ABSTRACT
Background: In September 2019, a large number of fever cases among troops and families in a military station in Maharashtra were admitted to the local Military Hospital. Detailed epidemiological investigations revealed the cause to be an outbreak of enteric fever due to sewage contamination of drinking water.Methods: A detailed site survey was undertaken; and a descriptive epidemiological study was carried out. Routine haemogram, blood culture, antibiotic sensitivity test besides serotyping of the isolates were carried out.Results: In all 28 cases who fulfilled the case definition criteria were admitted in the month of September 2019. Out of these 21 (75%) were confirmed by blood culture, while the remaining were probable cases. Bacteriological examination reports of water samples taken from various source as well as consumer end points both prior to beginning of the outbreak and during the outbreak revealed a high presumptive coliform count. Spatial and temporal clustering of cases was suggestive of common source outbreak. On 16 September 2019 exploration by digging was carried out undertaken which revealed massive leakage of water in close proximity to the overflowing manholes. The outbreak was promptly controlled after detection of this pipeline and provision of alternative source of water supply to the affected area.Conclusions: Salmonella enterica serovar typhi has been implicated in many outbreaks through history. The present outbreak was a common source focal outbreak due to sewage contamination of drinking water in a few areas in the station.
ABSTRACT
Dengue infections may present within a widely variable spectrum of clinical manifestations. However, neurologic complications in general are rare and unusual. A 19 yrs old healthy male army recruit was brought to a service hospital in South India in a state of unresponsiveness, following 12 km route march. Despite aggressive and prompt management, his condition progressively deteriorated and he finally passed away about 10 hrs after reporting to the hospital. The final cause of death was acute dengue encephalitis with raised intracranial pressure. Epidemio-clinico-pathological correlation in this case led to the conclusion that vigorous exertion with a hyper-metabolic state of fever in a setting of encephalitis led to metabolic injury, multi-organ failure, cerebral edema and intracranial hemorrhage. Encephalitis following dengue virus (DENV) infection is a rare phenomenon with the incidence ranging from 0.5% to 6.2%. Neurological features associated with DENV were first reported by Sanguansermsri et al in 1976. The rare neurologic presentations reported with DENV infection are transverse myelitis, acute encephalomyelitis, myositis, and gullain barre syndrome. As encephalitis caused by DENV mimics that caused by other pathogens it should always be kept in mind while managing encephalitis of unknown origin. Medical officers should maintain a high index of suspicion of DENV encephalitis. Training of medical officers; therefore, needs to be undertaken with regular refresher cadres, besides equipping of all peripheral facilities with rapid diagnostic kits for dengue. The same will ensure prompt detection of cases and timely referral to higher medical centres in chain. The instant case reflects an important, potentially fatal, complication of dengue. Pathophysiology of DENV encephalitis needs to be elucidated on priority through research involving all stakeholders.