Thread: NZ woman in Thailand food poisoning death

Unsurprisingly there is a great deal of speculation over the causes of the Down Town Inn cluster of deaths in Chiang Mai. With food poisoning ruled out, and no indication that anyone unconnected with the hotel has either died or became seriously ill exhibiting similar symptoms during the period, other causes are being examined.

Surely "Other possible excuses are being examined"?

These range from toxic spider bites to deliberate poisoning—perhaps intended to damage the Down Town Inn's reputation as part of a personal or business dispute. Local political leaders, the police and medical services have contributed to this atmosphere through their failure to provide credible and independently audited explanations for the deaths.

Local political leaders who happen to own the hotel.

This case will continue to grow unless it is resolved quickly and to the satisfaction of the victims' families and the media. Although it is unlikely to harm Thailand's overall appeal as a tourist destination it will do little shake off the country's reputation of a being a great place to holiday, but with dark and dangerous forces barely below the surface.

I bloody well hope so!

Tests link virus to dead Kiwi tourist
Last updated 05:00 12/03/2011

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.

Thai health authorities are still investigating what caused the sudden deaths of Ms Carter, 23, and four others in Chiang Mai within five week, including an elderly British couple, an American woman and a Thai woman.

Ms Carter and Kiwi friends Emma Langlands, 23, and Amanda Eliason, 24, became seriously ill with vomiting and heart complications while staying at the Downtown Inn in the northern tourist city.

Ms Carter died of myocarditis, or acute inflammation of the heart muscle, on February 6, and Ms Eliason needed emergency heart surgery. Their illness was initially blamed on food poisoning from a seaweed toxin.

Thai doctor Pasakorn Akarasewi met New Zealand embassy staff for a two-hour briefing on Thursday night to report the investigation's latest findings.

His report includes newly released autopsy tests, which showed Ms Carter had echovirus, a highly contagious disease linked to dirty, overcrowded conditions, which can cause myocarditis.

Dr Akarasewi, Bureau of Epidemiology director for Thailand's Department of Disease Control, said doctors were unsure what caused the Kiwis' illnesses.

"After the group of three New Zealanders, we set up the joint investigation team," he said.

Soon after, the team heard about the deaths of elderly British couple George and Eileen Everitt in the same hotel only two weeks later. Members also heard about Thai woman Waraporn Pungmahisiranon, 47, who died in the room next to Ms Carter on February 3 – the day before the New Zealanders became severely ill.

Dr Akarasewi said autopsy results showed the British couple had blocked heart arteries, which could have caused their deaths.

A fifth victim, American woman Mariam Soraya Vorster, 33, who died on January 11, though not in the Downtown Inn, had symptoms that were "in the same pattern" as Ms Carter's.

Although her death occurred a month earlier, an autopsy had been performed before her cremation in Chiang Mai, he said.

Thai police had checked the Downtown Inn's air conditioning and facilities but found nothing untoward.

- The Dominion Post

*************

link here for some info on echovirus

a slow, inept and apathetic response regarding public policy is the middle path.

If it was an echovirus, what I don’t get is all the vomiting reported by the victims. The emedicine.com info (some of which is below) that I got from Emedicine (a website by and for MDs) doesn’t say a word about vomiting as a symptom.

Since echoviruses are common, and usually cause no symptoms, it is entirely possible the Thais found traces of it in one of the victims. But correlation does not mean causation. Lots of people have this virus in them, usually without symptoms.

And the vomiting? Emedicine lists other symptoms, but not vomiting. In fact, most cases of echovirus infection are asymptomatic. No symptoms, no clinical illness. Also, an upper respirator tract infection often precedes—by weeks—any heart involvement in many of those who go on to get heart complications. But since most of the Chiang Mai victims were sickened (with vomiting) around the same time in hotel rooms located very close to each other, how does that jive with the timeline and symptoms given by emedicine?

Below from
Echoviruses: eMedicine Infectious Diseases

”Fifty to eighty percent of patients with echoviral infections are asymptomatic. The most common presentation is a nonfocal, asymptomatic febrile illness. Illnesses may be caused by virtually any enteroviral serotype and are indistinguishable clinically from infection with many other viral agents. Disease syndromes characteristic of enteroviral infections (eg, aseptic meningitis, pericarditis) are, in fact, unusual manifestations of infection.

Following ingestion of fecally contaminated material, viral replication begins in the pharynx or gut.

Following replication, enteroviruses spread to regional lymph nodes and cause subclinical transient viremia. During this low-grade viremia, the virus spreads to reticuloendothelial tissues, including the liver, spleen, bone marrow, and distant lymph nodes. Secondary sites of infection include the CNS, liver, spleen, bone marrow, heart, and lungs. More than 90% of echoviral infections are asymptomatic. When disease occurs, symptoms vary from undifferentiated febrile illness to severe illness, depending on the age, gender, and immune status of the host and the subgroup, serotype, and enteroviral strain.

Echoviruses are found worldwide and affect people of all races and cultures. Infection rates vary with the season, geography, and the age and socioeconomic status of the population sampled. Infection among lower socioeconomic groups is attributed to overcrowded living conditions and poor hygiene. Infections occur throughout the year in tropical climates. In temperate climates, infections are more prevalent during the summer and early fall.

Age

Three quarters of enteroviral infections, including echoviral infections, reported to the World Health Organization occur in children younger than 15 years. In the United States, attack rates in infants younger than 1 year greatly exceed those in older children and adults.

Myocardial/pericardial disease

* Enteroviral myocarditis is often associated with an upper respiratory tract illness and may occur at any age, but seems to be particularly prominent in adolescents and young adults. Males are affected twice as often as females. In many cases, an upper respiratory tract illness is reported within 2 weeks prior to the onset of cardiac manifestations.
* Common symptoms include shortness of breath, chest pain, fever, and weakness.

Myopericarditis

* Enteroviral infections can produce myopericarditis, with severity ranging from asymptomatic disease to intractable heart failure. Sudden death may occur in apparently healthy adults who are later found to have evidence of viral myocarditis at autopsy.
* Epidemic enteroviral myopericarditis appears to be rare. Most cases have been sporadic, even during enteroviral epidemics.
* Chest pain occurs in as many as 90% of cases and often is dull in nature. A transient friction rub has been observed in 35%-80% of cases

Medical Care

Most echoviral infections are self-limited and require no specific therapy. Medical treatment is supportive and symptomatic. Pleconaril, an experimental agent with in vitro activity against most enteroviruses, was evaluated in clinical trials but has not yet been approved by the FDA for use as an antiviral agent

The ubiquitous nature of echoviruses, and of enteroviruses in general, and the ease of person-to-person transmission complicate prevention of echoviral infections. As in other enteroviral infections, good overall public health, including adequate clean and potable water, sanitation, and clean living conditions, can act as deterrents.

Epidemics have been reported in Panama, Mexico, Switzerland, Cuba, the United States, and Turkey. Asian-Pacific countries have reported major enteroviral epidemics with significant morbidity and mortality. A Thai hospital reported the first nosocomial outbreak of hand-foot-and-mouth disease due to echovirus type 11, underscoring the importance of strict infection control and hand washing in preventing disease.10 A similar outbreak of echovirus 11 was reported from an Israeli children's home. Nine children shared a large room with a common basin.

Since the Thai authorities in Chiang Mai bring up echovirus—which is spread by fecal-to-oral route--I will offer some comments on the Thai ability to bring the fecal-to-oral route to many, probably as much as they bring their smiles to us. It is worth talking about this because lack of proper hygiene is a cause of a lot of disease, suffering and death. And so traveling to Thailand is not without its risks when the Thai people are so lacking in basic hygiene.


I lived in a Thai rice farming ‘village’ (small town) and observed Thais for at least 5 years, up close. I never saw a Thai wash his or her hands after walking into the kitchen. I never heard the bathroom sink water turned on after they used the toilet. My Thai wife explained to me how she was raised to go to the bathroom and she is insistent that many if not most Thais in the countryside still use only their hands (with no toilet paper) to wipe themselves after defecating and then pour dirty water over their hands as their version of cleaning. Think about it: in most bathrooms in Thailand you don’t see toilet paper and you don’t see sprayers (which have their own problems, see below). All you see is a bucket of water. How do you think the person gets the feces off of their bodies using simply a water pan with a handle? Answer: they use their bare hands.

If sprayers are available, then spraying the private parts after defecating is a great way to splash fecal material everywhere, including hands, legs, clothes, shoes, the bathroom. I urge you to try spraying yourself–as I have–and find out for yourself just how messy this method is. I know it sounds good in theory–it sounded good to me, too…until I tried it.

In Thailand dirty bathrooms are the rule. Even when Thai bathrooms don’t appear dirty, you still can’t find soap in them, or hot water (but I’d be happy with just the soap).

There is a reason the fecal-to-oral route is the number one cause of disease transmission in second and third world countries--because most people don’t practice good hygiene. I know many people in the West who fail to practice good hygiene, too---but this lack is much more prevalent in poorer countries.

I’m not trying to criticize Thailand unnecessarily. One of the reasons I love Thailand is because it is still a little ‘wild’. But it is better to be clear about the lack of hygiene here in the Land of Smiles.

Sounds like bollocks, doesn't it? And they're still saying "blocked arteries" could be the cause of death of the English couple?

Can't wait to hear the NZ version of this once they've reported back.

From Thursday:

"We have to admit that these deaths coming one after another are nothing more than coincidence," Mr Disakul said at a press conference on Tuesday.
But Ms Carter's father, Richard, said yesterday that he was certain the deaths were not a coincidence. "That's the sort of language you get with a coverup.
"Hopefully the pressure from the New Zealand Government ... will stir them into something a bit more positive," he said.
"The results can't bring Sarah back. My main concern is that something is done to work out the cause and correct what brought about the illness so that others don't suffer the same fate."
Mr McCully's spokesman said consular officials in Bangkok had spent "quite a bit" of effort to get Ms Carter's test results back.

What a surprise.

The Chiang Mai Mail's report on the press conference the other day:

Chiang Mai authorities are still working urgently on the investigation of the deaths of four people at the Downtown Inn Hotel near the Night Bazaar last month it was reported at a press conference. In three separate cases a Thai tourist guide, a New Zealand student and a British couple all died at the same hotel within days of each other.

Chiang Mai Governor M.L. Panadda Diskul reported that samples are being sent to the U.S. and Japan for further investigation, especially in the case of the New Zealand girl, Sarah Carter, originally reported as food poisoning.

The Provincial Public Health Office, the Office of Epidemiology, the Communicable Disease Control and Prevention Center, Maharaj Nakhon Chiang Mai Hospital, the Institute for Forensic Medicine, forensic police and Chiang Mai Provincial Police are all involved in the cases.

Thai authorities said the cause of death in two cases was still not clear; Mrs. Waraporn Yinghasawanont, 47, a Thai tour guide who checked in and stayed at the hotel February 2. After sightseeing tours to Doi Suthep the previous day, she was found dead in the morning of February 3 in front of the bathroom in her hotel room. Doctors reported that she had asthma and Pol. Col. Montri Sampunnanont, the Deputy Chiang Mai Provincial Police Commander told the Chiang Mai Mail that she had been seen with labored breathing and that might be the cause of her death.

However, Dr. Paskorn Arkarasewee, the Director of the Office of Epidemiology said the real cause of the death of the guide Mrs. Waraporn had not been determined and that the cause of death of Sarah Carter, the New Zealand tourist, was still unclear.

A Chiang Mai Muang District Police said that Ms. Sarah Katherine Carter, 23, a student from New Zealand traveled from Phuket to Chiang Mai and checked in to the hotel on February 2 with two friends. On February 3 they were found seriously ill with vomiting and nausea so the hotel staff called an ambulance to take them the hospital for treatment where, on February 6, Sarah Carter died. The other two girls also ill, eventually recovered and returned home.

Dr. Derek Bunnachak of the Medical Faculty of Maharaj Nakhon Chiang Mai Hospital told Chiang Mai Mail that bacteria might be a cause of food poisoning. Dr. Pasakorn of the Epidemiology Office said they were seriously sick, with bad stomachaches and vomiting, and Miss Carter may have gone into shock from this. “This was really a rare case.”

He added that the primary diagnosis suspected the E Coli bacteria caused by unclean food. “However, samples were sent for further examination in both the United States and Japan to find the real cause,” confirmed Dr. Pasakorn Arkaraseree, Director of the Epidemiology Office.

Provincial Public Health Office Deputy Head Dr. Surasing Wisarutrat said the case will not be concluded until all test results are in. Doctors confirmed that they did not eat seaweed as earlier reports suggested.

The Governor expressed his sadness and concern over the death of the young New Zealand girl, “Thai authorities are looking hard at the case to find the cause and we will inform formally and immediately the family members through the New Zealand Embassy.

He spoke on behalf of Thai authorities that “We are very much concerned and definitely look after all visitors to Chiang Mai.” He has ordered government officials to step up inspection of all food shops, restaurants and hotel services to ensure food cleanliness.

Chiang Mai Police then reported that the elderly British couple, Eileen and George Everitt who checked into the hotel on February 9. They were scheduled to check out February 19 but when they did not appear, staff called their room and then entered the locked room with a master key after they had not answered the phone. There they found the couple dead, Eileen Everitt, age 74 on the bed and George Everitt, 78, sitting near the bed.

Police found no evidence of a break in, no signs of illness or vomiting, no drugs or poisonous substances in the room. It is believed the couple died on February 17 or early morning the 18th since they did not appear for breakfast on the 18th. Doctors reported that both couples suffered from severe blockage of the arteries that resulted in a coronary thrombosis.

Incredible that they are trying to pass the cause of death off as coincidental heart attacks.

Some more background from Drummond:

A spokesman for the British Embassy in Bangkok said today: “As far as we are concerned the case of Mr & Mrs Everitt is definitely not closed and we are awaiting the results of further tests.”
New Zealand Foreign Minister Murray McCully said: “We will look into the matter further.
“It’s clear that we need to ask some more questions.”
The owner of the Downtown Inn in Chiang Mai, Boonlert Buranupakorn, is a former Mayor of the city.
Apart from the Down Town Inn, Empress, Park. and Sofitel Riverside in Chiang Mai city he owns, according to the ‘Nation’ newspaper, a shopping centre, coffee shops, and furniture and umbrella factories in the northern capital.
He also owns hotels in Bangkok and Southern Thailand, a chain of restaurants in Germany called ‘Rainbow’, and once planned to start an airline.

Chiangmaimail just reports what it wants to report and never publishes anything that may cause the slightest offence. With a Thaivisa moderator heading up the editorial side but with more interest in the hi so society of chiangmai you can't expect any real journalism. Thank God for Drummond.

Originally Posted by guyinthailand

”Fifty to eighty percent of patients with echoviral infections are asymptomatic.

ONly means thay aren't sick or die . Some get it , some get sicker, some die

Originally Posted by guyinthailand

Males are affected twice as often as females.

Doesn't fit

Originally Posted by guyinthailand

pericarditis)

Pericarditis - Wikipedia, the free encyclopedia

- [ แปลหน้านี้ ]Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart).
Isn't it a muscle that is inflamed on the autopsy?
I have no knowledge of anatomy.

Originally Posted by KAPPA

* Enteroviral infections can produce myopericarditis, with severity ranging from asymptomatic disease to intractable heart failure. Sudden death may occur in apparently healthy adults who are later found to have evidence of viral myocarditis at autopsy.

Certainly fits.

Delib or accidental? Delib or accidental ?

I've heard of another death today - supposedly an American woman in her fifties. I hope to confirm it in a short while.

^ Are you a bar owner in Chiang Mai Kevin? If you are is there much talk around your place about what is happening?

Welcome to TD.

The ol Visine in the Mai Thai ?

snopes.com: Visine Prank

Originally Posted by setaputra

Chiangmaimail just reports what it wants to report and never publishes anything that may cause the slightest offence.

They once did an excellent, hard-hitting, insightful front-page article on the Queen's taste in shoes. They approved of it and suggested that we should all follow her advice.

Originally Posted by mobs00

^ Are you a bar owner in Chiang Mai Kevin? If you are is there much talk around your place about what is happening?

Welcome to TD.

Yes I am a bar owner and there is plenty of talk about it. Unfortunately, a lot of rubbish and rumours. I've just checked about the fifth death and it doesn't sound like it's true. I checked with the hotel and nearby businesses and nobody seems to know about it. It was supposedly from a local radio report and somebody said that somebody said type nonsense. Of course it was said to me with great conviction and belief. Sorry about the mis-information.
George and Eileen were regulars at my place during their stays in Chiang Mai for the last few years. Lovely people, who will be deeply missed. I still find it hard to believe.