Dengue infections may present within a widely variable spectrum of clinical manifestations. However, neurologic complications in general are rare and unusual. A 19 yrs old healthy male army recruit was brought to a service hospital in South India in a state of unresponsiveness, following 12 km route march. Despite aggressive and prompt management, his condition progressively deteriorated and he finally passed away about 10 hrs after reporting to the hospital. The final cause of death was acute dengue encephalitis with raised intracranial pressure. Epidemio-clinico-pathological correlation in this case led to the conclusion that vigorous exertion with a hyper-metabolic state of fever in a setting of encephalitis led to metabolic injury, multi-organ failure, cerebral edema and intracranial hemorrhage. Encephalitis following dengue virus (DENV) infection is a rare phenomenon with the incidence ranging from 0.5% to 6.2%. Neurological features associated with DENV were first reported by Sanguansermsri et al in 1976. The rare neurologic presentations reported with DENV infection are transverse myelitis, acute encephalomyelitis, myositis, and gullain barre syndrome. As encephalitis caused by DENV mimics that caused by other pathogens it should always be kept in mind while managing encephalitis of unknown origin. Medical officers should maintain a high index of suspicion of DENV encephalitis. Training of medical officers; therefore, needs to be undertaken with regular refresher cadres, besides equipping of all peripheral facilities with rapid diagnostic kits for dengue. The same will ensure prompt detection of cases and timely referral to higher medical centres in chain. The instant case reflects an important, potentially fatal, complication of dengue. Pathophysiology of DENV encephalitis needs to be elucidated on priority through research involving all stakeholders.
Background: HEV infection is responsible for half of all outbreaks of acute liver disease in endemic areas. The present study deals with eighty eight cases of faeces orally transmitted Hepatitis E virus (HEV) in a regimental training center in South India in October 2016 to November 2016.Methods: Methodology and case definitions which were used for confirmed case and presumptive case of viral hepatitis were same as those which were used by Singh et al in their study. Surveillance data for all the cases was reviewed. The outbreak was described in terms of person, place and time. A sanitary survey carried out to detect the likely sources of contamination of water and to study the methods of sewage disposal with regards to septic tanks/soak pits.Results: Out of eighty-eight cases, two persons were HBsAg +ve, five were positive for both Hepatitis A and E, sixty-eight were positive for hepatitis E, five were positive for Hepatitis A, 8 persons were found negative for all the above hepatitis viruses. Overflow of sewage with foul smell and leaking water pipeline in 2 places were observed in the unit area. The overall attack rate was 27.69%.Conclusions: The present outbreak was due to faecal contamination of drinking water supplied to the regimental centre, which occurred due to old and corroded leaking pipelines in close proximity to old sewage lines having leakage through their walls. Medical authorities should maintain surveillance for all water and food borne diseases.
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