Skip to main content
×
Home

Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan

  • T. LESLIE (a1) (a2), C. A. WHITEHOUSE (a3), S. YINGST (a3), C. BALDWIN (a3), F. KAKAR (a4), J. MOFLEH (a4), A. S. HAMI (a1), L. MUSTAFA (a4), F. OMAR (a4), E. AYAZI (a4), C. ROSSI (a3), B. NOORMAL (a4), N. ZIAR (a4) and R. KAKAR (a5)...
Summary
SUMMARY

Plague, which is most often caused by the bite of Yersinia pestis-infected fleas, is a rapidly progressing, serious disease that can be fatal without prompt antibiotic treatment. In late December 2007, an outbreak of acute gastroenteritis occurred in Nimroz Province of southern Afghanistan. Of the 83 probable cases of illness, 17 died (case fatality 20·5%). Being a case was associated with consumption or handling of camel meat (adjusted odds ratio 4·4, 95% confidence interval 2·2–8·8, P<0·001). Molecular testing of patient clinical samples and of tissue from the camel using PCR/electrospray ionization–mass spectrometry revealed DNA signatures consistent with Yersinia pestis. Confirmatory testing using real-time PCR and immunological seroconversion of one of the patients confirmed that the outbreak was caused by plague, with a rare gastrointestinal presentation. The study highlights the challenges of identifying infectious agents in low-resource settings; it is the first reported occurrence of plague in Afghanistan.

Copyright
Corresponding author
*Author for correspondence: Dr T. Leslie, Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, LondonWC1E 7HT, UK. (Email: toby.leslie@lshtm.ac.uk)
References
Hide All
1.Prentice MB, Rahalison L. Plague. Lancet 2007; 369: 11961207.
2.Stenseth NC, et al. Plague: past present and future. PLoS Medicine 2008; 5: e3
3.World Health Organisation. Human plague in 2000 and 2001. Weekly Epidemiological Record 2003; 78: 253260.
4.Worsham PL, et al. Plague. In: Lenhart MK, Lounsbury DE, Martin JW, Dembek ZF, eds. Medical Aspects of Biological Warfare. Washington, DC: Borden Institute, 2007, pp. 91–119.
5.Arbaji A, et al. A 12-case outbreak of pharyngeal plague following the consumption of camel meat, in north-eastern Jordan. Annals of Tropical Medicine and Parasitology 2005; 99: 789793.
6.Bin Saeed AA, Al-Hamdan NA, Fontaine RE. Plague from eating raw camel liver. Emerging Infectious Diseases 2005; 11: 14561457.
7.Christie AB, Chen TH, Elberg SS. Plague in camels and goats: their role in human epidemics. Journal of Infectious Diseases 1980; 141: 724726.
8.Stenseth NC, et al. Plague: past, present, and future. PLoS Medicine 2008; 5: e3.
9.Wallace MR, et al. Endemic infectious diseases of Afghanistan [Review]. Clinical Infectious Diseases 2002; 34 (Suppl. 5): S171–207.
10.Sirisanthana T, Brown AE. Anthrax of the gastrointestinal tract. Emerging Infectious Diseases 2002; 8: 649651.
11.Ecker DJ, et al. Ibis T5000: a universal biosensor approach for microbiology. Nature Reviews Microbiology 2008; 6: 553558.
12.Christensen DR, et al. Detection of biological threat agents by real-time PCR: comparison of assay performance on the R.A.P.I.D., the LightCycler, and the Smart Cycler platforms. Clinical Chemistry 2006; 52: 141145.
13.Duermeyer W, Wielaard F, van der Veen J. A new principle for the detection of specific IgM antibodies applied in an ELISA for hepatitis A. Journal of Medical Virology 1979; 4: 2532.
14.Iacono-Connors LC, et al. Enzyme-linked immunosorbent assay using a recombinant baculovirus-expressed Bacillus anthracis protective antigen (PA): measurement of human anti-PA antibodies. Clinical Diagnostic Laboratory Immunology 1994; 1: 7882.
15.Wernery U, Kaaden O-R. Infectious Diseases in Camelids, 2nd edn.Berlin: Blackwell Wissenschafts-Verlag, 2002.
16.Baldwin CD, et al. Usefulness of multilocus polymerase chain reaction followed by electrospray ionization mass spectrometry to identify a diverse panel of bacterial isolates. Diagnostic Microbiololgy and Infectious Diseases 2009; 63: 403408.
17.Postinikova E, et al. Identification of bacterial plant pathogens using multilocus polymerase chain reaction/electrospray ionization-mass spectrometry. Phytopathology 2008; 98: 11561164.
18.Eshoo MW, et al. Rapid and high-throughput pan-Orthopoxvirus detection and identification using PCR and mass spectrometry. PLoS ONE 2009; 4: e6342.
19.Eshoo MW, et al. Direct broad-range detection of alphaviruses in mosquito extracts. Virology 2007; 368: 286295.
20.Sampath R, et al. Global surveillance of emerging Influenza virus genotypes by mass spectrometry. PLoS ONE 2007; 2: e489.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 16
Total number of PDF views: 24 *
Loading metrics...

Abstract views

Total abstract views: 262 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 12th December 2017. This data will be updated every 24 hours.