My cousin died of an Ebola-like viral hemorrhagic fever

One of my many cousins is a man named Jehanzaib: we all call him Zaib. He lived in Karachi, Pakistan, with his wife and three infant children.

About a week ago, he fell quite ill. I do not know the initial symptoms. He went to the hospital, they checked him, put in an IV (a “drip” as they call it there - it seems to be an expected part of any treatment requiring a trip to the hospital). After some them, they let him go home. He drove himself home. No problems. Very soon after reaching his home, he suddenly fell drastically ill. He had a high fever and began to bleed from his mouth. He was rushed to the hospital. He was in a very, very bad shape. Any time they would insert a needle, he would bleed profusely. His kidneys failed. They began doing dialysis. They say that while circulating his blood in and out, you could smell the stench of the bad blood floors away. He was unconscious for the most part. Nevertheless, he was never alone. Someone was always there with him.

A few days later, his heart stopped, and he died. His case was so bad that the hospital called Eidhi - a charity service - to dispose of him. They washed his body as well as they could, put his remains in a coffin, and buried him. Now, the coffin part is significant - the practice in Pakistan is to transport the body in a bier and then to put the shroud-covered body into the grave. Coffins are not used. But they needed to use a coffin for him. The Eidhi people also refused to let anyone see him after he died. They had a very hard time handling him: he was so fragile and dismemberable.

The doctors say that he contracted some sort of “Congo virus,” like Ebola. They say he did so when he recently went to Quetta, in Balochistan (which is near the tribal areas, Afghanistan, and the Patthan-dominated Northwest Frontier Province). Evidently, outbreaks of viral hemorrhagic fever (VHF) in that area is not unknown. How did this virus reach Quetta of all places? Would this one incident in Karachi trigger an epidemic episode?

All my relatives and family are in shock and deep sorrow. His wife and kids living in Pakistan will now have to survive on the charity of relatives, unless she can get married, which would not be easy. This happened so fast. We’re still confused as to what exactly happened, how it happened, and so on.

I just hope no one else will get infected. From what I have read, these viridae are highly contagious. If this is so, our present sorrow will only be the beginning.

Please, if someone has more information about VHF, especially the strains in Pakistan, I would greatly appreciate any information.

WRS

WeRSauron,

I am so sorry for your loss!
It was kind of strange to run into this thread today as I have been reading a book on VHFs, called “Virus Hunters of the CDC”, which has to do with the tale of two Drs who worked for the CDC and their work in various 3rd world countries including Pakistan.

My understanding is that in almost all cases VHF’s are spread by contact with infected fluids. Often times it is passed to relatives caring for the sick or by contact with the body during the funeral if the patent should die. Relatives of the deceased there have much more contact with the body during the funeral than we do here in the West because of the various rituals and rites involved, making infection much more likely. I suppose that is possibly why there were so many procautions.

There was also a strain which was transmitted by ticks which might be the congo varient you mentioned as I believe it is found in Pakistan, especially among people who deal with sheep. I wish I had the book with me as then I could give you much better specifics.

From what I read, VHF’s work by reducing the platelet count in the blood which allows blood to escape the blood vessels. Thus the terribly bleeding, which usually starts in the gums. It also does serious damage to the liver.

Sorry this is so vague. If I remember to bring the book to work I can post more later. There is a chapter or two that directly deals with strains in Pakistan.

-LastCall

So sorry for your family’s loss, Sauron.

Don’t know if this is any comfort to you, but from the little I’ve read about hemorrhagic fevers, the incubation peroids tend to be short, so if the immediate family has not displayed any symptoms, chances are they’re going to be OK.

I feel for the children, to lose their father so suddenly.

Yes, I should have mentioned that. I didnt immediately see the concern about other family members in your original post. I believe the incubation period is under 2 weeks.

Actually reading the article is appears to be shorter than that, more like 2-7 days. Sounds like if they aren’t showing signs they should be pretty close to all clear.

My prayers are with you and your family.

-LastCall

I’m so sorry for you loss. These types of diseases are especially hard for families because it happens so fast, the symptoms are horrific and the quarantine procedures are heartwrenching. Hopefully, the losses are over for your family.

Here’s what I can contribute. It sounds like he had Crimean Congo Hemmorhagic Fever which is known to have a pretty wide range including Pakistan. I’ve always heard that it is coorelated with sheep and goat farming, but that may be old info. The disease itself is very similar to Ebola, as you mentioned.

The good news is that these outbreaks tend to be self limiting. The disease is so quick, that the infected have little time to infect others. Generally, the most at risk are the medical workers but basic precautions like gloves can stop the spread. Also, disease severity tends to decrease with each transmission. In other words, the first case is severe, but the next case is less so andthe next even less so. Apparently, these viruses don’t survive in the human population very well. This results in explosive, but short outbreaks. And, as previously mentioned, the incubation period is short, a matter of days. So if your relatives aren’t showing signs, they’re probably OK.

My concern would be in identifying where Zaib was exposed. That is probably a bigger risk to the relatives (and others) than exposure to Zaib himself.

I hope this helps.

Thanks for your comments.

As of right now, many of us in the US are worried about relatives in Karachi who were close to (emotionally and physically) Zaib. We’re hoping and praying no one else got infected, and we all think people close to him should get tested now to find any signs of the virus, so that treatment can be administered immediately if found. But I don’t know if anyone’s suggested this to the folks there. All this worrying is concurrent with worrying about Zaib’s wife and kids.

Fortunately, we have no relatives in Quetta, where evidently Zaib picked up the disease. What he was doing there we (we=relatives in the US) are as of yet unclear. Plus, no one has come from Karachi, so we are not fearing an outbreak here.

I never imagined that a VHF-casuing virus could strike someone in Pakistan. I had always associated such viruses with African outbreaks (or outbreaks abroad from a carrier from Africa).

I have two books I’m rereading now: Virus X by Frank Ryan and The Hot Zone by Richard Preston. Such issues have always fascinated me. Now I have more personal reasons to learn what I can.

Thanks, all.

WRS

So sorry to hear of your loss and I hope it stops there. We had an outbreak of hemorrhagic fever in Saudi a few years ago in the Jeddah area. Like you, I always think of this as being in the Congo or some similar African country but evidently the various types can be caught in a wide range of climates. I believe the stuff in Jeddah was passed by mosquitos but I’m not sure.

Best regards

Testy

I’m not familiar with Virus X, but I want to warn you about the Hot Zone. It is a good read, but know that Preston has exagerrated some things for effect. Basically, he makes it sound worse than it is and to have more epidemic potential than it does.

If you want a more objective reporter’s view, try The Coming Plague by Laurie Garrett. It is intimidating at something like 900 pages, but it’s well worth the effort. Each chapter focuses on a different disease, so you can skip around and just read certain chapters. This is the original of the virus-hunters type books and still the best.

Virus-Hunters of the CDC by Joe McCormick and Susan Fisher-Hoch is also good. They are researchers in the field, not writers. This book might be of particular interest to you because they ended up moving to Pakistan to run the virology lab there. IIRC, there’s quite a bit about natural outbreaks in Pakistan, particularly of CCHF.

I have nothing to offer on the main subject except my condolences.

I will second the recommendation for reading *The Coming Plague * by Laurie Garrett. I’ve read most of the book once and then reread a few sections a couple times.