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Unexplained deaths and critical illnesses of suspected infectious cause, Taiwan, 2000-2005.

Wang TH, Wei KC, Jiang DD, Chiu CH, Chang SC, Wang JD - Emerging Infect. Dis. (2008)

Bottom Line: We report 5 years' surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection.A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%).

View Article: PubMed Central - PubMed

Affiliation: Taiwan Centers for Disease Control, Taipei, Taiwan.

ABSTRACT
We report 5 years' surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection. A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%).

Show MeSH

Related in: MedlinePlus

Flow of information and decision making for reported cases of unexplained death or critical illness. *If unexplained infectious causes were suspected, COUNEX mobilized an investigation team including experts, field epidemiology training program members, public health workers from the local branch of Taiwan Centers for Disease Control (TCDC), and public health authorities to proceed with further field investigation. TCDC was in charge of the investigation. †Cases were categorized into >1 of the following clinical syndromes: acute neurologic (encephalitis, meningitis), acute respiratory (pneumonia), acute hemorrhagic, acute diarrhea, acute jaundice (hepatitis), acute heart (myocarditis, pericarditis, endocarditis), and acute kidney-related. For every reported case, COUNEX investigators usually selected diagnostic tests relevant to a particular syndrome (www.cdc.gov.tw). Additional tests were prescribed if needed. The hospital laboratories were requested to save all remaining clinical specimens, including biopsy specimens, obtained from clinical management and send them to our reference laboratories, if indicated. ‡If an autopsy was performed, whenever possible tissue specimens were examined by pathologists of TCDC-designated medical centers and the Forensic Department of the Ministry of Justice to ensure the accuracy of the final diagnosis. Specimens were also sent for microbiologic cultures and tests as well as toxicologic examination for trace toxic chemicals, if needed. §All laboratory results and clinical, epidemiologic, and pathologic data were sent to the expert committee to determine if the etiologic agent could fully or most likely explain the disease. Otherwise, cases were categorized as unexplained. In general, histopathogic examination was the major evidence for determining cause. If case-patients could not be autopsied within 36 hours of death, laboratory results would be the most useful information for identification of cause of death.
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Figure 1: Flow of information and decision making for reported cases of unexplained death or critical illness. *If unexplained infectious causes were suspected, COUNEX mobilized an investigation team including experts, field epidemiology training program members, public health workers from the local branch of Taiwan Centers for Disease Control (TCDC), and public health authorities to proceed with further field investigation. TCDC was in charge of the investigation. †Cases were categorized into >1 of the following clinical syndromes: acute neurologic (encephalitis, meningitis), acute respiratory (pneumonia), acute hemorrhagic, acute diarrhea, acute jaundice (hepatitis), acute heart (myocarditis, pericarditis, endocarditis), and acute kidney-related. For every reported case, COUNEX investigators usually selected diagnostic tests relevant to a particular syndrome (www.cdc.gov.tw). Additional tests were prescribed if needed. The hospital laboratories were requested to save all remaining clinical specimens, including biopsy specimens, obtained from clinical management and send them to our reference laboratories, if indicated. ‡If an autopsy was performed, whenever possible tissue specimens were examined by pathologists of TCDC-designated medical centers and the Forensic Department of the Ministry of Justice to ensure the accuracy of the final diagnosis. Specimens were also sent for microbiologic cultures and tests as well as toxicologic examination for trace toxic chemicals, if needed. §All laboratory results and clinical, epidemiologic, and pathologic data were sent to the expert committee to determine if the etiologic agent could fully or most likely explain the disease. Otherwise, cases were categorized as unexplained. In general, histopathogic examination was the major evidence for determining cause. If case-patients could not be autopsied within 36 hours of death, laboratory results would be the most useful information for identification of cause of death.

Mentions: In 2000, the Taiwan Centers for Disease Control collaborated with academic institutions, medical examiners, local health authorities, and experts from different fields to establish a nationwide surveillance center for outbreak and unexplained death investigation due to unknown infectious causes (COUNEX) (Figure). This effort was to build Taiwan’s capacity for detecting and responding to uncommon and unrecognized pathogens, which was conceptually the same as that of the study of Hajjeh et al. (10). We defined the surveillance case-patient as a previously healthy resident who died or was admitted to a hospital with a life-threatening illness possibly caused by infection of unidentified etiology. Usually the death occurred within 3 days of the patient’s admission. Patients were excluded if the cause of death was noninfectious. A life-threatening illness was defined as any illness requiring admission to an intensive care unit or report as being critical. An infectious disease is generally suspected if the case-patient has >1 of the characteristics such as fever, leukocytosis, histopathologic evidence of an acute infectious process or more specific symptom patterns, or infection precipitating adult respiratory distress syndrome, renal failure, or sepsis.


Unexplained deaths and critical illnesses of suspected infectious cause, Taiwan, 2000-2005.

Wang TH, Wei KC, Jiang DD, Chiu CH, Chang SC, Wang JD - Emerging Infect. Dis. (2008)

Flow of information and decision making for reported cases of unexplained death or critical illness. *If unexplained infectious causes were suspected, COUNEX mobilized an investigation team including experts, field epidemiology training program members, public health workers from the local branch of Taiwan Centers for Disease Control (TCDC), and public health authorities to proceed with further field investigation. TCDC was in charge of the investigation. †Cases were categorized into >1 of the following clinical syndromes: acute neurologic (encephalitis, meningitis), acute respiratory (pneumonia), acute hemorrhagic, acute diarrhea, acute jaundice (hepatitis), acute heart (myocarditis, pericarditis, endocarditis), and acute kidney-related. For every reported case, COUNEX investigators usually selected diagnostic tests relevant to a particular syndrome (www.cdc.gov.tw). Additional tests were prescribed if needed. The hospital laboratories were requested to save all remaining clinical specimens, including biopsy specimens, obtained from clinical management and send them to our reference laboratories, if indicated. ‡If an autopsy was performed, whenever possible tissue specimens were examined by pathologists of TCDC-designated medical centers and the Forensic Department of the Ministry of Justice to ensure the accuracy of the final diagnosis. Specimens were also sent for microbiologic cultures and tests as well as toxicologic examination for trace toxic chemicals, if needed. §All laboratory results and clinical, epidemiologic, and pathologic data were sent to the expert committee to determine if the etiologic agent could fully or most likely explain the disease. Otherwise, cases were categorized as unexplained. In general, histopathogic examination was the major evidence for determining cause. If case-patients could not be autopsied within 36 hours of death, laboratory results would be the most useful information for identification of cause of death.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2609874&req=5

Figure 1: Flow of information and decision making for reported cases of unexplained death or critical illness. *If unexplained infectious causes were suspected, COUNEX mobilized an investigation team including experts, field epidemiology training program members, public health workers from the local branch of Taiwan Centers for Disease Control (TCDC), and public health authorities to proceed with further field investigation. TCDC was in charge of the investigation. †Cases were categorized into >1 of the following clinical syndromes: acute neurologic (encephalitis, meningitis), acute respiratory (pneumonia), acute hemorrhagic, acute diarrhea, acute jaundice (hepatitis), acute heart (myocarditis, pericarditis, endocarditis), and acute kidney-related. For every reported case, COUNEX investigators usually selected diagnostic tests relevant to a particular syndrome (www.cdc.gov.tw). Additional tests were prescribed if needed. The hospital laboratories were requested to save all remaining clinical specimens, including biopsy specimens, obtained from clinical management and send them to our reference laboratories, if indicated. ‡If an autopsy was performed, whenever possible tissue specimens were examined by pathologists of TCDC-designated medical centers and the Forensic Department of the Ministry of Justice to ensure the accuracy of the final diagnosis. Specimens were also sent for microbiologic cultures and tests as well as toxicologic examination for trace toxic chemicals, if needed. §All laboratory results and clinical, epidemiologic, and pathologic data were sent to the expert committee to determine if the etiologic agent could fully or most likely explain the disease. Otherwise, cases were categorized as unexplained. In general, histopathogic examination was the major evidence for determining cause. If case-patients could not be autopsied within 36 hours of death, laboratory results would be the most useful information for identification of cause of death.
Mentions: In 2000, the Taiwan Centers for Disease Control collaborated with academic institutions, medical examiners, local health authorities, and experts from different fields to establish a nationwide surveillance center for outbreak and unexplained death investigation due to unknown infectious causes (COUNEX) (Figure). This effort was to build Taiwan’s capacity for detecting and responding to uncommon and unrecognized pathogens, which was conceptually the same as that of the study of Hajjeh et al. (10). We defined the surveillance case-patient as a previously healthy resident who died or was admitted to a hospital with a life-threatening illness possibly caused by infection of unidentified etiology. Usually the death occurred within 3 days of the patient’s admission. Patients were excluded if the cause of death was noninfectious. A life-threatening illness was defined as any illness requiring admission to an intensive care unit or report as being critical. An infectious disease is generally suspected if the case-patient has >1 of the characteristics such as fever, leukocytosis, histopathologic evidence of an acute infectious process or more specific symptom patterns, or infection precipitating adult respiratory distress syndrome, renal failure, or sepsis.

Bottom Line: We report 5 years' surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection.A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%).

View Article: PubMed Central - PubMed

Affiliation: Taiwan Centers for Disease Control, Taipei, Taiwan.

ABSTRACT
We report 5 years' surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection. A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%).

Show MeSH
Related in: MedlinePlus