The recurring epidemic of heat stroke in children in Muzaffarpur, Bihar, India

Context: Characterization of heat stroke cases on arrival to hospital may lead to early recognition and improved management. Delay in treatment leading to high rate of mortality and poor outcomes so a high index of clinical suspicion in appropriate setting is warranted. Aims: Recurring seasonal(summer) outbreak of heat stroke among children from Muzaffarpur district, Bihar was investigated to describe clinico-epidemiological features. Materials and Methods: A retrospective study involving 50 patients of classic heat stroke admitted to Sri Krishna Medical College and Hospital (SKMCH) Muzaffarpur in June 2005 and June 2011 were carried out. These patients had presented with a rectal temperature of more than 40°C and central nervous system disturbance. The patients were treated with standard regimen of management of heat stroke and sponging in ICU after emergency resuscitation. Results: A total of 50 case records were studied of children below12 years of age. Case fatality ratio was 60% .The disease had peak incidence in June. Previously healthy, rural children (mean age-3.78 yr) of very low socio-economic background were found most vulnerable. The main presenting feature ware high fever (100%), convulsion (100%), unconsciousness (100%), decebrate rigidity (50%), tachycardia (80%), and tachypnea (80%). No one had splenomegaly. Cerebrospinal fluid (CSF) was under high pressure but normal otherwise in all cases. Biochemical investigation reveled hyponatremia (50%), hypokalemia (5%), mild raised SGPT (30%), blood urea (40-50mg/dl) (40%) with normal creatinine. Smear for malarial parasites were negative. CT scan of head done in 20 cases; 10- showed feature of generalized cerebral edema while rest was normal. ECG showed non-specific ST-T changes and tachyarrhythmia. Moderate to severe residual neurologic deficit was observed in 20% of survivors. Male to female ratio was 1.5:1.No infective organism or its antigen or antibody was found in the any of the samples tested locally or at various apex virological centers of India. Conclusions: Heat stroke is a medical emergency with serious complication and requires prompt treatment. It is associated with multi-organ dysfunction with high mortality and substantial neurological squeals.