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CORRESPONDENCE
Year : 2013  |  Volume : 138  |  Issue : 3  |  Page : 362-363

Dual infection in human by Japanese encephalitis virus & chikungunya virus in Alappuzha district, Kerala, India


1 Centre for Research in Medical Entomology (ICMR) 4, Sarojini Street, Chinna Chokkikulam Madurai 625 002, India
2 Kerala State Institute of Virology & Infectious Diseases Thiruvambady, Pazhaveedu, P.O. Alappuzha 688 009, India

Date of Web Publication8-Oct-2013

Correspondence Address:
V Thenmozhi
Centre for Research in Medical Entomology (ICMR) 4, Sarojini Street, Chinna Chokkikulam Madurai 625 002
India
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Source of Support: None, Conflict of Interest: None


PMID: 24135182

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How to cite this article:
Thenmozhi V, Paramasivan R, Samuel P P, Kamaraj T, Balaji T, Dhananjeyan K J, Venkatasubramani K, Tyagi B K. Dual infection in human by Japanese encephalitis virus & chikungunya virus in Alappuzha district, Kerala, India. Indian J Med Res 2013;138:362-3

How to cite this URL:
Thenmozhi V, Paramasivan R, Samuel P P, Kamaraj T, Balaji T, Dhananjeyan K J, Venkatasubramani K, Tyagi B K. Dual infection in human by Japanese encephalitis virus & chikungunya virus in Alappuzha district, Kerala, India. Indian J Med Res [serial online] 2013 [cited 2020 Feb 23];138:362-3. Available from: http://www.ijmr.org.in/text.asp?2013/138/3/362/119375

Sir,

Japanese encephalitis virus (JEV) is a major mosquito-borne encephalitic flavivirus of rural eastern, south eastern and southern Asia. Outbreaks of Japanese encephalitis (JE) have occurred in many States in India [1] . An explosive insular outbreak of meningoencephalitis occurred during early 1996 in the Kuttanad area of Allepey district, Kerala [2] .

Numerous cases of chikungunya virus (CHIKV) infection have been reported from a major outbreak around the Indian Ocean which included southern India [3] . In India, during 2006, 14 States and Lakshadweep Island were affected by chikungunya fever [4],[5] . In Kerala, outbreak of chikungunya began for the first time in 2006 affecting nearly 70,000 persons from 14 districts [5] . In May 2007, another outbreak occurred affecting almost all the districts [6] . Increased death toll was due to chikungunya in Kerala [7] .

Alappuzha district lies at the western part of Kerala and was worst affected. During the outbreak in May 2011, 23 cases were recorded in Alappuzha district. An epidemic survey was done by a team of Centre for Research in Medical Entomology (CRME), Madurai and Kerala State Institute of Virology and Infectious Diseases.

After obtaining informed written consent from the suspected JE patients blood samples (2 ml) were obtained with the help of Government Tirumala Devaswom (TD) Medical college hospital staff and Kerala State Institute of Virology staff. The serum samples were analyzed for JEV-specific immunoglobulin M (IgM) antibodies, dengue virus (DENV) - specific IgM antibodies and CHIKV specific IgM antibodies separately by using separate and specific MAC ELISA kits supplied by National Institute of Virology, Pune, India. The serum samples were simultaneously tested for JE, DEN and CHIK IgM antibodies using separate negative and positive controls supplied in the respective kits.

Serum samples were collected from 23 suspected fever cases reported to the hospital. Of the 23 samples tested, four were found positive for JE IgM/CHIK IGM. Of these four positive patients, two male adult patients (37 & 47 yr old) were from Muhamma and Pollathai area of Kerala, respectively, had dual infection showing the presence of both JE IgM and CHIK IgM antibodies. A 40 yr old male patient was positive for CHIK IgM antibodies alone and a 76 yr old female patient had JE IgM antibodies alone. The age group found positive ranged between 37-76 yr. No serum sample was found positive for dengue IgM.

Two cases are described in the present study with dual infection with JEV and CHIKV. This report highlights the multifaceted mosquito-borne arboviral infections. Dual infection by dengue virus and Plasmodium vivax has been earlier reported from Alappuzha district, Kerala [8] . So far, for patients with CHIKV infection, simultaneous co-infection has been reported for dengue virus [9],[10] . A French man travelled and returned from India was documented with dual infection by CHIKV and systemic amoebiasis [11] . Most of the JE cases reported from Kerala were adults as pointed out earlier also [12] .

In conclusion, the two patients with dual infection with JEV and CHIKV indicate the multifaceted infection that can be encountered in Kerala with water saturated places which are the ideal breeding sources for different species of mosquitoes.


   Acknowledgment Top


Authors acknowledge the Director General, Indian Council of Medical Research, New Delhi, for providing facilities and encouragement, and thank Dr K.M. Sirabudeen, District Medical Officer (Public Health), Alappuzha district and Dr A. Remla Beevi, Principal of TD Medical College & Director In-charge of Kerala State Institute of Virology and Infectious Diseases, for their co-operation for conducting the investigations at Alappuzha. Authors also acknowlegdge all laboratory and field supporting staff of CRME, Madurai, and staff of Kerala State Institute of Virology, involved in this study.

 
   References Top

1.Rodrigues FM. Epidemiology of Japanese encephalitis in India: A brief overview. In: Proceedings of the National Conference on Japanese Encephalitis. New Delhi: Indian Council of Medical Research; 1984. p. 1-9.  Back to cited text no. 1
    
2.Dhanda V, Thenmozhi V, Kumar NP, Hiriyan J, Arunachalam N, Balasubramanian A, et al. Virus isolation from wild-caught mosquitoes during a Japanese encephalitis outbreak in Kerala in 1996. Indian J Med Res 1997; 106 : 4-6.  Back to cited text no. 2
    
3.Yergolkar PN, Tandate BV, Arankalle VA, Sathe PS, Sudeep AB, Gandhe SS, et al. Chikungunya outbreaks caused by African genotype, India. Emerg Infect Dis 2006; 12 : 1580-3.   Back to cited text no. 3
    
4.World Health Organization. Chikungunya in India, Epidemic and Pandemic Response, October 17, 2006. Available from: http://www.who.int/csr/don/2006_10_17/en/index.html, accessed on October 10, 2007.  Back to cited text no. 4
    
5.National Vector Borne Diseases Control Programme, Chikungunya fever situation in the country during 2006. Available from: http://www.nvbdcp.gov.in/Chikun-cases .html, accessed on November 30, 2006.  Back to cited text no. 5
    
6.Kannan M, Rajendran R, Sunish IP, Balasubramaniam R, Arunachalam N, Paramasivan R, et al. A study on chikungunya outbreak during 2007 in Kerala, south India. Indian J Med Res 2009; 129 : 311-5.  Back to cited text no. 6
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7.Joseph AY, Babu VS, Dev SS, Gopalakrishnapai J, Harish M, Rajesh MD, et al. Rapid detection and characterization of Chikungunya virus by RT-PCR in febrile patients from Kerala, India. Indian J Exp Biol 2008; 46 : 573-8.  Back to cited text no. 7
    
8.Thangaratham PS, Jeevan MK, Rajendran R, Philip Samuel P, Tyagi BK. Dual infection by dengue virus and Plasmodium vivax in Alappuzha district, Kerala, India. Jpn J Infect Dis 2006; 59 : 211-2.  Back to cited text no. 8
    
9.Powers AM, Brault AC, Tesh RB, Weaver SC. Re-emergence of chikungunya and o'nyong-nyong viruses; evidence for distinct geographical lineages and distant evolutionary relationships. J Gen Virol 2000; 81 : 471-9.  Back to cited text no. 9
    
10.Myers RM, Carey DE. Concurrent isolation from patient of two arboviruses, chikungunya and dengue type 2. Science 1967; 157 : 1307-8.  Back to cited text no. 10
    
11.Ezzedine K, Cazanave C, Pistone T, Catherine Receveur M, Neau D, Jean-Marie RJ, et al. Dual infection by chikungunya virus and other imported infectious agent in a traveler returning from India. Travel Med Infec Dis 2008; 6 : 152-4.  Back to cited text no. 11
    
12.Banerjee K. Japanese encephalitis outbreak in Kerala has unusual features. Lancet 1996; 347 : 678.  Back to cited text no. 12
    




 

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