Jaipur: Fourth confirmed case of Japanese Encephalitis (JE) of the state has been detected in Bundi which is giving sleepless nights to health authorities. It is the disease transmitted through infected mosquito bite to a healthy person, which primarily affects central nervous system of the patient.Health department's teams are continuously taking round of the area where the case of JE was found in Patan area in Bundi district. They are conducting screening of people in the area for JE. Also, they are extensively conducting anti-larvae activities."We have been doing intensive fogging in the area to kill the mosquitoes. Also, we are conducting survey of the area for detect patients with symptoms such as fever," said, Dr Suresh Chand Jain, chief medical health officer (CMHO), Bundi.The patient underwent treatment in Kota's New Government Medical College Hospital. "She died while undergoing treatment in the hospital," said Dr Girish Chandra Verma, principal and controller, Government Medical College, Kota.Officials confirmed that the 30-year-old woman was tested positive for JE in a report issued by National Institute of Virology (NIV), Pune.She was brought to Kota from Bundi for treatment in government's MB Hospital on October 8 but she died of the disease on October 16."It is not the first such case of JE reported in the state. Earlier, two confirmed cases of JE were reported from Rajsamand and Udaipur in 2009 and one case was reported from Rajsamand in 2016," said Dr Ravi Prakash Mathur, additional director (rural health), health department.He said that they have sent teams of microbiologists and epidemiologist in the affected area, which has collected samples of patients found suffering from fever. "These samples will be tested for JE in SMS Hospital's microbiology laboratory," Dr Mathur said.Earlier, this year, a 10-year-old boy, resident of Daraganv of Dariyawad block of Pratapgarh district was brought to RNT Medical College with symptoms of JE. The doctors sent the samples to National Institute of Virology in Pune.A health department official in Pratagarh said, "The boy tested positive for JE in a test of serum. But, he was tested negative for JE in cerebrospinal fluid (CSF) test. The test of serum shows he is JE positive but CSF samples which are collected from brain and spine showed no positivity of the disease. It supports doubts but does not confirm the disease."The official said that according to World Health Organisation, Individuals who live in or have travelled to a JE-endemic area and experience encephalitis are considered a suspected JE case. To confirm JEV infection and to rule out other causes of encephalitis requires a laboratory testing of serum or, preferentially, cerebrospinal fluid (CBF).Deadly biteBox:World Health Organisation says,Signs and symptoms of most JEV infections are mild fever and headache or without apparent symptoms— Severe disease is characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and ultimately death— The case-fatality rate can be as high as 30% among those with disease symptoms— To confirm JEV infection and to rule out other causes of encephalitis requires a laboratory testing of serum or, preferentially, cerebrospinal fluid— JE transmission intensifies during the rainy season, during which vector population increaseBox:Facts from National Vector Borne Disease Control Programme—JE viral activity has been widespread in India. The first evidence of presence of JE virus dates back to 1952— First case was reported in 1955— Outbreaks have been reported from different parts of the country— Annual incidence ranged between 1,714 and 6,594 and deaths between 367 and 1,665

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