Date: Sat 11 May 2019
Source: The Jakarta Post [edited]
No one really knows what is spreading in the small village of Garonggong in Jeneponto regency, South Sulawesi. However, for the last couple of months, nearly all people living there have been experiencing mysterious symptoms, which started with a fever and pain all over the body, especially in their joints. The unknown disease killed 4 people from a total of 72 people that had experienced similar symptoms. The village administration has declared a health emergency. Several villagers have moved to avoid contagion. "It has been going on for 2 months. They have experienced the same symptoms, and 4 people have died because of it, including my child, a local, said on Thursday [9 May 2019] as quoted by kompas.com.
The acting head of Jeneponto Health Agency, Syafruddin Nurdin, said it all began in April  when a couple of villagers were infected. By 24 Apr , 17 residents had been admitted to hospitals and community health centers for the same symptoms. Syafruddin said most of them had experienced similar symptoms, such as a fever, headache, nausea and joint pain. "All of them came from the same village, Garonggong village," Syafruddin told The Jakarta Post on Friday [10 May 2019].
However, the health workers and agency have not been able to identify the disease or the cause of it, or why it had struck many people at the same time. "The patients gradually lost consciousness. [...] When their blood was tested, all of the suspected diseases such as malaria, dengue fever, Zika, leptospirosis, anthrax, H5N1, were all ruled out. The tests came back negative for all of them," Syafruddin said.
The Health Ministry has yet to provide an explanation on this matter, but the ministry's disease control and prevention director general, Anung Sugihantono, said his side was investigating the outbreak. A special team consisting of academics, health and environment experts, as well as veterinarians have been deployed to the village to carry out disease surveillance and epidemiology research.
Also, 3 patients have been moved to Makassar, the provincial capital, for further examination and treatment. "Initial laboratory research had shown indication of typhoid, but further studies are needed," he added. South Sulawesi Health Agency acting head Bachtiar Baso said one of the deceased patients was pregnant. Doctors have been treating the patients using different approaches. "Most doctors treated those admitted to the hospitals for typhoid. Some of them saw their health improve, and some of them did not," he said.
Bachtiar said the investigative team had collected blood samples from the infected patients and animals in the area and had collected soil samples. The team suspects those affected may have had either leptospirosis, meningitis or the hantavirus, Bachtiar said. "I hope the research results will be revealed soon and the team can gain a better understanding of the disease that has been spreading across Garonggong so we can prepare the necessary medicine and preventative measures," he added.
[A comprehensive laboratory workup is necessary to establish a diagnosis. There is no indication that autopsies were carried out that might provide addition clues about the aetiology. Mention was made of hantaviruses, but no mention was made of supporting laboratory results that might point to Seoul hantavirus infections, but the large number of cases occurring in a single village in a short period of time would be unusual for hantavirus infections or for scrub typhus. There was an outbreak of Japanese encephalitis (JE) in North Sulawesi last year (2018). Although there is no specific mention of encephalitis in these patients, JE should be ruled out.
ProMED-mail would be interested in receiving further information about confirmation of typhus, any new cases, or laboratory results as they become available. - ProMED Mod.TY]
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