Epidemiological Determinants of Leprosy in a High Endemic District of India: A Community Based Case Control Study

The leprosy elimination at national level was achieved in India in December 2005, however, Chhattisgarh is the only State yet to achieve same at State level and reported highest ANCDR/100000 population, i.e., 29.7 as on 31st March 2020. The efforts of the National Leprosy Eradication Programme (NLEP) are admirable wherein several initiatives introduced in phased manner since 2015, but there is need to understand the local scenario for effective control of this chronic disease in Chhattisgarh. This study conducted to identify various socio- demographic, behavioural, environmental factors associated with leprosy occurrence in high endemic district named Raipur. A community-based case control study design was adopted with inclusion criteria for cases as diagnosed, confirmed, and classified leprosy patients as per the WHO recommendation and NLEP Guidelines and controls as matched with cases' sex, age, (excluding the family members) and inhabiting same local area. Total 448 cases and 439 controls were interviewed from the district, after stratification of blocks based on G2D percentage among new cases detected & distribution of the sample (meant to be drawn from district) in proportion to the new cases reported by each stratum during year 2019. Data regarding socio-demographic profile, personal practices, disease profile & case history was collected through 2 different predesigned schedules. Descriptive, stratified analysis was performed along with chi square test score calculation for each variable. Further, bivariate & multinomial logistic regression was done to calculate adjusted odds ratio (for religion, age, caste, gender, education, occupation, residential area, family income) as measure of association. Low education level, absence of windows and safe water supply in household, use of same towel by multiple family members and history of contact with leprosy patients in family/ friends were found to be significantly associated with leprosy occurrence. The interventions targeted against these factors, i.e., emancipation of education level, IEC for hygiene, ventilation etc. may help in curbing the leprosy transmission in this high endemic district and other districts facing the same menace.

Clinical impact & pathogenic mechanisms of human parvovirus B19: A multiorgan disease inflictor incognito

Human parvovirus B19 (B19V) causes myriads of clinical diseases; however, owing to lack of awareness and undetermined clinical impact, it has failed to become a virus pathogen of global concern. Cryptically, B19V causes significant morbidity and mortality. Half of the world population and 60 per cent of Indians are known to be serologically naive and are at risk of acquiring B19V infections. Cumulatively, our data showed 21.3 per cent B19V-infected patients with juvenile chronic arthropathy, recurrent abortions, multi-transfused thalassaemia and leukaemia. In addition, B19V-infected cases that ended fatally included patients with pure red cell aplasia, fulminant hepatitis and haemophagocytic syndrome. Novel clinical associations of B19V observed were amegakaryocytic thrombocytopaenia, myositis and non-occlusive ischaemic gangrene of bowel. B19V possesses multiple receptors which are distributed widely in human tissues. Vascular endothelial cell infection by B19V causes endothelialitis and vasculitic injuries besides antibody-dependent enhancement which empowered B19V to cause multiorgan diseases. Owing to lack of suitable animal model for B19V, true causal role remains to be determined, but numerous reports on B19V infections substantiate a causal role in multiorgan diseases. Hence, B19V infections need to be recognized, investigated and treated besides making efforts on vaccine developments.

Prolonged remission in a child with chronic myeloid leukemia following Parvo virus B19 (B19V) infection.

Parvovirus B19 (B19V) has been associated with a wide spectrum of clinico‑pathological disorders in human beings depending upon the host immunity. The present report describes a child with chronic myeloid leukemia (CML) on hydroxyurea in haematological remission, who developed profound erythroid suppression following B19V infection requiring multiple transfusions and withdrawal of hydroxyurea. Despite being off-therapy the child remained in complete clinical and haematological remission till anti B19V antibodies appeared. This case illustrates the ability of B19V infection in suppressing neoplastic myeloid clone, a phenomenon not described earlier.

Fatal missed case of hemophagocytic lymphohistiocytosis co-infected with parvovirus B19 and Epstein-Barr virus in an infant: Test hyperferritinaemia early.

Hemophagocytic lymphohistiocytosis (HLH) triggered by Parvovirus B19 and Epstein-Barr virus co‑infection is rare and unknown in infants. A 2‑month‑old male infant with fever, rash, bicytopenia and hepato‑splenomegaly died owing to diagnostic dilemmas. Hence simply testing for hyperferritinaemia and hypertriglyceridemia/hypofibrinogenemia could diagnose HLH early while robust treatment be life‑saving.

Perceptions and concerns of women undergoing Pap smear examination in a tertiary care hospital of India.

Background: Cervical cancer is one of the major causes of deaths due to cancer among women in India. Pap smear is one of the best methods to detect early changes in cervix. However, there is lack of data on awareness level of women about Pap smear and various risk factors for cervical cancer. Objectives: To study the awareness about various risk factors for cervical cancer, health-seeking behavior and hygienic practices among women and to assess the distress experienced by these women before the Pap smear examination. Materials and Methods: This cross-sectional study was carried out on women coming for a Pap smear examination in a tertiary teaching hospital in New Delhi. A pretested interview schedule was used to get information after obtaining their informed consent. Results: Fifty-seven percent stated that they did not consult a doctor when they noticed the symptoms the first time. Sixty-one percent did not know what a cervical cancer is and a same percentage of women did not know what a Pap smear examination was. Older age group, Muslim and literate women had higher number of abnormal Pap smear results. Women who reported being stressed in their lives had higher number of abnormal smears as compared to women who claimed to lead a stress free life. Poor hygienic practices among these women from urban areas were also associated with abnormal Pap smear results. Conclusion: The study concluded that factors such as poor awareness, shyness, poor hygiene, and old age could be responsible for abnormal Pap smears and this needs special attention in cancer prevention activities of the government.

Impact of health education intervention on knowledge and community action for malaria control in Delhi.

Malaria affects millions of people in India despite decades of efforts to control it. It has acquired greater importance in last two decades due to emergence of vector resistance, poor quality of care and low utilization of services. The study was conducted to improve the management of malaria by IEC and training activities in slum areas of Delhi. The baseline and post intervention data on knowledge, attitude, behavior and practices (KABP) regarding malaria was collected from 601 and 593 subjects respectively from two zones of Municipal Corporation of Delhi (MCD). At the same time, knowledge and skills regarding management of malaria were assessed among 15 health workers working in these two zones of MCD. An intervention package in the form of health education material for the community and training modules for the workers were designed and implemented. Post intervention data were collected. The knowledge about cause of malaria, season of malaria and breeding places of mosquito increased among community members after the intervention, which was found to be statistically significant. Similarly, more people were aware about the methods of prevention of mosquito breeding after the intervention. Methods like mosquito coil (post-64.92% vs pre-55.41%) and bet nets (post-24.96% vs pre-14.47%) were used by more people in post intervention phase. The Interval between onset of symptoms and seeking treatment decreased after the intervention from 1.66 days to 1.37 days. Among the workers, knowledge and skills regarding malaria management improved after the intervention. More blood slides were made, side effects of the treatment were explained to the patients and better compliance to treatment was observed in post intervention phase. IEC activities using attractive pamphlets to the community and on-job training of workers improves management of malaria and should be used more frequently more so in the slum areas for the success of the National Anti-Malaria Program.

Frequency of leptospirosis in patients of acute febrile illness in Uttar Pradesh.

OBJECTIVE: This study was performed to asses the disease burden of leptospirosis in and around Lucknow among patients presenting with acute febrile illness and conforming to the case definition of leptospirosis. METHODS: A total of 346 serum samples (mostly paired) and an equal number of urine samples were collected from patients presenting with acute febrile illness and fulfilling the criteria of clinical diagnosis of leptospirosis from January 2001 to December 2001. Patients attending a tertiary care hospital as well as from various communities in and around Lucknow were included in this study. All sera and urine samples were tested for the presence of IgM antibody by Leptodipstick test and by dark-field microscopy (DFM) respectively. All positive and 10% negative sera were tested at national leptospirosis reference centre at Andaman and Nicobar Islands for microagglutination test (MAT). RESULTS: IgM antibody was detected in 25/346 (7%) patients ranging in age from 9-65 years. DFM was positive in only in one case. MAT was positive in 4/17 cases tested and the prevalent serogroups were L. grippotyphosa and L. pomona in two each. Common presenting features in these patients were fever (25/25) and jaundice (17/25). History of contact with animal or water contaminated with animal urine was present in 96% cases. CONCLUSION: Leptospirosis is not uncommon in Uttar Pradesh. However larger epidemiological studies are required to know the actual disease burden. Dark-field microscopy is an insensitive method for the diagnosis of leptospirosis and is not suitable for surveillance.

Persistence of parvovirus B19 IgM antibodies and DNA in pure red cell aplasia resulting in myelodysplasia--a case report.

Human erythrovirus B19 (B19), previously known as parvovirus B19, is a small spherical, non-enveloped single stranded DNA virus. It has been shown to cause a wide spectrum of clinical conditons including various hematological disorders. We report here for the first time from Inida a case of pure red cell aplasia in a 45-year-old female for last 7 years due to chronic persistent B19 infection leading to myelodysplasia after 4 years. Her sera were positive for two times 4 months apart for B19 IgM and B19 DNA at the initial stage. Presently the patient is on repeated blood transfusion on every 15-20 days.

Erythrovirus B19 infection in humans.

Erythrovirus B19 (B19) previously called parvovirus B19 is the only human pathogen in the family Parvoviridae. B19 is an autonomously replicating small single stranded non-enveloped DNA of 5.5 Kb with hairpin termini through which it replicates, when the cells are in the S-phase. Virus host interactions are mediated through the capsid protein VP2 attaching to P antigen receptor expressed on certain host cells, which imparts narrow host and tissue tropism. It affects the progenitor red cells, megakaryoblast, endothelial cells and a few organs like the kidney and the heart. VP1 antibodies are neutralizing, non-structural protein NS-1 exert cell cytotoxicity while NS-2 regulates replication. The virus is present world-wide. Most infections are asymptomatic but individuals with red cell defect, immune system defects or immunosuppression manifest disease, which may be persistent. In the immunocompetent host it causes erythema infectiosum in children, arthralgia or chronic polyarthritis especially in females, nonimmune hydrops foetalis, several haematological disorders and recently fulminant hepatitis in children. The virus is transmitted through the upper respiratory tract by droplets, transfusion of blood or its components (factor VIII) and transplacentally. The incubation period is 6-11 days after intranasal inoculation, in human volunteers. Detection of IgM antibodies is most important in serological diagnosis. Viral DNA can be detected by polymerase chain reaction (PCR) or hybridization procedures in patients sera or infected tissues. Intravenous immunoglobulin can be used in the treatment as well as in prophylaxis. In view of its increasing association with a wide variety of clinical diseases, a closer look in its biology, host virus interactions and evaluation of VP1 and VP2 recombinant proteins as B19 vaccines are areas which need the urgent attention of parvovirologists, epidemiologists and clinicians.

Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India.

All 64 dentists working in a teaching hospital of New Delhi participated in a survey. A pre-tested self-administered questionnaire was used to assess knowledge and practices of biomedical waste management and infection control among these dentists. The results show that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management. The dentists need to be educated on Biomedical Waste (Management & Handling) Rules, 1998 through extensive training programme.

Risk behaviour in an urban and a rural male adolescent population.

BACKGROUND: There is an increasing trend of risk behaviour in adolescents worldwide but very little literature is available in India on this important subject. We surveyed an urban male adolescent population and a comparable rural population to determine the difference in their risk behaviour. METHODS: A comparative cross-sectional study was conducted among 199 and 152 male adolescents from an urban village of south Delhi and a rural village in Uttar Pradesh. A pretested semi-structured interview schedule with 36 items was applied on all subjects by trained interviewers. RESULTS: Consuming alcohol, smoking, pre-marital sexual intercourse and consuming bhang (cannabis) were present in 32.2%, 25.1%, 12.5% and 11.5% of the urban village adolescents and in 1.3%, 48.7%, 11.2%, and 16.5% of those residing in the rural village, respectively. About 66.8% of urban and 51.3% of rural adolescents had indulged in physical fights and 12.5% of urban and 6.6% of rural adolescents were in possession of assault weapons such as iron rods, chains or knives sometime in the 30 days prior to the interview. CONCLUSION: The results of our study indicate that there is a high prevalence of risk behaviour in both urban and rural adolescents. However, except for smoking which was more common amongst rural adolescents all the other risk behaviours were more in those residing in urban areas. The reasons for this need to be ascertained, taking the geographical and socio-cultural factors into account, prior to considering the introduction of behaviour modification programmes.

Raised IgM antibodies to parvovirus B19 in juvenile rheumatoid arthritis.

To delineate the role of human parvovirus B19 in the etiopathogenesis of juvenile rheumatoid arthritis (JRA), IgM and IgG antibodies specific for parvovirus B19 surface protein antigen(s) were estimated in the sera using commercial ELISA kits. Sera of 69 JRA patients (median age 16 yr, male : female ratio 1.1:1) satisfying the criteria of American Rheumatism Association along with 26 sera of rheumatoid arthritis (RA) and 12 sera of healthy children as disease and normal controls respectively were screened. Of the 69 patients with JRA, 19 (27.5%), 35 (50.7%) and 9 (13%) were positive for IgM, IgG and both IgG and IgM antibodies respectively. Of the 26 disease control sera, 11 (42.3%) were positive for IgG antibodies while none had elevated IgM antibodies. Among 12 healthy controls, 7 (58.3%) were positive for IgG and 1 was positive for both IgG and IgM antibodies. Thus, a statistically significant proportion of children with JRA had evidence of parvovirus B19 infection.

Neonatal cholestasis syndrome: an appraisal at a tertiary center.

OBJECTIVE: To know the magnitude, etiology and clinical profile, the efficacy of various investigations and the outcome in patients with neonatal cholestasis syndrome (NCS). DESIGN: Prospective evaluation of 60 consecutive infants with NCS (mean age 3.9 +/- 1.9 months; 49 males) over a period of 3.5 years. SETTING: Tertiary level referral gastroenterology center in North India. METHODS: Liver function tests, urine examination, serum antibodies against Cytomegalovirus (CMV), Rubella and Toxoplasma; abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy were done. In appropriate setting, laparotomy and surgical corrections were done for biliary tract disorders. RESULTS: NCS constituted 19% of pediatric liver diseases. Considerable delay in presentation was observed [mean delay, extrahepatic biliary atresia (EHBA) = 4 +/- 2.0 months, neonatal hepatitis (NH) = 2.2 +/- 1.3 months]. Thirty three (55%) infants had EHBA, 14 (23%) NH (4 CMV, 2 galactosemia, 1 urinary tract infection and 7 idiopathic), 2 (3%) paucity of intralobular bile ducts and 11 (18%) were of indeterminate etiology. Liver biopsy was the most accurate (96.4%) investigation in discriminating between EHBA and NH. Of the 18 operated infants with EHBA (portoenterostomy-15 and hepatico-jejunostomy-3), 10 were alive (mean follow up = 22.8 +/- 8.6 months) of which 4 were completely asymptomatic. CONCLUSIONS: (i) NCS is an important cause of liver disease in Indian children. (ii) It requires prompt referral, quick investigative approach and targeted management. (iii) Liver biopsy is highly accurate in differentiating EHBA and NH. (iv) infants with EHBA and compensated status of liver should undergo corrective surgery irrespective of age at presentation.

An epidemic of acute haemorrhagic conjunctivitis caused by coxsackie A24 variant.

An epidemic of acute haemorrhagic conjunctivitis (AHC) caused by a variant of coxsackie A24 (cox A24) occurred in Delhi during August to September 1988. Cox A24 antigen was detected by indirect immunofluorescence (IFA) in conjunctival cell smears of 13 of the 38 (34.2%) patients studied. Virus was isolated from conjunctival swabs in 11 (28.9%) patients and all isolates were neutralized by cox A24 antiserum. Five virus strains sent to Virology Division of Centres for Disease Control, Atlanta, USA, were confirmed as cox A24 variant. Enterovirus type 70 (EV70) was not demonstrable either by IFA or neutralization tests. Conjunctival swabs from 10 healthy laboratory controls did not show any evidence of EV70 or cox A24 virus or their antigens.

Circulating immune complexes in leukaemias and lymphomas.

Circulating immune complexes (ClC) were estimated in 78 patients of leukaemias and lymphomas by Clq deviation ELISA and PEG assay. In all leukaemias a significant elevation in ClC was seen at the time of first presentation. While in ALL a decrease occurred on therapy as partial or complete remission was achieved, no such fall was seen in AML or CML-BC when treated. ClC levels were much higher in non-Hodgkins lymphoma than in Hodgkins disease and showed a direct correlation with B symptoms and activity of the disease. The ClC levels were highest in null-ALL followed by those in common ALL and T-ALL. The mean duration of remission in patients of ALL without elevation in ClC was much longer than in those with ClC.

Prevalence of rubella virus and cytomegalovirus infections in suspected cases of congenital infections.

Although rubella virus and cytomegalovirus (CMV) are important causes of congenital infections, information on their prevalence in our country is scarce. We studied a total of 249 infants suspected of having congenital infections from January 1988 to September 1989. Serum samples of these infants were tested for rubella and cytomegalovirus specific IgM antibodies by mucapture ELISA. Thirty (12%) infants were positive for rubella IgM antibody, and 50 (20%) had CMV specific IgM antibody. In the group presenting with hepatosplenomegaly (n = 56) rubella and CMV specific IgM antibodies were detected in 1 (1.7%) and 25 (44.6%) infants respectively. In the group presenting with congenital malformations (n = 90), 23 (25.5%) were positive for rubella, and only 9 (10%) had CMV IgM antibodies. Of the infants presenting with mental retardation (n = 39), only CMV infection was detected in 3 (7.7%) infants, whereas amongst the group showing intrauterine growth retardation (n = 16), 5 (31.25%) had CMV specific IgM antibodies and 2 (12.5%) had rubella specific IgM antibodies. In the miscellaneous group (n = 48), 4 (8.3%) and 8 (16.6%) infants had rubella and CMV IgM antibodies respectively. CMV infection was prevalent in a significantly higher number of children with hepatosplenomegaly than rubella while in infants with congenital malformations a significantly higher number had rubella infection. It is concluded that rubella and CMV infections are commonly seen in children with intrauterine infections in our population.

Acute rubella infection in pregnant women in Delhi.

Serum samples of 17 pregnant women with suspected rubella who presented at the Department of Microbiology, AIIMS, New Delhi, from March to May 1988 for confirmation of diagnosis were tested for rubella haemagglutination inhibiting (HAI) antibodies and rubella specific IgM antibodies by mu-capture ELISA. Ten of the 17 women were diagnosed to have acute rubella infection as they showed the presence of rubella specific IgM antibodies. Nine of these gave history of fever and rash whereas one woman remained asymptomatic. These observations suggest an increase in the incidence of rubella infection in pregnant women from March to May 1988 in Delhi.