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Pastimes : SARS - what next?

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To: Maurice Winn who wrote (717)8/30/2003 8:21:02 PM
From: Maurice Winn  Read Replies (2) of 1070
Here's the Sunday Star Times article about the cadaver pathologist's investigations:

<Doctors turn detectives in hunt for clues in Dunedin deaths
31 August 2003

Health experts are working around the clock to solve the mystery deaths of three people in Dunedin. Ruth Laugesen goes behind the scenes.

Dunedin pathologist Han-Seung Yoon had a sinking feeling last Sunday as he examined the lungs of the person who had died in strange circumstances a couple of days earlier.

"I was concerned. Oh, again!" said Dr Yoon, associate professor of pathology at Otago Medical School.

The post-mortem examination was uncannily similar to one Yoon had carried out just 11 days earlier.

The lungs were full of blood. Death had been savagely quick. Both patients were relatively young and in good health.

And there was no obvious clue to what had triggered the haemorrhage in the lungs that had killed the patient. There was no sign of the usual suspects - a blood clot, a burst large blood vessel, or of a disease of the blood vessels.

Now Yoon started wondering about a third autopsy involving bleeding in the lungs that he had carried out two days earlier. Perhaps that case wasn't as straightforward as it had seemed.

Last Monday, the word went out. In the world of pathology, this was two unusual deaths too many.

"Once is chance, two is coincidence and three is enemy action, or something like that," says professor John Blennerhassett of Otago Medical School, an expert in lung pathology who has been working with Yoon on the case.

"If it happens once you get very distressed or worried about missing something but you say, well these things happen. But if you get two cases or maybe three, it's just not acceptable to put it aside and say we don't know what the cause is," says Blennerhassett.

A medical detective case had begun. By last Monday the Dunedin medical officer of health, Dr John Holmes, was told of the strange cluster of cases. By Thursday night, the Health Ministry had decided to go public before word got out that three Dunedin people - Julie Millan, 46; Robyn Campbell, 56; Vincente Rawson, 39 - were dead from a mystery disease.

Since then, blood and tissue samples from the three victims have been going through exhaustive analysis at labs in New Zealand. Nothing has come back positive.

Among the samples being checked is one from Yoon himself, after he was splashed in the face with body fluid during one of the post-mortem examinations. He then came down with the flu, which he is now recovering from. [Editor {me} - so, there's another 'flu' case among the staff].

Samples have also been sent to world experts in infectious illnesses, the Centres for Disease Control in the United States.

Blennerhassett says their first thought was of some sort of a toxin all three victims might have been exposed to, such as an anti-coagulant like rat poison. But that had so far been excluded from tests.

The other leading possibility was haemoerraghic fevers, deadly viruses such as Ebola or the Hanta virus. But these viruses are not known in New Zealand and testing has shown no trace of any obvious viral agents at work.

University of Otago staff have begun exhaustive questioning of the next of kin of the two women, Robyn Campbell and Julie Millan, and one man, Vincente Rawson, who died.

The victims lived between 4 and 7km apart but did not know each other.

The quest is now to find something - anything - they had in common.

Rawson, who died on August 12, was brought in for a post-mortem the following day.

"Obviously I was puzzled. The post-mortem was quite a dramatic one because of the extensive, severe massive haemorrhagic bleeding in the lungs. There was a significant amount of blood in the airway, also in the stomach. I couldn't see any obvious pathology other than the lungs, so I thought maybe it was meningicoccal meningitis or maybe some acute viral type inflammation.

"But there was no sign of meningitis at all. So I immediately thought it was some type of virus-type infection, so I took fresh tissue from the lung and sent it to microbiology for culture study. I also secured blood and sent it to ESR for any sign of chemicals or drugs," says Yoon.

The next case, who he examined nine days later, was Campbell, who had been to see her GP with flu-like symptoms and had later collapsed at home. Initially Yoon believed he had got to the bottom of the cause of death.

A strange feature of the case was that there seemed to be some problem with the blood; it was not coagulating normally. Yoon found pneumonia in the upper lobe of the lungs.

He believed she had early pneumonia and that some bacteria that had caused the pneumonia had got into the bloodstream and caused septicemia, leading to her death.

Now, says Yoon, he is puzzling over what organism caused the pneumonia in the first place.

Millan, who died on August 22 and who Yoon examined two days later, appeared to have been feeling ill for at least a couple of days before her death.

She collapsed at home and was unable to be revived at the hospital.

In all three cases, the patients died because the bleeding in their lungs meant they could no longer breathe properly.

"There are a number of reasons why that might occur. And yet we have not yet been able to pinpoint exactly what this was," says Blennerhassett.

Blennerhassett, a senior practitioner in his field, says he has only ever seen one other similar case in his career.

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