No diagnosis centres for rabies patients in Mumbai

Data with Brihanmumbai Municipal Corporation (BMC) shows two rabies deaths were recorded in Mumbai in March. One was a resident of Thane, while second was from Mumbai. Both were treated in JJ Hospital.

The recent case of a 22-month-old child, who passed away in JJ Hospital while undergoing treatment for suspected rabies, has underlined the need for not just more centres to diagnose the infectious disease but even facilities to treat such patients.

Data with Brihanmumbai Municipal Corporation (BMC) shows two rabies deaths were recorded in Mumbai in March. One was a resident of Thane, while second was from Mumbai. Both were treated in JJ Hospital. On April 1, another death was recorded when 22-month old Azan Shaikh succumbed to the infection. Two hospitals refused to admit the boy, following which he was taken to JJ Hospital on March 26.

Although the test reports were negative for the disease, JJ Hospital is now awaiting histopathology report to ascertain if he had contracted rabies. Azan’s father, constable Wasim Shaikh, had to travel all the way to Bengaluru for prompt laboratory analysis of his brain tissue to assess whether the boy suffered from rabies. The reports were negative.

Following the case, doctors in the city claim that diagnosis of rabies is difficult as samples have to either be sent to National Institute of Virology (NIV), Pune, or National Institute of Mental Health and Neuro Sciences (NIMHNS), Bangalore. In Mumbai, Haffkine Institute has ceased its laboratory tests for rabies.

In the latest case, Azan was taken to Lilavati Hospital first where doctors suspected he suffered from rabies. Chief Operating Officer Dr Ravi Shankar said, “Since we do not have the facility to treat rabies, we referred the child to Kasturba hospital.”

At Kasturba, a civic-run hospital specialised in infectious diseases, the boy was referred to JJ Hospital. “We treat infectious diseases that spread from human to human. Rabies is not tackled as it is caused by dog bite and has no treatment,” said Dr Chandrakant Pawar, medical superintendent at the hospital.

As private hospitals turn away suspected rabies patients due to fear of the infection most patients are forced to seek admission in KEM or JJ Hospital, diagnosis poses another challenge. According to Dr Om Srivastava, infectious disease expert, diagnosis of rabies can be done through biopsy where tissue is collected from nape of the neck, or through brain tissue diagnosing or cerebro-spinal fluid. “I mostly send samples to NIMHANS. There is nothing in Mumbai to confirm this infection,” he said.

Dr Tanu Singhal, paediatric infectious disease expert at Kokilaben Dhirubhai Ambani Hospital, who has treated three such patients, said most doctors do not wait for laboratory results and initiate treatment on clinical diagnosis.
“Survival in rabies is rare, though there are cases in medical literature recording survivals. We can put patients on intensive support or in comatose condition for treatment. But the cost can range between Rs 40,000 to 50,000 per day,” she said.

Singhal added that most rabies cases are easy to identify due to hydrophobia. “Only in confusion, do we rely on laboratory test,” she added.

Dr Pravin Amle, infectious disease expert at Bombay Hospital, said that vaccine can be best preventive measure against the disease. “We usually rely on history of dog bite. Sending samples to NIV or NIMHANS can take time. Another option is to collect the dog’s brain tissue and analyse it under pathologist.”

At Bombay Veterinary Hospital in Parel, superintendent Dr JC Khanna said the pathology department extracts a sample of brain tissue to analyse if it is infected with virus. “We usually use fluorescent antibody test,” he said, adding that there is no mechanism to conduct similar test for humans in the hospital.

Khanna added that rabies cases have reduced over the years due to dog sterilisation programs and regular vaccination by BMC.

In Mumbai, only KEM and JJ are designated hospitals to treat rabies patients, said Dr Sheela Jagtap, attached with BMC.