Date: 23 Oct 2018
Source: Nacion.co [in Spanish, machine trans. edited]
<https://www.nacion.com/el-pais/salud/virus-de-la-rabia-tiene-a-biologo-de-43-anos-en/GYVZWRC3SZGI5B3XK6SMSXWGJE/story/>

A 43-year-old biologist remains in very delicate condition at the San Juan de Dios Hospital infected with the rabies virus, the Ministry of Health has confirmed. Daniel Salas Peraza, director of the Directorate of Health Surveillance in the Ministry of Health, said the man contracted the virus during a family outing on 15 Aug 2018 when he entered a cave in Copey de Dota with his family where there were bats, and he touched one of these animals. The patient entered the San Juan de Dios on Sun 21 Oct 2018, Salas confirmed.

This information was corroborated by the hospital, as the patient arrived there with paralysis from the neck down and is being maintained with an artificial respirator in the intensive care unit.  "The patient remains with organ failure at the renal level with deterioration. Although he had previously consulted other health services, he never mentioned the incident with the bat," Salas said.

The patient has been in intensive care since 21 Oct 2018. Officials from that ministry and from the National Animal Health Service (SENASA) have been tracking the entire area of Dota since Monday [22 Oct 2018] in order to detect whether there are other cases of infection with the virus. "The search for [other] potential patients in Dota is being done to see whether there are other accidents with bats; it is being followed up on; we check whether people have been vaccinated or whether they have had symptoms. Coordination is also being done with SENASA, which is in the field to see whether the situation with the bats in that area can be further documented by taking samples to see whether the virus is present. These actions began yesterday [Mon 22 Oct 2018]," the official added, and he also confirmed that, so far, there have been no suspicious cases.

This biologist apparently came into contact with the bats of his own volition, and that was when the bite occurred in his left arm. The patient, originally from San Ignacio de Acosta, also presented with problems swallowing, high fever, and mental confusion, Salas reported.  Symptoms began on 11 Oct 2018, almost 4 weeks after contact, with numbness of the arm and, later, other limbs of the body. Salas Peraza warned that people should never come into contact with bats or other types of wild animals. In this case, apparently, the biologist entered the cavern on his own and touched these mammals, and from there, he became infected with the virus.

Bats are, for now, the only transmitters of human rabies detected in the country. If there is any type of bite, you should go immediately to a health center to get the rabies vaccine [post exposure prophylaxis, PEP], because as soon as the symptoms appear, there is little that can be done for the person.  Human rabies has a mortality close to 100 percent. Symptoms of this disease include bodily pain, seizures, hallucinations, paralysis, headache, fever and irritability.

The last death in the country of a person for this reason was recorded in 2014, when a 9-year-old boy died in Palmar Norte, in the southern zone. Bats play prominent roles in the ecosystem that bring benefits to humans. Hence, it is important that people do not invade their habitats. Salas Peraza emphasized this because, he said, it is not about attacking these animals, because they are in our midst. "What interests us most is that the population becomes aware; we must take care and distrust them. Do not kill them, but do not touch them," he reiterated.

According to specialists consulted by La Nacion, bats are the only group of mammals that fly. They are the 2nd most diverse group of mammals in the world, after rodents. Some eat fish, others, insects, frogs, mice or spiders, but bats can also feed on fruits or the nectar of flowers, which makes them fundamental in the reproductive cycle of plants.
====================
[Rabies is a viral infection affecting the nervous system of mammals. It invariably causes swelling of the brain and death after a relatively short illness.

The rabies virus is found in the nervous tissue of infected mammals. As the virus travels to the brain, it is secreted in the saliva of the animal. All mammals get rabies when infectious saliva is introduced into the body, usually through a bite from an infected animal.

Rabies may be transmitted by other means, which are rarer. These exposures include saliva or nervous tissue entering an open wound, or saliva or nervous tissue coming into contact with a mucous membrane such as the eyes, nose or mouth.

Animals may be aggressive, known as the furious form. An animal may also be very withdrawn, known as the dumb form. It may be difficult to tell whether a bat is suffering from either form. However, a bite from any bat is reason for concern. Any bat, even found in your home or room, especially at night, is reason for concern. Bites may occur at night without waking the victim. It is possible that in this case, the bitten individual was unaware he had been bitten.

If the individual knew he had been bitten, washing with soap and water and seeking immediate treatment may have saved his life. After a bite, post-exposure prophylaxis is needed. Rabies post-exposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.

Medical attention should be sought as rapidly as possible after a possible exposure. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Sun, 21 Oct 2018 07:19:57 +0200

San José, Oct 21, 2018 (AFP) - Four American tourists were killed and a fifth Costa Rican tourist is missing after a river rafting accident in the Central American country on Saturday, the Red Cross said.   The alarm was raised Saturday afternoon following the accident in a swollen river on Costa Rica's Pacific Coast, Alexander Morales of the Red Cross told AFP.   "Fourteen tourists and three guides on board three rafts, and a kayaker, were on the Naranjito river in Quepos, Puntarenas when the accident occurred," Alexander Morales told AFP.   Another spokesman, Johnny Zamora, confirmed the American tourists had yet to be identified.

Costa Rica's President Carlos Alvarado expressed his "dismay" at the incident and said in a statement that he had instructed authorities to provide all necessary support to the victims' families.    The statement added that Costa Rica's foreign ministry has been in communication with the US consulate in the capital San Jose, some 55 kilometers (35 miles) from Quepos.   Rafting is hugely popular with tourists in Costa Rica, which is currently in its wet season, causing waterways to flood.
Date: Wed 19 Sep 2018
From: Marton Szell <docmarton@gmx.at> [edited]

We report a case of leptospirosis in a 26-year-old Austrian backpacker returning from Costa Rica. The infection occurred most likely at a waterfall near the village of Montezuma on the Pacific coast of Costa Rica. This waterfall is a popular place especially with backpackers; therefore, other tourists could be affected, too.

The patient returned on 28 Aug 2018 after traveling for 5 weeks in Panama and Costa Rica. He had a high fever and a feeling of overall weakness 2 days before his return to Austria. He consulted a local doctor who ruled out dengue fever (point-of-care test) because of a high blood leukocyte count; the doctor prescribed a 5-day course of oral ciprofloxacin as an antibiotic treatment. No other tests were performed.

After the patient's return to Austria, his general condition improved and his body temperature returned to normal. The fever reappeared 9 days after the initial onset of the disease, and the patient complained of severe headache and flulike symptoms. His family doctor initiated a broad diagnostic check-up. In the end, only leptospirosis serology yielded positive [results].

We carried out a complete blood check. All parameters, except slightly elevated liver enzymes, [were] normal. We repeated tests for leptospirosis: [Leptospiral] DNA in blood and urine was undetectable and serology showed normal IgG, but a 4-fold increase of IgM antibodies (enzyme immunoassay) confirmed the diagnosis.

Our patient could recall having contact with fresh water 7 to 10 days before the onset of fever. He took a bath in a waterfall near Montezuma on the Nicoya peninsula of Costa Rica. The patient had no contact with animals. Because of the patient's remaining symptoms (slightly elevated body temperature and general weakness), we prescribed a 7-day course of oral doxycycline therapy. With this treatment, all symptoms have disappeared.
---------------------------------------------------
Communicated by:
Dr. Marton Szell
Infectious Diseases Consultant
Dr. Verena Sperl
Infectious Diseases Resident
Emergency Department
Danube Hospital
Vienna, Austria
marton.szell@wienkav.at
=============================
[Leptospirosis is caused by exposure to _Leptospira_ bacteria in fresh (not salty) water, wet soil, or vegetation that has been contaminated by urine of animals chronically infected with one of the several hundred serovars of the spirochete _Leptospira interrogans_. Rodents, dogs, cattle, and pigs are the usual reservoirs for this organism.

Leptospirosis is an occupational hazard for people who work outdoors or with animals; for example, workers in wet agricultural settings (such as rice field workers), ranchers, slaughterhouse workers, trappers, loggers, sewer workers, veterinarians, fishery workers, dairy farmers, or military personnel.

Leptospirosis is also a risk during recreational activities such as camping, fresh water swimming, canoeing, kayaking, rafting, golfing, and trail biking that involve exposure to water in lakes, rivers, or ponds contaminated by urine from leptospire-infected animals, as well as a risk from household exposure to infected pet animals or rodents. - ProMED Mod.ML]

[HealthMap/ProMED maps available at:
Austria: <http://healthmap.org/promed/p/109>
Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Thu 26 Jul 2018
Source: TN8 TV Nicaragua [in Spanish, machine trans. edited]
<https://www.tn8.tv/america-latina/454135-costa-rica-llama-prevencion-ante-brote-hepatitis/>

The Costa Rican Ministry of Health reported today [26 Jul 2018] that it is responding to an outbreak of hepatitis A in a town in the eastern sector of San Jose and asked the population to take hygienic preventive measures. So far, there are 3 confirmed cases and 8 suspected in the canton of Goicoechea, located in the eastern sector of the capital. Health authorities have made an active search in recent days in the areas close to the outbreak, the Health Ministry said in a statement.

In addition, health officials called in primary health care technical assistants to receive more information about hepatitis A, including the mechanisms of transmission, symptomatology, and prevention. The authorities also provided educational material to the population in shopping centres and common areas, and it is planned that tomorrow [27 Jul 2018] they will begin activities in educational centres so that students know the preventive measures.

The Ministry of Health ordered people with hepatitis A to refrain from attending study or work centres for at least 12 days and, upon their return, to attend to extreme hygiene measures, especially handwashing. To the population in general, the authorities urged frequent handwashing with soap and water, especially after going to the bathroom, before preparing or consuming food, or changing diapers.
=======================
[No information is given about the age of those affected. In much of the developing world, where hepatitis A is quite endemic, the population is almost all seropositive for HAV by the age of 10. I would wonder whether the infection was confirmed by a specific IgM anti-HAV antibody. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Thu 24 May 2018
From: Henry Wu [edited] <henry.m.wu@emory.edu> [edited]
[re: ProMED-mail Malaria - USA: ex Costa Rica: (PU)
http://promedmail.org/post/20180514.5790914]
----------------------------------------------------------------------
The American traveller reported to ProMED on May 9, 2018 to have acquired _P. falciparum_ malaria during travel to Costa Rica has been determined to have not been infected with malaria. Although rapid diagnostic testing (RDT) performed at the hospital and PCR testing performed at the state health department were positive for _P. falciparum_, further testing by CDC on the specimen using multiple tests (antigen, PCR, and serology) has been negative, indicating that the initial positive results were false positives.

CDC has rescinded the malaria notice posted on [10 May 2018] that recommended chemoprophylaxis for travellers to the Osa Peninsula area of Puntarenas Province in Costa Rica. No chemoprophylaxis is recommended for travellers to Costa Rica at this time.

The rescind notice is posted at <https://www.cdc.gov/malaria/new_info/2018/Costa_Rica_5_22_2018.html>
---------------------------------
Henry Wu, MD GeoSentinel Site Director Atlanta <henry.m.wu@emory.edu>
Patricia Schlagenhauf, PhD Tracking and Communication Working Group GeoSentinel, EuroTravNet
David Hamer, MD GeoSentinel PI
==================
[ProMED thanks Henry Wu and the GeoSentinel team for the prompt communication, that the case was misdiagnosed as malaria. If malaria microscopy had been done the false diagnosis could probably have been avoided.

The microscopy of a Giemsa stained thick blood film is more sensitive than a rapid diagnostic test and would have been negative. - ProMED Mod.EP]
 
[HealthMap/ProMED-mail map Penansula de Osa, Puntarenas, Costa Rica:
<http://healthmap.org/promed/p/39539>]
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