For the first time ever, dengue fever was followed by a tomato flu-like sickness in an adult in Nepal. Tomato flu is on the rise in Nepal.
On May 6, 2022, the Kollam district of Kerala, India, reported the first cases of tomato flu. Since then, hundreds of kids—mostly those under nine—have been impacted, reports Kathmandupost. The cause of this outbreak was unknown at the time, but since the symptoms in children resembled those of the chikungunya virus, including peculiar tomato-shaped red rashes and blisters, it was assigned the name tomato flu.
Instead of being a brand-new viral infection, some doctors think it might be a chikungunya or dengue fever aftereffect. The main symptoms among children who had tomato flu included fever, rashes, and joint problems, according to a letter that was published in the journal The Lancet Respiratory Medicine. Children developed skin irritations as a result of the red, tomato-shaped rashes and painful blisters that emerged on their skin. They also experienced influenza-like symptoms, tiredness, nausea, and vomiting while they were unwell.
A 45-year-old guy in Nepal who had never been to India before initially displayed no symptoms other than joint soreness. However, about two weeks after being told that he had dengue virus infection, he started to have tomato-shaped red rashes and blisters, notably on his palms, feet, and tongue. The patient also complained of itchy, painless blisters and rashes. Following laboratory tests and clinical examinations, the attending dermatologist excluded various viral illnesses such as HIV (1 & 2), hepatitis B and C, chicken pox, and herpes. After India, Nepal is the second country where a tomato flu-like sickness has been reported.
The patient who contracted the sickness in Nepal was an adult with different symptoms from the outbreak seen among youngsters under nine years old in India. Currently, it is uncertain what causes the various symptoms seen in India and Nepal. However, one reason could be the influence of age.
The Kollam outbreak in India was initially thought to be caused by a novel viral pathogen. Tomato flu, on the other hand, quickly became a contentious term among professionals until the causal agent was identified. An enterovirus (CA16), the most prevalent cause of hand, foot, and mouth illness, was found to be the cause of tomato flu in two kids who had just returned to the UK from Kerala, according to a letter that was just published in The Pediatric Infectious Disease Journal (HFMD). HFMD is not a brand-new illness. Infants and kids had previously been reported to have it. It demonstrates how the absence of a molecular laboratory testing facility can delay diagnosis, which ultimately results in ineffective management and makes it difficult to swiftly stop an outbreak or spread.
Following the advent of the SARS-CoV-2 virus, the cause of the Covid-19 pandemic, numerous public and private molecular laboratories (PCR technology) were established in Nepal.
The authors of The Lancet Respiratory Medicine publication said that they were uncertain of the cause of the Kollam district tomato flu outbreak. Despite the lack of confidence, the authors advised treating this illness symptomatically with rest, lots of fluids, and a hot water sponge to soothe irritation and rashes, on the theory that it might be a viral infection comparable to that of chikungunya, dengue, or HFMD. Since HFMD is a self-limiting infectious condition, the majority of patients recover within seven to ten days without the need for special care or medication. Though exceedingly unlikely, severe side effects like meningitis, encephalitis, or paralysis are conceivable. During the “Kollam tomato flu” outbreak, no fatalities were reported. The lesions in two infants with tomato flu infection virtually vanished without scarring on days 6 and 16, according to The Pediatric Infectious Disease Journal. According to the patient, after a week, his tomato-shaped red rashes and blisters started to heal by themselves.
HFMD is regarded as a highly contagious viral infection, particularly during the first week of the disease, and is therefore easily spread by contaminated surfaces or items, feces, blister fluid, and respiratory droplets carried by an infected person’s cough or sneeze. Our patient, however, vehemently denied having any interaction with sick patients exhibiting tomato flu-like symptoms. Despite being in close proximity to one another and exchanging household items, none of his family members contracted the illness or showed symptoms resembling tomato flu.
The authors did not address the dissemination of this virus among family members (i.e. family history) in a letter published in the Pediatric Infectious Disease Journal after two children with tomato flu were diagnosed with an enterovirus (CA16) that causes hand, foot, and mouth disease (HFMD). As a result, the virus’s spread appears to be a mystery. According to some researchers, the current tomato flu outbreak is caused by a new type of HFMD. As a result of genetic variation, its presenting symptoms, route of transmission, and illness severity may differ from its initial HFMD, although more research is needed to disprove or confirm this idea. It is worth mentioning that three Covid-19 waves in Nepal with various forms of SARS-CoV-2 resulted in diverse outcomes in terms of symptoms, age groups, illness severity, and/or mortality.
For the first time ever, dengue fever was followed by a tomato flu-like sickness in an adult in Nepal. It raises a number of intriguing but important concerns, such as: Was it an extended dengue syndrome or a complication of dengue fever? Is the hand, foot, and mouth disease (HFMD) caused by the dengue virus? Is HFMD evolving into a brand-new variant? Such inquiries have not yet received a response.
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