The study, named “A fatal case of monkeypox virus infection from Kerala India 2022" has been published as a pre-print. It has not yet been peer-reviewed. India has so far registered 11 cases of monkeypox -- five from Kerala and six from Delhi.
The fatal case refers to a 22-year-old man who was admitted to a private hospital in Kerala following a single episode of acute onset generalized tonic-clonic seizures, the study stated.
The man developed fever and headache on 15 July while he was in the UAE. He sought medical care on 19 July. On 21 July, he returned to Kerala when partially relieved from his symptoms.
On 23 July, he played some football, which resulted in the worsening of pain in right inguinal area. He consulted a surgeon for it on 25 July in Kerala and was diagnosed to have hidradenitis suppurutiva.
He continued to report fatigue and low-grade fever which was not associated with persistent headache, alteration of sensorium, loss of appetite or weight. On the evening of 26 July, he had a fever spike followed by generalized tonic clonic seizure.
Serological tests for HIV, Hepatitis B, Hepatitis C and syphilis were negative.
The study mentioned that over the next 48 hours he developed coagulopathy and acute kidney injury. On 28 July, the man developed features of worsening cerebral edema and was intubated and mechanically ventilated, the study said.
Despite anti-cerebral edema measures, he progressed to brainstem dysfunction and died on 30 July. A little before his death, his relatives obtained a test result from the UAE, which showed that he had tested positive for MPXV or the monkeypox virus in the UAE on 19 July.
"This is the first fatal case of Monkeypox reported from India. This case highlights the importance of maintaining a high index of suspicion to diagnose MPXV in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from monkeypox endemic or outbreak countries," the study said.
It added: "The OPS/NPS specimen, as well as possibly urine specimens, should be considered as the critical specimens for MPXV diagnosis in cases with no active skin lesions.In conclusion, the overall findings of the case and the history confirm that the case to be infected with monkeypox."
The study mentioned that the monkeypox outbreak is largely limited to the community of men who have sex with men primarily with multiple bisexual or homosexual partners. Many persons who have been diagnosed with monkeypox have been recovered.
(With agency inputs)
