How The Kerala Doctors Diagnosed Nipah Virus, Which Had Almost Slipped Undetectd
The earlier Nipah virus strike in Kozhikode was in 2018, claiming 17 lives. In the last 12 days of the virus resurfacing this time, only 2 casualties have been reported in the initial stages. However, the possibility of the virus going undetected, disguised as just another fever or death, is shocking. The repercussions of this could have been many and unthinkable in dimension.
The diagnosis could have misplaced the nipah virus as another cause, because this time, the symptoms seen on patients are very different from what was seen in them before. The symptoms known before in 2018, differs significantly from the symptoms exhibited now, said the experts on this.
Dr Anoop A S, a critical care specialist in Aster MIMS, Kozhikode, and an expert in infectious disease in ICU who was instrumental in diagnosing Nipah then and now said that, encephalitis, or inflammation of the brain was the symptom which was seen in 2018, along with it, neurological symptoms such as seizures, inability to think clearly or concentrate, involuntary shaking of limbs (convulsions), and loss of consciousness was also reported, according to Onmanorama.
This time, the symptoms which have been reported are respiratory symptoms which progress into bronchopneumonia, constricting the airways, and then leading to hypoxia or insufficient oxygen. The diagnosis becomes trickier because of the timing. The resurfacing of the nipah virus has coincided with the influenza outbreak which usually occurs during the monsoon. Fever, cough, cold and difficulty in breathing are common occurrences now, making the diagnosis tricky.
The first patient, this time, passed away because of bronchopneumonia in a private hospital. The hospital, missed the case as nipah infected; tested the case only for common influenza and Covid-19, later after death, passed the body to relatives. Eight days after the first patient’s death, another death had occurred, and patients to the second death (who had died) reached Aster MIMS for treatment.
Mohammed Ali, 49-year-old, from Maruthonkara Grama Panchayat had passed away, and his two children, a brother in law and a relative were brought in to MIMs with fever and cough. Breathing difficulties were also starting to show. Bronchopneumonia was detected in one of the patients, a child.
The team led by Dr. Anoop, on-going through patient history, found that their father had passed away due to difficulties of bronchopneumonia and multi organ failure just 10 days ago. From the doctors who treated Mohammed Ali, the team learned that he also had slurred speech, double vision, and was a bit confused towards the end. By then the elder child had begun to have seizures, with this, adding things together, the team realised that there was a cluster of cases before them which needed the most urgent attention. Without any further delay, the cases were isolated, samples taken and sent to pune for further confirmation from the National Institute of Virology, the Times of India said.
“We realised we have a cluster and an index case and the usual symptoms. They are from the same area which was the epicentre of the Nipah outbreak in 2018,” Dr. Anoop said to Onmanorama on this.
Mohammed’s hometown Maruthonkara was only a five kms distance from Janakikadu (literal translation is Janaki forest), which had bats of several species and had tested positive for nipah virus in 2018. Janakikadu is a woodland, also promoted as an eco-tourist spot, which belonged to a Janaki Amma before it was taken over by the government.
Another patient was brought to Aster MIMS 12 days after Mohammed’s death, a 40-year old patient from Ayanchery. He complained of cough for three days, then developed low oxygen level in his blood, hypoxemia, and later died of cardiac arrest, soon after being admitted.
Taking the patient’s history, the doctors found that though Ayanchery was 20 kms away from Mohammed’s Maruthonkara, the patient had been a care giver for one of his relatives at the same hospital that Mohammed was treated and died. With this, the health officials were alerted, the body of the patient was not released and a screen test was undertaken which tested positive for nipah. Further, samples for confirmation was sent to Pune’s institute of virology, reported the Times Of India.
The virus could have undergone mutations, Virologist Rajendra Pilankatta, also a member of the core committee of experts at the Institute of Advanced Virology, Thiruvananthapuram said. On this, he said to Onmanorama that, the Malaysian strain of the virus would not spread from a person to another, unlike the Bangladesh strain, which would spread. Kerala has the Bangladesh strain. Thailand has both the strains in their country. He also added that the respiratory problems were seen more in pigs and encephalitis is seen more in humans.
As a measure to find the origin of the infection, prof. Pilankatta suggested that a survey of the area would aid in understanding if there were any changes in the biodiversity which was aiding in the spread of the virus. He also stressed upon health survey as a measure to combat the spread of the infection. The direct contact of humans with fruit bats could be few but there could be intermediaries present in the form of pigs, dogs, fruits and other crops which could spread the infection, he had said. Farming on the edges of forest area in that region was not uncommon.
Nipah is a stable virus which can stay alive in fruit juices for three days and in bat urine for two days. Today, the contacts of the dead, who are suspects has gone up above 700 people, some places have been declared as containment zones with schools and other institutions shut for the time being. The state has begun to take the necessary measures. It is advised to wear N95 masks, wash hands frequently with soap and water or use alcohol-based sanitiser and to keep social distancing.
