61-year-old Zika virus patient in Pune reports rare neurological complication

Meningoencephalitis is a rare and life-threatening condition in which the patient has both meningitis and encephalitis at the same time

Doctors at a private hospital in the city on Thursday reported an extremely rare neurological complication in a 61-year-old man from Hadapsar suffering from Zika virus infection. Officials said that the virus infection in the cerebrospinal fluid (CSF) of the patient has been confirmed by the Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV) Pune.

Pune city has reported an outbreak of Zika virus infection since June 20 and till date, 27 cases of Zika virus infection have been reported. Of these, 11 patients infected with Zika virus are expecting mothers, said PMC officials. (REUTERS)

Dr Ameet Dravid, infectious diseases’ expert at Noble Hospital and Research Centre, Hadapsar, and his team are treating the patient. “This is the first case in the country which has reported Zika meningoencephalitis in a patient. Till now, similar neurological complications were reported in countries like USA and Brazil,” he said.

Meningoencephalitis is a rare and life-threatening condition in which the patient has both meningitis and encephalitis at the same time. Meningitis is infection or inflammation of the area surrounding the brain and spinal cord (meninges). Whereas encephalitis is inflammation in the brain tissue.

Dr Dravid further informed that meningoencephalitis is an extremely rare complication of Zika virus infection. The patient in question was admitted to Noble Hospital on July 9 and complained of fever, headache, body ache and loose motions. A series of investigations and tests were conducted but nothing was found. Later, the patient collapsed on July 12 and went into a coma. He was rushed to the intensive care unit (ICU) for further management and was intubated.

Dr Dravid said that while the patient was in a coma, his samples were sent for a tropical fever panel test and he was intubated. The blood reports tested positive for Zika virus on July 13. “To rule out brain infection, the test for tuberculosis, routine viruses, bacterial and fungal infections that cause brain infection were carried out but all tests were negative. Finally, the cerebrospinal fluid tested positive for Zika virus infection,” he said.

The CSF samples of the patient were sent to NIV on Tuesday and the test reports were received on Wednesday which confirmed Zika virus infection in the patient. Along with the CSF samples, urine and blood samples of the patient were also sent to the NIV and Zika virus was confirmed in both samples.

Dr Dravid and his team including Dr Zafer Khan, Dr Dilip Mane, Balasaheb Bande, Dr Aparna Kodre, and Dr Paras Borse are treating the patient. After the CSF samples tested positive for Zika, the doctors treated the patient with steroids and provided invasive ventilation. The patient has come out of a coma and has been shifted to the normal ward on Thursday.

“We could not find or rule out any other reason behind the meningoencephalitis in the patient other than Zika virus infection. The virus infection is normally mild but the patient has comorbid conditions such as blood pressure, diabetes and hyperthyroidism and is elderly due to which the infection might have caused neurological complications,” said Dr Dravid.

Dr Kalpana Baliwant, health officer of the PMC, said that the case has to be studied in detail to confirm if the Zika virus infection is the reason for meningoencephalitis in the patient. “We will ask the hospital to share the details of the patient with us to discuss it with the experts. However, the NIV scientists during the recent training sessions never spoke about meningoencephalitis being caused by the virus infection,” she said.

Pune city has reported an outbreak of Zika virus infection since June 20 and till date, 27 cases of Zika virus infection have been reported. Of these, 11 patients infected with Zika virus are expecting mothers, said PMC officials.

Maha reports five cases of Zika virus; three in Pune city & two in Sangamner

The state on Thursday reported five fresh cases of Zika virus infection, taking the total number of Zika virus cases in Maharashtra to 33. Out of these five cases, three cases have been reported in Pune city while two cases have been reported in Sangamner, said officials.

The three new cases of Zika virus reported in Pune city include: a 33-year-old pregnant woman from Karve Nagar; a 78-year-old man from Kothrud; and an 84-year-old man from Pashan, said Dr Kalpana Baliwant, health officer of the Pune Municipal Corporation (PMC).

The woman from Karvenagar complained of symptoms such as fever and rash. She is 35 weeks’ pregnant and her recent anomaly scan reports are normal. Her samples were sent to the National Institute of Virology (NIV) Pune on July 16. The NIV reports received on July 17 confirmed Zika virus infection.

The 78-year-old man from Kothrud also complained of symptoms such as fever and body ache and his samples were sent to the NIV on July 13. The samples tested positive for Zika virus infection on Thursday, said Dr Suryakant Devkar, assistant health officer of the PMC.

The 84-year-old man had symptoms such as fever, weakness and joint pain. His samples were sent to the NIV for testing on July 11. The NIV reports confirmed Zika virus in the man on Thursday. He also has hypertension and diabetes.

Whereas two fresh cases of Zika virus infection were reported in Sangamner in the Ahmednagar district on Thursday, taking the total number of Zika virus cases in Maharashtra to 33. Both new Zika virus cases in Sangamner are those of pregnant women.

As many as 39 samples were sent from Pune rural and Sangamner to NIV for testing on Thursday, said Dr Radhakishan Pawar, joint director of health services.

Dr Baliwant informed that on Thursday, 13 samples of suspected patients were sent to the NIV. Of the 13 samples, 11 are of pregnant women; five are from Lohegoan; two from Kalas; and one each from Mundhwa, Pashan and Dhankawadi.

Zika virus is transmitted through the bite of an infected Aedes mosquito, known to transmit infections like dengue and chikungunya. A majority of those infected with Zika either remain asymptomatic (up to 80%) or show mild symptoms of fever, rash, conjunctivitis, body ache, and joint pain. Zika virus can be passed from a person before symptoms begin, while they have symptoms, and after their symptoms end. Zika virus in pregnant women can cause congenital microcephaly, Guillain-Barre syndrome, and other neurological complications, said officials.