Everything You Need To Know About Encephalitis, The Deadly Disease Behind The Gorakhpur Tragedy

In one of the more deadly infectious attacks that the country witnesses every year, over 70 children succumbed to the lethal encephalitis virus at the state-run Baba Raghav Das Medical College Hospital in Gorakhpur over the last five days.

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The Baba Raghav Das Hospital Medical College Hospital has been at the helm of most encephalitis outbreaks that occur every year in the state of Uttar Pradesh (U.P.). In a sorry state of affairs, some of the children admitted to the hospital died due to the lack of oxygen supply!

In fact, according to a report by the Indian Council of Medical Research, the first traces of encephalitis was recognised in 1955 in Tamil Nadu. Since 1972 the disease has spread to other regions, including West Bengal, Uttar Pradesh, Assam, Bihar, Manipur, Andhra Pradesh, Goa, Pondicherry and Karnataka.

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UP remains to be one of the hardest hit states by the disease. According to a report by the Directorate of National Vector Borne Disease Control Programme (NVBDCP), there are been 26,686 cases of encephalitis between 2010 and 2017 in UP.

What is encephalitis and why is it so deadly?

Encephalitis is described as an inflammation of brain tissues, which is caused by viral infections, bacteria or fungi. The disease leads to a host of symptoms including fever, headache, stiff neck, vomiting, exhaustion, fever, confusion, drowsiness, hallucinations, coma, seizures, irritability, unconsciousness, disorientation and death. Inability to treat it within the first few hours increases the chances of death by around 30 percent.

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There are two types of Encephalitis that have been taking the lives of children in Gorakhpur, Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE).

According to the report by the Directorate of National Vector Borne Disease Control Programme (NVBDCP), out of the reported cases 24,668 cases were related to AES and 2,018 were to JE.

AES can be caused by a wide range of factors including toxins from unripe lychee fruits, viruses, bacteria, fungi that originate from different strains of bacteria that are difficult to identify.

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JE, on the other hand, is spread through the bite of infected mosquitoes of the Culex family and is related to dengue, chikungunya, bacteria such a streptococcus and West Nile virus that often lead to seizures.

What does the diagnosis involve?

The World Health Organisation (WHO) states that diagnosis for a patient suffering from an altered mental status with or without a seizure should be first tested for Japanese encephalitis. If the results are negative then it would be tested for AES.

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Although ECG¡¯s, CT scans and MRI¡¯s can detect changes in the structure of your brain to help determine what kind of virus you have and blood tests can reveal the type of virus causing the AEC can be chaotic.

According to the WHO, around 100 pathogens can trigger AEC and around a three dozen can be narrowed down to India, which makes the diagnosis vague for AES, reported the Fountain Ink in a report.

Although the Japanese Encephalitis virus is of the most common viruses it accounts for less than a quarter of all reported cases in India, which explains why the number of AES cases are significantly higher than reported number of JE cases, states the report.

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61-year-old Ravi Vasanthapuram, a neurovirologist at NIMHANS calls AES a ¡°dustbin diagnosis¡±; a label he uses to file every reported case of encephalitis for which you can¡¯t find an exact cause. ¡°For around 80 per cent of the patients who come here, we can¡¯t give a proper diagnosis,¡± says Mahima Mittal, head of the department of paediatrics at the Baba Raghav Das Hospital (BRD), as stated in the report.

Is it treatable?

Since most types of encephalitis show similar symptoms, not only is difficult diagnose but also challenging to treat. A report from The New York Times stated that the Viral forms of encephalitis are not treatable. The idea is to diagnose symptoms being caused by the disease and provide medication accordingly.

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Antiviral medicines such as acyclovir and corticosteroids to reduce brain inflammation are prescribed during infectious cases of encephalitis.

In severe cases of infection, the patient can even be put on mechanical ventilation to assist them in breathing. Anticonvulsants and sedatives are used for patients suffering from seizures.

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Instead of treating or along with the treatment of encephalitis doctors recommend measures to offer relief while the patient fights off the virus. This includes rest, lukewarm sponge baths and plenty of fluids (through IV if required).

Can encephalitis be prevented?

Although encephalitis isn¡¯t always preventable, you can protect yourself from the onset by getting vaccinated. This includes getting vaccines for measles, mumps, rubella.

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It¡¯s also important to protect yourself from getting bitten by mosquitoes carrying the disease. Use repellent creams and cover yourself well to prevent getting bitten while moving out into mosquito-ridden areas.