In an acute febrile illness outbreak in a remote part of the Democratic Republic of the Congo (DRC), a man recently died following hemorrhagic fever symptoms, and samples have been sent to Kinshasa for testing, an official with Africa Centres for Disease Control and Prevention (Africa CDC) said at a briefing today.

Ngashi Ngongo, MD, PhD, who leads Africa CDC's mpox incident management team, said though malaria has been reported in several samples during follow-up testing, testing on more samples is under way, as is the epidemiologic investigation. On quantitative polymerase chain reaction (qPCR) testing, 25 of 29 samples were positive for malaria, and, on rapid testing, 55 of 88 samples were positive. Testing continues on samples from blood, sera, swabs, and stool to see if other pathogens are involved.
Earlier this week, the DRC's health ministry said preliminary lab tests suggested the outbreak's cause was a severe form of malaria, with malnutrition as one of the illness factors.
Officials weighing 2 scenarios
Ngongo said officials are weighing two hypotheses: that severe malaria is occurring against the background of malnutrition and viral infection or that a viral infection is occurring against a background of malaria and malnutrition.
Over the past week, 65 more cases were reported, along with 5 additional deaths. Though 37 deaths have been recorded in healthcare facilities, Ngongo said investigators are working to determine whether 44 deaths reported in the community are linked to the outbreak, which has a case-fatality rate of 62%. Overall, 592 cases have been reported, with the largest portion in children younger than 10 years old.