Date: Wed 15 Aug 2018
Source: Le Soir D'Algerie [machine trans., edited]
It all began on [Wed 8 Aug 2018], when the emergency department of AH Bessem, 26 km [about 16 mi] southwest of Bouira, received a patient from the commune bordering Raouraoua who was showing signs of food poisoning, namely, vomiting and diarrhea.
According to testimony of the patient's relatives, during the 4 days while the patient was still hospitalized, other family members who visited him fell ill one by one and were hospitalized in the same location, EPH of Ain Bessem. On [Sun 12 Aug 2018], one of the 5 admitted and hospitalized patients died without anyone being able to explain to the family the causes of death.
Yesterday, the panic was at its height, and the members of this family, who all reside in Raouraoua, had to alert the media so that the officials of the DSP would deign to send a commission of inquiry and a prevention team immediately.
The same day, an elderly woman, who had fallen ill less than 2 days earlier, also died, bringing the number of deaths due to this strange disease that no one has been able to identify to 2 deaths. According to one family member, all hospitalized patients had the same symptoms, namely kidney blockage, which requires dialysis sessions.
However, on the spot, the prevention team, seeing the seriousness of the situation of the other 3 patients from the same family who were admitted to the emergency room, decided to evacuate them to the El Kettar specialized hospital in Algiers.
Contacted yesterday afternoon by telephone, the head of prevention service at the Bouira DSP, Dr. Henni, who was on site at the EPH of Ain Bessem, said that "medical teams are in the process of investigating to determine the true causes of these deaths and the origin of this contagion."
"Another team moved to the home of this family in Raouraoua to take samples and try to understand what really happened and how they were infected," he added. Asked about the nature of the disease that killed 2 people, while 3 others were in serious condition, Dr Henni said that "he preferred to wait for the results of the investigation and analyses to formally comment on the disease and causes of these deaths." Meanwhile, a real panic has seized the citizens of Raouraoua and even Ain Bessem, especially since there are rumors of contamination of anyone who has been in contact with members of this family.
Date: Wed 15 Aug 2018
Source: Algerie Monde infos [edited]
Four people, including 3 from the same family, died after having contracted an unidentified illness in Ain Bessem, Bouira wilaya. According to various sources, the people died at the hospital Mohamed Bachir of Ain Bessem. The last one was a 40-year-old woman. Two others were in their 70s, while the 3rd was 60 years old.
According to the head of the department in charge of prevention at the health department of the wilaya of Bouira, an investigation was opened to learn the precise causes of these deaths.
The symptoms of this mysterious disease are characterized by high fever, diarrhea, and liver damage.
The families of the deceased observed a sit-in, demanding the sending of a commission of inquiry to elucidate this mystery.
[From the above description, it appears as though there is a cluster of cases of an as yet undiagnosed illness associated with fever, vomiting and diarrhea, and renal failure (although there is also mention of liver failure). The description of "intoxication" (used to describe foodborne illness) is helpful, but the differential diagnosis can be fairly extensive. By the timing of the presentations, one suspects there may have been a common source exposure with possible varying infective doses, or the possibility of human-to-human transmission (although less likely as there haven't been reports of healthcare workers with the same symptoms).
Running the symptom complex through Gideon, the high-probability diagnoses consistent with the symptoms include the following: Leptospirosis, 53 percent probability; Legionellosis, 20 percent probability (I question this); typhoid and enteric fever, 10 percent probability; relapsing fever, 8 percent probability; Crimean-Congo hemorrhagic fever, 7 percent probability; septicemia (bacterial), 1 percent probability (I question this, as this is a cluster of cases); and Q-fever, 1 percent probability.
A possible diagnosis may be hemolytic uremic syndrome associated with an _E. coli_ O157 (or related organism) infection. Interestingly, running the ProMED-mail archives for posts on events in Algeria, a common event involving human cases in the past few years has been brucellosis outbreaks, although checking posts on our MENA network (MidEast North Africa), there have been a number of foodborne illness outbreaks reports in recent times.
Rather than continue to speculate, it seems most prudent at this point in time to request more information from knowledgeable sources in the area. Information that would be helpful includes results of an epidemiologic investigation, including history of common exposures and ages, and a more in-depth clinical presentation.
Ain Bessem is located in Bouira province in the north central part of Algeria (see