New Delhi: Oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS) and urine samples should be considered as critical specimens for monkeypox diagnosis in cases with no active skin lesions, an ICMR study said. It said the first fatal case of monkeypox in India from Kerala highlights the importance of maintaining a high index of suspicion to diagnose the viral disease in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from endemic or outbreak countries. The study, ‘A fatal case of monkeypox virus infection from Kerala, India, 2022’ has been published as pre-print on September 14 and has not been peer reviewed.
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So far, 11 cases of monkeypox have been reported in India — five from Kerala and six from Delhi.
A 22-year-old apparently immunocompetent male with no significant past medical history was admitted in an unconscious state to a private hospital in Kerala following a single episode of acute onset generalised tonic-clonic seizures, the study stated.
The patient developed fever and headache on July 15 while in the UAE, followed by development of painful right inguinal lymphadenopathy with pus discharge, for which he had sought medical care on July 19.
He was partially relieved of his symptoms and returned from the UAE to Kerala on July 21. He played football on July 23, which led to worsening of pain in right inguinal area for which he consulted a surgeon on July 25 in Kerala and was diagnosed to have hidradenitis suppurutiva.
He continued to report fatigue and low-grade fever which was not associated with persistent headache, alteration of sensorium, loss of appetite or weight.
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On July 26, he had a fever spike followed by generalised tonic clonic seizure. Serological tests for HIV, Hepatitis B, Hepatitis C and syphilis were negative.
At presentation, he had neutrophilic leucocytosis with normal hepatic and renal function. Over the next 48 hours he developed coagulopathy and acute kidney injury, the study said.
On July 28, the patient developed features of worsening cerebral edema and was intubated and mechanically ventilated.
Despite anti-cerebral edema measures, he progressed to brainstem dysfunction and succumbed on July 30.
Just before his death, his relatives obtained a test result from the UAE, which showed that he had tested positive for MPXV in the UAE on July 19, the study stated.
“This is the first fatal case of monkeypox reported from India. This case highlights the importance of maintaining a high index of suspicion to diagnose MPXV in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from monkeypox endemic or outbreak countries.
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“The OPS/NPS specimen as well as possibly urine specimens should be considered as the critical specimens for MPXV diagnosis in cases with no active skin lesions. In conclusion, the overall findings of the case and the history confirm the case to be monkeypox,” the study stated.
A total of 15 fatalities have been reported globally from endemic and non-endemic countries in 2022, it said.
The current outbreak of monkeypox had been largely limited to the community of men who have intercourse with men primarily with multiple bisexual or homosexual partners, the study stated.
The vast majority of the cases infected with monkeypox had recovered and the complications like sepsis and encephalitis had been reported in the immunocompromised individuals.
The mortality in Brazil and Mexico were primarily in the immunocompromised individuals, while in Spain the fatal cases were immunocompetent with no underlying conditions.
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(This story has not been edited by NDTV staff and is published from a syndicated feed.)
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.
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