Tourist Deaths In Chiang Mai Just A ‘Coincidence’

[ding]

It has just occured to me that one thing actually does surprise me, that being this thread is still open and references to the hotel name and pictures of it not removed. I would like to suggest that perhaps the best way to resolve this little issue is to change the name of the hotel to the Uptown inn, which will only need four letters removing and two new ones adding which should be inexpensive.

It's an integral part of the story IMHO. Next, news stating the city name of Chiang Mai -or country name of Thailand - would be banned. Just another element of the story, the 'where' element of the 5 w's.

[oldsailor35]

These deaths are very likely caused by cyanide.

The cases in Chiang Mai are very similar to what happened in Phi Phi two years ago when four people also died and a few people fell very sick but recovered. They all stayed at the same guest house. Like this time, the police said that the deaths were a co-incidence and the guest house remains open with the same owner today. The autopsey was inconclusive but referred to a possibility of a food poison or other toxin. The police unofficially said they drank moonlight (although not together) somewhere however one of the victims didn't drink according to her boyfriend.

At Phi Phi there was a waste water treatment being expanded by the guest house owners to serve Phi Phi and one way to sterilize the new equipment before use is to coat it with a chemical agent containing cyanide.

Cyanide in tiny doeses causes severe food poisoning like symptoms and violent cramps. In higher does it's fatal with seizure of respitary and heart muscles. It's very easy to buy chemical compounds containing cyanide, especially bags of industrial cleaners imported (probably illegally) from China via the north of Thailand. Cyanide is almost odourless and tasteless.

The only food poison that could kill quickly is clostiduim botulinum which is found in damaged cans. However, botulinum would not kill two people almost simultaneously. Botulinum would also not be found on bbq port of chicken from outside however dirty while from cans would be a widespread problem not confined to the 5th floor of one hotel. E-coli is another potentially fatal pathagen but death is not common in healthy adults and patients would be sick for several days or even a couple of weeks.

Some posters have mentioned carbon monoxide. This is very unlikely as air-conditioners are electric not gas, unless there was a fire somewhere behind the air-condition but then there should also be smoke, and carbon monixde makes one sleepy rather than violently sick

Legionnairs once in every few years breaks-out somewhere and is a potentially lethal virus that can trap it's self in dirty air-conditioning units. However, the problem wouldn't just dissapear but would become a growing and continuing problem not just for guests in a room but also for cleaning staff and others.

Eating puffer fish causes muscle paralysis including the heart and lungs. It can also start with severe stomach upsets and cramps, however, there's not usually any in between. If you eat the contaminated mean, you're dead. Also, probably unlikely to for sale in Chiang Mai albeit once it was found on a market stall in some off beat Thai city a few years ago.

Other possibilities are a heavy dose of pesticides, many of which are odourless these days or some other chemicals such as the ones used for lethal injections. However, cyanide remains the easiest to buy.

What about excessive MSG ?

[oldsailor35]

For a third world country Thailand is pretty safe, but this is a third world country, where the police are a waste of space, so you have to watch out for yourself.

I would never book a cheap hotel before I had seen it, nor would I eat at a place that looked iffy, nor venture into an area that looked unsafe. If I did any of these things, realising my mistake, I would walk away very quickly and always find a better alternative.

I make the assuption that the police are there as a visual deterent to crime... and nothing more. In the same way that shop assistants are a visual deterent to shoplifting.... and nothing more.

The only thing that is of help is this sort of website, now I know not to stay in a Downtown Inn in Phuket.

Maybe we need a full blacklist directory to consult, "A tourist guide to avoiding death.."

There are quite a few miles between Phuket and Chaing Mai

[oldsailor35]

The sad thing is, I have become numb to this sort of news. I expect it, I know the answer before I get to the end of the first paragraph. I don't even blink anymore!

I hope I become more compassionate when I move back to the UK.

Ditto.

Hopefully without moving back to the UK my compassion for the victims will remain the same, but my disdain for the authorities increases daily.

Thaddeus. I feel the same as you. But with stories such as this, happening far to often and the general every day corruption, it is gradually gnawing away at me.

jb1

Hi Thad, dont tell me that things like this happen in beautiful Ban Kruat

[msg362]

These deaths are very likely caused by cyanide.

The cases in Chiang Mai are very similar to what happened in Phi Phi two years ago when four people also died and a few people fell very sick but recovered. They all stayed at the same guest house. Like this time, the police said that the deaths were a co-incidence and the guest house remains open with the same owner today. The autopsey was inconclusive but referred to a possibility of a food poison or other toxin. The police unofficially said they drank moonlight (although not together) somewhere however one of the victims didn't drink according to her boyfriend.

At Phi Phi there was a waste water treatment being expanded by the guest house owners to serve Phi Phi and one way to sterilize the new equipment before use is to coat it with a chemical agent containing cyanide.

Cyanide in tiny doeses causes severe food poisoning like symptoms and violent cramps. In higher does it's fatal with seizure of respitary and heart muscles. It's very easy to buy chemical compounds containing cyanide, especially bags of industrial cleaners imported (probably illegally) from China via the north of Thailand. Cyanide is almost odourless and tasteless.

The only food poison that could kill quickly is clostiduim botulinum which is found in damaged cans. However, botulinum would not kill two people almost simultaneously. Botulinum would also not be found on bbq port of chicken from outside however dirty while from cans would be a widespread problem not confined to the 5th floor of one hotel. E-coli is another potentially fatal pathagen but death is not common in healthy adults and patients would be sick for several days or even a couple of weeks.

Some posters have mentioned carbon monoxide. This is very unlikely as air-conditioners are electric not gas, unless there was a fire somewhere behind the air-condition but then there should also be smoke, and carbon monixde makes one sleepy rather than violently sick

Legionnairs once in every few years breaks-out somewhere and is a potentially lethal virus that can trap it's self in dirty air-conditioning units. However, the problem wouldn't just dissapear but would become a growing and continuing problem not just for guests in a room but also for cleaning staff and others.

Eating puffer fish causes muscle paralysis including the heart and lungs. It can also start with severe stomach upsets and cramps, however, there's not usually any in between. If you eat the contaminated mean, you're dead. Also, probably unlikely to for sale in Chiang Mai albeit once it was found on a market stall in some off beat Thai city a few years ago.

Other possibilities are a heavy dose of pesticides, many of which are odourless these days or some other chemicals such as the ones used for lethal injections. However, cyanide remains the easiest to buy.

What about excessive MSG ?

I am not excessive!!!!!

( And you'd have to eat about several kilos or more of it!!!!! not reallly)

[Markaew]

I have not commented in this thread because I wanted to see what the conclusions of the cultures and tests. The findings do make sense to me. Coxsackieviruses are part of the genus enterovirus.The enteroviruses are made up of 5 subgenera which include the coxsakieviruses, the echoviruses and one virus that should cause people to pay attention, the poliovirus. Coxsackievirus A should be familiar to people that read the papers since it is associated with hand, foot and mouth disease, of which there have been outbreaks of in Thailand. The reported symptoms all are compatible with the suggestion of an enterovirus. The finding of myocarditis as well as the reports of apparent disorientation all point to an enterovirus. As well, the viruses have different impact on people. Some people might just have what appears to be a common stomach upset or a cold, while it kills others.

Here's the part that concerns me. The manner in which the virus spread. Enteroviruses are spread by human contact with surfaces contaminated with the the secretions from an infected person. You know how the cruise ships can get hit with a norovirus outbreak causing passengers to fall ill and require the ship to be thoroughly decontaminated? I believe the same situation is occurring here. More importantly, some of the carriers of the enteroviruses are asymptomatic, meaning they do not show any symptoms, but they function as a carrier spreading the virus wherever they go. Wherever the cough, whatever they touch, whenever they poop, they leave the enterovirus behind. The bugger can survive for days on a surface. The best way of preventing transmission is hand washing.

My expectation of how this is going to be handled. Staff at the suspect hotel may be tested to see if someone is a carrier. This testing will not be made public due to patient confidentiality and more importantly to avoid panic. I think Chiang Mai has its own version of a Typhoid Mary.

Assuming you are correct, the authorities would have to acknowledge there is a problem before they can resolve it. Their denial will compound this problem rapidly. Also, there were reports of a foul smell coming from the room. How do you account for that?

[Thaddeus]

The sad thing is, I have become numb to this sort of news. I expect it, I know the answer before I get to the end of the first paragraph. I don't even blink anymore!

I hope I become more compassionate when I move back to the UK.

Ditto.

Hopefully without moving back to the UK my compassion for the victims will remain the same, but my disdain for the authorities increases daily.

Thaddeus. I feel the same as you. But with stories such as this, happening far to often and the general every day corruption, it is gradually gnawing away at me.

jb1

Hi Thad, dont tell me that things like this happen in beautiful Ban Kruat

You mean, things that make you go hmmmmm...... they happen everywhere, just feels like they happen more frequently in Thailand in general.

Beauty in Thailand is there for tourists and non-Thais with a business interest, for its inhabitants, the beauty is just a surface veneer and sometimes you can discover how thin that veneer is and how nasty it can be underneath.

The cause of the unfortunate incidents in this topic should be discovered and made public, or at the very least measures put in place to prevent them from happening again everywhere. Will that happen, it's unlikely, especially if it costs money or causes someone important to look incompetent.

Instead a large sign will be erected that says "Nothing to see here, move along, ooh look, an elephant"

[geriatrickid]

[Assuming you are correct, the authorities would have to acknowledge there is a problem before they can resolve it. Their denial will compound this problem rapidly. Also, there were reports of a foul smell coming from the room. How do you account for that?

The public healh authorities do acknowledge that there is a problem. People really need to stop with the cyanide and msg murder theories and look at the reality. Chiang Mai's Chief Medical officer didn't cover anything up, but acted in a responsible manner by waiting for some culture and test results. The deaths observed are common in SE Asia. That's right, common. The cases just are not reported because people get sick and and some die all the time. We see it with influenza. We see it with hospital infections and we see it when there are meningitis outbreaks in schools. Thailand has experienced hand, foot & mouth disease epidemics. The pediatric HFMD epidemic was reported at the time. What we have here are a few cases, not an epidemic yet. Look at the denials that took place when there was the swine flu scare a year ago. A great many people in Thai Visa came up with conspiracy theories and denied there was a risk. This is a situation of being damned if they do and damned if they don't when making a public announcement.

My earlier statements are all consistent with the published studies and the daily reality in Thailand. Enteroviruses do not kill most people, but when they find the right host, they can be fatal. What seems to be happening here is that the virus has mutated into a more deadly variant. What exactly would you like the public health authorities to do if people do not want to wash their hands or cover their mouths when they cough? There have been multiple pleas for proper hygiene. It is up to the general population to wash their hands and the government cannot do it for them. This is Thailand and the government doesn't police food facilities. It's that simple. If you want food hygiene enforcement, it isn't going to occur in Thailand. Ask some of the TVF members that have restaurants or bars if they are tough on worker hygiene or put soap in their washrooms. I guarantee you that most of them don't care.

So what if there was a foul smell coming from a room? The dead start to stink after a few hours in Thailand's heat. Ever been near a toilet when someone is suffering from a GI upset? It stinks too.

Enterovirus 71 (EV71) infections have been a public health priority in the Asia-Pacific region since 1998 when a major outbreak of hand, foot and mouth disease (HFMD) and herpangina due to EV71 occurred in Taiwan involving 129,106 cases and 78 deaths. In 2006, Malaysia also experienced a large scale EV71 HFMD outbreak, involving at least 13,800 cases and 13 deaths2. Fatal cases in both the Taiwan and Malaysia outbreaks had high rates of brain stem infection and cardiopulmonary failure. EV71 infection is most often asymptomatic or mildly symptomatic, but it may cause acute febrile illness, upper respiratory tract infection, gastroenteritis, limb weakness, myocarditis and/or pericarditis, brain stem infection and other illnesses. EV71 was first identified in Thailand in 1998 by positive serology at Sukhothai Province and HFMD was included as a notifiable disease in national surveillance in 2001. Severe HFMD cases, those requiring hospitalization or fatal cases, require investigations that include viral isolation. EV71 was the major cause of HFMD in Thailand between 1998 — 2003, but the yield of EV71 isolation was low (16.7%) compared to other Asian countries.

Source: Cluster of Fatal Cardiopulmonary Failure among Children Caused by an Emerging Strain of Enterovirus 71, Nakhorn Ratchasima Province, Thailand, 2006

Rome Buathong1, Hanshoaworakul W1, Sutdan D1, Iamsirithaworn S1, Pongsuwanna Y2, Puthawathana P3,O'Reilly M1,4, Ungchusak K1

1 International Field Epidemiology Training Program (FETP), Bureau of Epidemiology, Department of Disease Control,Ministry of Public Health (MOPH), Thailand 2 Enterovirus Section, National Institute of Health (NIH), Department of Medical Science, Ministry of Public Health(MOPH), Thailand 3 Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 4 Thailand MOPH-US CDC Collaboration (TUC)

Edited March 13, 2011 by geriatrickid

[lannarebirth]

This is what my buddy, who is the guy that clears treatment for many foreigners here in Thailand sent me today:

Disease Outbreak News

Myocarditis cases in Chiangmai – update 1 (11 March 2011) On 9 February, the Department of Disease Control was requested by the Chiangmai Provincial Health Office to assist in an investigation into myocarditis cases. The joint investigation team found four clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another two patients with mild symptoms. These six patients were among three separate groups of tourists visiting Chiang Mai, Thailand, between 9 January and 4 February 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3). Of these six patients three died (one each from the USA, France and New Zealand). Five of them became ill while visiting Chiang Mai and one developed symptoms three days before arriving there. Common features of the illness among these patients include vomiting without diarrhea and lack of respiratory symptoms. One patient had a fever but all others were afebrile. Extensive epidemiological investigation has not revealed any common exposures across the three groups. Laboratory testing of blood and stools to date has not revealed anything except for evidence of infection by an echovirus in one patient and by a Coxsackie virus in another patient from New Zealand. Autopsies on two of the dead patients (American and French) were done by forensic medical expert of Chiang Mai University. The autopsies found nothing abnormal except for inflammation of the heart muscle. The Department of Disease Control has shared this information with the WHO and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation (IHR) focal points of France and the European Community. In a separate episode, since 3 February, there were three other deaths in the same hotel where the three New Zealanders stayed. This included an elderly British couple and a 47 year old Thai woman. As these three deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the two elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death. Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare. The Department of Disease Control will continue its intensive investigation and collaborate with the WHO, IHR authorities and embassy contact persons of the USA, France and New Zealand to determine the causes of myocarditis in all these cases, which may be of the same or of different etiologies. While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

[TigerWan]

Pretty explosive post Can you provide a link? Sounds like one woman had the virus , the rest really unknown

This is what my buddy, who is the guy that clears treatment for many foreigners here in Thailand sent me today:

Disease Outbreak News

Myocarditis cases in Chiangmai – update 1 (11 March 2011) On 9 February, the Department of Disease Control was requested by the Chiangmai Provincial Health Office to assist in an investigation into myocarditis cases. The joint investigation team found four clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another two patients with mild symptoms. These six patients were among three separate groups of tourists visiting Chiang Mai, Thailand, between 9 January and 4 February 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3). Of these six patients three died (one each from the USA, France and New Zealand). Five of them became ill while visiting Chiang Mai and one developed symptoms three days before arriving there. Common features of the illness among these patients include vomiting without diarrhea and lack of respiratory symptoms. One patient had a fever but all others were afebrile. Extensive epidemiological investigation has not revealed any common exposures across the three groups. Laboratory testing of blood and stools to date has not revealed anything except for evidence of infection by an echovirus in one patient and by a Coxsackie virus in another patient from New Zealand. Autopsies on two of the dead patients (American and French) were done by forensic medical expert of Chiang Mai University. The autopsies found nothing abnormal except for inflammation of the heart muscle. The Department of Disease Control has shared this information with the WHO and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation (IHR) focal points of France and the European Community.

In a separate episode, since 3 February, there were three other deaths in the same hotel where the three New Zealanders stayed. This included an elderly British couple and a 47 year old Thai woman. As these three deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the two elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death. Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare. The Department of Disease Control will continue its intensive investigation and collaborate with the WHO, IHR authorities and embassy contact persons of the USA, France and New Zealand to determine the causes of myocarditis in all these cases, which may be of the same or of different etiologies. While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

Edited March 20, 2011 by sabaijai

[james24]

These deaths are very likely caused by cyanide.

The cases in Chiang Mai are very similar to what happened in Phi Phi two years ago when four people also died and a few people fell very sick but recovered. They all stayed at the same guest house. Like this time, the police said that the deaths were a co-incidence and the guest house remains open with the same owner today. The autopsey was inconclusive but referred to a possibility of a food poison or other toxin. The police unofficially said they drank moonlight (although not together) somewhere however one of the victims didn't drink according to her boyfriend.

At Phi Phi there was a waste water treatment being expanded by the guest house owners to serve Phi Phi and one way to sterilize the new equipment before use is to coat it with a chemical agent containing cyanide.

Cyanide in tiny doeses causes severe food poisoning like symptoms and violent cramps. In higher does it's fatal with seizure of respitary and heart muscles. It's very easy to buy chemical compounds containing cyanide, especially bags of industrial cleaners imported (probably illegally) from China via the north of Thailand. Cyanide is almost odourless and tasteless.

The only food poison that could kill quickly is clostiduim botulinum which is found in damaged cans. However, botulinum would not kill two people almost simultaneously. Botulinum would also not be found on bbq port of chicken from outside however dirty while from cans would be a widespread problem not confined to the 5th floor of one hotel. E-coli is another potentially fatal pathagen but death is not common in healthy adults and patients would be sick for several days or even a couple of weeks.

Some posters have mentioned carbon monoxide. This is very unlikely as air-conditioners are electric not gas, unless there was a fire somewhere behind the air-condition but then there should also be smoke, and carbon monixde makes one sleepy rather than violently sick

Legionnairs once in every few years breaks-out somewhere and is a potentially lethal virus that can trap it's self in dirty air-conditioning units. However, the problem wouldn't just dissapear but would become a growing and continuing problem not just for guests in a room but also for cleaning staff and others.

Eating puffer fish causes muscle paralysis including the heart and lungs. It can also start with severe stomach upsets and cramps, however, there's not usually any in between. If you eat the contaminated mean, you're dead. Also, probably unlikely to for sale in Chiang Mai albeit once it was found on a market stall in some off beat Thai city a few years ago.

Other possibilities are a heavy dose of pesticides, many of which are odourless these days or some other chemicals such as the ones used for lethal injections. However, cyanide remains the easiest to buy.

What about excessive MSG ?

I am not excessive!!!!!

( And you'd have to eat about several kilos or more of it!!!!! not reallly)

MSG is basically a chemical which tricks the brain, any amount is probably not a good idea if you want to keep a clear head

[msg362]

These deaths are very likely caused by cyanide.

The cases in Chiang Mai are very similar to what happened in Phi Phi two years ago when four people also died and a few people fell very sick but recovered. They all stayed at the same guest house. Like this time, the police said that the deaths were a co-incidence and the guest house remains open with the same owner today. The autopsey was inconclusive but referred to a possibility of a food poison or other toxin. The police unofficially said they drank moonlight (although not together) somewhere however one of the victims didn't drink according to her boyfriend.

At Phi Phi there was a waste water treatment being expanded by the guest house owners to serve Phi Phi and one way to sterilize the new equipment before use is to coat it with a chemical agent containing cyanide.

Cyanide in tiny doeses causes severe food poisoning like symptoms and violent cramps. In higher does it's fatal with seizure of respitary and heart muscles. It's very easy to buy chemical compounds containing cyanide, especially bags of industrial cleaners imported (probably illegally) from China via the north of Thailand. Cyanide is almost odourless and tasteless.

The only food poison that could kill quickly is clostiduim botulinum which is found in damaged cans. However, botulinum would not kill two people almost simultaneously. Botulinum would also not be found on bbq port of chicken from outside however dirty while from cans would be a widespread problem not confined to the 5th floor of one hotel. E-coli is another potentially fatal pathagen but death is not common in healthy adults and patients would be sick for several days or even a couple of weeks.

Some posters have mentioned carbon monoxide. This is very unlikely as air-conditioners are electric not gas, unless there was a fire somewhere behind the air-condition but then there should also be smoke, and carbon monixde makes one sleepy rather than violently sick

Legionnairs once in every few years breaks-out somewhere and is a potentially lethal virus that can trap it's self in dirty air-conditioning units. However, the problem wouldn't just dissapear but would become a growing and continuing problem not just for guests in a room but also for cleaning staff and others.

Eating puffer fish causes muscle paralysis including the heart and lungs. It can also start with severe stomach upsets and cramps, however, there's not usually any in between. If you eat the contaminated mean, you're dead. Also, probably unlikely to for sale in Chiang Mai albeit once it was found on a market stall in some off beat Thai city a few years ago.

Other possibilities are a heavy dose of pesticides, many of which are odourless these days or some other chemicals such as the ones used for lethal injections. However, cyanide remains the easiest to buy.

What about excessive MSG ?

I am not excessive!!!!!

( And you'd have to eat about several kilos or more of it!!!!! not reallly)

MSG is basically a chemical which tricks the brain, any amount is probably not a good idea if you want to keep a clear head

No it doesn't trick the brain, it's a naturally occurring ingredient in many foods and it has been shown to be safe. But in any event to go from your assertion, which is untrue, to one that suggests that it might be the cause of these sad deaths is just living in cloud cuckoo land

[Ulysses G.]

No it doesn't trick the brain, it's a naturally occurring ingredient in many foods and it has been shown to be safe. But in any event to go from your assertion, which is untrue, to one that suggests that it might be the cause of these sad deaths is just living in cloud cuckoo land

Real facts!

[No1]

I am not sure about the whereabout of the sources which claim "Coincidence". The Bangkok Post paints a different picture claiming that local health authorities and WHO are still investigating, inspecting restaurants, food shops and have found the Coxsackie B virus in the body of one of the deaths and are waiting for autopsy results from the other bodies. Coxsackie B is known to cause myokarditis.

http://www.bangkokpost.com/news/health/226312/who-asked-to-look-into-suspicious-chiang-mai-deaths

[geriatrickid]

I am not sure about the whereabout of the sources which claim "Coincidence". The Bangkok Post paints a different picture claiming that local health authorities and WHO are still investigating, inspecting restaurants, food shops and have found the Coxsackie B virus in the body of one of the deaths and are waiting for autopsy results from the other bodies. Coxsackie B is known to cause myokarditis.

http://www.bangkokpo...iang-mai-deaths

ummm, yes. The viruses are common in Thailand and they cause fatal illnesses every week. Every couple of years one of the related viruses causes an outbreak of HFMD in Thai schools.

The public health agency is attempting to identify the carriers and to identify clusters. It's like finding a needle in a haystack. Everydy people in Chiang Mai demonstrate symptoms of the infection, but these people do not report their illness because it is mild in some.

Edited March 14, 2011 by geriatrickid

[TigerWan]

Here is link to CDC outbreak bulletin Note it reveals a sixth death, woman from France before Feb 4

http://pr.ddc.moph.go.th/pnews/showimgdetil.php?id=243

Note that while virus was found in two patients, it is not the subject of the bulletin, heart enlargement is

Vomiting with no other symptoms and enlargemnet of the heart is the common thread .

Myocarditis cases in Chiangmai – update 1 (11 March 2011)

วันที่ :2011-03-12 Disease Outbreak News

Myocarditis cases in Chiangmai – update 1 (11 March 2011) On 9 February, the Department of Disease Control was requested by the Chiangmai Provincial Health Office to assist in an investigation into myocarditis cases. The joint investigation team found four clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another two patients with mild symptoms. These six patients were among three separate groups of tourists visiting Chiang Mai, Thailand, between 9 January and 4 February 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3). Of these six patients three died (one each from the USA, France and New Zealand). Five of them became ill while visiting Chiang Mai and one developed symptoms three days before arriving there. Common features of the illness among these patients include vomiting without diarrhea and lack of respiratory symptoms. One patient had a fever but all others were afebrile.

Extensive epidemiological investigation has not revealed any common exposures across the three groups. Laboratory testing of blood and stools to date has not revealed anything except for evidence of infection by an echovirus in one patient and by a Coxsackie virus in another patient from New Zealand. Autopsies on two of the dead patients (American and French) were done by forensic medical expert of Chiang Mai University. The autopsies found nothing abnormal except for inflammation of the heart muscle. The Department of Disease Control has shared this information with the WHO and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation (IHR) focal points of France and the European Community. In a separate episode, since 3 February, there were three other deaths in the same hotel where the three New Zealanders stayed. This included an elderly British couple and a 47 year old Thai woman. As these three deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the two elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death. Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare. The Department of Disease Control will continue its intensive investigation and collaborate with the WHO, IHR authorities and embassy contact persons of the USA, France and New Zealand to determine the causes of myocarditis in all these cases, which may be of the same or of different etiologies. While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

[jimbeam1]

No it doesn't trick the brain, it's a naturally occurring ingredient in many foods and it has been shown to be safe. But in any event to go from your assertion, which is untrue, to one that suggests that it might be the cause of these sad deaths is just living in cloud cuckoo land

Real facts!

Yes MSG does in fact occur naturally in Soya Beans. For some reason there are some on here that will blame MSG for everything that happens. In my opinion, It is absolutely ridiculous to link it to these deaths.

For myself I hate the stuff and avoid it like the plague. Where ever I travel I make it a point to find out that country's name for MSG.

jb1

Edited March 14, 2011 by jimbeam1

[jfchandler]

I've been away for a couple days on Japan quake related stuff...so forgive me if I've missed something...

To recap, it seems as though Thai health authorities have diagnosed the common cause of death in some of the victims, myocarditis. But that can be caused by a variety of sources, and it seems there remain various possibilities for the cause and source...

Is that about right, or am I missing something?

Extensive epidemiological investigation has not revealed any common exposures across the three groups.

Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare.

While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

Edited March 14, 2011 by jfchandler

[No1]

ummm, yes. The viruses are common in Thailand and they cause fatal illnesses every week. Every couple of years one of the related viruses causes an outbreak of HFMD in Thai schools.

The public health agency is attempting to identify the carriers and to identify clusters. It's like finding a needle in a haystack. Everydy people in Chiang Mai demonstrate symptoms of the infection, but these people do not report their illness because it is mild in some.

All true, with one important difference: HFMD is caused by the A-type which is by far not as lethal as the B-type.

[TigerWan]

^^ Yeah like enlargement t of the heart from profuse vomiting and dehydration ? I How about if you get dosed after you had a few drinks -are you more likey to die? Or if you have an existing virus or other condition.

That bulletin is un F'ING believable - shows they've know something was amiss for a while.

It is NOT listng cause of death yet nor for some time if ever but are listing found abnormalities. Thank stars for real info.

I've been away for a couple days on Japan quake related stuff...so forgive me if I've missed something...

To recap, it seems as though Thai health authorities have diagnosed the common cause of death in some of the victims, myocarditis. But that can be caused by a variety of sources, and it seems there remain various possibilities for the cause and source...

Is that about right, or am I missing something?

Extensive epidemiological investigation has not revealed any common exposures across the three groups.

Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare.

While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

Edited March 14, 2011 by TigerWan

[TigerWan]

The US State department repeat today that no link has been established between any of the deaths and has offered assistance

http://www.andrew-dr...i-deaths-probe/

Nice to see we can rely on them .

[TigerWan]

Thank you very much for that CDC post Bubbalicious

Well, I can see why that press conference was held seeing now about the ownership group.

But, from reports I heard today from a health care industry friend (and confirmed by another friend's FB page) this case DOES go beyond the Downtown Inn. First, there is the case of this American woman, Soraya, and then, apparently, there are 3 other Thai deaths that are being looked at as being related (though unrelated to the hotel). And which apparently haven't hit the newspapers yet (no secret as to why that might be, seeing as how it would be bad for the whole town, business wise). But, from what I was told they are looking at a variety of things that it could be - various food contamination possibilities, and things like pesticides or chemical toxins getting into vegetables, etc. that might have been used in the dishes, as well as viral infections and a variety of other possible causes (sketchy mix of English and Thai from my friend, but from what I gathered the health office is casting a wide net as to the possibilities).

Part of the delay in naming causes for this is that some samples have been sent overseas for testing (US and Japan were mentioned), I assume either for higher tech testing or to double/triple check whatever results they've gotten locally.

Whatever else is going on investigation wise, I'm pretty sure this press conference wont be the last of what we hear on this issue. But it sure would be nice if the media keeps pressing on this so we can get more timely answers.

Edit: One other thing. I haven't read thru all the latest pages but I see a lot of talk here about the Phuket cases. A Phuket link is also one of the long list of things they are looking at (trying to eliminate, etc) I guess seeing as how those causes of death were never completely determined (even with the European - Norwegian? specialists who came in).

[TigerWan]

Whoops Sorry that was LannaRebirth wh oposted the CDC bulletin Thanks very much

Pretty explosive post Can you provide a link? Sounds like one woman had the virus , the rest really unknown

This is what my buddy, who is the guy that clears treatment for many foreigners here in Thailand sent me today:

Disease Outbreak News

Myocarditis cases in Chiangmai – update 1 (11 March 2011) On 9 February, the Department of Disease Control was requested by the Chiangmai Provincial Health Office to assist in an investigation into myocarditis cases. The joint investigation team found four clinically-confirmed cases of myocarditis (inflammation of the heart muscle) and another two patients with mild symptoms. These six patients were among three separate groups of tourists visiting Chiang Mai, Thailand, between 9 January and 4 February 2011. All were young women aged 23-33 years and were from the United States (1), Canada (1), France (2) and New Zealand (3). Of these six patients three died (one each from the USA, France and New Zealand). Five of them became ill while visiting Chiang Mai and one developed symptoms three days before arriving there. Common features of the illness among these patients include vomiting without diarrhea and lack of respiratory symptoms. One patient had a fever but all others were afebrile. Extensive epidemiological investigation has not revealed any common exposures across the three groups. Laboratory testing of blood and stools to date has not revealed anything except for evidence of infection by an echovirus in one patient and by a Coxsackie virus in another patient from New Zealand. Autopsies on two of the dead patients (American and French) were done by forensic medical expert of Chiang Mai University. The autopsies found nothing abnormal except for inflammation of the heart muscle. The Department of Disease Control has shared this information with the WHO and US CDC offices in Bangkok, as well as the New Zealand Embassy and the International Health Regulation (IHR) focal points of France and the European Community.

In a separate episode, since 3 February, there were three other deaths in the same hotel where the three New Zealanders stayed. This included an elderly British couple and a 47 year old Thai woman. As these three deaths occurred outside the hospital, the police took charge of the investigation. The autopsies of the two elderly Britons found a high degree of coronary occlusion while the examination of the Thai woman found no inflammation of the heart muscle or any other clear evidence to explain the cause of her death. Myocarditis is a well known illness that may result from many possible etiologies such as viral infection, bacterial infection and toxins and can be found everywhere from time to time. However, four cases among young healthy adults in the same location is rare. The Department of Disease Control will continue its intensive investigation and collaborate with the WHO, IHR authorities and embassy contact persons of the USA, France and New Zealand to determine the causes of myocarditis in all these cases, which may be of the same or of different etiologies. While the causes of the illnesses remain unknown at this time, travelers are recommended to take general preventive health measures that include eating only hot food, drinking clean water and taking enough rest and exercise. Those who experience severe sudden multiple vomiting with or without diarrhea, should seek medical attention immediately.

[mamborobert]

These deaths have now picked up some traction in Australian media.

Today (15 March) there are articles by Angela Saurine that have been syndicated to the Courier Mail, Daily Telegraph, and the Herald Sun (and I gather quite a few web based news services).

It seems that there are quite a few people that were very ill without resuting in deaths....

The handling of this by the authorities leaves a lot to be desired. I appreciate they want to protect Tourism, Hotel owner, restaurant owner etc but this is cold comfort at minimum and a slap in the face at the other end for the grieving families.

[TigerWan]

Someone please test for Tetrahydrozoline poisoning Common eyedrops commonly used in prank does not cause diarrhea, but sudden vomiting and with enough dosage can kill )

URL of this page: Tetrahydrozoline poisoning: MedlinePlus Medical Encyclopedia

Tetrahydrozoline is a form of a medicine called imidazoline, which is found in over-the-counter eye drops and nasal sprays. Tetrahydrozoline poisoning occurs when someone accidentally or intentionally swallows this product.

Tetrahydrozoline poisoning: MedlinePlus Medical Encyclopedia

Symptoms

• Airways and lungs
  • Difficulty breathing
  • No breathing

  [*]Eyes and skin

  • Blurred vision
  • Blue lips and fingernails
  • Change in pupil size

  [*]Heart

  • High blood pressure (at first)
  • Low blood pressure (later)
  • Rapid heartbeat

  [*]Stomach and intestines

  • Nausea
  • Vomiting

  [*]Nervous system

  • Coma
  • Headache
  • Irritability
  • Nervousness
  • Tremors
  • Seizures

  [*]Other

  • Low body temperature

Home Care

Seek immediate medical help. DO NOT make a person throw up unless told to do so by Poison Control or a health care professional.

More at link

[Donnyboy]

not sure if this has been reported, another mystery death, a french woman

Sixth mystery death in Thai city

A sixth person has died in Chiang Mai in circumstances similar to New Zealander Sarah Carter's death, it has been revealed.

An unnamed Frenchwoman died after she and her travelling companion fell ill while visiting the northern hill city, according to a report released by Thailand's Department of Disease Control.

Her death is one of six in as many weeks in Chiang Mai.

Ms Carter's father, Richard, told the Herald yesterday that the news of another death came as no surprise.

"I've suspected all along that this spate of deaths may possibly uncover several others.

"It's my view that it's good that all the others are uncovered, so that we can start to understand the actual risk that faces New Zealand travellers."

American Mariam Soraya Vorster, 33, died of swelling of the heart muscles - which can be caused by food poisoning or viral and bacterial infections - on January 11.

Ms Carter, 23, died of the same heart inflammation two days after she and friends Amanda Eliason and Emma Langlands became sick at the Downtown Inn on February 4.

The day before the New Zealanders became ill, Thai tour guide Waraporn Pungmahisiranon, 47, died from apparent food poisoning in a room neighbouring the one where the friends had stayed.

British pensioners George and Eileen Everitt were found dead in the same hotel less than two weeks later. Thai authorities said they had blocked arteries and had suffered heart attacks, a claim that has been rejected by their son Stephen Everitt.

The Department of Disease Control report does not reveal the Frenchwoman's name or where she was staying, only that she died between January 9 and February 4.

A post-mortem examination at Chiang Mai University revealed she had the same swelling of the heart that killed Ms Carter and Ms Vorster.

The report said investigations had found no common link between the different groups with heart inflammation, and earlier statements by Thai authorities suggested the deaths were coincidental.

New Zealand embassy staff were told last Thursday that newly released autopsy results showed Ms Carter had echovirus, a highly contagious disease that can cause inflammation of the heart, one newspaper reported on Saturday.

However, Mr Carter said the New Zealand Ministry of Foreign Affairs had advised him that the cause of death had not been established, and they were waiting on the results of further tests being carried out in the United States and Japan.

The Herald understands that an initial swab result has given an indication that Ms Carter had contracted echovirus.

The disease is linked to dirty and overcrowded conditions, but Thai police have given the all-clear to the Downtown Inn after checking conditions - a decision that MrCarter has little faith in. "To me it's way beyond coincidence that deaths were in adjoining rooms. I feel there should be another independent inquiry into it. Some further toxicology analysis would be appropriate in these circumstances."

He said he was thankful for the New Zealand Government's effort to speed the investigations along.

"I think it's moving in the right direction ... and as far as the work on the ground in Chiang Mai, it certainly seems to be moving a bit quicker than it did in the first week or two. Which is a good thing."

By Nicholas Jones | Email Nicholas

[softgeorge]

This is a warning in the Australian media.

Tourists heading to Thailand warned after spate of mysterious deaths

Read more: http://www.news.com.au/travel/news/tourists-heading-to-thailand-warned-after-spate-of-mysterious-deaths/story-e6frfq80-1226021683375#ixzz1GiiYJUxG

[craigt3365]

I just read this:

http://www.stuff.co.nz/world/asia/4760041/Tests-link-virus-to-dead-Kiwi-tourist

Tests have revealed that Kiwi backpacker Sarah Carter had a highly infectious virus that can cause the same heart condition that killed her in Thailand last month.

<snip>

[TigerWan]

Please note that virus found in Ms Carter is NOT listed as a cause of death. Cause of death is UNKNOWN which is why the CDC Bulletin does not warn of a virus but unexplained heart inflammation in five deaths in Chiang Mai. The Thai woman had no such condition.

REPEAT myocarditus ( inflammation )of the heart muscle) outbreak is the subject of the bulletin, not a virus. I bet if you randomly tested 10 people at least one of them would have some variation of an echovirus.

And the CDC is SPECIFIC l Look for vomiting with no other symptoms, this is not indicative of food laden pathogens that would also cause diarrhea, but a toxin poison.

I gather myocarditus can be caused by just about any stress to the body, like dehydration and or rapid heart beat? High blood pressure, too.?

Note LannaRebith's source states" it is being treated as a criminal poisoning investigation "

The one fact that to me says POISONER is aside from the one British man within th e elderly couple, all the deaths and illnesses are attractive young women.

I think there is a serial poisoner, who may not even be aware some of his victims are dying. It is a revenge prank using a substance, eye drops that is featured on crime drama TV shows as an innocuous agent that merely gives victims diarrhea when in fact it causes vomiting and rapid heart rate that leads to other complications in some victims that either don't get medical help, or have other conditions- like an echo virus - or hardening of the arteries-that contribute to death.

I just KNOW this is related to Andaman region deaths in May and June of 2009 and to my own poisoning in Ko Samet Jan 2005. Same persons? Maybe , maybe not- but I think it is deliberate.

I just read this:

http://www.stuff.co....ad-Kiwi-tourist

Tests have revealed that Kiwi backpacker Sarah Carter had a highly infectious virus that can cause the same heart condition that killed her in Thailand last month.

<snip>

Edited March 17, 2011 by TigerWan

[Donnyboy]

Update on Thai probe into deaths expected

Foreign Affairs Minister Murray McCully is expecting to receive updated information today about the death of Sarah Carter, one of seven who have died in mysterious circumstances in Thailand.

New Zealand officials in Thailand have been monitoring the investigation into Ms Carter's death but Mr McCully asked for a further briefing after it emerged Canadian Bill Mah, 59, died after using the facilities of the same hotel where Ms Carter, 23, fell fatally ill.

Ms Carter's father, Richard, contacted the Ministry of Foreign Affairs and Trade yesterday and asked them to start an independent investigation into the deaths.

"If the Thais are doing it themselves it's just likely to get glossed over," he said.

"Hopefully with all these deaths from all different countries, the various embassies will be able to put on enough pressure to get some sort of independent inquiry going."

When the sixth death was revealed this month, Mr Carter said he was not surprised and thought more would be uncovered.

Now he wants action to get answers.

"It's certainly at a stage now where they need to get cracking ... and my conversations with the friends of other deceased indicate that they have been frustrated in their attempts to find answers as well."

Ms Carter died in hospital from heart inflammation two days after she and two friends became sick while staying at the Downtown Inn in Chiang Mai.

An elderly British couple and a Thai tourist guide also died after staying at the hotel, and two other women died in Chiang Mai in similar circumstances within one month.

Thailand's Department for Disease Control said it could not find links between the deaths and authorities labelled them coincidental.

An initial report into Mr Mah's death on January 26 stated "suspected natural disease pending lab reports and toxicology" as the cause of death, but his friend said those results had still not been released.

Tests to determine the cause of Ms Carter's death are being carried out overseas, although the Herald understands an initial swab result indicated she had contracted echovirus.

The virus is linked to dirty conditions but Thai police gave the all-clear to the Downtown Inn, owned by a former mayor of the city, after checking it.

Mr Carter said he was searching for answers on behalf of visitors to Thailand.

"The grieving element will be hard to go away because of the fact we'll never get Sarah back. But the situation with following up on this is really more for the sake of future tourists, so the same situation doesn't happen to them."

He had tried to keep busy since his daughter's death but there were inevitably moments when the grief would catch up with him.

"When you're waking up to that as your first thought every day ... certainly the mornings and the weekends when we've got more time to ourselves seem to be the times when we're thinking a lot more of the tragic situation that befell Sarah."

By Nicholas Jones | Email Nicholas