Emerging and Re-emerging Infections — MCQs

Q: A 35-year-old farmer from Kerala presents with high-grade fever, myalgia, and altered sensorium. He has a history of contact with infected pigs. CSF examination shows lymphocytic pleocytosis. Which organism is most likely responsible?

Nipah virus. ***Nipah virus*** - The clinical triad of **encephalitis**, proximity to **Kerala**, and history of **contact with infected pigs** is classic for Nipah virus outbreaks in India. - It characteristically presents with **high-grade fever**, **altered sensorium**, and high mortality rates, often involving **lymphocytic pleocytosis** on CSF analysis. *Herpes simplex virus* - While it is a common cause of sporadic **encephalitis**, it typically targets the **temporal lobes** and is not historically linked to pig contact. - It lacks the specific **epidemiological association** with travel to or residence in Kerala pig-farming clusters. *West Nile virus* - This virus is transmitted via **Culex mosquito** bites rather than direct contact with livestock like pigs. - While it can cause neurological symptoms, it more frequently presents with **generalized weakness** or **flaccid paralysis** rather than the rapid encephalitic progression seen here. *Japanese encephalitis virus* - Although associated with pigs as amplifying hosts, JE is more commonly linked to **rice paddy** cultivation where mosquitoes breed. - JE typically presents with **thalamic involvement** on imaging and is less likely than Nipah in the context of recent high-profile Kerala outbreaks.

Emerging and Re-emerging Infections — MCQs

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