Yet another strange outbreak has arisen. This time it’s Africa.
Chickenpox? Mild Smallpox?
Monkey pox?
A ProMED-mail post
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International Society for Infectious Diseases
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Date: Mon 23 Nov 2020
Source: Afrik [in French, trans. Corr. SB, edited]
https://www.afrik.com/senegal-maladie-des-pecheurs-a-thiaroye-le-mystere-perce
Senegal, fishermen's disease in Thiaroye: the mystery unraveled?
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The mysterious disease which has afflicted hundreds of fishermen from different regions of Senegal seems to have an explanation, which is not toxic, and a long way from being viral. What could be the cause?
The details
A mysterious disease has appeared in recent days among fishermen in Thiaroye-sur-Mer, a Dakar suburb, and has spread to other localities in Senegal, triggering panic in all the fishing villages. While hundreds, even a thousand people suffer from attacks, in particular dermal, linked to the disease, the health authorities reassured, indicating that the source is not viral.
While specialists evoke a toxic origin, asking that research be directed towards fishermen's nets, a Senegalese doctor seems to have unraveled the mystery of this mysterious disease. According to the "white coat" that was published by the online newspaper Seneweb, the fishermen are suffering from chickenpox.
"'Chickenpox is a contagious disease caused by the chickenpox virus [varicella-zoster virus]. You only catch it once in your life; after that you acquire immunity. Its infection is very rapid. This is why in the fishing villages, where there is great promiscuity, it may seem logical that the disease affects so many people in such a short time,' said the white coat.
'The treatment is just symptomatic with antiseptics to wash off and also antihistamines to stop the itching. At times, to avoid bacterial superinfection, antibiotics can be added. This treatment bears fruit 2 or even 3 weeks later,' continues the doctor.
'Chickenpox in children is less severe than in adults. That is to say, the longer we delay having chickenpox, the more likely we are to get a fairly severe chickenpox like what we are currently seeing in these young adult fishermen. We should isolate them, give them symptomatic treatment, and wait for spontaneous recovery,' he concludes."
Note that this mysterious disease spread very quickly among the fishermen of Thiaroye-sur-mer. Of 60 cases, some 200 people were affected in less than 48 hours, pushing the health authorities to deploy big means to try to contain the disease. Serious cases were quickly taken care of.
[Byline: Alioune Diop]
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[The information in the above report raises several questions about this outbreak. One physician indicated that these are chickenpox cases, but health authorities are quoted as saying that the source is not viral. It is not clear if the chickenpox diagnosis has been laboratory confirmed or was made on clinical grounds based on the lesions the fishermen have. The lesions can be seen in a photograph published in the above source URL. Although the report indicates that there are 60 cases and 200 people were affected, only fishermen are mentioned, and it does not indicate if any individuals other than fishermen had the diseases. The report states that fishermen in different regions of Senegal are affected, but only Thiaroye is mentioned. Over the past 10 years, ProMED-mail has posted just 2 reports of chickenpox in Africa, in Liberia and Uganda, but not from Senegal. However, there is no reason to think that Senegal is free of chickenpox. ProMED-mail would appreciate receiving any additional information that would address the questions raised in the comments. - Mod.TY]
[The rapid spread of the rash is compatible with chickenpox, which is seen in outbreaks in adults in Africa in contrast to Europe and North America. Monkeypox cannot entirely be excluded based on the appearance of the lesions, but such a large outbreak would be unusual (Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, Zumla A. Infect Dis Clin North Am. 2019 Dec; 33(4): 1027-1043). - Mod.EP]
[I am not sure the lesions shown in the photo that accompanies the Afrik news report look like chickenpox (
https://www.afrik.com/senegal-maladie-des-pecheurs-a-thiaroye-le-mystere-perce). Unlike the rash in this news report picture, all the various stages of the chickenpox rash, i.e., papules, vesicles, pustules, and scabs, are seen at the same time. Also, unlike the rash in the news report picture, chickenpox vesicles are superficial, i.e., they look like "dew drops."
The Senegalese pocks in the news report picture are all in the same stage of development. Although varying somewhat in size, all resemble each other in appearance. Also, unlike chickenpox, they appear to be deeply embedded in the skin and dome-shaped, as well as umbilicated, more like the smallpox rash (
https://www.cdc.gov/smallpox/clinicians/clinical-disease.html).
The Senegalese pocks looks more like the pocks shown in Figure 2 in MMWR report of the multistate outbreak of monkeypox in Illinois, Indiana, and Wisconsin in 2003 (
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5223a1.htm#fig1). The MMWR text says, "The monkeypox rash includes macules, papules, vesicles, pustules, and crusts that evolve in the same stage over 14-21 days, similar to smallpox (6). A major clinical difference between monkeypox and smallpox is pronounced lymphadenopathy in a majority of patients with monkeypox (6)." (Reference 6: Jezek ZM, Scczeniowski KM, Paluku M, Putombo M, Grab B. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987; 156:293-8.) Laboratory confirmation of the virologic diagnosis is urgently needed. - Mod.ML