Re: "Mystery fever" in West Bengal
Archive Number 20080625.1954
Published Date 25-JUN-2008
Subject PRO/EDR> Unidentified virus, fatal, children - India (02): (WB) RFI
UNIDENTIFIED VIRUS, FATAL, CHILDREN - INDIA (02): (WEST BENGAL)
REQUEST FOR INFORMATION
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Date: Tue 24 Jun 2008
From: T Jacob John <vlr_tjjohn@sancharnet.in>
Re:
Unidentified virus, fatal, children - India: (WB), RFI 20080623.1939
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The news about encephalitis due to unknown virus states that the
illness was not measles -- children did not have high fever or a rash.
There is a relatively poorly known background to the connection
between measles and convulsions with high case-fatality in young
children.
There were 2 reports on measles virus etiology in such
illness (1-2). Later, the same laboratory misclassified an outbreak
of fatal illness in adults in Siliguri (West Bengal) also as due to
measles virus infection (3). The evidence presented in all these
reports had many flaws and their veracity has been seriously
questioned (4, 5). The 1st outbreak claimed to be due to measles
virus infection had already been reported as clinical Reye syndrome
(6). The Siliguri outbreak has subsequently been diagnosed as Nipah
virus disease (7).
I have learned from reliable sources that the
problem was recurrent lab contamination with measles vaccine virus.
However, measles without rash causing acute fatal convulsive disease
has become widely accepted among pediatricians in India and there has
been no correction of error or retraction of reports.
The illness with convulsions in young children in the reports above
was not encephalitis but encephalopathy -- with acute onset, rapid
deterioration, CSF (cerebrospinal fluid) without pleocytosis, death
within a day or 2, and full recovery of those who did not die.
Another annually recurrent "acute encephalitis due to unknown virus"
in western Uttar Pradesh has turned out to be a non-infectious,
non-encephalitic illness now named acute hepato-myo-encephalopathy
(HME) (8).
In short, there is a tendency to jump to the conclusion that any
illness with convulsions in young children is "encephalitis" and all
such episodes are due to viruses.
The
HME syndrome is due to toxicity
from a plant -- _Cassia occidentalis_ (raw seeds or beans) (9). The
recent cluster of cases in West Bengal may also be due to plant
toxicity, but investigation requires detailed clinical description,
essential lab investigations on CSF and blood serum, and a best-fit
clinical diagnosis -- such as acute encephalopathy, Reye syndrome,
acute HME syndrome etc., followed by careful epidemiologic
investigations. There is no short-cut, and sophisticated but
misplaced virological investigations tend to lead local doctors and
the health system astray.
- snip -
Dr T Jacob John
Former Prof and head of Clinical Virology
Christian Medical College
Vellore
India
vlr_tjjohn@sancharnet.in
[We'd like to thank Dr T Jacob John for his comments. He points out
some very real challenges in the diagnoses of outbreaks with
neurologic manifestations in India both in terms of clinical
interpretations of events as well as laboratory support and
interpretation of laboratory findings.
If there are ProMED-mail
subscribers currently in West Bengal with more detailed information
of the clinical syndrome reported in the newswire of the original
ProMED-mail posting on this outbreak (Unidentified virus, fatal,
children - India: (WB), RFI 20080623.1939) and results of
investigations conducted to date as per Dr John's suggestions,
ProMED-mail would greatly appreciate receiving this information.
For the HealthMap/ProMED interactive map of India with links to other
recent outbreak reports in India and neighboring countries, go to
http://healthmap.org/promed?v=22.9,79.6,5. - Mod.MPP]
More , including References :
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,72922