Epidemiology and Infection

Gastrointestinal infection

Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan

T. LESLIEa1a2 c1, C. A. WHITEHOUSEa3, S. YINGSTa3, C. BALDWINa3, F. KAKARa4, J. MOFLEHa4, A. S. HAMIa1, L. MUSTAFAa4, F. OMARa4, E. AYAZIa4, C. ROSSIa3, B. NOORMALa4, N. ZIARa4 and R. KAKARa5

a1 Health Protection and Research Organisation, Kabul, Afghanistan

a2 London School of Hygiene and Tropical Medicine, London, UK

a3 U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA

a4 Ministry of Public Health, Kabul, Afghanistan

a5 World Health Organization, Kabul, Afghanistan

SUMMARY

Plague, which is most often caused by the bite of Yersinia pestis-infected fleas, is a rapidly progressing, serious disease that can be fatal without prompt antibiotic treatment. In late December 2007, an outbreak of acute gastroenteritis occurred in Nimroz Province of southern Afghanistan. Of the 83 probable cases of illness, 17 died (case fatality 20·5%). Being a case was associated with consumption or handling of camel meat (adjusted odds ratio 4·4, 95% confidence interval 2·2–8·8, P<0·001). Molecular testing of patient clinical samples and of tissue from the camel using PCR/electrospray ionization–mass spectrometry revealed DNA signatures consistent with Yersinia pestis. Confirmatory testing using real-time PCR and immunological seroconversion of one of the patients confirmed that the outbreak was caused by plague, with a rare gastrointestinal presentation. The study highlights the challenges of identifying infectious agents in low-resource settings; it is the first reported occurrence of plague in Afghanistan.

(Accepted June 30 2010)

(Online publication July 22 2010)

Correspondence:

c1 Author for correspondence: Dr T. Leslie, Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. (Email: toby.leslie@lshtm.ac.uk)

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