Published May 20, 2026 | DOI: 10.1056/NEJMc2606496 | Copyright © 2026
To the Editor:
On April 27, 2026, a man (later classified as Patient 3 in the outbreak) was medically evacuated to Ascension Island from the Dutch-flagged expedition cruise ship MV Hondius; he had severe acute respiratory infection (SARI) and reported shortness of breath and fever that had begun on April 21. He had signs of pneumonia, although findings on chest radiography were unremarkable. While he was on Ascension Island, his condition worsened, and he was transferred to Johannesburg, South Africa, for ventilator support and intensive care.1 He was in shock and had acute respiratory distress syndrome; findings on chest radiography were consistent with atypical pneumonia. The differential diagnosis in this clinical context is very broad and includes atypical pneumonias, bacterial or fungal sepsis, and vectorborne diseases such as malaria or dengue. The diagnostic evaluation, including respiratory pathogen panels, malaria smear and antigen, fungal biomarkers, blood cultures, and legionella urinary antigen, was unrevealing. Further details are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.
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Source:
Link: https://www.nejm.org/doi/full/10.1056/NEJMc2606496?query=TOC#ap1
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