Kyasanur Forest Disease: Clinical profile, diagnostic approaches, and management protocol

Abstract

Background: Kyasanur Forest Disease (KFD) is an emerging tick-borne flavivirus first identified in 1957 in Karnataka, India. Since 2012, the disease has expanded to four other states, posing an increasing public health threat. This study aims to develop a comprehensive, standardized protocol for clinical characterization, diagnostic approaches, and management of KFD to assist clinicians and public health specialists in navigating its expanding geographical footprint and reducing associated mortality. Methods: With the involvement of multiple experts and their experiential learnings in managing the KFD cases, this comprehensive protocol was developed emphasizing on clinical presentation and management. Results: KFD poses a significant public health challenge with a mortality rate ranging from 2% to 10%, and reported higher fatality in non-endemic regions. The disease typically presents with an abrupt onset of fever, severe headache, myalgia, and prostration, progressing to a biphasic course in 10-18% cases. Haemorrhagic and neurological complications, including altered sensorium, seizures, and meningitis, can occur and are associated with increased mortality with multi-organ dysfunction syndrome (MODS). Diagnosis relies on molecular methods (RT-PCR, real-time RT-PCR) and serological assays (IgM/IgG ELISA). Currently, no specific antiviral treatment is available, and management is primarily supportive, focusing on symptom control, fluid balance, and addressing complications. Conclusion: The current manuscript consolidates current knowledge on the epidemiology, clinical characteristics, differential diagnosis, laboratory investigations, and management strategies for KFD primarily for the clinician and public health specialist. This also highlights the critical need for early diagnosis, robust surveillance, and improved supportive care to reduce morbidity and mortality.