Nyamuk Menyebabkan Demam Di India
Sudah lebih dari sepekan ini anak-anak di beberapa distrik di negara bagian Uttar Pradesh, India utara, bangun tidur dengan demam dan badan yang basah kuyup oleh keringat.
Banyak dari mereka mengeluhkan nyeri sendi, sakit kepala, dehidrasi, dan mual. Dalam beberapa kasus, mereka melaporkan ruam yang tersebar di lengan dan kaki mereka.
Setidaknya 50 orang, kebanyakan anak-anak, telah meninggal karena demam itu, dan ratusan lainnya dirawat di rumah sakit di enam distrik di bagian timur negara bagian. Tidak satu pun yang meninggal dinyatakan positif Covid-19.
Saat India tampak perlahan-lahan pulih dari gelombang kedua virus corona, kematian di Uttar Pradesh memancing sejumlah tajuk berita bernada panik tentang “demam misterius” yang melanda daerah pedesaan negara bagian terpadat di India itu.
Para dokter di beberapa distrik yang terdampak – Agra, Mathura, Mainpuri, Etah, Kasganj, dan Firozabad – percaya bahwa demam berdarah, infeksi virus dengue yang ditularkan oleh nyamuk, bisa jadi merupakan penyebab utama kematian.
Mereka berkata banyak pasien yang dibawa ke rumah sakit mengalami penurunan jumlah trombosit, komponen darah yang berperan dalam penggumpalan darah, yang merupakan ciri-ciri demam berdarah parah.
“Para pasien di rumah sakit, khususnya anak-anak, meninggal dengan sangat cepat,” kata Dr. Neeta Kulshresta, tenaga kesehatan paling senior di distrik Firozabad, tempat 40 orang, termasuk 32 anak, meninggal dunia dalam satu minggu terakhir.
Ditularkan oleh nyamuk betina, dengue utamanya adalah penyakit tropis dan telah beredar di India selama ratusan tahun. Penyakit ini endemik di lebih dari 100 negara, namun sekitar 70% kasus dilaporkan dari Asia. Ada empat jenis virus dengue, dan risiko kematian bagi anak-anak bisa sampai lima kali lipat dibandingkan orang dewasa dalam infeksi kedua.
Nyamuk pembawa virus dengue – Aedes aegypti – berkembang biak di dalam wajan berisi air bersih di dalam dan di sekitar rumah-rumah. Hampir 100 juta kasus demam berdarah parah – pendarahan hebat, kerusakan organ – dilaporkan di seluruh dunia setiap tahun.
“Dampak gabungan dari Covid-19 dan epidemi dengue berpotensi menyebabkan bencana bagi populasi berisiko,” menurut Organisasi Kesehatan Dunia (WHO).
Tetapi masih belum jelas apakah epidemi dengue satu-satunya penyebab di balik banyak kematian terkait demam di Uttar Pradesh.
Uttar Pradesh, negara bagian dengan lebih dari 200 juta populasi dan standar sanitasi yang secara tradisi rendah, tingkat malnutrisi tinggi pada anak-anak, dan fasilitas kesehatan terbatas kerap melaporkan kasus-kasus “demam misterius” setelah musim hujan setiap tahun.
Wabah ensefalitis Jepang yang ditularkan oleh nyamuk – pertama kali diidentifikasi di Uttar Pradesh pada 1978 – telah menyebabkan lebih dari 6.500 orang meninggal.
Penyakit ini menyebar terutama di Gorakhpur dan distrik-distrik tetangganya yang berbatasan dengan Nepal di kaki pegunungan Himalaya. Hampir semua daerah itu merupakan dataran rendah dan rentan dilanda banjir sehingga menyediakan banyak tempat berkembang-biak bagi nyamuk yang menularkan virus.
Kampanye vaksinasi, yang dimulai pada 2013, telah menyebabkan penurunan kasus, namun masih banyak anak-anak yang meninggal. Pada tahun ini saja sudah ada 17 anak meninggal karena ensefalitis Jepang di Gorakhpur, dan 428 kasus tercatat.
Pada 2014, bereaksi pada peningkatan kasus kematian anak karena ensefalitis dan myokarditis – inflamasi pada otot jantung – para ilmuwan memeriksa 250 anak-anak yang sakit di Gorakhpur. Mereka menemukan bahwa 160 dari mereka memiliki antibodi terhadap bakteri yang menyebabkan scrub typhus.
Scrub typhus, juga dikenal sebagai tifus semak, adalah infeksi bakteri yang tersebar melalui gigitan tungau. Tungau-tungau itu hidup di vegetasi yang tumbuh subur di desa-desa setelah musim hujan.
Para ilmuwan menemukan tungau pada kayu bakar yang disimpan warga desa di dalam rumah. Seringkali, scrub typhus menyebar ketika anak-anak menggunakan kayu bakar di rumah atau buang air besar di semak-semak yang penuh dengan tungau.
Dalam studi terpisah, para ilmuwan juga mendapati bahwa kebanyakan kasus demam pasca-musim hujan di enam distrik Uttar Pradesh bagian timur antara 2015 dan 2019 disebabkan oleh tifus semak dan demam berdarah.
Patogen lainnya yang menyebabkan demam adalah infeksi bakteri yang disebut leptospirosis, ditularkan dari hewan ke manusia dan dapat berakibat fatal, serta chikungunya, penyakit lainnya yang ditularkan oleh nyamuk.
“Jadi ada banyak penyakit terkait-demam yang terjadi di wilayah ini setelah musim hujan. Perlu pemantauan sistematis untuk melacak penyakit-penyakit ini dan merawat mereka,” kata V Ravi, profesor virologi di Institut Nasional Kesehatan Mental dan Neurosains (Nimhans), yang memimpin studi kedua.
Sebelumnya, pada 2006, para ilmuwan menyelidiki wabah “misterius” lainnya yang menyebabkan kematian terkait-demam pada anak-anak di Uttar Pradesh. Kali ini mereka menemukan bahwa anak-anak itu meninggal setelah memakan kacang-kacangan cassia, yang tumbuh subur di bagian barat negara itu.
Keracunan makanan tersebut adalah akibat dari “kemiskinan, kelaparan, kurangnya pengawasan orang tua, ketidaktahuan, anak-anak bermain sendiri, tidak tersedianya mainan, dan kemudahan akses pada tumbuhan tersebut,” para ilmuwan menyimpulkan.
Jelas bahwa hanya penyelidikan lebih lanjut dan analisis genom yang akan mengungkap apakah gelombang kasus “demam misterius” baru-baru ini di India hanya dipicu oleh virus dengue, atau penyakit lainnya.
Karena itu klinik dan rumah sakit setempat perlu dilatih untuk mengumpulkan sampel dari orang-orang yang menderita demam dan mengirimnya ke laboratorium untuk tes genomik.
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