Role of IL-17 gene polymorphism in Indian kala-azar.

BACKGROUND & OBJECTIVES: Visceral leishmaniasis or kala-azar is a fatal protozoan disease caused by an obligate intracellular parasite, Leishmania donovani. Susceptibility, establishment of infection and severity of this disease depend upon many factors, but it is the host immune system that plays decisive role in disease progression. Keeping this view into consideration, we investigated the probable relationship between polymorphisms rs2275913 and rs8193036 in IL-17 gene, and its association as a risk factor for kala-azar in an endemic population of Assam, India. METHODS: A total of 209 subjects, 76 kala-azar cases (male: 46, female: 30, mean age ± SD: 34.60 ± 12.61) and 133 controls (male: 66, female: 67, mean age ± SD: 33.35 ± 14.48) were included in this study. We analysed the polymorphisms, rs2275913 and rs8193036 by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The data were analysed using logistic regression analysis and SPSS software. RESULTS: The results revealed that the mutant rs8193036 TT genotype conferred 4.7-fold higher risk for kala-azar (p = 0.00991, OR = 4.72, 95% CI = 1.330-16.911). A significant difference was found between the allele frequencies of rs8193036 (p = 0.029, OR = 1.64, 95% CI = 1.04-2.57) when comparisons were done using the genetic models of association. When stratification analysis was done on the basis of active and past cases we found that during active infection rs2275913 A allele was significantly associated with increased risk of kala-azar (p = 0.016, OR = 3.95, 95% CI = 1.21-12.87). INTERPRETATION & CONCLUSION: The findings revealed that IL-17 genetic variant, rs8193036 is an independent risk factor for kala-azar infection and may contribute in pathogenesis of the disease. Further, rs2275913 polymorphism of IL-17 gene is associated with kala-azar during active infection.

Role of IL-21 in host pathogenesis in experimental visceral leishmaniasis.

Visceral leishmaniasis (VL) is a major global health problem but still remains one of the neglected tropical diseases. Currently available chemotherapeutics are associated with severe toxicity and increased drug resistance. There is a need to explore for novel therapeutic strategies that could modulate host immune responses or work in synergy with chemotherapy of VL. Therefore, understanding the host immunological changes that play a vital role in disease pathology is a prerequisite for designing any interventions. We have investigated the role of IL-21 during the course of Leishmania donovani infection and after drug treatment. BALB/c mice were used to investigate the mRNA levels of IL-21 during active Leishmania donovani infection and after treatment using real time polymerase chain reaction (RT-PCR). Mice were divided in four groups i.e. Control (Group A), Infected (Group B), Uninfected treated (Group C) and Infected treated (Group D). Animals of Group C and D were treated with Amphotericin B. IL-21 mRNA levels in the spleen were estimated on days 1, 3, 7, 14, 17, 21, 28, 35, 45 and 60 post infection and also during course of treatment. We found that IL-21 mRNA levels was significantly up-regulated in the infected group with a fourfold increase at D60 p.i. (p < 0.001) and it was decreased significantly after the treatment. Our results suggest that IL-21 mRNA is associated with pathogenesis of Leishmania donovani infection and that therapeutics designed to suppress IL-21 could provide promising antileishmanial activity.

Incidence of bla NDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India.

PURPOSE: Increasing reports on New Delhi metallo-ß-lactamase-1 (NDM-1) producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. MATERIALS AND METHODS: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤ 21 mm) were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. RESULTS: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. CONCLUSIONS: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.

Growth and production performance of monosex tilapia (Oreochromis niloticus) fed with homemade feed in earthen mini ponds.

Field experiment was conducted to evaluate the growth performance of monosex tilapia using homemade feed with Peninsula Group fish meal and commercially available feed with local fish meal in earthen mini ponds from June-September 2010. Three ponds (T1) were supplied with prepared feed and the other three ponds (T2) with commercially available fish feed. Fish were fed at the rate of 10% of their body weight for the first thirty days then gradually reduced to 6% for the next ten days, 2% for the next ten days and 3% for remaining days. The temperature were ranged from 31.5-33.0 degrees C, DO from 5.5-15 mg L(-1) in T1 and 6.5-14 mg L(-1) in T2, pH from 7.1-8.0 in T1 and 7.1-7.7 in T2, alkalinity from 105-160 mg L(-1) inT1 and 100-145 mg L(-1) in T2, nitrate was 0.06 mg L(-1) in both treatments and ammonia from 0.02 and 0.04 mg L(-1) in T1 and T2, respectively. The results of the present study showed that the best weight gain was observed as 123.48 g in T1 than T2 (111.82 g). The Specific Growth Rate (SGR) was recorded 3.09 and 2.97 and the Food Conversion Ratio (FCR) was 1.51 and 1.40 in T1 and T2, respectively. There was significant (p < 0.05) variation among the survival rate (%) of fishes which were 75.55 and 90.37% in T1 and T2, respectively. The fish productions were 19076 and 16312.11 kg ha(-1) in T1 and T2. The highest net profit (Taka/ha/70 days) of Tk. 15, 83,213 was obtained with T1 So, the prepared feed showed better performance with monosex tilapia in compared with commercial fish feed with local fish meal.

Prevalence and risk factors for colonisation with extended spectrum beta-lactamase producing enterobacteriacae vis-à-vis usage of antimicrobials.

PURPOSE: A point prevalence study was carried out in a teaching hospital in Assam to determine the prevalence, sensitivity profile and risk factors for acquisition of extended spectrum beta-lactamase (ESBL) producing enterobacteriacae vis-upsilon-vis amount and pattern of antibiotic use. MATERIALS AND METHODS: ESBL was detected by double disc synergy method. Defined daily dose and bed-days were calculated. RESULT: Colonisation rate of ESBL producing enterobacteriacae ranged from 14% (n=73) in medicine to the highest 41% (n=29) in orthopaedic with an intermediate 23% (n=80) in surgery. Presence of ESBL was found to be strongly associated with resistance to specific classes of antimicrobials. Exposure to cefotaxime and gentamicin, and surgery were risk factors for acquiring ESBL producing enterobacteriacae. Non-ESBL producing community isolates were found to be considerably more sensitive to different antibiotics with no resistance detected to trimethoprim, co-trimoxazole, ciprofloxacin and aminoglycosides. CONCLUSION: The study confirms the role of certain 'high risk' antimicrobials in acquisition of ESBL producing Enterobacteriaceae and shows that periodic cohort studies could be an effective strategy in surveillance of antimicrobial resistance in hospitals of resource poor countries to inform antibiotic policy and treatment guidelines.

Characterisation of methicillin resistant S. aureus strains and risk factors for acquisition in a teaching hospital in northeast India.

PURPOSE: A point prevalence study was carried out in a teaching hospital in Assam to characterise S. aureus strains, establish the rate of colonisation of methicillin resistant S. aureus (MRSA) and associated risk factors for its acquisition. MATERIALS AND METHODS: Antibiogram-Resistogram profile was done by BSAC standardized disc sensitivity method; Phage and RFLP typing were carried out by the PHLS, London. RESULTS: Single MRSA strain resistant to multiple classes of anti-staphylococcal antibiotics dominated the hospital. The MRSA colonisation rate was found to be 34% (n=29) and 18% (n=80) in orthopaedics and surgery, respectively and only approximately 1% (n=73) in the medical units. Exposure to ciprofloxacin and surgery were risk factors but duration of hospital stay was not. In contrast, methicillin sensitive S. aureus (MSSA) strains were usually distinct strains and sensitive to most of the anti-staphylococcal antibiotics including 18% to penicillin. CONCLUSIONS: The MRSA strain prevalent in the hospital phenotypically resembles the predominant Asian strain viz., Brazilian/Hungarian strains (CC8-MRSA-III). Duration was not a risk factor, which suggests that in absence of exposure to specific antimicrobials, even in a hospital with no or little infection control intervention, a vast majority remain free from MRSA. This underlines the importance of rational prescribing empirical antibiotics.

Infection control with limited resources: why and how to make it possible?

The risk of healthcare-associated infections (HCAIs) in developing countries can exceed 25% compared to developed countries. Lack of awareness and institutional framework to deal with patient safety in general and HCAI in particular perpetuates the culture of acceptance of avoidable risks as inevitable. Most HCAIs are avoidable and can be prevented by relatively simple means. It is no longer acceptable to put patients at risk of avoidable infections. The World Health Organization (WHO)-led World Alliance for Patient Safety launched a worldwide campaign on patient safety focusing on simple means like hand hygiene to combat HCAIs. To drive necessary changes to deliver sustainable improvement in clinical care requires strategic approach and clinical leadership. This article reviews the scale of the problem, the WHO recommended interventions and improvement strategies in institutional setup in developing and transitional countries.