A three year retrospective study on the increasing trend in seroprevalence of dengue infection from southern Odisha, India.

Background & objectives: In Odisha, several cases of dengue virus infection were detected for the first time in 2010, the importance of dengue as a serious mosquito-borne viral infection was felt only in 2011 with the reporting of many more positive cases. This retrospective three year study was done to find out the seroprevalence of dengue Igm antibody and to know the predominant serotype of dengue virus among the patients suspected to have dengue virus infection in a tertiary care hospital in southern Odisha, India. Methods: Blood samples from clinically suspected dengue cases admitted in the Medicine and Paediatrics departments of a tertiary care hospital were collected. These were processed for detection of dengue specific IgM antibody, carried out by the ELISA method. Dengue IgM antibody positive serum samples were tested for serotypic identification. Results: of the 5102 samples tested, 1074 (21.05 %) were positive for dengue IgM. Maximum numbers of cases were found in 2012. Majority (47.86 %) of cases were detected in the month of September. The most common affected age group was 11 to 20 yr. DENV1 and DENV2 were the detected serotypes. Interpretation & conclusions: Rapid increase in the dengue cases in 2012 became a public health concern as majority of cases were affecting the young adolescents. Most of the cases were reported in post-monsoon period indicating a need for acceleration of vector control programmes prior to arrival of monsoon.

Incidence of Bacterial Enternopathogens Among Hospitalized Children Less Than 5 Years with Diarrhoea in Southern Orissa.

Bacteriological analysis of 1661 stool samples from children (<5 years) with diarrhoea who have been admitted to 3 different hospitals of Southern Orissa from Jan 2007 to Dec 2010 was carried out using standard procedures. Among all the samples, enteropathogens were isolated in 1199 culture positive samples wherein Escherichia coli was isolated in 927 cases( including 136 pathogenic Escherichia coli),Vibrio cholerae O1 in 174 samples; Shigella spp in 50 samples; Salmonella spps.in 18 samples, Klebsiella pneumoniae in 5 samples. The isolation of bacterial enteropathogens was highest during July 2008 followed by August 2006 and Cholera cases were isolated more during rainy season. Vibrio cholerae O1 isolates were resistant to co- trimoxazole, furazolidone and nalidixic acid. Many of the Pathogenic Escherichia coli strains showed varying resistance to ampicillin, furazolidone, cotrimoxazole, ciprofloxacin and nalidixic acid. Shigella spp. and Salmonella spp also showed varying resistance patterns. More studies are necessary to evaluate the contribution of enteropathogens in causing diarrhoeal diseases and to define the changing antibiogram patterns in this region.

Pyopericardium due to infection with Mycobacterium tuberculosis - A rare case report.

Summary: Pyopericardium or purulent pericarditis is a rare entity but usually associated with a high mortality. We report a case of 30-year-old male presenting with pyopericardium due to Mycobacterium tuberculosis. The patient was treated with Anti-tubercular therapy (ATT) alongwith pericardiocentesis and pericardiectomy. The patient responded well to treatment and recovered completely in due course of time.

Primary meningococcal arthritis of sacroiliac joint: A rare case report.

Infection of the sacroiliac joint is a rare entity. Clinical signs and symptoms are usually nonspecific and result in delayed diagnosis. We report a rare case of primary meningococcal arthritis of right sacroiliac joint in an 11-year-old male child. Synovial fluid aspirated from the joint space showed Gram-negative diplococci which were confirmed as Neisseria meningitidis by culture and necessary biochemical tests followed by serogrouping by using polyvalent antisera. He was treated successfully with antibiotics.

Dipylidium caninum infection in a child: A rare case report.

Dipylidiasis is a zoonotic parasitic infestation caused by the dog tapeworm Dipylidium caninum. Human dipylidiasis has been rarely reported in English literature. Young children are mostly at risk of acquiring the infection due to their close association with dogs and cats. We report a rare case of Dipylidium caninum infection in a 4 year old male child. The diagnosis was based on microscopic examination of stool. Confirmation of the proglottid segments was done by histopathological examination. To the best of our knowledge this is the first human case of Dipylidium caninum reported from this part of the country.

A community-based study on the effect of hexachlorocyclo-hexane (HCH) exposure in spraymen and general population.

The study was carried out in Allahabad district, (Uttar Pradesh) with 260 spraymen as test subjects and 50 persons as controls from a sprayed and unsprayed village respectively. Majority of the spraymen (44%) had worked for 3-4 years (seasons) and 31% had worked in the programme for 5-10 years. The spraymen were relatively healthy with no complaints in 77% whereas the figures were 76% for the Community living in the sprayed village, and 50% for the Community in the unsprayed village. A comparison of the biochemical parameters revealed lowered Cholesterol more than 150 mg % in 38% of the spraymen and 58% had altered A:G ratio. Other biochemical estimations were not significantly different from the control population. The mean residue of Alpha, Beta and Gamma Isomers and the total Alpha, Beta and Gamma isomers were 0.0317, 0.2254, 0.0288 and 0.2859 mg/1 respectively; the corresponding mean values in the control population were 0.0211, 0.1112, 0.0197 and 0.1520 mg/1 respectively. The values in spraymen were twice those of the general population. A significant association (p < .05) was observed between their length of exposure and the levels of Cholesterol and HCH isomers in blood of spraymen. No significant morbidity was evident in spraymen due to HCH exposure.

Comparative efficacy of chloroquine and amodiaquine in Plasmodium falciparum strain of north-eastern India.

The present study describes the comparative efficacy of chloroquine and amodiaquine in two different presumptive therapy areas of north eastern India. The study recorded insignificant differences in respect of Mean Parasite Clearance Time (MPCT) of sensitive cases, MPCT and Mean Parasite Recrudescence Time (MPRT) of RI resistant cases and recrudescence rate in chloroquine and amodiaquine therapy areas. It is concluded that amodiaquine is not a superior drug as compared to chloroquine. In the chloroquine resistance area, Plasmodium falciparum developed cross resistance to amodiaquine and this phenomenon appears to be unidirectional. However, amodiaquine may help to slow-down the rate of precipitation of higher grade of resistance.

Malaria transmission in Nagaland, India. Part-I--Anophelines and their seasonality.

A longitudinal study on malaria transmission was conducted from January 1983 to December 1988 in two villages of Dimapur PHC in Nagaland. A diverse anopheline fauna comprising of 23 species was identified including three species viz. An. aitkeni, An. bengalensis and An. insulaeflorum which were observed in larval stages only. An. vagus was the predominant species followed by An. philippinensis, An. culicifacies and An. minimus. An. minimus though maintained relatively high density throughout the year manifested two peaks in June and October. An. fluviatilis and An. dirus though found in relatively low density their seasonal prevalence was suggestive of a post-monsoon and monsoon species respectively.

Susceptibility status of Culex quinquefasciatus in Patna to insecticides.

To obtain the base line data, a study conducted in district Patna, Bihar to note the susceptibility status of adult Culex quinquefasciatus against organochlorine, organophosphorous and synthetic pyrethroids. It was found that adult of Cx.quinquefasciatus developed double resistance to DDT and dieldrin but susceptible to O.P. compounds and pyrethroids. Cx.quinquefasciatus larvae are also found susceptible to O.P compounds like malathion, temophos, fenthion and fenitrothion.

Present perspectives of malaria transmission in Boko area of Assam.

A longitudinal study on malaria transmission was conducted from January 1984 to December 1988 in three villages in Boko PHC of Assam, where indoor residual DDT spray was withdrawn during the period of study. Anopheline fauna comprising of 19 species was identified and their seasonal density estimated. Anopheles philippinensis was the predominant species followed by An. minimus. The principal role of An. minimus in the transmission of malaria and predilection for indoor resting in this area was clearly evident. Though An. dirus and An. fluviatilis were found in low density, sporozoite infection was detected in them along with An. minimus. The high malaria incidence predominantly with Plasmodium falciparum was closely related to sporozoite infection in the vectors and their densities. The biting cycle of An. minimus was maximum in the first half of the night.

Malaria transmission during post-spray period of pirimiphos-methyl in Arunachal Pradesh.

Observations made for a period of four years from 1985 to 1988 on post-spray impact of pirimiphos-methyl (25 per cent Wp) on malaria vectors in Tirap district of Arunachal Pradesh showed that a low density (0.0 to 0.02 PMH) of Anopheles dirus was maintained in the areas sprayed with the insecticide at the dosages of 1 and 2 g/m2 from 1981 to 1984. The post-spray data (1985 to 1988) showed a reduction of 62.5 to 62.8 per cent in SPR, 55.6 to 64.7 per cent in SRF and 72.3 to 75.5 per cent decline in API as compared to baseline data of 1980 in areas sprayed with pirimiphos methyl.

Critical appraisal of entomological data of Madhya Pradesh for 1991 and its relevance to the National Malaria Eradication Programme.

Entomological data generated in five entomological zones, of Madhya Pradesh State during 1991 including, Bhopal, Bilaspur, Gwalior, Indore and Raipur were analyzed. The entomological parameters that were studied included per man hour (pmh) density, abdominal physiology and parity status. The inferences were related to i) resting behaviour (exophily/endophily) ii) duration of indoor resting period of mosquitoes iii) man-vector contact iv) efficacy of residual insecticide and v) vulnerability of the area to focal malaria outbreaks. The data chiefly pertains to the putative malaria vector Anopheles culicifacies in all the five zones under study. The studies have brought out that A. culicifacies, traditionally endophilic and endophagic, has demonstrated radical departure in its resting and feeding behaviour. In Gwalior zone the species shows high preference for exophily. In Bhopal and Indore zones there is differential resting behaviour with respect to season. The species shows, for most part of the year exophily but is also endophilic during post monsoon period. In Bilaspur zone the species shows marked exophily and endophagy. Irrigation practices seem to have affected the mosquito population density patterns in these regions as brought out in Indore and Bilaspur zone, where high density pattern is observed between November and February. These findings have obvious implications in selecting the appropriate intervention methods and the period of spray in areas where residual spray is the method of choice for interruption of transmission.

Importance of mean parasite clearance time and recrudescence time and their role in gradation of Plasmodium falciparum resistance.

The present paper describes the relationship of Mean Parasite Clearance Time (MPCT) and Mean Parasite Recrudescence Time (MPRT) in the epidemiology of Plasmodium falciparum. The role of MPCT in grading the resistance of an area has been discussed. Further, MPRT revealed a positive correlationship with the percentage of RI resistant cases, and showed an increase with age. The ratio of MPRT/MPCT is an indicator of stability status of the resistance.

Efficacy of a low dose oral quinine therapy in Plasmodium falciparum cases of Assam, Meghalaya and Arunachal Pradesh in India.

A low dose oral quinine schedule with 1050 mg in two divided doses daily for five days was tried for treatment of Plasmodium falciparum cases in Assam, Meghalaya and Arunachal Pradesh, in areas where resistance to chloroquine was confirmed. The drug schedule was found effective in 76.92 per cent cases. The treatment was also found effective in 45.55 per cent of the known chloroquine resistant P. falciparum cases. The drug in this low dose was well tolerated and clinical response was quick.

Residues of DDT and its metabolite in blood of exposed factory workers and their correlation with ill health symptoms.

The residue levels of DDE, op1--DDT and pp1--DDT of the factory workers exposed to DDT formulations having temporary clinical symptoms and of those without any such symptoms did not show any significant difference in their values suggestive of no direct correlation between insecticide residues and ill health symptoms. The average residue values of DDT (mg/litre) and its metabolite DDE (mg/litre) in exposed workers were 0.8634 +/- 0.1529 and 0.2106 +/- 0.0458 respectively while in unexposed control subjects 0.0826 +/- 0.0238 and 0.0278 +/- 0.0040. Total DDT residue in blood in exposed workers is more than 10 times higher than the same in unexposed control.

Evaluation of training programme.

Resurgence of malaria in the country during seventies and subsequent implementation of Modified Plan of Operation (MPO) through Primary Health Care (PHC) system highlighted the urgent need for short term courses for PHC medical officers and clinicians at the periphery. In pursuance of these objectives. Dte. of National Malaria Eradication Programme (NMEP) laid down series of "Orientation Courses" for medical officers of PHCs and "Workshops" in management of severe and complicated malaria for physicians, paediatricians and pathologists in hospitals/teaching institutions. While there exist standard methods for evaluation of institutional courses, for peripheral short term courses, a new method i.e. "Retrospective assessment at the work sites of the participants" was followed for evaluation of the above mentioned two types of courses. The findings were revealing in as much as, besides being highly successful, medical officers of PHCs who so far did not consider them as part of the programme, then onward aligned themselves as an integral part of the campaign. These courses helped them in updating with knowledge viz. concept of malaria control, passive case detection, dosages and choice of drugs, treatment schedules particularly in pregnancy and significance of quinine and primaquine therapy. Assessment of workshops for clinicians, provided the forum for first ever interaction between clinicians and the programme in the country. The workshops provided an update with current advances/researches in the treatment of severe and complicated cases of malaria. These were considered highly beneficial, as it cleared many doubts about pathological processes and clinical manifestations including induced by drugs. The study also highlighted the deficiencies in the delivery process by the faculty.

Deterioration of DDT 50 per cent water dispersible powder packed in hessian bags during storage.

One hundred seventeen samples of DDT 50% WP received from field where supplies were effected, were tested during 1988-89 for suspensibility without accelerated storage treatment (ATS) as per ISI specifications and compared with their suspensibilities after ATS obtained during the initial testing to know the stability status of the insecticide during transit and tropical storage in the field when packed in hessian bags. Out of 117 samples tested 95 (81.2 per cent) failed and only 22 (18.8 per cent) passed the test for suspensibility indicating deterioration of the formulation in the field.