title: Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan.
abstract: Plague, which is most often caused by the bite of Yersinia pestis-infected fleas, is a rapidly progressing, serious disease that can be fatal without prompt antibiotic treatment. In late December 2007, an outbreak of acute gastroenteritis occurred in Nimroz Province of southern Afghanistan. Of the 83 probable cases of illness, 17 died (case fatality 20·5%). Being a case was associated with consumption or handling of camel meat (adjusted odds ratio 4·4, 95% confidence interval 2·2-8·8, P<0·001). Molecular testing of patient clinical samples and of tissue from the camel using PCR/electrospray ionization-mass spectrometry revealed DNA signatures consistent with Yersinia pestis. Confirmatory testing using real-time PCR and immunological seroconversion of one of the patients confirmed that the outbreak was caused by plague, with a rare gastrointestinal presentation. The study highlights the challenges of identifying infectious agents in low-resource settings; it is the first reported occurrence of plague in Afghanistan.
authors.affiliation: Health Protection and Research Organisation, Kabul, Afghanistan. toby.leslie@lshtm.ac.uk
authors.forename: T
authors.initials: T
authors.lastname: Leslie
authors.forename: C A
authors.initials: CA
authors.lastname: Whitehouse
authors.forename: S
authors.initials: S
authors.lastname: Yingst
authors.forename: C
authors.initials: C
authors.lastname: Baldwin
authors.forename: F
authors.initials: F
authors.lastname: Kakar
authors.forename: J
authors.initials: J
authors.lastname: Mofleh
authors.forename: A S
authors.initials: AS
authors.lastname: Hami
authors.forename: L
authors.initials: L
authors.lastname: Mustafa
authors.forename: F
authors.initials: F
authors.lastname: Omar
authors.forename: E
authors.initials: E
authors.lastname: Ayazi
authors.forename: C
authors.initials: C
authors.lastname: Rossi
authors.forename: B
authors.initials: B
authors.lastname: Noormal
authors.forename: N
authors.initials: N
authors.lastname: Ziar
authors.forename: R
authors.initials: R
authors.lastname: Kakar
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D000818:Animals; D001431:Bacteriological Techniques / Q000379:methods; D002162:Camelus; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D010930:Plague / Q000453:epidemiology* / Q000401:mortality; D016133:Polymerase Chain Reaction / Q000379:methods; D021241:Spectrometry, Mass, Electrospray Ionization / Q000379:methods; D015010:Yersinia pestis / Q000302:isolation & purification*; D055815:Young Adult