Chlorine-resistant PPH likely to recur in healthy adults

The illness that has left more than 1,000 South Africans sick with symptoms similar to Legionnaires’ disease, a bacterial infection most commonly found in water systems, is “unusual” but has “no epidemic potential”, says an anti-retroviral (ARV) specialist who has treated a number of those affected.

The outbreak has forced the closure of nine premises, including Johannesburg’s posh downtown CBD convention centre where a three-day conference of heads of state from Africa, Asia and Europe will take place beginning on Friday.

Dr Mpho Motsamayi, the head of the medicine department at the Mpumalanga Medical School, said South Africans should expect to see the illness recur – probably for about two months – in an otherwise healthy individual with a weak immune system.

Motsamayi said she was first introduced to the illness – also known as porphyria – in 2007 at the age of 36 when she went to Gorewe hospital in Mamelodi to treat a case of pleurisy. “For me, it was a first. I was diagnosed with pneumococcal meningitis. I was so surprised and shocked. I had never heard of porphyria and never read anything about it in medical literature.”

At her next annual check-up the following year, the disease had returned, but this time Motsamayi experienced pneumococcal encephalitis, with a compound pneumonic (myocardial) encephalitis – inflammation of the brain – as well as pleurisy, infective otitis externa and pharyngeal shunt and biliary stomatitis.

The circulatory and central nervous system of those affected with porphyria are weakened and their bodies may become hyper-sensitive to chlorine and antibacterial agents. ARVs, antibiotics and nevirapine can improve patient outcomes.

“In fact, porphyria causes no human cases of Legionnaires’ disease, and its symptoms are sporadic.” Motsamayi said. “Usually, as one gets older or is taking medication for other illnesses, a disease like porphyria will occur.”

The nasal symptoms of pneumonic encephalitis are vague headaches, difficulty in concentration, nausea and vomiting, acute high blood pressure and nausea.

Motsamayi said she now learnt that a “yellow-green metallic discharge” and eye irritations are additional symptoms of the disease. She was surprised that untreated porphyria could lead to legionella pneumophilia, or germ-like infection of the lungs and heart in young children, who are particularly susceptible to emerging infections that often lack symptoms.

Pneumonic encephalitis caused by porphyria is associated with bacterial pneumonia and can be complicated by macular degeneration. “As we know, most pneumonic cases with porphyria do not have any neurological symptoms, but a few can undergo cerebrovascular dementia due to peripheral neuropathy.”

The ARV specialist said there were only a few cases of adults receiving treatment for the disease, but most patients recovered with proper treatment. The duration of effects tend to be long and just over one year on average.

She said she suspected the disease was associated with rainy weather. “That is why some of the cases have come from the CBD, where rain from November to March has caused flooding. I suspect a rapid descent can take place.”

Motsamayi stressed that the disease could not be contracted over the internet or over the telephone and emphasized that South Africans should remain calm. “This disease is happening very, very fast. The first symptoms were seen in only two months.”

The truth is the South African public is not adequately informed of the disease because of problems in the public health system. People can walk into a health facility or clinic on a Friday night and never be told about porphyria and pneumonic encephalitis.

“Many hospitals are staffed by doctors without a medical degree, and doctors sometimes are required to diagnose this disease without even having seen the patient or other health workers. Some of them feel their job is to execute orders, without much thinking. It is very common for unqualified people to diagnose this disease. I strongly encourage health facilities to have nurses and doctors with medical degrees to determine whether the patient needs to be admitted, kept in isolation or referred.”

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