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HindustanTimes Wed,30 Jul 2014

A rash of fevers, but doctors without a clue

Sanchita Sharma, Health Editor, Hindustan Times   October 23, 2010
First Published: 23:16 IST(23/10/2010) | Last Updated: 23:18 IST(23/10/2010)

Everyone around is down with fever but even the best of medical minds appear to be clueless about what’s causing it. A friend’s daughter has high fever and rash that is not dengue, measles or chickenpox. The six-year-old has undergone a battery of expensive tests that have ruled out everything. What the tests haven’t done is zeroed in on the cause of her illness.

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All that the pathologists and internists have managed to conclude from three sets of tests is that it is a viral infection. They say many viruses cause rash, they just don’t know which one is to blame in this case. The parents have gone away wiser knowing what it is not: it is not dengue, H1N1 (swine flu), chikungunya, typhoid, malaria, chickenpox, gastroenteritis or a bacterial or fungal infection.

Fever of unknown origin is common in India. Beginning July, mysterious viruses that cause fever strike almost every part of the country. The cause of death is usually put down as “acute viral fever”, jargon for what the media more dramatically calls killer flu or mystery fever.

Fever — or high body temperature — is not bad news. It is not a symptom of disease but a sign of the body aggressively fighting infection. Fever acts as a trigger for infection-fighting cells, such as phagocytes, neutrophils and lymphocytes, to mount a response. Most disease-causing viruses and bacteria thrive in normal body temperature — 98.6 °F — so raised body temperature actually helps kill the infecting agents.

Fever causes no permanent damage unless it crosses 107.6 °F. Even when untreated, body temperature never really crosses 105°F. When it does, simple measures such as moving the person to a cool, airy place and bringing down the body temperature with wet towels is very effective, as is paracetamol. Avoid wrapping up the patient as it traps heat.

Despite simple and affordable treatment, there have been 1,200 recorded fever deaths in over two months in Uttar Pradesh alone. Some of these deaths have been attributed to dengue, malaria, measles, kala azar and H1N1, but many more have had no diagnosis.

Thursday’s The Lancet estimate of 2.05 lakh (205,000) malaria deaths in India each year — up from the existing estimate of 15,000 deaths a year — has been challenged by the World Health Organisation (WHO), but the fact is that all of these deaths followed fever of unknown origin.
The Lancet study used verbal autopsy — interviewing the family of people who had died about the symptoms and circumstances of the death — to conclude malaria killed 50,000 in Orissa. The WHO has challenged the data saying that this number suggests, implausibly, that Orissa has 17–50 million falciparum malaria cases annually in a population of 40 million. Since malaria has symptoms common with many other diseases so the actual number of people who die of the infection will remain a guesstimate at best.

But what we do know here is all these people had fever. And that unchallenged data from the Prospective Study of One Million Deaths in India, the country’s first nationally representative study from 1998 to 2014, shows that 90 per cent deaths of these deaths were in rural areas, with 86 per cent occurring at home without being treated.

The shocking fact is that in most cases, the fever could have been treated before it caused death. A simple paracetamol to bring down the body’s temperature could have saved some. But with no advice or few medicines at hand, it seems fevers will win a few more rounds before good sense prevails.
nsanchitasharma@hindustantimes.com


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