Unexplained Critical Illnesses and Deaths of Possible Infectious Etiology, 2005

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 up 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.

Sixty-seven cases (32 deaths and 35 critical illnesses) were reported in 2005, compared to 52 cases in 2004. The cause(s) of illness subsequently were determined for 11 cases. Among the remaining 56 cases, 15 case-patients presented with respiratory symptoms; eight presented with shock/sepsis; 20 presented with neurologic symptoms; nine presented with cardiac symptoms; one presented with sudden unexpected death (SUD); one presented with hepatic symptoms; and two had illnesses that did not fit a defined syndrome. Case-patients with respiratory symptoms ranged from 4 months to 60 years of age; those with sepsis were 17 to 77 years of age; the neurologic case-patients were 1 month to 65 years of age; the cardiac case-patients were 13 and 73 years of age; the sudden unexpected death was 11 months of age; the hepatic case-patient was 17 years of age; and the case-patients without a defined syndrome were 43 and 72 years of age. Nine patients with respiratory symptoms, four patients with sepsis, two patients with neurologic symptoms, and seven patients with a cardiac syndrome died as did one patient with without a defined syndrome. Thirty patients resided in the Twin Cities metropolitan area, 16 case-patients resided in Greater Minnesota, and 10 case-patients were out-of-state residents hospitalized in Minnesota.

Thirteen cases were eligible for the CDC project (five respiratory, one sepsis, two neurologic, four cardiac case(s); and one SUD). Specimens were obtained for testing at MDH or CDC for 10 cases. Probable etiologies were established for two cases. A 34-year-old female who died with respiratory symptoms had positive 16s PCR tests for Fusobacterium necrophorum from tonsil and peritonsillar soft tissue samples. A 44-year-female who died with a shock/sepsis syndrome had immunohistochemical testing of multiple organ samples that were positive for Staphylococcus aureus. PCR testing of a blood sample was also positive for S. aureus.

Testing was also provided at MDH and/or CDC at the physician’s request for 22 of the 43 cases that were not eligible for the CDC project. Probable etiologies were found for four of these cases. A young child with a critical illness and history of travel in China had positive PCR tests of a nasopharyngeal sample for respiratory syncytial virus and picornavirus. A 23-year-old female with a critical illness and exposure and symptoms compatible with rat-bite fever had positive 16s PCR results of a blood sample for Streptobacillus moniliformis. A 40-year-old asplenic male who died of shock/sepsis had immunohistochemical tests of multiple organ samples that were positive for Streptococcus pneumoniae. A postmortem blood sample also had a positive PCR result for S. pneumoniae. A 50-year-old male who died of a respiratory syndrome had immunohistochemical test results of a lung sample that were positive for S. pneumoniae and a PCR test result of a lung sample that was positive for picornavirus.

• 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, 2005