Out break of coma epidemic in children in Muzaffarpur, Bihar Mystery or missed diagnosis
Journal Title: Journal of the Indian Medical Association - Year 2019, Vol 117, Issue 2
Abstract
In the month of June 2005 and June 2011, there was an outbreak of fever with convulsion and coma [Acute Encephalopathy Syndrome (AES)] occurred in children in Muzaffarpur district of Bihar. About 500 children were affected and more than 200 died. The outbreak of acute encephalopathy syndrome among children were investigated to confirm the etiology and describe clinico-epidemiological feature. A retrospective study involving 50 patients of AES admitted to S K Medical College, Muzaffarpur in June 2005 and June 2011 was carried out. These patients presented with a rectal temperature of >40oC and central nervous system disturbance. The patient were treated with standard regimen of management of acute encephalopathy syndrome and sponging in ICU. The main presenting feature were fever (100%), convulsion (100%), unconsciousness (100%), decebrate rigidity (50%), tachycardia (80%), tachypnea (80%) and no splenomegaly. Serum and CSF were tested for IgM antibodies and RT-PCR against Chandipura virus (CHPV), Japanese encephalitis virus (JE) and Nipah virus. A total of 50 AES cases were recorded in children <12 years of age. Case fatality ratio was 60%. Male to female ratio was 1:1.5. There was no evidence of any infective etiology. All patient were negative of IgM and PCR of CHPV, JE and Nipah virus. As heat hyperpyrexia is a diagnosis of exclusion, It include such as drug withdrawal syndrome, neuroleptic malignant syndrome, septicemia, cerebral malaria, CNS infection, thyroid storm, drug toxicity (anticholinergic). So the outbreak of acute encephalopathy syndrome may be due to heat hyperpyrexia.
Authors and Affiliations
Gopal Shankar Sahni
Keywords
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