Perhaps Bili|1956 was an Ebola virus disease outbreak...

I didn't blog this one earlier in April when it was mentioned in the literature, but have been reminded of it by Secret Squirrel D in relation to my last post.[1]

The main gist of the Letter to Lancet Infectious Diseases by Colebunders and Van den Ende [2] is that there was a clinically compatible outbreak of disease in Bili, Democratic Republic of Congo in 1956 - 20 years earlier than the first documented and laboratory-confirmed EVD outbreak there - when the DRC was called Zaire.

The 5-week disease outbreak manifested as a fever and rash followed after 10 or so days by bleeding from the mouth and nose and some times bloody diarrhoea. Vomiting blood was a precursor to death. Those without any bleeding survived and recovered after 3-weeks.

About 80 of at least 215 people died (37%), with cases clustering among family groups. A very good survival rate for some filovirus infections. Quarantine efforts and safe burials  seemed to halt the outbreak although some bodies were "recovered" by family for re-burial under more traditional circumstances. Its not clear if this process caused any new infections as it did in west Africa in 2014.

The authors of this letter conclude that the disease course, consumption of monkey meat (but not bats, despite the proximity of colonies) suggests the outbreak could have been due to a filovirus of some sort.[1]

Unfortunately we don't know which filovirus, if a filovirus at all, was responsible since there was no laboratory testing to confirm the specific agent. 

So this one remains a "could be" for now. If only there were stored samples.

References...

1. Yes, there were signs that Ebola was in west Africa, perhaps as far back as 1973...
   http://virologydownunder.blogspot.com.au/2015/04/yes-there-were-signs-that-ebola-was-in.html
2. Filovirus epidemic in 1956 in Bili, DRC
   http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70092-7/fulltext

Resp virus causing gastro but little respiratory symptoms...

Hat tip to Secret Squirrel D for this.

To add to my first two post's today,this paper by de Jong and colleagues in the New England Journal of Medicine details a 4-year old male (4M) who presented with a 2-day history of fever, headache and diarrhoea which after admission progressed; cough, then to coma and death.

4M was found to have systemic influenza A(H5N1) virus infection (viable virus was isolated from cerebrospinal fluid, throat and rectal swabs and were RT-PCR positive).4M and his sister (9F who died 2-weeks previously but had no diagnostic specimens collected) were diagnosed with acute encephalitis.

Chest X-rays were normal and 4M exhibited some lung sounds suggestive of infection after transfer to a paediatric referral hospital and he went on to respiratory failure.

This highlight my earlier points: respiratory viruses could spread from gastrointestinal disease and encephalitis has a lot of causes in addition to the usual suspects.