ABSTRACT
Objectives: Neuroborreliosis is generally known to be a disease confined to the Western part of the globe. It is not commonly encountered in this part of the world. Interestingly, we recently came across a series of cases of Lyme’s disease with a plethora of neurological presentations. Most of the cases were a diagnostic dilemma, with poor response to immunotherapy and on subsequent evaluation all were found to have positive Borrelia antibodies. Materials and methods: Eight cases were selected from the tertiary care hospital in North western India. Patients were suspected to have Neuroborreliosis whose neurological presentations were atypical for other classical neurological disorders, who had a progressive or relapsing clinical course and had responded poorly to the initial treatment given for the previous neurological diagnosis. Skin lesions were present in some cases. The patients underwent a detailed clinical assessment which comprised of an elaborate history including history of travel, any insect bite or skin rashes along with a complete systemic and neurological examination. All the required blood investigations, Magnetic Resonance Imaging (MRI) Brain, Computer Tomography Angiography (CT), Nerve conduction study (NCS) and Electromyographic (EMG) studies and Cerebrospinal fluid (CSF) studies were done as indicated in each case. Borrelia antibody titre was done in all the patients using immunoblot technique. Results: Among the 8 patients, 6 were male and 2 were females. The age group was between 25-70 years. The clinical presentation was acute, subacute or chronic. One patient gave a clear history of tick bite. Two patients had skin lesions and one had the pathognomic "eschar". All the suspected 8 patients had either IgG or IgM or both IgG and IgM Borrelia antibodies positive. Almost all the patients had previously received either steroids or intravenous immunoglobulins, but had not adequately responded to immunotherapy. These patients were given a trial of injectable Ceftriaxone and oral Doxycycline. Most of them either showed partial or complete clinical improvement. Conclusion: Lyme’s disease, a common disease of the west does exist in the Indian subcontinent as well. Because of increasing global travel and migration and change in vector habitat the disease seems to have percolated in the non endemic areas too. Proper history of travel or exposure to tick bite is important. We want to emphasize, Neuroborreliosis, a great mimicker may have diverse and varied neurological presentations and has a potential for reversibility with appropriate treatment even after a significant delay in diagnosis.
ABSTRACT
Background: Blood transfusion has become an essential part of treatment in number of medical or surgical emergencies. It is also true that blood transfusion is an important mode of transmission of infection to recipients. Present study was planned to know the seroprevalence and pattern of such infections among voluntary as well as replacement donors in this area. Culture and molecular techniques have demonstrated that it is associated with increased prevalence of bacteria. This study was conducted to determine the sero-prevalence of transfusion transmitted infections (TTIs) among the blood donors at Chirayu medical college and Hospital, Bhopal over a period of 5 years. All blood units received from replacement as well as voluntary blood donations at Blood Bank, Chirayu medical college and associated Hospital, Bhopal during the period from February 2011 to January 2016 were selected for the study. Methods: A 5 year retrospective study was conducted at the blood bank of Chirayu medical college Bhopal Madhya Pradesh. All data were collected from blood bank records maintained as per Drugs and Cosmetic Act of India and included records of 4208 voluntary and 10852 replacement donors from February 2011 to January 2016. Screening of blood units was done by enzyme-linked immune sorbent assay (ELISA) method for HIV, malaria and hepatitis B and C. Fourth generation ELISA kits were used for HIV testing while Syphilis was tested by latex agglutination assay. Any sample found reactive was retested for confirmation and seropositive units were discarded. Results: Overall TTIs incidence in voluntary donors and replacement donors was found to be 1.568% (66/4208) and 5.215% (566/10852)respectively. Seroprevalence of HIV, HBV, HCV, Syphilis and Malaria was found to be 0.071% (3/4208), 0.712% (30/4208), 0.119% (5/4208), 0.665% (28/4208) and 0.00% in voluntary blood donors as against the figures of 0.166% (18/10852), 2.681% (291/10852), 0.82% (89/10852), 1.548% (168/10852) and 0.00% of replacement blood donors respectively. It is clear from this data that the seroprevalence of HIV, HBV, HCV and syphilis is higher in replacement blood donors as compared to voluntary blood donors. The highest seroprevalence of TTI was found to be in the age group of 18-30 years. Conclusion: Prevalence of TTI is less in voluntary blood donors as compared to replacement donors. Hence, efforts should be made to increase the number of voluntary donors and reduce replacement donations to a minimum. A strict selection of all donors and proper testing of a donor’s blood by using standard methods is highly recommended to ensure safety for the recipient.