Sero-prevalence of Hepatitis E Virus in Blood Donors: The Current Scenario in a Tertiary Care Teaching Hospital of North India.

Background: Hepatitis E Virus (HEV) infection occurs predominantly by the faeco oral route. Cases of transmission through blood transfusion have also been reported. Currently, blood donors in India are not screened for HEV. So the present study has been undertaken to know the sero-prevalence of HEV and to determine the status of endemicity of this infection. The aim of this study is to determine the sero-prevalence of hepatitis E virus (HEV) among blood donors in a tertiary care teaching hospital. Method: 551 blood donors’ samples analysed for presence of Anti HEV IgG using 3rd generation HEV ELISA kit. The serum samples were also tested for detection of HIV, HBsAg, HCV infections, Syphilis and Malaria. Results: The study included 551 donors, of which 99% (546) were males. The sero-positivity for anti-HEV IgG antibodies was 10.7%, the maximum sero-positivity being in the age group 51-65. All the donors were non- reactive for HIV, HCV, HBsAg infections, Syphilis and Malaria. Conclusion: High Prevalence of IgG antibodies (10.7%) shows that HEV is endemic in our region. However, more studies with confirmatory assays need to be done before making it a mandatory screening test for blood donors.

Disease Dynamics and Surveillance of Malaria in Malwa Region of Punjab and Evaluation of RDT Test.

Aim: Malaria remains an enormous public health problem. Regular and ongoing surveillance to detect changes in its trends to initiate the control measures is the need of the hour. The present study was undertaken to provide the malaria transmission dynamics using surveillance indicators through active and passive surveillance in district Faridkot. Usefulness of rapid malaria diagnostic test was also evaluated. Methodology: This retrospective study extended over a period of two years (2010-2011). Thick and thin blood smears were prepared from suspected cases of malaria complaining of fever and headache for the last three days (i) of 2 CHC’s, 8 PHC’s and 68 sub centers as a part of active surveillance and (ii) those who visited GGS Medical College & Hospital and civil hospital Faridkot as a part of passive surveillance. Out of all the samples collected during the passive surveillance 995 samples collected at GGS Medical College and Hospital, Faridkot were also subjected to rapid diagnostic test (OptiMAL®). Results: The annual blood examination rate (ABER) was 9.0 and 9.7 in 2010 and 2011 respectively. Annual parasite incidence (API) recorded was < 2 (0.5) in both the years and slide positive rate (SPR) was 0.5 and 0.05 in the two respective years of study. Significant gap in the rate of case detection of active and passive surveillance systems was observed with predominance of passive surveillance. More than 96% of cases were of P. vivax. RDT’s showed an excellent correlation with conventional microscopy. Conclusion: Malaria (P. vivax) is a persistent problem in the Malwa region with variation in its transmission dynamics with in the year. P. vivax is the main species of malarial parasite in the Faridkot district with occasional cases of falciparum malaria. Prevention strategy should be targeted towards on the spot diagnosis by using RDT and hence prompt treatment. It could help to prevent spread of drug resistance and complicated malaria.

HIV seroprevalence and HIV associated dermatoses among patients presenting with skin and mucocutaneous disorders.

Background and Aims: Skin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Methods: Eleven hundred and seventy patients having any type of skin or mucocutaneous disorders were screened for HIV infection (NACO guidelines) after recording their clinical and epidemiological profile. Results: Of the 1170 patients screened, 38 (3.24%) were found to be positive for HIV 1 and none for HIV 2 antibodies. Seropositive patients belonged to the age group of 9 to 48 years, with a male:female ratio of 0.9:1. Heterosexuality was the most common mode of transmission (86.8%). A wide range of infectious and noninfectious lesions were observed and herpes zoster was the most common infectious disease (31.5%) followed by mucocutaneous candidiasis (26.3%). The most common noninfectious manifestation was seborrhoeic dermatitis (18.4%) followed by pruritic papular eruptions (7.9%). Conclusion: High prevalence and wide variety of skin and mucocutaneous disorders in HIV-positive patients highlight the importance of better vigilance and early suspicion of HIV infection in such patients.

Seroprevalence of human immunodeficiency virus-2 in and around Amritsar.

A total of 14555 serum samples collected between January, 2001 to April, 2006 were screened for HIV infection. Antibodies to HIV-1/ HIV-2 were present in 985 (6.76%) of which 964 (97.86%) and 2 (0.22%) were positive for HIV-1 and HIV-2 alone respectively and 19 (1.92 %) for both HIV-1 and HIV-2. Of the 21 in whom HIV-2 infection was detected (alone and dual), 19 (90.5%) were in the age group of 21-40 years and 2 were children below the age of 11 years. Predominantly mode of transmission in them was heterosexual (85.71%) while the 2 children (9.53%) had most probably got the infection through perinatal route. Nine (42.85%) were asymptomatic and 12 (57.15%) clinically presented with chronic diarrhoea (5), prolonged fever (4) and symptoms related to sexually transmitted diseases (3). Opportunistic infections like Oral candidiasis was observed in 3 and pulmonary tuberculosis in 2.

HIV-1 infection in early seroconversion stage missed by rapid or ELISA tests--two case reports.

Two cases of HIV-1 infection demonstrating lack of sensitivity of rapid and ELISA screening tests are being reported. The first case was that of a 23 years old female whose recent infection was picked up by ELISA (Tetra ELISA) test but missed by two rapid tests (Comb AIDS and HIV Tridot). The 2nd case presumably too in early seroconversion phase, was that of a 39 years old male. In this case ELISA test failed to diagnose the infection while the two rapid tests were found to be strongly positive.

Primary rubella virus infection: prevalence and relationship to pregnancy wastage.

A total of 580 females (200 in prepubertal age and 380 in reproductive age group) were screened for primary rubella infection. Rubella specific serology (IgM and IgG) was studied by ELISA using commercially available diagnostic kits. IgM seropositivity was observed in 56 of 200 females (28%) of prepubertal age and 26 of 380 females (6.84%) in reproductive age group. Out of 380 females in reproductive age, 183 presented with history of adverse pregnancy outcome and they showed a higher percentage of IgM seropositivity (10.38%) as compared to those with normal obstetric performance (3.55%). However, the difference was not statistically significant (p > 0.05). IgG seronegativity was found in 109 females (28.68%) in reproductive age suggesting their susceptibility to acquire primary rubella infection. Five of 380 (0.32%) females were seropositive for both IgG and IgM indicating reinfection.