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 A recent case of Nipah virus infection has underscored the urgent need for better diagnostic facilities in Malappuram district. The patient, a child referred from Pandikkad PKM Hospital, presented with severe symptoms that led to a critical diagnosis at Moulana Hospital, Perinthalmanna.

The case began with the patient experiencing four days of fever and severe tiredness. After being admitted to the hospital and starting IV fluids, the child developed seizures. Despite initial treatments, the patient's condition deteriorated, prompting a referral to Moulana Hospital's emergency department.

Upon arrival at 8:30 PM on July 15th, the child was in a post-ictal state, displaying signs consistent with suspected meningoencephalitis. An MRI revealed small diffusion restriction areas in both hemispheres, indicating possible vasculitis. The patient was intubated, mechanically ventilated, and transferred to the Pediatric Intensive Care Unit (PICU).

Clinical assessments and treatments included administering antibiotics, antivirals, and managing raised intracranial pressure. Despite these measures, the patient's condition continued to worsen, exhibiting myoclonic jerks, increased hematocrit levels, and chemosis.

Given the lack of response to initial treatments and the severity of the symptoms, the medical team considered rare viral encephalitis, including Nipah virus. CSF and serum samples were sent to the National Institute of Virology (NIV) Pune for testing. By Saturday, the results confirmed a Nipah virus infection.

Dr. Dipu K, Pediatrician and Pediatric Intensivist at Moulana Hospital, emphasized the need for rapid consideration of Nipah in similar cases. "Mild hemoconcentration, hyponatremia, segmental myoclonus, and rapid clinical worsening are key indicators of Nipah virus," he noted.

The case revealed significant overlaps between Nipah and rickettsial encephalitis, such as myoclonic jerks, hyponatremia, and mild thrombocytopenia. However, the rapid deterioration and lack of response to doxycycline pointed towards Nipah.

In light of this case, Dr. Dipu stressed the importance of taking all possible precautions when treating patients with seizures or altered sensorium. He also called for the establishment of a Nipah testing facility in Malappuram and the authorization of private labs to conduct Nipah tests.

"The need of the hour is to ensure timely diagnosis and treatment. We should be able to test for Nipah locally without delays," he asserted.

This case serves as a stark reminder of the critical need for enhanced diagnostic capabilities and awareness of Nipah virus in regions prone to outbreaks. The swift actions and thorough investigation by the medical team at Moulana Hospital were pivotal in identifying and managing this severe case.