Outlook – July 06, 2019

croscopic predators, called pathogens. They cause infectious

diseases and spread from one person to another through food,

touch, air and water. Some spread from the environment,

through animals. Within AES, different pathogens follow dif-

ferent routes, but all affect the human central nervous system

(CNS), can cause serious complications and death—children

being at highest risk because of their immature immunity.

Those who survive often end up with neurological, physical

and psychological consequences.

Viruses are believed to form a significant proportion of AES

in children. Their actual contribution, however, is not en-

tirely known, because other causes—from benign tumours,

cerebral malaria, several disorders of the central nervous

system to the “unknown” causes—mimic AES. Studies have

reported central nervous system involvement among a sub-

stantial number of scrub typhus bacteria in patients from

Dehradun, Vellore, Puducherry and Lucknow, explains Dr

Manoj V. Murhekar, director of the National Institute of

Epidemiology, Chennai. The bacterial malady transmitted by

a microscopic mite has been found to be an important cause

of AES in Bihar last year, for the first time. “Policy makers

should consider investigations for scrub typhus as part of the

surveillance algorithm for AES cases,” Murhekar adds.

Viral pathogens behind AES, however, are much more let-

SUDDEN ONSET: Rabina had taken dinner

as usual and gone to bed. Around 3 am,

her parents noticed that she was shiver-

ing with high fever. They took her to the

local ojha (quack) first. Seeing no

improvement, they took her to the Sadar

Hospital and from there, to Muzaffarpur’s

Sri Krishna Medical College. She was

declared brought dead.

THE MYSTERY: It’s a mystery how four-

year-old Rabina Kumari contracted AES and

died. Born to Chunchun Devi and Chulhai

Ram, a casual labourer earning Rs 200-250

a day, Rabina did not go to school, have li-

tchis, bathe in local waterbodies, play with

domestic animals or defecate in the open.

She also did not skip dinner the day before.

The possible explanations of litchi toxin,

heat stroke, contamination or malnourish-

ment do not apply to her case, though she

received delayed care.

CALL FOR INVESTIGATION: AES from

scrub typhus virus (O. tsutsugamushi).

Since 2016, researchers have linked AES

outbreaks in Assam, Mizoram, Gorakhpur

and Odisha with this emerging infection.

In May 2013, entomologists from the

Centre for Medical Entomology and

Vector Management, NCDC, Delhi, sur-

veyed the Mushahari block and found

houses in all villages infested with

rodents and parasites like rat flea, chig-

ger mites, ticks and lice—all established

scrub typhus vectors.

NoNe oF

The usual

suspecTs

Rabina Kumari, 4

Village Manika Bishunpur

Muzaffarpur district

cover sTory

34 OutlOOk 8 July 2019

PraBhaT raNjaN kumar

sTill eYes rabina’s family

in Manika Bishunpur

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