Monday, October 10, 2011

Encephalitis around - SOS

Yesterday, sometime around 3 in the afternoon, I had a patient in the outpatient department with a history of fever since the last 5 days and illegible conversations since yesterday morning. He was being managed elsewhere for malaria. The family was well off and our wards were quite full. I gave them the option of going ahead. They were not very forthcoming. Later, one of the relative turned up and asked me what I think about the diagnosis. I told him it is some fever which is affecting his brain. Then he told me that he was already on treatment for malaria and typhoid.

We had been having quite non-specific fevers over the last month and we've been suspecting viral encephalitis. Some of them seemed to have done good and improved. There are couple of them who did not make it and I had few children who has neurological sequelae.

I told the doctor about my suspicion of encephalitis. Later, there was one of the local leader who came in for discussions. I was thankful that they ultimately took the decision to move ahead to Ranchi. However, I had sent for blood tests before the results had come. After they left, I was more relieved when the blood tests came. His platelet count was just 50,000.

I bumped into the village leader today afternoon. He updated me about the patient. It seemed that he was diagnosed to have viral encephalitis in Ranchi. Overnight, his condition deteriorated. He is in the ventilator. The doctors have told him that he has brain edema and the chances of survival is quite bleak.

So, we are in the midst of an epidemic of encephalitis. It is very surprising that I'm yet to recieve any intimation from the government machinery. I had called the Civil Surgeon couple of weeks back and told him about my suspicion.

I still have about 5 patients in the ward whom I suspect encephalitis. I've asked my store manager to get intravenous acyclovir. Without a medicine consultant it is very exhausting to manage these patients. And to make things complicated, we had been suspecting other causes of fever for quite long.

One of the 5 patients, 7 year old IK was doing good and improving with oral acyclovir. I wanted to refer him - but the family was too poor. He developed seizures yesterday and has become unconscious again. Today evening, he shows signs of improvement. I praise God. I pray that he does not have any neurological sequelae.

I'm concerned about the surrounding poor villages and our staff families. I pray that this epidemic will move on without causing much more damage. I wonder where the government machinery is. I wonder when shall we grow out of the 'malaria and typhoid 'malaria and typhoid only' attitude. It is high time we plan to explore more on what causes fevers in many areas of the country.

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