How doctors spotted nipah
Critical-care doctor Anoop Kumar A.S. had realised within hours that the brain inflammation of the young man brought in that morning was unusual, and that it was something he'd never faced before in his 15 years of practice.
- Published 25.05.18
New Delhi: Critical-care doctor Anoop Kumar A.S. had realised within hours that the brain inflammation of the young man brought in that morning was unusual, and that it was something he'd never faced before in his 15 years of practice.
The twenty-something patient, admitted to Baby Memorial Hospital at Kozhikode in Kerala on May 17, had symptoms of encephalitis. Although patients with severe encephalitis are at risk of falling blood pressure, here the pressure seemed to be rising.
The patient also displayed heart muscle inflammation and his illness deteriorated rapidly. He died on May 18. The toll now stands at 12.
"Nothing seemed to work. There was another patient in the family (a 50-year-old woman) with similar symptoms, and we learnt the patient's brother had died similarly a few days earlier," Kumar said. The brother, believed to have been the first patient or "index case", had fallen sick on May 2 and died on May 5.
Baby Memorial informed officials and sent blood, cerebrospinal fluid and throat swab samples to the Manipal Centre for Virus Research in Karnataka, about 300km away, on May 17.
Health officials say quick action by the Baby Memorial doctors and virologist G. Arunkumar, head of the Manipal centre, helped early diagnosis of the illness as one caused by the nipah virus, a lethal infection never documented in south India before.
"We had a diagnosis by May 18 evening. This allowed us to mount our responses. We started tracing the contacts of the patients," Kerala health bureaucrat Rajiv Sadanandan said. "I think this early recognition has allowed us to contain the outbreak."
At the Manipal virology centre, Arunkumar too sensed from the case descriptions that the infection was unlikely to be one of those that commonly cause encephalitis.
"Encephalitis from the herpes simplex virus is sporadic and rarely occurs within a family. Japanese encephalitis doesn't occur within a family, either - you see about one case in a village during an outbreak," Arunkumar said. "The rapid deterioration and the cluster from a family were warning signs of nipah."
Arunkumar and his colleagues tested the samples for multiple microbes - viruses, bacteria and parasites - but found the signatures of the nipah virus. The state authorities sent samples to the National Institute of Virology, Pune, for a confirmation, which arrived on May 20.
"Someone in Kerala thought about nipah - that is critical for early diagnosis," said Lalit Kant, a specialist in infectious disease control in New Delhi.