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Investigation Of ARDS Death Cases

Report on Investigation Of Acute Respiratory Distress Syndrome (ARDS) Death Cases In Zhemgang in October,2011

Objective: To determine the cause of death by infectious pathogens and its significant to public health risk.

Method: Visited Yebilaptsa hospitals and Zhemgang BHU-I to review previous death case. Interviewed close contacts and friends of the deceased, inspected apartment/room and vicinity where deceased lived in Zhemgang town and conducted autopsy to collect tissue samples.

Finding: Both death cases had similar clinical presentation and succumbed to death within 4-5 hours of onset of episode with cardio-pulmonary arrest. The disease progressions in both cases were very rapid and dramatic and moreover, both cases were mates and have been living in same apartment in different rooms. However, time gap between two death cases were 40 days apart and the first case to be the source for second case is highly unlikely because 40 days of incubation periods for any possible infectious agent to cause ARDS is very long. Moreover, none of the contacts or friends of both the cases have not developed any similar signs and symptoms nor there was any similar cases reported in the areas during the time of death of both cases. Also none of the two cases had travel history outside Zhemgang to suspect zoonotic or vector borne related pathogens.

Conclusion: The two death cases were isolated case and have no epidemiological link between them to determine the 1st cases as source to 2nd cases although both died from ARDS and lived together is the same apartment. The death appears to be coincidental and probably has no public health significance. However, tissues samples were shipped to CDC Atlanta in the US for further laboratory tests.