INTRODUCTION:

The virus that causes tomato flu, which was originally identified in Kerala, India in May 2022, is unrelated to the SARS-CoV-2 virus, despite the fact that both diseases initially present with fever, tiredness, and body aches, with some COVID-19 patients also having skin rashes. The illness is known as "Tomato flu" because its main symptom is the appearance of tomato-shaped red blisters all over the body¹.

The illness is brought on by a viral fever or develops as a result of contracting the dengue or chikungunya viruses. Tomato flu considered to be a new HFMD (Hand Foot and Mouth Disease). According to Dr. Amar S Fettle, Epidemiologist and state Nodel Officer of Kerala, it’s a common viral infection and its found mainly in the children under the age of 5 years². Virus can spread from one person to another person through: Nausea and throat secretion, such as nasal mucus, drool, saliva.

The first week of illness is typically the most contagious period for those with hand, foot, and mouth disease. Sometimes, even after symptoms subside or even in the absence of any symptoms, people can still transmit the virus to others for days or even weeks in a dormant stage.

In general HFMD is caused by viruses that belongs enterovirus genus the single standard RNA viruses. Some example of enterovirus are echoviruses, coxsackie viruses, polioviruses and other. Coxsackie virus A16is most frequent cause of HFMD³. Although there is a low chance that this illness will produce meningitis, it has happened. Therefore, on experiencing any symptoms, a visit to a doctor is must. According to Kerala's Health Minister Veena George⁴.

"The new infections are not unexpected because we are observing that bacterial infections are falling down and viral infections are rising up across the world, mostly in China," as stated by Dr. TS Anish, one of the authors of the study. People have improved their cleanliness habits as a result of the COVID pandemic, which is one of the main reasons why there has been adecrease in bacterial illnesses⁴. Drug repurposing and vaccination are the most effective and cheap ways to prevent viral infections in the general population, especially in children, the elderly, and people with weaker immune systems. There are currently noantiviral drugs or vaccinations that can be used to treat or prevent tomato flu. Long-term follow-up is essential to better understand the morphology of the virus and available therapeutic options⁵. Tomato fever incidents have historically been reported in Kerala.

Infected individuals were prevalent at the period in Mudakayam, Varzur, and Kanirapally districts of Kottayam and Pathinamtita in Kerala, which were previously infected with Chikungunya⁶. The majority of patients only exhibit a few clinical traits. Considering the prevalence of enteroviruses, older children and adults are probably immune. Breath droplets, coming into contact with infected person or the contact with blister fluids are the two primary ways enterovirus transmission⁷. Keeping distance from sick people and avoiding touch and maintaining personal hygiene, can substantially decrease the transmission. Adults, especially women who are expecting, are more prone, as they are never exposed to an illness the defending antibodies to these viruses. The majority of enterovirus infections during pregnancy leave moms with a mild sickness or no symptoms, although there is no conclusive proof. A maternal enterovirus infection may result in undesirable pregnancy results, including abortion, still birth, or a congenital disorder. Mother who get the virus right before giving birth, however might pass it on the baby⁸. Tomato flu exposure is more likely since viral illness is common in children under the age of five and spread is most likely through close contact. Young children can contract the virus by touching unclean surfaces, using diapers, and putting things in their mouths. If the outbreak in children is not controlled and stopped, tomato flu transmission could have serious consequences by spreading to adults given the similarity to hand, foot, and mouth disease. Tomato flu is very contagious and is a strain of influenza. To prevent the tomato flu virus from spreading from Kerala to other regions of India, it is crucial to carefully isolate confirmed or suspected cases and take additional preventive measures. Usually, isolation should be practised for 5-7 days after the onset of symptoms to prevent the virus from spreading to other kids or adults. Maintaining good cleanliness, sanitising the area, and preventing a sick child from sharing toys, clothes, food, or other items with other kids who are healthy are the best ways to stop transmission. However, researchers are still working to identify the precise etiological factor causing this illness.

EPIDEMIOLOGY:

After Kerala state reported 80 cases, Karnataka and Tamil Nadu warned officials to tread carefully. All of the below-five-year-old affected children have recovered thanks to treatment. In severe cases, in addition to a rash and uncomfortable blisters the infection leads to brain infections, which can be fatal. The first tomato flu incidence in 2022 occurred in Kerala's Kollam district on May 6; as of July 26, 2022, the local government hospitals have recorded the virus in over 82 children under the age of five.

The flu was first discovered in the Tamil Nadu and Kerala border villages of Aryankavu, Anchal, and Neduvathur before later spreading to other locations. The first case of Aryankavu involved a four-year-old child and was reported on May 6. As the number of cases began to increase, health officials contacted the local governments and anganwadis. "We have sent health workers to raise awareness and set up a monitoring team to keep an eye on the villages reporting cases of tomato fever. The nearby anganwadis have been closed. The affected kids have been kept apart. Veena George, the state's minister of health, told INDIA TODAY that there was no need to fear⁹.

Karnataka and Tamil Nadu, two nearby states, are on high alert. Madukkarai, close to Palakkad, has screening facilities set up by Tamil Nadu. Health experts in Kerala claim that local governments have started cleaning up water sources and urging residents to practise good personal hygiene and household cleanliness to stop the spread of viruses. Dr.Bindu Mohan, the district medical officer for Kollam, stated that there are significant concentrations of illnesses in the villages of Aryankavu, Anchal, and Neduvathur¹⁰. Since then, 26 cases in Orissa have tested positive for the HFMD which is thought to be tomato flu. Health Services director Bijay Mohapatra told reporters that At the Regional Medical Research Centre in Bhubaneswar, 36 samples were received, and 26 of them confirmed positive¹¹.

No other regions in India have yet seen the effects of the virus outside Kerala, Tamil Nadu, and Orissa. The Kerala Health Department is taking preventative measures to keep an eye on the viral infection's progress and prevent it from reaching other parts of India⁴. This is thought to be because heat and humidity help spread. Although HMFD is more prevalent in rural than urban regions, socioeconomic position and standards of hygiene must also be taken into account. A risk factor for hand, foot, and mouth disease is poor hygiene.

SYMPTOMS:

There are no significant illnesses brought on by tomato flu. Complications from the condition are uncommon.

· Skin irritation: It is one of the most common signs of someone who has the tomato flu.

· Decolouration: Decolouration occurred in hands and legs.

· Fatigue and tiredness: While weariness is sometimes normal among frequent travellers, it can also pose some health issues that are discoloured and difficult to diagnose.

· Abdominal cramps, nausea, vomiting, or diarrhoea: Although these symptoms are widespread, they can have an impact on your physical health.

· Coughing, fever, sneezing or runny nose: These symptoms are similar to the coronavirus.

· Joint pain and body ache: A Tomato virus-infected person would have difficulty moving smoothly.

· Rashes: rashes the size of tomatoes on the skin.

· Swelling: on the joints.

Fig: 1 Symptoms of tomato flu

Additionally, some patients have stated that worms have come out of the blisters that have formed on their rashes.

Diagnosis for Tomato Flu:

Patients should undergo molecular and serological testing to determine whether they have the Zika virus, Chikungunya, or Dengue¹².

Management of Tomato Flu:

Tomato flu is a self-limiting viral fever. As a result, it typically resolves itself in 7 to 10 days. 6 Clinical examination and history are used to identify the illness, particularly in areas where there areoccurrences of pandemic⁴.

TREATMENT:

Treatment for patients who do not belong to a high risk group concentrates on reducing influenza symptoms like fever. Patients should seek medical assistance and begin antiviral medication treatment as soon as feasible. If they are in a group recognised to have a high risk of getting a severe or serious illness¹³. There are now no specific medications available to treat the tomato flu virus because it is a very rare viral disease that has only recently emerged. Because there are no disease-specific medications, only the symptoms can be managed with them such as any further illness with the appropriate analgesics and antipyretics. Acetaminophen or Ibuprofen can be used to treat the fever. In the absence of skin blisters, antibiotics are useless. Turn purulent consuming a lot of liquids, primarily water, juice or milk are recommended because dehydration is frequently seen¹⁴.

Children are checked for other viruses that have symptoms similar to these ones when they first appear in order to rule them out and begin tomato flu treatment. The course of treatment is comparable to that for viruses including chikungunya, dengue, chickenpox, and others. The patient is isolated and given an excess of fluids. A sponge dipped in hot water can be used to the affected region to treat the rash and irritation. The patient should avoid from bursting or rubbing the blisters. The patient should be fed a healthy food, and the area around them should be kept hygienic and neat. The best treatment in these circumstances is adequate rest¹⁵.

Outbreak Vigilance:

Parents are advised to see a doctor as soon as possible if their child exhibits any symptoms of HFMD. They must also keep an eye out for any changes in their child's behaviour. Typical behaviour, including refusing to eat or drink or vomiting frequently or being sleepy.

· Both children and adults should regularly and thoroughly wash their hands, especially after changing diapers or using the restroom.

· Contaminated objects and surfaces must be meticulously cleaned, disinfected, and cleansed using a diluted bleach solution that contains chlorine.

· Through enhanced disease surveillance, a case definition will be created to assist in the early detection of severe cases as well as the reporting, monitoring, and treatment of these patients. setting a daily reporting schedule for the HFMD Every level of healthcare institutions must disclose HFMD when establishing or growing paediatric acute care facilities (ICUs).

· Programs for ICU staff development should be established.

· Creating an expert medical team and offering 24-hour on-call assistance.

· It's critical to improve surveillance and assessment of serious cases using clinical signs.

· Clinical surveillance to identify severe cases early and quick action should be taken to reduce mortality.

· To stop the spread of illness to additional sick youngsters.

There should be built up consultation rooms for febrile rash sufferers.in paediatric wards or outpatient clinics for fever. For every Sterilization of the medical equipment is required, patient.

Tomato Flu Vs COVID-19¹²

Topic	Tomato Flu	COVID-19
Period of Incubation Isolation	1 week or 4-5 days	14 days
Infectious	Less Infectious	More Infectious
Response to human being	Mainly effect the offsprings under the age of 5.	All ages of people are getting the disease.
Medication	Dengue or Chikungunya medications are effective.	There are few FDA-approved oxygen medications
Complications	Non-life threatening till now	Blood clotting has occurred in the brain, lungs, heart, legs, arteries, and veins.

Prevention Techniques for Tomato Flu:

The old saying "Prevention is the best medicine" is true when it comes to tomato flu. The most effective strategy to protect our kids from tomato fever is to take preventative measures because more research is required to understand the reasons and develop a cure. Here are some precautions to take in order to avoid contracting this flu:

· Avoid getting too near to an infected individual.

· Explain to your kids how this illness affects the body.

· Inform them on the symptoms and signs of tomato fever so they can keep a safe distance from anyone exhibiting or experiencing those symptoms.

· Remind them not to massage or scrape the blister and to wash their hands after touching one.

· To keep them hydrated, encourage your kids to drink lots of water, milk, juice, etc.

· If your child exhibits tomato fever symptoms, isolate them.

· Frequently wash and sanitise all of your children's clothing, toys, and other belongings.

· It is advised to bathe or clean your child's skin with warm water.

· Include immune-stimulating foods and nutrient-dense foods in your child's diet.

· Avoid direct contact with those who are infected and teach your kids about the symptoms and adverse effects.

· Tell your child not to embrace or touch somebody who has a fever or rash.

· Encourage your kids to practise good hygiene and to quit sucking their thumbs or fingers.

· Encourage the youngster to use a handkerchief if they have a runny nose or a cough to prevent the disease from spreading.

· Encourage your child to drink plenty of water, milk, or juice—whatever they prefer—to stay hydrated.

· If your child shows signs of tomato fever, keep them away from other kids right once to stop the illness from spreading.

Steps Taken by The Government:

The neighbouring state of Tamil Nadu has enhanced border surveillance as a result of cases of tomato flu found in Kerala. The initiatives were launched by in all Anganwadi and medical facilities, the Kerala government care for the afflicted people¹⁶. In Coimbatore, disease tests are being carried out at anganwadi centres, and According to reports, 24 mobile teams with medical personnel have been dispatched. With fevers and rashes, three teams of tax inspectors, health inspectors, and police have been dispatched to search for anyone¹⁷. Since Kerala accounts for the majority of cases, the surrounding areas are closely monitored. There are 19 outpatient clinics and all hospitals in the neighbouring states have been instructed to report any patients exhibiting symptoms resembling the tomato flu¹⁸.

The central government has developed certain disease prevention strategies. Here are some of the most important guidelines that should be followed once the Tomato Virus advisory was released.

· People must practise good hygiene.

· Children should be aware of the disease's symptoms and warning indications.

· To prevent the spread of the flu from children sharing toys, clothes, food, or other items, every location must be sterilised.

· After the appearance of symptoms, infected children must stay in isolation for 5-7 days¹³.

CONCLUSION:

Cases of the tomato flu were discovered as the nationwide monkey pox outbreak was becoming more concerning. Although its quick spread, the government has taken fast steps to the spread of the virus has been curbed by preventive and therapy in a significant degree. Although this disease is not lethal preventive measure should be taken in order to establish good and healthy life. Some time it can lead to serious skin damage and can cause long time marks on the skin. Some people, especially adults, might spread the virus without ever showing any symptoms of the sickness. Government should take quick action regarding to the spread of this disease and should not be ignorant, even though it is not as contagious as the other viral disease precaution and preventive measures should be taken for the safety of the children who are mostly effected by this disease.

REFERENCE:

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Received on 27.12.2022 Modified on 29.05.2023

Asian J. Pharm. Res. 2023; 13(4):287-291.

DOI: 10.52711/2231-5691.2023.00052