Diagnosis of neurocysticercosis among patients with seizures in northern coastal districts of Andhra Pradesh, India

Objective: To report cases of neurocysticercosis (NCC) from three neighboring districts of Andhra Pradesh state in India where NCC burden was never explored before. Methods: A total of 160 patients presenting with recent onset seizures were recruited from neurology, general medicine, and pediatric outpatient clinics of a local major tertiary care teaching hospital serving above districts during the period 2011–2014. Brain imaging was performed in all the above cases. A commercial immunoglobulin G-ELISA kit (sensitivity=85%;specificity=94%) was employed for the serological diagnosis of NCC. Results: The recruited patients presented with generalized, simple partial, and complex partial seizures (55%, 31.25% and 13.75% respectively). NCC was diagnosed in 44 of 160 (27.5%) seizure cases based on imaging characteristics, and a positive serum anti-body ELISA. No association was detected between seropositivity with the number and location of the lesion(s) in the brain. Conclusions: The possible potentiality of NCC could be identified as an underlying cause of the recent onset of seizures in this region as explored in the present study. It is recommended that NCC should be suspected as one of the major differential in every recent onset seizure with or without a radio imaging supportive diagnosis, especially in areas endemic for taeniasis/cysticercosis.

Development & validation of a quantitative anti-protective antigen IgG enzyme linked immunosorbent assay for serodiagnosis of cutaneous anthrax.

Background & objectives: Anthrax caused by Bacillus anthracis is primarily a disease of herbivorous animals, although several mammals are vulnerable to it. ELISA is the most widely accepted serodiagnostic assay for large scale surveillance of cutaneous anthrax. The aims of this study were to develop and evaluate a quantitative ELISA for determination of IgG antibodies against B. anthracis protective antigen (PA) in human cutaneous anthrax cases. Methods: Quantitative ELISA was developed using the recombinant PA for coating and standard reference serum AVR801 for quantification. A total of 116 human test and control serum samples were used in the study. The assay was evaluated for its precision, accuracy and linearity. Results: The minimum detection limit and lower limit of quantification of the assay for anti-PA IgG were 3.2 and 4 μg/ml, respectively. The serum samples collected from the anthrax infected patients were found to have anti-PA IgG concentrations of 5.2 to 166.3 μg/ml. The intra-assay precision per cent CV within an assay and within an operator ranged from 0.99 to 7.4 per cent and 1.7 to 3.9 per cent, respectively. The accuracy of the assay was high with a per cent error of 6.5 - 24.1 per cent. The described assay was found to be linear between the range of 4 to 80 ng/ml (R2=0.9982; slope=0.9186; intercept = 0.1108). Interpretation & conclusions: The results suggested that the developed assay could be a useful tool for quantification of anti-PA IgG response in human after anthrax infection or vaccination.

Bacterial keratitis in and around Visakhapatnam.

Introduction: Microbial keratitis is a common potentially vision threatening ocular infection caused by bacteria, fungi, viruses or parasites. Bacterial corneal ulceration is an ocular emergency. Hence an understanding of epidemiological features is important in rapid recognition, timely institution of therapy and optimal management. Objectives: To isolate the specific bacterial pathogens and to determine their antibiotic susceptibility pattern. To determine the risk factors and other epidemiological characteristics of infectious keratitis, and the importance of direct microscopy. Methods: Corneal scrapings were collected under strict aseptic conditions from each patient. The scrapings were subjected to direct microscopy (Gram’s stain), culture, and identification by standard microbiological techniques, and antibiotic sensitivity testing was performed by Kirby-Bauer disc diffusion technique. Results & Conclusions: Bacterial isolates were obtained from 41 out of 100 samples. Gram positive isolates accounted for 56.09% of the isolates, and Gram negative isolates 43.90%. Pseudomonas aeruginosa was the predominant bacterial isolate (26.82%), followed by Streptococcus pneumoniae (19.51%). Corneal ulcers showed a higher prevalence in the 21-50yr age group (58.53%), with agricultural labourers contributing to 51.21%. Peak incidence of corneal ulceration was seen during the monsoon season (June – September). History of trauma to the eye, with vegetative matter, was the most frequent predisposing factor noted, representing to 65.85% of the cases. Both Gram negative and Gram positive isolates were more commonly sensitive to amikacin and gentamicin. Both smear & culture positivity was noted in 35 out of 41 samples by Gram’s stain giving a sensitivity of 85.36%.

Fungal keratitis in and around visakhapatnam.

Introduction: Corneal infection of fungal etiology is very common and represents 30% to 40% of all cases of culture positive infectious keratitis. Hence an understanding of the epidemiological features is important in rapid recognition, timely institution of therapy, optimal management and prevention of this disease entity. Objectives: To isolate the specific fungal agents causing keratitis. To determine the risk factors and other epidemiological characteristics of infectious keratitis. To evaluate the importance of direct microscopy in the isolation of etiological agents and institution of therapy. Material Methods: Corneal scrapings were collected under strict aseptic conditions from each patient. The scrapings were subjected to direct microscopy using 10% Potassium Hydroxide (10% KOH), fungal culture and identification by standard microbiological techniques. Results & Conclusions: Fungal isolates were obtained in 30 out of 100 samples. The predominant fungal isolate was Fusarium spp. (30%), followed by Aspergillus spp. (26.66%). Corneal ulcers showed a higher prevalence in the later age groups (31-70 yr), representing a total of 89.99% of the fungal isolates. Male preponderance was seen, with 70% of the fungal ulcers occurring in males. 93.33% of the ulcers occurred among the lower socio economic group and 80% in the rural areas (villages). Agricultural labourers contributed to 63.33% of the corneal ulcers, and peak incidence of corneal ulceration was seen during the monsoon season- 43.33%. History of corneal trauma (83.33%), with vegetative matter (68%), was the most common predisposing factor noted. 10% KOH mount was positive in 28 out of 30 fungal ulcers- 93.33% sensitivity.

Herpes simplex virus 2 infection: a risk factor for HIV infection in heterosexuals.

BACKGROUND: Genital ulcerative disease is one of the risk factors for acquisition of HIV. As HSV-2 infection is currently the most common cause of genital ulcerative disease, it acts as a potential risk factor for HIV infection. The present study was undertaken to know the seroprevalence of antibodies to HSV-2 in HIV seropositive individuals and in the general population, and to ascertain if HSV-2 is a risk factor for developing HIV infection. METHODS: The study group included one hundred new HIV seropositive persons irrespective of active genital herpes or history of genital herpes. Fifty age- and sex- matched healthy volunteers were included as controls. In all patients and controls, diagnostic serology was done for HSV-2 using HSV-2-specific glycoprotein IgG2 by indirect immunoassay using the ELISA test. Statistical value 'P' was calculated using the Chi-squared test. RESULTS: Out of the 100 HIV seropositives, 66 were males and 34 were females with an age range of 20-54 years. In only 22 (19 males and 3 females) of these, positive history of genital herpes was obtained. In 49 out of the 100 HIV seropositives, IgG2 antibodies against HSV-2 were detected. In the control group, 11 out of 50 controls were seropositive for HSV-2 IgG2 antibody. There was a statistically significant association between HSV-2 and HIV seropositivity with 'P' value CONCLUSION: The high prevalence of HSV-2 seropositivity in the HIV-infected group (49%) as compared to normal controls (22%) was statistically significant. Prior HSV-2 infection could be an important risk factor for acquisition of HIV in our patients.

An outbreak of cutaneous anthrax in a non-endemic district--Visakhapatnam in Andhra Pradesh.

BACKGROUND: Anthrax is a disease of herbivorous animals, and humans incidentally acquire the disease by handling infected dead animals and their products. Sporadic cases of human anthrax have been reported from Southern India. METHODS: Five tribal men presented with painless ulcers with vesiculation and edema of the surrounding skin on the extremities without any constitutional symptoms. There was a history of slaughtering and consumption of a dead goat ten days prior to the development of skin lesions. Clinically cutaneous anthrax was suspected and smears, swabs and punch biopsies were taken for culture and identification by polymerase chain reaction (PCR). All the cases were treated with intravenous followed by oral antibiotics. Appropriate health authorities were alerted and proper control measures were employed. RESULTS: Smears from the cutaneous lesions of all five patients were positive for Bacillus anthracis and this was confirmed by a positive culture and PCR of the smears in four of the five cases. All the cases responded to antibiotics. CONCLUSION: We report five cases of cutaneous anthrax in a non-endemic district, Visakhapatnam, Andhra Pradesh, for the first time.