On 1 August 2022, the Epidemic and Disease Control Unit of the Ministry of Health in Gambia reported an unusual event detected at the Edward Francis Small Teaching Hospital in Banjul, the main tertiary hospital in the country. A total of 75 cases of acute kidney injury (AKI) of unknown etiology with 50 deaths ( CFR 66.7%) have been reported by the World Health Organization.
The median age is 17 years old and range from five to 46 months. The index case was traced to 4 July 2022 . Patients presented with symptoms such as inability to urinate (100% of cases), fever (100% of cases), vomiting (91%), and diarrhea (55%).
All children had an acute onset of symptoms, and clinical progression was rapid.
Stool samples from children with similar clinical symptoms to AKI cases (fever, vomiting and diarrhea) were negative for rotavirus and Vibrio cholerae. However, 38 (61%) out of 62 stool samples (from children with similar clinical presentation as AKI cases) tested positive for Escherichia Coli (E. coli.). Two samples were positive for Shiga toxin- producing E. coli (O157). Whole-genome sequencing of E. coli to identify lineage was also done and is awaiting interpretation.
Water quality assessment tests conducted in household of children with AKI revealed the presence of E. coli, but were negative for heavy metals including mercury and lead. Additionally, increased nitrite levels mainly in boreholes and one major national water source (Fajara) were also reported. The 2018 Multiple Indicator Cluster Surveys also revealed the presence of E. coli in all the water points tested.
Preliminary investigation was conducted to identify contacts of the cases. No similar illness among other siblings of similar age or other household members was detected.
Further investigation is ongoing.
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