Hemorrhagic Fevers : Few Clues after 25 Years

There is a high prevalence of Ebola antibodies found in the Kenya population; related to geographical area and season; although the clinical disease was never found and the virus was not isolated. A field study was carried out in 7 hospitals in western Kenya; 1986 -1987 (including surveillance studies in suspect areas); to intensify collection and transport of samples; testing facilities; patient observation with record keeping and follow-up. This study involved 1109 admitted patients with fever and/or bleeding; 155 contacts of haemorrahagic fever antibody (Hfab) patients; and 916 people in suspect areas. Respectively 160;44 and 80 persons were found Hfab positive mainly to Ebola; using an indirect immunofluorescent assay. From 676 viral cultures no virus was isolated. A relationship between antibody titres and ecological factors; social habitat; age; sex or season was not found. The non-specificity of IF testing was demonstrated by: 1) the disagreement between the results of two reference laboratories; 2) the unpredictability of the titre conversation course; and 3) by proving a significant cross-reactivity with Borrelia burgdorferii antibodies; Plasmodium falcparum antibodies and Salmonella typhi antibodies. Renewed testing in 1995 of 90 positive sera (with low titres) showed 19 sera to be positive by Elisa (2 in Zaire; 1 in Sudan; 9 in Reston and 7 in Cote d'Ivoire) from which 4 were confirmed by IFI 2 in Reston and 2 in Cote d'Ivoire. These findings are more proof that non-human virulent strains of Filoviridae; especially Ebola virus; are around in Kenya

Analysis of Infectious Diseases in Rural Tropical Areas

A study of 256 annual reports from 17 rural tropical hospitals in 4 African countries over a period of 16 years showed an absolute increase in the number of patients admitted with infectious diseases. Admissions were highest for malaria; followed by pneumonia and gastroenteritis. Admissions for immunisable diseases are decreasing in all countries. Fever remains the most important indicator of infectious diseases. Analysis of fever patients in rural tropical hospitals relies on knowledge of the epidemiology of diseases; plus expertise in physical examination. In this study; a detailed analysis of 900 fever patients indicated that 4showed no infection; 21of infections could be diagnosed by physical examination; 35were diagnosed with the help of additional laboratory tests and 40of patients were diagnosed as FUO (fever of unknown origin). 17of FUO patients had a short; self limiting fever; but the remaining 23were severely ill; suggesting bacterial sepsis; as was indicated by earlier studies. Undiagnosed fevers with resulting over-treatment and high resistance are costly and dangerous. These effects stress the need for better and more laboratory facilities; including possibilities for bacterial cultures. At present; patients are generally over-treated with antimalarials and antibiotics; since further diagnostic facilities are not available. Resistance is high for antimalatials ( Malaria) and for Amoxycillin; Cotrimoxazole and Gentamicin (Gram-bacteria from urine and blood)