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Background & objectives: The interaction of Leishmania spp. with microbiota inside the midgut vector has significant output in pathogenesis. This study aimed to identify the profile of Leishmania major gene expression of LACK, gp63, and hsp70 after exposure to Staphylococcus aureus and group A beta-hemolytic Streptococci (GABHS). Methods: Leishmania major (MRHO/IR/75/ER) promastigotes were exposed with S. aureus, with GABHS, and with both GABHS and S. aureus at 25°C for 72 h. The gene expression analysis of Lmgp63, Lmhsp70, and LmLACK was assessed using SYBR Green real-time PCR by ??Ct. All experiments were repeated in triplicate. Statistical analysis was done using two-way ANOVA. A P-value less than 0.05 was considered significant. Results: Lmgp63 was expressed in the group exposed to GABHS with 1.75-fold lower than the control group (p=0.000). The LmLACK had expression in both groups exposed with GABHS and GABHS with S. aureus with 2.8 and 1.33-fold more than the control group, respectively (p=0.000). The Lmhsp70 gene expression was reported in the group exposed with GABHS with relative quantification of 5.7-fold more than the control group. Interpretation & conclusion: This study showed that the important genes encoding LACK, gp63, and hsp70 changed their expression after exposure to the S. aureus and GABHS.
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@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients Rheumatic Heart Disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. </p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1% versus diluted water in reducing injection pain in patients with RF and RHD.</p><p style="text-align: justify;"><strong>METHODS</strong>: This is a randomized double-blind crossover study conducted at the PCMC OPD. Thirty-three patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride 1% after 21 days, the second group received the same medication in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post-injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient's compliance.</p>
Subject(s)
Humans , Rheumatic Fever , Rheumatic Heart Disease , Penicillin G Benzathine , Lidocaine , Penicillins , PainABSTRACT
Background & objectives: There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Methods : Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterion was used to diagnose cases of acute rheumatic fever (ARF) and identical 2D-morphological and Doppler criteria were used to diagnose RHD in both the survey studies. The socio-economic and healthcare transitions of study area were assessed during the study interval period. Results: Time trends of prevalence of RF/RHD revealed about five-fold decline from 2.98/1000 (95% C.I. 2.24-3.72/1000) in 1992-1993 to 0.59/1000 (95% C.I. 0.22-0.96/1000) in 2007-2008. (P<0.0001). While the prevalence of ARF and RHD with recurrence of activity was 0.176/1000 and 0.53/1000, respectively in 1992-1993, no case of RF was recorded in 2007-2008 study. Prevalence of RF/RHD was about two- fold higher in rural school children than urban school children in both the survey studies (4.42/1000 vs. 2.12/1000) and (0.88/1000 vs. 0.41/1000), respectively. The indices of socio-economic development revealed substantial improvement during this interim period. Interpretation & conclusions: The prevalence of RF/RHD has declined by five-fold over last 15 yr and appears to be largely contributed by improvement in socio-economic status and healthcare delivery systems. However, the role of change in the rheumatogenic characteristics of the streptococcal stains in the study area over a period of time in decline of RF/RHD cannot be ruled out. Policy interventions to improve living standards, existing healthcare facilities and awareness can go a long way in reducing the morbidity and mortality burden of RF/RHD in developing countries.
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We studied the level of ASO (anti streptolysin O) titer and throat culture for GABHS (group A beta hemolytic streptococci) in 200 normal healthy school children between 5 to 15 years of age. We noted the upper limit of normal titer of 242 IU in the healthy school children around Mysore city. Throat culture was positive for GABHS in 9% of healthy school children indicating the carrier state.
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Group A ß-hemolytic streptococci (GABHS) is the most frequent bacterial cause of acute suppurative tonsillitis. Antimicrobial agents are required only in the bacterial acute suppurative tonsillitis. So it becomes must to determine the cause of acute suppurative tonsillitis and to institute the appropriate antibiotic therapy thus avoiding use of costly antibiotics in case of nonbacterial etiology. In our study 44 children were diagnosed as having acute febrile suppurative tonsillitis with the etiologies of Gr. A streptococci, adenovirus and Epstein-Barr (EB) virus. There were 20 cases of adenoviral tonsillitis, 15 cases of Epstein- Barr viral tonsillitis and 09cases of Gr. A Streptococcal tonsillitis. The aim of this study was to find out whether the serum C-reactive proteins (CRP), peripheral WBC counts and the age of the patient could make an influence in differentiating the etiological agent in acute tonsillitis. There was no significant difference between adenoviral and streptococcal groups, in the measurement of serum (CRP) or peripheral WBC count. Patients with Gr. A streptococcal tonsillitis were significantly older than EB-viral or adenoviral tonsillitis (p < 0.05).Sixty six per cent of patients with adenoviral tonsillitis were under 4 years of age, 67% of the patients with EB-viral tonsillitis were under 6 years of age, whereas 71% of the patients with streptococcal tonsillitis were over 6 years of age. Based on clinical examination, serum CRP and peripheral WBC cannot differentiation between bacterial or viral cause of acute suppurative tonsillitis whereas age was clearly the most important factor.