Unexplained Critical Illnesses and Deaths of Possible Infectious Etiology, 2004

Surveillance for unexplained critical illnesses and deaths of possible infectious etiology began in September 1995. Any case should be reported, regardless of the patient’s age or underlying medical conditions. A subset of cases (persons 6 months to 49 years of age with no underlying medical conditions who died of apparent non-nosocomial infectious processes) are eligible for testing performed at CDC as part a special project. For cases not eligible for the CDC project, some testing may be available at MDH or CDC, at the physician’s request.

Fifty-two cases were investigated by MDH in 2004, compared to 38 cases in 2003. The cause(s) of illness subsequently were determined by the providers for 11 cases. Among the remaining 41 cases, 17 case-patients presented with respiratory symptoms; five presented with shock/sepsis; six presented with neurologic symptoms; two presented with cardiac symptoms, seven presented with sudden unexpected death (SUD), and four presented with gastrointestinal (GI) symptoms. Case-patients with respiratory symptoms ranged from 15 to 72 years of age; those with sepsis were 22 to 43 years of age; the neurologic case-patients were 10 to 76 years of age; the cardiac case-patients were 29 and 45 years of age; the sudden unexpected deaths were 2 months to 44 years of age; and the case-patients with GI symptoms were 30 to 83 years of age. Eleven patients with respiratory symptoms, four patients with sepsis, and one patient with neurologic symptoms died as did one patient with GI symptoms and one with a cardiac syndrome. Seven respiratory case-patients; two of the neurologic case-patients, three shock/sepsis case-patients; and both cardiac case-patients; and two case-patients with sudden unexpected death resided in the Twin Cities metropolitan area. The remaining case-patients resided in Greater Minnesota, except for two respiratory case-patients who were out-of-state residents hospitalized in Minnesota.

Eighteen cases were eligible for the CDC project (eight respiratory, three sepsis, one neurologic, one GI, one cardiac case(s); and four SUDs). Specimens were obtained for testing at MDH or CDC for all cases. Plausible etiologies were established for four cases. A 28-year-old female who died with respiratory symptoms had positive PCR tests for S. pneumoniae and picornavirus from two lung samples. The same samples had viral cultures positive for Echovirus 5. A 44-year-male who died with a respiratory syndrome had a urine antigen and immunohistochemical testing of lung samples that were positive for Legionella pneumophila serogroup 1. The 48-year-old male who died of a neurologic syndrome had a 16s PCR test of a brain abscess that was positive for Fusobacterium nucleatum. Immunohistochemistry and PCR testing demonstrated the presence of Clostridium perfringens in necrotic bowel of a 30-year-old female who died with GI symptoms.

• For up to date information see>> Unexplained Deaths and Critical Illnesses
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2004