels, etc.

Another possibility, Pittariasis Rosea, is something my son just had. It's viral and not serious. Bumps and a certain degree of itchiness. It lasts several weeks. He lives in Virginia.