Multiple Viral Co-infections in a Pediatric Patient of Acute Encephalitis Syndrome (AES) - An Unique Case Report
Maneesh Kumar
Department of Virology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Roshan Kamal Topno
Department of Epidemiology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Binod Kumar Singh
Department of Pediatrics, Nalanda Medical College and Hospital, Agamkuan, Patna-800007, India.
Major Madhukar
Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Bheemarao Kamble
Department of Pediatrics, Nalanda Medical College and Hospital, Agamkuan, Patna-800007, India.
Ganesh Chandra Sahoo
Department of Virology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Pradeep Das
Department of Molecular Biology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Krishna Pandey *
Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Agamkuan, Patna-800007, India.
Alka Singh
Department of Pediatrics, Nalanda Medical College and Hospital, Agamkuan, Patna-800007, India.
*Author to whom correspondence should be addressed.
Abstract
The occurrence of viral co-infection is always a challenging issue in pediatrics which indicates underestimation of causal viral pathogens. A 6-year-old girl child from Patna had diagnosed a rare case of multi-viral co-infection in February 2020. She was manifested with oblivion along with high-grade fever, weakness, nasal bleed, headache, and body ache. She had altered sensorium with mildly dilated pupils. Her three classical meningeal sign i.e. Kernig's sign, Brudzinski's sign, and nuchal rigidity were found positive. She clinically investigated with a strong suspicion of viral infectivity. Awfully, she was diagnosed with multi-viral co-infection including Japanese Encephalitis, Dengue, Chikungunya, Cytomegalovirus, and Rubella where as HSV and VZV detected borderline. The IgM detection for JE using the CSF sample was found equivocal. The infection was also confirmed by CECT brain scanning. She got proper medication including antiemetic, antipyretic, antiepileptic drugs, antibiotics, anti-viral drugs, and 20% Mannitol for reducing the intra cranial pressure. After medication under proper clinical supervision, she improved completely with any seizures and viral infections. She advised for follow-up after a month. Such occurrences of multi-viral co-infections deserve proper attention and awareness among the healthcare experts about the severity of drugs.
Keywords: Acute encephalitis syndrome, multi-viral co-infection, central nervous system, viral pathogenesis, meningo-encephalitis.