Unexplained Critical Illnesses and Deaths of Possible Infectious Etiology, 2000
Surveillance for unexplained critical illnesses and deaths of possible infectious etiology in Minnesota began in September 1995 as part of the EIP. Original eligibility criteria for the project specified that cases must be Minnesota residents between the ages of 1 and 49 years who were previously healthy with no chronic medical conditions (e.g., diabetes) and had critical illnesses or died due to illnesses suggestive of infectious etiology. During 2000, the CDC revised the protocol for the project. In future years, only deaths among persons 1 to 39 years of age will be eligible for enrollment in the core surveillance project. However, MDH requests that any case of unexplained critical illness or death that appears to have a possible infectious cause be reported regardless of age and underlying conditions. A subset of reported cases will continue to be eligible for testing at CDC. Also, some testing may be available through CDC and/or MDH at the physician's request for cases that are not eligible for enrollment in the project.
Seventeen possible cases were reported in 2000. The patients' health care providers subsequently determined causes of illness for six of these cases. Of the 11 remaining cases, five presented with respiratory symptoms, four with neurologic symptoms, and two with shock/sepsis. The respiratory cases were 20, 24, 40 (two patients), and 55 years of age. The neurologic cases were 21, 27, 40, and 46 years of age, and the sepsis cases were 19 and 25 years of age. Two patients with respiratory syndromes (a 20-year-old and a 40-year-old) and two patients with neurologic syndromes (a 27-year-old and a 46-year-old) died. Three respiratory cases, three neurologic cases, and one sepsis case resided in the seven-county Twin Cities metropolitan area; the remaining cases resided in greater Minnesota.
The four case-patients who died were eligible for inclusion in the project. The two case-patients over the age of 39 years died before changes in the protocol took effect. Laboratory specimens for all except the 27-year-old neurologic case have been submitted to CDC. Possible etiologies for two cases have been determined through the project since it began. Using universal primers for polymerase chain reaction, Streptococcus pneumoniae was detected in pleural fluid of a case-patient with a respiratory syndrome. Influenza A was detected by immunohistochemistry of lung tissue of a case-patient diagnosed with myocarditis.