The first case of murine typhus – a bacterial infection spread by fleas – in Kerala, diagnosed in a 75-year-old man on October 11, was an imported case, a health expert told TNM. The man had travelled to countries like Vietnam and Cambodia, before coming to Kerala, and likely got the infection from abroad.
Symptoms for the disease include the usual ones for viral infections, such as fever, headache, body pain and rashes. “It has similar risks as other communicable diseases such as dengue or leptospirosis. It is just that this is the first time it is diagnosed in Kerala,” the medical professional said.
The disease is common in tropical, subtropical and temperate climates – in countries of Southeast Asia, south and central America, Africa and West Asia, according to the Centers for Disease Control and Prevention.
Complications can occur in the affected individuals like in the case of the 75-year-old in Kerala. In his case, age might have made the infection more severe, the expert said. There is little chance of a spread of the infection since the elderly man had been infected from abroad, and the infection transmits only through rat flea, and not from person to person.
Aggressive testing and amoebic disease in Kerala
The disease was diagnosed since medical professionals in the state have taken to aggressively testing infections from abroad, to check for exotic diseases. A serology test was done to understand if the infection was caused by a pathogen. Further tests, including sequencing, determined that the pathogen was the bacteria – Rickettsia typhi – which caused murine typhus.
The practice of aggressive testing became more prevalent in Kerala with the state diagnosing several cases of the rare brain infection called amoebic meningoencephalitis in recent months. About 30 cases have been reported in Kerala this year, causing some alarm, since it is a rare and fatal infection with a 90% mortality rate. However, after the first few cases of infections in children, the state was able to make quicker diagnoses and provide effective treatment. In September, the state achieved the difficult feat of reducing the mortality rate to 26%, when 14 of the 19 infected were cured.
The infection is caused by free-living amoeba found in freshwater, and while in some cases the source of water-contact could be found, it is not always possible. For one, there are different types of the disease, caused by different kinds of amoeba. Only in the case of Primary Amoebic Meningoencephalitis, caused by the amoeba naegleria fowleri, the patient would have displayed symptoms within two weeks of coming in contact with water (that contained the amoeba). In other cases – like granulomatous amoebic encephalitis (GAE) – it could take months, and one need not be able to trace the source.
“Earlier, the protocol was to test for the amoebic infection only in case of clinical suspicion – which in this case is contact with water in recent days. But that would not work here, as we have seen in multiple cases. So it was decided that the test for amoebic meningoencephalitis will be done for any kind of meningitis,” the health expert said.
One reason that so many cases have been detected in Kerala is that the state became vigilant with its testing procedure. “Otherwise 70% of the cases are not diagnosed. It is because we are testing so much that we could diagnose these many cases,” the expert said.
An action plan will soon be released by the government of Kerala. While it may not be possible to avoid bathing in ponds (which may likely contain amoeba), it has been advised that nose clips or plugs be used so that water would not enter the body through the nose (which is how naegleria enters the human body). Doctors in the state are also being sensitised to mandatorily test for the infection in case of any kind of meningitis.
