Dr. Sukhato Sema and Dr. BSR Mahapatra
[dropcap]S[/dropcap]ince last two weeks, newspapers are flooded with the news of outbreak of Japanese Encephalitis (JE). Many deaths are being claimed in different provinces of India. Today’s newspaper also contained many cases of JE being detected in Nagaland.
First of all we will give a sort of wikepedia about Japanese Encephalitis. It is a viral disease which is caused by the bite of a mosquito-culex tritaeniortrynchus or culex vishnui. The bite of the aforesaid mosquitoes affects domestic pigs and wild birds (herons) who are vectors for the disease JE.Signs and symptoms
JE has an incubation period of 5 to 15 days and vast majority of cases are asymptomatic. Only 1 in 250 infection develops into Encephalitis. Severe rigor, fever (100.4 to105.8 f), severe headache, malaise, neck rigidity (most important), cachexia, hemiparesis, convulsion, mental retardation develop from the disease if it becomes severe. Lastly, it leads to coma and death may occur. Mortality is more higher in children. Residual affect can give rise to neurological defects like deafness, emotional liability and hemiparesis to those who have Central Nervous System(CNS) involvement.
Prevention
Presently there are three vaccines given for JE. But they are not very reliable. One cannot be assured after vaccination one cannot suffer from JE.
Treatment
There is no specific treatment for JE and the treatment is supportive. The professional medical practitioners should advise proper feeding, management of breathlessness and seizure control. In case of raised Intra Cranial Pressure, patient may be given MANNITOL (Osmotic Diuretic). There is no transmission from a diseased patient to other persons. So it is not an infection of person to person (infectious). So isolation is not necessary.
Diagnosis
JE can be diagnosed by detection of antibodies in serum and cerebro spinal fluid (CSF). But it is not conclusive. Unless viropositivity is detected, one cannot come to a conclusion of patient suffering from Japanese Encephalitis. Viropositivity means in serum, presence of JE is there.
Here I am putting forth, an old Incidence of JE which occurred in Dimapur town. In 1990, I (Dr.Mahapatra) was full in charge of medical cases of Dimapur civil hospital. Although Dr. Sukhato is a gynaecologist and obstetrician, he was also adept in medical aspects, other than his own subject. It happened so a number of cases having high fever and neck rigidity were treated by me. The army doctors propagated there is outbreak of JE in Dimapur through pigs. I treated all the cases with quinine sulfate with I.V. drip, steroids, etc. and not a single patient died. Dr. SI Tushi Ao was director of Health and Family Welfare. Some professors from Indian School of Tropical Medicine, Kolkata came down to Dimapur civil hospital and we had interaction. Although they are very highly qualified doctors and I was a pygmy before them, I politely told –Sero positivity (to detect through serum and cerebro spinal fluid) is not conclusive diagnosis of Japanese Encephalitis. Unless the serum shows the presence of JE virus, one cannot come to propagate-it is a case of Japanese Encephalitis. All of them agreed with me and I assured them with anti malarial treatment, steroids, mannitol and plenty of I.V. fluids cured all the patients.
For the information of all, one should send the serum either to Pune Serum Institute and in Bangalore Serum Institute where viral study is done. Of course, this is the incidence of 1990. But now I hope many more serum institutes have opened all over India where viral study is done.
In conclusion, this morning I had a telephonic talk with Dr. Sukhato in Kohima, who is presently Director of Health and Family Welfare. I told him to make professional as well as common public awareness on Japanese Encephalitis and not to be panic stricken. So Dr. Sukhato readily agreed to publicise this article in the interest professionals and common people –I repeat. This is a combined effort of Dr. Sukhato and I.
