Mystery illness lab data awaited

By Robbie Dingeman
Advertiser Health Writer

The state Health Department is investigating a second disease, leptospirosis, as a possible cause of the death of a Hawai'i college student who came down with a mysterious flu-like illness last month in Maryland.

HULTMAN

His mother, Diane Hultman, said this week that Maryland officials told her a preliminary test indicated the illness might have been dengue hemorrhagic fever, a rare form of dengue fever. She also indicated that tests were being done for leptospirosis.

State Health Department spokeswoman Janice Okubo said preliminary tests indicated that leptospirosis could be the cause.

Diane Hultman said her son went hiking and swimming in a number of places while at home, including Waipio Valley, a known source of leptospirosis.

Leptospirosis is a bacterial disease that can also cause fevers and, in rare cases, death. It is usually transmitted by contact with the urine of infected animals. The most common form of transmission in Hawai'i is when people wade or swim in fresh water contaminated by the animal urine.

"We are seriously looking at other possible causes of the illness including leptospirosis," Okubo said.

Dr. Paul Effler, Hawai'i state epidemiologist, said officials will wait for results of more definitive tests being run by the Atlanta-based federal Centers for Disease Control and Prevention before discussing a possible cause of death. He expects those results next week.

So far, Effler said, officials have found no signs of illness among Hultman's family, friends or close contacts and no similar cases being reported on the Big Island.

All those indications show no immediate health threat from something likely to be transmitted from person to person, Effler said. But health officials ordered mosquito spraying in the areas where Hultman spent the most time in Pahoa while home for the holidays.

Dengue fever, which can cause a flu-like illness, is spread by mosquitoes. The state had an outbreak in 2001-02 — the first in decades — with 119 reported cases but no deaths and no cases that originated on the Big Island. There were no reported cases of dengue hemorrhagic fever during that outbreak, Effler said.

Aaron Ueno, district environmental health program chief for the Big Island, said his crews found areas in Pahoa where mosquitoes could be breeding. The workers emptied containers of water to get rid of mosquito larvae. If standing water couldn't be dumped, they sprayed soapy water on the surface to prevent mosquito breeding.

Ueno said they will likely go back in a week to check on the mosquito threat there. He said that if the cause of Hultman's death turns out to be dengue, his crews might do more spraying.

Effler said the initial test done in Maryland has a track record of faulty first results and that's why the department is taking precautions but not issuing a statement about any potential cause of Hultman's illness without the more rigorous lab tests.

If the diagnosis is dengue fever, Effler said, Hawai'i officials would ramp up surveillance. He said the state won't launch a full-scale dengue alert until the public health laboratories provide a more definitive diagnosis.

Hultman's mother said the family is preparing for today's memorial services for Simon, the youngest of her 10 children. Although he received many school honors, spoke at least three languages and studied in Japan and Hungary, he remained low-key about his accomplishments.

Today, they plan to put aside the puzzle of his death and welcome all to a memorial service at 10 a.m. at Pu'ula United Church of Christ. She is looking forward to seeing friends and family who plan "a good celebration of a great kid's life."

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.