Infections of the nervous system are potentially the most dangerous and difficult to treat because reaching a correct diagnosis is hard. And if you live in a country like ours where even simple diagnostic tests are unavailable or problematic to process, then such infections can turn life-threatening.
Take meningitis for example where the final diagnosis is made through a simple lumbar puncture which involves inserting a needle from the back into the spinal cord and obtaining the cerebrospinal fluid (CBF) for examination. Microscopic study of this fluid helps in determining the cause of illnesses so therapy can be started. But it is easier said than done and specially challenging to carry out in South Asian hospitals.
So when a mystery illness related to the nervous system broke out in Muzaffarpur, Bihar in 1995, diagnosis was, unsurprisingly, difficult. Even after hundreds of cases, doctors like the ones at Shri Krishna Medical College Hospital (pic, below) are stumped.
The disease is characterised by sudden onset, swelling of the brain, and like most other infectious diseases, it is seasonal, seen almost exclusively during the summer. But the usual suspects - meningitis or Japanese encephalitis - that plague this part of India and Nepal are not to be blamed.
Indian health authorities working with the Centres of Disease Control and Prevention in the United States have put the disease under the ‘acute encephalitis syndrome’ category. Since the illness does not spread through human to human contact like tuberculosis or typhoid, researchers are now looking into viruses, bacteria, fungi, and carriers (like fleas, rats, mites, livestock) for answers.
The Muzaffarpur mystery will need painstaking work and a certain degree of luck to be decoded. However, in nearby Nepal recent studies on the causes of central nervous system infections have produced fascinating and potentially life-saving findings. In August this year, researchers from Patan Hospital with Abhishek Giri as lead author published the first prospective DNA and culture-based study of 87 adult patients with acute neurological problems in the open-access Scientific Reports (publishers of Nature). Besides the usual meningitis causing bacteria, enteroviruses in the CSF was also discovered for the first time in Nepal. When these viruses cause meningitis the disease is less severe (called aseptic meningitis) and does not require long-term antibiotics.
Since antibiotics are readily available over the counter at most pharmacies in Nepal, they are being grossly abused by both patients and doctors. As a result, significant bacterial infections are now becoming resistant to commonly used antibiotics. One of the important lessons doctors and medical professionals can learn from this study is to consider the possibility of aseptic meningitis in patients with acute neurological problems and avoid over-prescribing antibiotics (like TB drugs) for long periods of time.