Congo's Disease X: Could it be malaria?

Initial lab analyses suggest the mysterious disease spreading in the Democratic Republic of Congo could be malaria, though authorities still believe more than one infection may be involved in the outbreak. 

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus on Tuesday confirmed results of the first lab tests of the disease showed the presence of the mosquito-transmitted infection.

"Of the 12 initial samples collected, 10 tested positive for malaria, although it’s possible that more than one disease is involved," he said during a media briefing.

So far, Congo has recorded 416 cases of the undiagnosed disease. Severe cases have been reported among severely malnourished people, including 31 deaths, mostly children. 

The spread of the disease is currently concentrated in the Panzi district in Kwango province, located about 700 kilometers (435 miles) from the capital, Kinshasa. Panzi district is remote, with difficult-to-access roads and nearly non-existent health infrastructure.

Health officials say the disease is most likely to be an already-known illness rather than a brand-new one.

"Reports of outbreaks with fatalities crop up somewhere in the world several times a year. Almost all turn out to be an already well-known infection with limited global consequences," said Paul Hunter, an epidemiologist at the University of East Anglia, UK, in a press statement.

What is the likeliest cause of the disease outbreak?

Jake Dunning, an infectious disease specialist at the University of Oxford, UK, said calling the incident a Disease X outbreak could be misleading and counterproductive.

"Disease X should only really be used when there is an infectious disease with epidemic or pandemic potential and a novel pathogen has been identified or is strongly suspected. It would be more appropriate to say that, currently, this is an undiagnosed morbidity and mortality event," Dunning told DW via email.

The disease causes flu-like symptoms of fever, headache, cough and anemia. 

That's why the WHO also believes the unidentified disease will most likely be traced back to already known causes. 

Based on the symptoms, acute pneumonia, influenza, COVID-19, measles and malaria are being considered as possible causes.

These symptoms are associated with malaria, but other infections that may be causing the illness include measles and mosquito-borne diseases like dengue and chikungunya.

Africa CDC investigating causes with local authorities, WHO

The Africa Centres for Disease Control and Prevention (Africa CDC) has deployed a multidisciplinary team of science and health experts to support the WHO and DRC's Ministry of Health's ongoing investigation. 

Meanwhile, they are running diagnostic tests and implementing disease control measures on the basis that more than one disease is responsible for the infections.

However, they are likely to face difficulties detecting the cause because of the affected area's remoteness and logistical barriers. 

Limited mobile phone and internet coverage across the region have hampered deployment of response teams. It's a two-day drive from the nearest major healthcare hub in Kinshasa due to the rainy season affecting roads.

Why is this disease such a mystery?

Health experts believe the causes of the outbreak are unknown because of limited testing capabilities in the region. 

Clinical laboratories in the Panzi district can only test for common pathogens. The detection of rarer pathogens often requires samples to be sent to specialist laboratories. Scientists there use techniques that aren't available in remote areas, such as gene sequencing, to find which pathogens are causing a disease to spread.

For DRC, this might mean samples will be sent abroad for testing, increasing delays. 

"The DRC has some great clinicians, scientists, and laboratories, all well versed in outbreaks and emerging infections, but the DRC is a huge country and arguably remains resource-limited and a complex environment," Dunning told DW.

The lack of information about the disease makes it harder for local health authorities to accurately assess the threat they face.

International healthcare teams are investigating so-called transmission dynamics, and actively searching for additional cases, both within health facilities and at the community level.  

"It is vital that these cases are investigated promptly so that appropriate treatment and control measures can be implemented," said Hunter.

Deputy governor of Kwango Remy Saki told DW on December 8 that the province had implemented measures to prevent the epidemic from spreading. 

The measures include limiting the movement of people and registering the entry and exit of people from surrounding villages, as well as wearing face masks.

Edited by: Zulfikar Abbany

This article was updated on December 11 to add information about the WHO’s laboratory testing results.