case study #8
Alequina had a difficult month of May. She was at her grandmother’s funeral in Kouwaloken, Liberia exactly two weeks ago, on May 1. This past week, however, numerous friends, family members, and others have become ill. She is worried that she will be next. Her 11-year-old niece, Paulette, was brought to a local hospital in Greenville, Liberia by her parents on May 14th. Paulette was hallucinating, seemed confused, and was vomiting and having frequent diarrhea. She died just hours later, though samples of her cerebrospinal fluid and blood were taken prior to her death so that they could be analyzed.

The next day, more of Alequina’s family members and friends came to the same hospital, including Paulette’s parents. Three of the ten who came in died within 24 hours. Most of these cases presented with abdominal pain, diarrhea, vomiting, and mental confusion. Only a few (including two who died), had a fever. Some of the patients presented with purpura (purple-colored spots on the skin) and/or petechiae (pinpoint, round spots on the skin, reddish-brown in color). Local public health officials have passed along the surveillance data and an investigative team from the National Public Health Institute of Liberia. Even members of the Centers for Disease Control and Prevention from the United States, have come to the hospital.

All of those who died and all but one of those ill had been at the funeral on May 1st. The CDC is also testing serum, blood, and urine for metals and some environmental poisons. Samples have also been sent for polymerase chain reaction (PCR) testing at the National Reference Laboratory in Liberia. Once an agent is confirmed, additional conformational testing is recommended by the National Institute for Communicable Diseases and the National Institute of Occupational Health in Johannesburg, South Africa.

List at least 4 possible diseases that caused this outbreak and state why you think each may be the culprit. Be detailed. At least 2 pages should be written.