Infectious Disease

Investigating rising ailments in India requires “a really thorough course of”.

December 09, 2020

4 min read

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Disclosure:
Pardo-Villamizar does not report any relevant financial information.

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Preliminary blood tests on people with an unidentified disease in southern India showed high levels of lead and nickel, but no evidence of a viral infection, according to the BBC.

Health officials there have also ruled out water or air pollution, the BBC said.

The unidentified disease in the southern Indian state of Andhra Pradesh has made hundreds of people sick, with symptoms including seizures, nausea and loss of consciousness. A patient suffering from this novel disease died, according to CNN. However, this patient had a fatal but unrelated cardiac arrest.

According to Dr. Carlos A. Pardo-Villamizar, Professor of Neurology and Pathology at Johns Hopkins University Medical School and Director of the Johns Hopkins Transverse Myelitis Center, “not much information” is currently available about the emerging disease in India. Healio Neurology asked Pardo-Villamizar about the most pressing questions for health officials in India and the context of another novel disease related to the COVID-19 pandemic. India has more than 9.7 million COVID-19 cases as of December 9, 2020. This is evident from the Johns Hopkins COVID-19 tracking map, which ranks second after the US in number of cases.

Q: What do we know about this novel, unidentified disease?

I don’t have too much information about this emerging situation. I have listened to the news from India but I have no additional information or specific medical information. I will share my point of view and perspective as a neurologist working on emerging viral diseases.

Q: What are the immediate priorities for health researchers?

A: When something like this happens around the world, if there is a group of acute diseases that involve elements of neurological symptoms such as dizziness, headache, nausea, vomiting or even seizures, the first thing that comes to mind is a possible infection of the brain or some other type from acute infection that may cause meningitis or another neurological complication such as encephalitis. In this setting, we must first understand the clinical profile of the disease. In an outbreak like this that suddenly involves more than 300 people, with symptoms of nausea and vomiting, and some neurological manifestations, the first thing we need to do is make sure that there is no viral or infectious agent present. Infectious agents are viruses or bacterial diseases.

The second line of investigation should focus on locating the presence of toxins in the environment in which the people who are experiencing the symptoms live. From this perspective, a very careful assessment of potential environmental factors is required. This is important because there are many toxins, many pesticides, and many materials that are used in agriculture, especially in tropical regions, that may be neurotoxic. These two possible causes are the first to be investigated – infectious causes and toxic causes for this problem.

From an epidemiological point of view, the first and most urgent step is to create a very clear profile of the clinical problems faced by these patients: we need to identify the main symptoms associated with this disease, regardless of whether there is any evidence of a clear infectious profile. For example, if we believe this may be linked to an infectious disorder, then patients with an infectious disorder can often have a fever and other systemic manifestations of infection in the form of a skin reaction, pulmonary symptoms, diarrhea, and gastrointestinal symptoms. Once we have a good clinical profile, we may need to try to identify other elements of the disease. These are provided through blood tests; If there are concerns about infection, blood tests may help. Brain imaging may be needed if there are concerns about infection in the brain. It is important to identify potential infectious agents in the spinal fluid in these patients. We have to go through a very, very thorough process of identifying what caused this outbreak.

Q: How is the COVID-19 pandemic affecting the study of this new disease?

A: Everyone thinks about COVID-19 all the time, but it is important to remember that there are other infectious agents in tropical regions of the world that are still very prominent. The active process of transmission of these infectious agents continues despite COVID-19. For example, in many areas of India, including areas like the one where this outbreak is occurring, there are many infectious diseases that are prominently linked to other viral infections including mosquito-borne infections. In these areas of India, these include dengue fever and chikungunya. Yes, we are obviously concerned about COVID-19, but we need to remember the possibility that there are other viral or bacterial infections that are more common in the areas affected by the outbreak that may be affected here.

There is also a possibility that other viral factors may appear. In India, for example, there are some outbreaks of other rare diseases. An outbreak of Nipah virus infection broke out in 2018, creating significant concern. Fortunately, it was concentrated in a very reduced area of ​​India. However, there are options that need to be evaluated outside of COVID-19.

My understanding from the news reports is that the patients affected by this emerging disease have been thoroughly screened for COVID-19 with negative results. Many of these patients have also been screened for dengue fever, chikungunya, the viral disease that is prevalent in this region. There is a need for a very comprehensive assessment of other infections. This is the next step that health officials in this state of India need to focus on.

Q: What are the effects of two infections occurring at the same time?

A: Concerns about treating two emerging infections at the same time are a very good point. That should be on the radar of epidemiologists and investigators in the region. There are several things that can happen during an outbreak; The possibility of co-infections is particularly high during the pandemic. What we know about the epidemiology of this outbreak is still minimal, but I understand that the disease affects people of all ages, including children. It is a very unusual outbreak and until we have more specific details we cannot speculate about possible causes.

We don’t have much information yet, but we are very curious about the neurological features of this disease, whether these patients have seizures or other types of neurological manifestations. We are very excited to learn more about the clinical picture, particularly with an emphasis on the neurological manifestations of this outbreak.

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