Investigation of a haemorrhagic febrile illness in Nakaseke District, Central Uganda: A case series report

Abstract

Persons in Nakaseke and neighbouring districts within Central Uganda suffered from a haemorrhagic febrile illness. Four tested positive for the Crimean-Congo Haemorrhagic Fever (CCHF) virus, five for the Rift Valley Fever (RVF) virus, however over twenty tested RT-PCR-negative for Ebola, Marburg, CCHF, RVF and Sosuga viruses. In January-February 2018, we investigated cases and deaths with Viral Haemorrhagic Fever (VHF)-like manifestations that tested negative. Patients isolated at Kiwoko, Nakaseke and Mulago-Kiruddu hospitals were evaluated, homes were visited and hospital records were reviewed, noting admissions with haemorrhage since 2017. The nine isolations had fever and came from Nakaseke and Luweero districts. There was haematemesis, epistaxis, haematochesia, melaena and otorrhagia. Clinical findings included lymphadenopathy, splenomegaly and hepatomegaly. Laboratory analysis revealed anaemia, thrombocytopenia, microfilariae in blood, urine and faeces, schistosome ova in urine and faeces and Leishmania in blood. Two deceased had had fever, haematemesis and epistaxis. Home-visiting noted termite mound-riddled terrain, domestic use of pond and swamp water and open excretion. The suspicion of VHF was appropriate, however in Africa there are other possible causes of haemorrhagic fever like the multiparasitism demonstrated which included filariasis, schistosomiasis and leishmaniasis. The communities living environment was considered favourable for the vectors and transmission of the parasites.