Dr Anoop Kumar AS, critical care specialist in Kozhikode, was part of the teams that were able to diagnose Nipah virus with their quick thinking and swift action.
On 10 September 2023, four people were admitted to Aster MIMS Hospital in Kozhikode, Kerala. This included three children and one adult, all of whom were related to each other. They all presented with fever, cough and respiratory symptoms.
On further enquiry, the multidisciplinary team of doctors treating them found out that there was a death in their family 10 days back.
The father of two of the children, a 49-year-old, had died in another hospital nearby. Interestingly, all patients hailed from Maruthonkara, which was near the epicentre of the Nipah virus outbreak in Kerala in 2018. This worried the treating team, which included Dr Anoop Kumar AS who is the director of North Kerala (Cluster) of Critical Care Medicine at the Aster Hospitals.
Nipah is a zoonotic virus that spreads from infected animals like bats or pigs to humans. Dr Kumar has also been credited for catching the first Nipah outbreak in 2018 in time. His quick thinking and swift action helped the patients back then and are showing the same effect today.
“This clustering of cases with respiratory symptoms, coupled with a probable index (primary) case and the fact that they hail from the area near the previous epicentre, gave us a suspicion that it was a rare virus and that it could be Nipah,” Dr Kumar tells The Better India.
The team of doctors acted quickly by isolating these four patients and sent their samples to the National Institute of Virology (NIV), Pune. They also informed the state health authorities.
But the sudden death on 11 September of a 42-year-old patient with similar symptoms but in a different hospital kept the doctors suspicious.
Tracing the disease route
“We first started probing the death of the kids’ father. The initial reports said that he died of bronchopneumonia and multi-organ failure. However, on reanalysis, we found that he had unusual symptoms like slurring of speech, diplopia (double vision),” Dr Kumar tells The Better India.
At the same time, his nine-year-old elder son, who was admitted with severe breathing difficulties, started developing convulsions and was put on ventilator support.
This development was followed by the patient admitted in a different hospital. He had severe pneumonia with a fever and cough for three days along with a low platelet count and died of a cardiac arrest in the emergency room. Although he didn’t hail from the same village as the index case, the doctors were alert.
So why would a healthy, young adult die of pneumonia in just three days?
“This was unusual in the case of normal bronchopneumonia. We started probing in detail. We followed the Nipah protocols in handling the body and didn’t give it to the family. We sent his sample also to NIV the same night,” adds Dr Kumar.
They found that there was an overlap between this patient and the first patient.
“He was a patient’s relative who was being treated in the same hospital as the index case. We got the discharge summary of that patient to establish the exact connection. He had been in the same ICU as the first patient who died on 29 August,” adds the critical care doctor.
This 42-year-old man and two of the four admitted tested positive for Nipah virus. Three others have also tested positive in Kozhikode, taking the total Nipah cases currently to six.
With this, Dr Kumar’s team has helped the state government establish containment zones and trace all contacts of these patients and isolate them.
How 2018 experience helped
What enabled Dr Kumar’s quick thinking was his experience in 2018. He was part of the team at Baby Memorial Hospital, Kozhikode, who had identified the first cases of the virus in the state in May 2018.
At that time, Dr Kumar recalls, three members of a family were admitted with fever.
“One patient had severe encephalitis (inflammation of the brain). On evaluation, we found that his brother had died two weeks back with unusual symptoms. So the same three conditions, clustering of cases, unusual clinical symptoms, and contact with an index case gave us suspicion of a rare virus. Some symptoms mimicked Nipah and we sent the sample to Manipal virology institute,” he adds.
These patients also lived near Janaki forest, home to many bat species. Fruit bats in a forest area here had tested positive for Nipah in 2018. Coincidentally, Dr Kumar hails from Ulliyeri village, which is just 20 kms from Janaki forest.
The Nipah outbreaks in 2018, 2019 and 2021 all presented with encephalitis symptoms. However, this time, the symptoms are flu-like, making it difficult for diagnosis.
“The symptoms mimic flu, along with some central nervous system symptoms like confusion, convulsions, seizures. This time the presentation is very different. This is the season when influenza and pneumonia cases are a lot. We have to look carefully at family history and blood work. Most of these patients have low platelet count,” adds Dr Kumar.
This doctor was part of the medical teams in 2018 and 2023 who first diagnosed the virus, and helped in even faster discovery this time.
He says that in 2018, it took 36 hours for diagnosis, while this time, they were able to diagnose in just 12 hours.
What should you watch out for?
Nipah spreads through droplet transmission and close contact with an infected person. This makes COVID like precautions of maintaining hygiene, washing hands regularly, masking up, and social distancing necessary.
“If you have fever, cough, breathing difficulties, which are rapidly progressing to pneumonia, or slurring of speech, confusion, convulsions, and have been in contact with anyone from a containment zone, just isolate yourself. Don’t mingle with others and get yourself tested,” adds Dr Kumar.
The Kerala government has released a contact-route map to help one establish connections. They have found 950 people who were in contact with the first five patients and 213 have been marked as high-risk. Close contacts are being quarantined, while containment zones have been made and fever cases are being tested for Nipah.
Many questions are arising about why it is Kerala where these cases are first diagnosed. Dr Kumar attributes this to the excellent healthcare surveillance system in the state which is responsible for this.
“We have been evaluating rare viruses thanks to our quick diagnosis. We have a great public healthcare system. We contain diseases fast due to swift action in any unusual fever cases. Private clinicians work closely with the government health department which prevents the disease from spreading further,” adds the doctor.
Edited by Padmashree Pande