A case study of the mystery virus

BANGALORE: You've put up with nagging pain in the joints for the past two months and even your doctor is clueless about what's causing it. You're not alone, just one among the many stalked by the mystery virus that's almost crippling Bangaloreans. Shockingly, the joint pain preceded by fever has left doctors baffled. Several city hospitals have been reporting 10 to 20 such cases every day for the past few months. Doctors are diagnosing it as 'viral arthritis' and concur it's due to a new virus strain. "Surprisingly, even those who tested negative for chikungunya are complaining of crippling joint pain and that's puzzling us. In some cases, the fever is low, but the joint pain is disabling. Though children are recovering fast, those in the age-group of 20 to 30 years complain of nagging joint pain for nearly three months. What starts of as a small rash in some part of the body develops into fever and then joint pain. Swelling of the feet is very common,'' said Dr Ramesh Jois, rheumatologist, Wockhardt Hospitals. Many doctors say that in 2005 when chikungunya and dengue fever laid Bangalore low, it lasted only till September. "This year, the fever and joint pain refuses to go away though we are close to December. General physicians are referring many patients to us which is very uncommon. I see nearly 10 patients every day who complain of post-viral arthritis,'' Dr Jois added. Doctors are also puzzled by differing symptoms. A common fever, which usually subsides in three to four days or a week, lingers on and on. "Even if it subsides, the joint infection remains for months. Though Bangaloreans have a history of stiff joints, it's shocking to see 20-somethings walk in with crippling pain. The worrying aspect is that our medicines for such a young age group is not aimed at long-term cure,'' explained general physician Dr Ramana Rao, who said the viral attacks began in June and are continuing. NEW DELHI: It's a virus that has already claimed over 100 lives but Indian and American scientists seem to have no clue about what it is. While the entire country is busy dealing with H1N1 influenza, a mystery virus is causing havoc in Uttar Pradesh. Since January, the state has recorded 665 cases of Acute Encephalitis Syndrome (AES) -a severe neurological condition associated with significant morbidity and mortality. Around 137 people have already succumbed to the viral infection. Lab investigations have revealed that only 34 of the cases and four of the deaths were caused by Japanese Encephalitis -- a known scourge in the state. However, scientists have no clue what caused the rest of the 133 encephalitis deaths and 631 cases.

According to officials, this mystery virus has been causing brain fever and killing people in UP since last year but no breakthrough has been made regarding the virus's identity and nature. Experts from Centre for Disease Control and Prevention (CDC) Atlanta had picked up 150 samples from UP to help identify the virus. But they too have failed to make any headway. Speaking to TOI, director of National Institute of Virology (Gorakhpur) Dr Milind Gore said, "We are working on identifying the virus and its origin. At present we don't know what's causing these cases of AES and deaths. We suspect it could be a type of enterovirus." Dr Gore added, "It is clear that JE alone isn't causing AES. We recently checked 450 stool swabs and found that 68% of them were positive for enteroviruses. However, we don't know exactly which one from this family of viruses is the dominant one behind the deaths. Even CDC experts haven't figured it out." Officials said the search for the "real culprit" behind the AES cases had taken a beating in the last few months with scientists in NIV Pune drowned with H1N1 samples. "H1N1 has proved to be a setback for the work on encephalitis in UP. Improved methods of diagnosis and new primers were to be tested against the unknown virus. But everybody at NIV Pune is busy with H1N1," an official said. AES is characterised by inflammation of the brain, seizures and convulsions among children. International NGO PATH's senior programme officer for JE Dr Pritu Dhalaria told TOI, "Usually, around four to five enteroviruses work in tandem, in clusters in particular areas. It is therefore difficult to identify exactly which virus is the deadly one. By this time last year, UP had recorded 435 AES cases of which only 15 were caused by JE. This year, the cases have increased, and we don't know which virus is behind it." Non-polio enteroviruses are very common across the globe. They are second only to the common cold viruses, the rhinoviruses, as the most common viral infectious agents in humans. Although infection often has no symptoms and goes unnoticed, these viruses are also associated with occasional outbreaks in which a larger-than-usual number of patients develop clinical disease, sometimes with fatal consequences. Transmission of enterovirus infections is increased by poor hygiene and overcrowded living conditions. Measures that can be taken to avoid getting infected with enteroviruses include frequent hand washing.

Enteroviruses can be found in the respiratory secretions and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects. According to some experts, UP has seen a nearly 40% increase in AES cases this year, majority of them not belonging to the enterovirus category. Health authorities here have rushed a sample to National Institute of Virology in Pune after a 14-year-old girl died due to the hemorragic fever leading to failure of multiple organs on Saturday. Doctors who treated the girl claimed such a type of virus had come to their notice for the first time. Health authorities have also started a survey in the neighbourhood where the girl lived as well as in her school. The girl, Hemangni Patel, daughter of a power loom operator Kaushik Patel from Bhatar Road in Surat, fell ill on Tuesday last week. Her family consulted their family doctor Kaushal Kania, who runs Astha clinic. The girl was treated for viral fever, but as the fever continued, she was referred to Dr Dhiren Patel of Sanjivani Hospital at Bhatar for further treatment. Dr Patel examined the patient and found that besides high fever, there were signs of multi-organ failure. He advised the patient to undergo several blood and urine tests. Hemangini was later shifted to Mahavir Hospital for further treatment after it was found that some virus was damaging organs like lever, kidney etc. The doctors at Mahavir Hospital urgently carried out tests of leptospiroses on the patient, which turned out positive. But the patient showed different symptoms. Also, leptospiroses is reported from rural areas in south Gujarat and is not considered an urban occurrence. Hemangini was later shifted to Sterling Hospital in Ahemdabad. On the way, she suffered cardiac arrest and died in the hospital on Saturday.