Do you know why doctors across the world are able to provide some form of treatment to the COVID-19 patients? It’s because we at least have some basic information about the coronavirus. But have you ever wondered what will happen if you have a disease which even doctors have no clue about? Just the thought of it makes us feel sick with apprehension. But much to our dismay, every year hundreds of Indians lose their lives to ‘mysterious disease’ outbreaks. The sheer plethora of these ‘mysterious diseases’ has baffled the government and doctors for years.
According to Dr. Prabir Chatterjee, former epidemiologist with Chhattisgarh State Health Resources centre, “If the expert is unable to identify the disease; it is classified as mysterious.” One such ‘mysterious disease’ outbreak has shaken UP to the core for more than 15 years. A different kind of fever was reported in UP in 2005, three decades after it was last heard of. Doctors initially called it the ‘Japanese Encephalitis’ or JE. In 2005, more than 1,000 children succumbed to death after suffering from JE. JE transmits within a population via mosquitoes. Hence, the prime focus of the government was vector control. But even after such thoroughgoing efforts, patients complaining of fever continued to come to hospitals seeking emergency care.
After an increase in the number of cases, researchers started looking for other causes behind the fever. They thought that enteroviruses can be a potential culprit. This is because both JE and enterovirus diseases exhibit similar symptoms such as high fever, vomiting, unconsciousness and seizure. However, the only difference between the two is that; JE fever lasts for only one week whereas enterovirus fever lasts for at least 15 days. Enterovirus primarily targets the patient’s brain and destroys the brain cells permanently. Furthermore, it leads to multiple organ failure or permanent mental and physical disabilities in the patients.
Two strains of enterovirus were identified by the National Institute of Virology (NIV), Pune, in 2007. They were EV 76 and EV 89. But, the institute wasn’t sure if these strains can lead to brain fever. So, to confirm its findings, NIV conducted rectal swabs and cerebrospinal fluid testing in patients. The results were absolutely shocking. Only some rectal swabs indicated the presence of enterovirus and the number was zero in cerebrospinal fluid of patients.
More cases came in 2017, and this time the doctors called it the ‘scrub typhus.’ This is a disease caused by Orientia tsutsugamushi, a rickettsial group of bacteria. However, only a quarter of the patients tested positive for it. Moreover, the disease was affecting a large number of infants. Scrub typhus is transmitted via mites which live in scrub vegetation. Children are usually not exposed to such environments. Hence, the chances of scrub typhus bacteria causing fever in infants were negligible. Moreover, scrub typhus does not have a high mortality rate, but the city of Gorakhpur indicated otherwise. Recently, the number of fatalities due to encephalitis in UP have gone down, and hopefully, this trend will continue.
One theory behind this ‘mysterious disease’ is the litchi theory. Litchi contains a toxin called methylenecyclopropylglycine or MCPG which leads to a drop in blood sugar. When a malnourished child consumes litchi, his/her blood sugar level drops to zero. Hence, the child slips into a coma. However, even this hypothesis could not be proved by the doctors. Dr. Vipin M Vashishtha, consultant pediatrician, Bijnor, says, “Due to the failure of government organizations such as NCDC and the Indian Council of Medical Research (ICMR) to identify the pathogens, individual researchers and doctors often try to unravel the mystery outbreaks. However, in absence of support from the government, a consensus on the cause of a disease is rarely reached.”
Dr. Vipin M Vashishtha further suggests that proper clinical, biochemical, histopathological and microbiological studies should be carried out to confirm a diagnosis. Furthermore, a team of epidemiologists, pathologists, neurologists, toxicology experts, public health experts and pediatricians must lead the way. Moreover, autopsies must be performed to arrive at a diagnosis.
Hopefully, the Indian Council of Medical Research will take these suggestions seriously. And if all goes as planned, then these ‘mysterious diseases’ will soon have a name and a course of treatment available for those who are suffering from it.