Mys­tery ill­ness 20

Doc­tors are clue­less about the vi­ral strain that has gripped sev­eral states in In­dia this mon­soon KUNDAN PANDEY | DELHI

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OUT­BREAKS OF vi­ral fever oc­cur with sea­sonal reg­u­lar­ity dur­ing the mon­soon in In­dia. For the past few years, dengue and chikun­gunya viruses have been the pre­dom­i­nant pathogens. But this year, the coun­try is in the grip of a strange fever. Its symp­toms are sim­i­lar to chikun­gunya and dengue but tests on pa­tients show neg­a­tive re­sults for these mos­quito-borne vi­ral dis­eases. Reena, a res­i­dent of Bho­gal in south Delhi, is one such pa­tient. She ran high tem­per­a­ture for 10 days and suf­fered from severe pain in the joints, rashes and swollen face—symp­toms as­so­ci­ated with chikun­gunya. But the tests showed neg­a­tive re­sults. Sim­i­lar was the case of Prachi Nau­tiyal, a res­i­dent of Noida, Ut­tar Pradesh. In Au­gust, Prachi suf­fered from high fever, body ache, joint pain and skin rashes

but tests for dengue and chikun­gunya showed neg­a­tive re­sults.

The phe­nom­e­non is not lim­ited to Delhi. Vivek Bil­lam­pelly, for­mer pres­i­dent of Gen­eral Prac­ti­tion­ers As­so­ci­a­tion, Pune, says the city too has had a high num­ber of vi­ral fever cases. Sa­mar­jit Naskar, crit­i­cal care ex­pert at Belle Vue Hos­pi­tal, Kolkata, also says that there is a huge num­ber of pa­tients with un­di­ag­nosed vi­ral fever this year.

Dif­fi­culty in di­ag­no­sis also in­creases the treat­ment cost for pa­tients be­cause they have to un­dergo sev­eral tests. Ajay Na­gar of Ra­jbeer Colony, Delhi, had to spend R10,000 on treat­ment and iden­ti­fi­ca­tion of the vi­ral strain her mother was suf­fer­ing from. But the tests re­mained in­con­clu­sive.

Ex­perts clue­less

Doc­tors have no clue about what could be lead­ing to this fever. Of­fi­cials from hos­pi­tals in Delhi es­ti­mate that around 30 per cent of all fever cases are un­di­ag­nosed. S Chat­ter­jee, in­ter­nal medicine ex­pert at In­draprastha Apollo Hos­pi­tal, Delhi, says that apart from dengue and chikun­gunya there are two other kinds of fever cases this year—one caused by nor­mal res­pi­ra­tory in­fec­tions and an­other which shows symp­toms of chikun­gunya but does not get con­firmed in tests. Naskar is of the opin­ion that the virus could have changed its ge­netic pat­tern. R S Taneja, head of in­ter­nal medicine depart­ment at Ram Manohar Lo­hia Hos­pi­tal, Delhi, too be­lieves that the virus could have mu­tated. Bil­lam­pelly says that since symp­toms are sim­i­lar to chikun­gunya, the virus could be its vari­ant.

But there has been very lit­tle re­search on mu­ta­tions in chikun­gunya and dengue, says P Jam­bu­lingam, di­rec­tor of Vec­tor Con­trol Re­search Cen­tre, Puducherry. For ex­am­ple, a mu­ta­tion in chikun­gunya was last iden­ti­fied in 2007. This mu­tated virus had caused a high num­ber of cases that year, he says. How­ever, Soumya Swami­nathan, di­rec­tor of In­dian Coun­cil of Med­i­cal Re­search, says that so far, the in­sti­tute has not found ev­i­dence of the viruses be­ing new or mu­tated ver­sions of older dengue or chikun­gunya strains. The Na­tional In­sti­tute of Virol­ogy, Pune, the key body on vi­ral re­search in the coun­try, did not re­spond to phone calls and emails on the state of re­search on the uniden­ti­fied vi­ral strains.

Usual sus­pects

Dengue and chikun­gunya con­tinue to plague sev­eral states. Chat­ter­jee says that the num­ber of fever cases has in­creased at least five times since July. A pathol­o­gist from Bansal Hos­pi­tal in New Friends Colony, Delhi, says that al­most 150 cases come for di­ag­no­sis daily. The hos­pi­tals are in­ca­pable of deal­ing with the ris­ing num­ber of pa­tients. Apollo Hos­pi­tal and Sir Ganga Ram Hos­pi­tal have al­lot­ted more beds for fever pa­tients. Saf­dar­jung Hos­pi­tal is us­ing its psy­chi­a­try ward to ac­com­mo­date the ris­ing num­bers. Till Au­gust 31, a to­tal of 27,879 cases of dengue and 12,255 cases of chikun­gunya were reported in the coun­try, ac­cord­ing to data re­leased by the Union Min­istry of Health and Fam­ily Wel­fare. In Delhi, the fig­ure stood at 487 for dengue and 432 for chikun­gunya. Other states in the grip of chikun­guya are Kar­nataka, Andhra Pradesh, Te­lan­gana and Ma­ha­rash­tra, while states with high num­ber of dengue cases are Bi­har, Haryana, Andhra Pradesh, West Ben­gal, Kar­nataka and Ker­ala.

En­vi­ron­men­tal fac­tors could be be­hind the spurt in cases, says A C Dhari­wal, Di­rec­tor of Na­tional Vec­tor Borne Dis­ease Con­trol Pro­gramme. He warns that the num­bers could rise be­cause Septem­ber and Oc­to­ber are suit­able for mos­quito breed­ing. P K Das, for­mer di­rec­tor of Vec­tor Con­trol Re­search Cen­tre, Puducherry, points out that the prob­lem would con­tinue till we do not take steps to re­duce the breed­ing points of the vec­tor.

More­over, there is now ev­i­dence that vec­tors which ear­lier bred only in clean wa­ter have de­vel­oped ca­pa­bil­ity to breed in sa­line wa­ter as well. Un­less the govern­ment takes steps to aug­ment re­search and health in­fra­struc­ture, the signs are omi­nous.

VIKAS CHOUDHARY / CSE Of­fi­cials of Delhi's Hindu Rao Hos­pi­tal say the num­ber of un­di­ag­nosed fever cases has in­creased man­i­fold since July

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