‘Dengue-like undiagnosed viral fevers on the rise in Pakistan’

Karachi
Infectious vector-borne diseases with symptoms similar to dengue haemorrhagic fever — which endemic in the South Asian countries including India and Bangladesh — are on the rise in Pakistan but they cannot be diagnosed here.
Experts of infectious diseases while speaking at a symposium at the Aga Khan University, held in collaboration with the University of Florida and the American Society for Microbiology, warned that diseases spread by Arboviruses (arthropod-borne viruses), such as dengue, yellow fever, Chikungunya, Japanese B encephalitis and other types of tuberculosis and pneumonia had become resistant to almost every available antibiotic.
They said Arboviruses were endemic to the South Asian region and believed that similar climatic conditions and ground realities such as poverty and lack of health care facilities also made Pakistan vulnerable to these diseases.
“Patients infected by Arboviruses show dengue-like symptoms. If they test negative for dengue then they are categorised as patients with unknown fever or a febrile illness,” said Dr Erum Khan, who heads the Department of Pathology and Laboratory Medicine at the Aga Khan University.
Elaborating further, Dr Khan revealed that during a study conducted on patients with the ‘unknown fever’ in Sindh, 20 to 30 percent of the patients complained of dengue-like symptoms while laboratory tests turned up negative for dengue.
“This led us to conclude that there may be cases of Arbovirus-related infectious diseases in this region as well,” she said. “Unfortunately, we lack the diagnostic facilities and the right tools to confirm the actual number of cases.”
If the diagnoses was delayed, she said, Arbovirus diseases could be life-threatening. “But the problem is that nearly every illness in the Arbovirus family, shows more or less similar symptoms including fever and rash in the initial stages. This is why they go undiagnosed,” said Dr Khan. “Our interest is to look for these viruses and differentiate between them to identify the actual causes of infections.”
She announced that the Aga Khan University and the University of Florida were launching a pilot project in Sindh to detect cases of Arbovirus diseases. “Patients with febrile illnesses in Karachi, Hyderabad, Thatta, Larkana, Sukkur and Mirpurkhas will be recruited and tested for a range of viruses. The findings will be shared with the government to develop a better understanding of Arboviruses,”she said.

Drug resistance
Another health concern highlighted at the symposium was drug resistance. Over time, mutated forms of bacteria had emerged which were immune to every known antibiotic.
Shedding light on the topic, Dr Rumina Hasan, a professor at the Department of Pathology and Laboratory Medicine of Aga Khan University, said, “We are losing all we had in our hands. It is like going back to old days when there was no antibiotic available and people would die of minor infections. The situation is very bleak.”
To add to the gravity of the problem, she said, pharmaceutical companies had lost interest in producing antibiotics. “It can take up to 10 years to come up with a new antibiotic and if a bacterium adapts to it in a few months, the antibiotic loses its effectiveness,” she said.
The reason why bacteria had mutated so rapidly was inappropriate and frivolous use, rather the abuse of drugs, and the poor management of biological wastes at hospitals and microbiological labs.
“Here in Pakistan, we do not enforce drug regulations and most of microbiological labs do not employ bio-safety measures while managing wastes,” said Dr Hasan. “The government has to play a big role. Over-the-counter availability of antibiotics needs to be checked and physicians should also be responsible enough not to prescribe antibiotics for minor viral infections.”
Similarly, she said, without stringent disposal measures, there was a high possibility of people getting exposed to and infected by the resistant bacteria.
She shared that the Aga Khan University and American Society for Microbiology will also work together on a project to train selected microbiologists and help them learn about international standards to zero in on resistant bacteria and properly manage biological wastes.
However, to help overcome these challenges, there is a need for an effective surveillance system, said Dr Rana Jawed, resident adviser of the Field Epidemiology and Laboratory Training Programme at the Centre for Disease Control and Prevention.
“Good surveillance is the need of the hour because in the case of a delayed response to an epidemic or an endemic, there is a fair chance that the mortality rates will be sky high,” he said.
Concluding the symposium, healthcare experts asked the government to play a responsible role and take vital steps for the implementation of drug regulations and bio-safety measures, besides devising an effective surveillance system for a healthy tomorrow.