GPT and encephalitis: A total of 12 of the 18 fatal cases had severely raised liver enzymes (either one or both ALT and AST) on admission to hospital (liver enzymes could not be measured in two cases due to poor sample quality or insufficient volume); 12 had raised urea and creatinine; 16 had thrombocytopenia; 14 presented with hemorrhagic symptoms and four presented with encephalitis.