When 26-year-old Muhammed Salih was admitted to Kozhikode’s Baby Memorial Hospital at 2 am on May 17, a team of six doctors took charge of his case. Salih’s blood pressure was fluctuating, his heart beat was irregular and he was sweating profusely. The medical team that attended to the patient from Soopikkada village in Changaroth gram panchayat of Kozhikode district included Dr C Jayakrishnan from the neurology department.
As it turned out, Jayakrishnan had recently read a book about various types of encephalitis. From the symptoms that the patient displayed, he came to the conclusion that Salih had a rare condition. “The patient showed all the clinical symptoms of the Nipah virus infection that I read in the book a month ago,” said Jayakrishnan. “So I pressed the panic button. The team decided to send the cerebral spinal fluid, secretion from throat, blood and urine samples to the Manipal Centre for Virus Research on May 18.”
Nipah encephalitis, which is caused by infection from the Nipah virus, is not something that most doctors even know about. Until this fortnight, there had been one known outbreak of the infection in Malaysia in 1998, two in West Bengal – Siliguri in 2001 and Nadia in 2007 – and several in Bangladesh since 2001. Infected patients show symptoms of fever and cold in the early stages, which quickly advance to encephalitis, or inflammation of the brain. The infection is often fatal.
So far, the virus has killed 12 people in Kerala. Nine victims were from Kozhikode district and three from the neighbouring Malappuram district.
Team effort
The quick identification of the virus, Jayakrishnan said, was a team effort. When doctors at Baby Memorial Hospital need samples tested at the Manipal Centre for Virology Research, they usually courier them to the facility, which is about 300 km north of Kozhikode. That takes two days. But in this case, speed was essential. “We had very little time to wait,” said Jayakrishnan.
The doctors convinced Salih’s relatives that to immediately take the sample for testing to Manipal themselves. “We thank the relatives for heeding our request,” Jayakrishnan said.
Dr Anoop Kumar who was also part of the team at Baby Memorial Hospital said that the Manipal Centre for Virus Research unofficially confirmed the presence of the Nipah virus in the samples on the evening of May 18. “Since it is a highly contagious disease, the samples were re-tested at the National Institute of Virology in Pune and they officially confirmed the presence of the virus on May 20,” he said.
This was too late to save Salih, who died in hospital on May 18.
Other family members succumb
In the meantime, the doctors also enquired about the health of other members of Salih’s family and discovered that Salih’s brother, Muhammed Sabith, had died on May 5 at Kozhikode Medical College Hospital after showing the same symptoms. “That is when we decided to bring the remaining members of the family to the hospital and keep them under observation,” said Anoop Kumar.
Anoop Kumar said Salih’s father Valachukettil Moosa and his paternal aunt Mariyam began showing symptoms of a Nipah infection within hours of reaching hospital. Mariyam died on May 19 while Moosa passed away on May 24.
Still, the fact that the Nipah virus was identified less than 48 hours after body fluid samples were taken from the patient helped the state health department put in place measures to isolate others suspected of carrying the virus. This has helped save live and earned Kerala the appreciation of the World Health Organisation, Kerala Health Minister KK Shylaja told journalists last week.
Jayakrishnan said it was god who prompted him to read the book about encephalitis a month ago. “Otherwise how could I read it just a month before the Nipah virus appeared in Kerala?” he asked.
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