Coinfection by human immunodeficiency virus, hepatitis B virus and hepatitis C virus in injecting drug users.

Detection of hepatitis B surface antigen (HBsAg), anti hepatitis C virus (HCV) antibody and anti human immunodeficiency virus (HIV) antibody was carried out in serum samples from 250 injecting drug users (IDUs) from a deaddiction centre, Shalom, in Churachanpur district, Manipur during the period of August-October, 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was coinfection of HIV, hepatitis B virus (HBV) and HCV in 15 (6%) of the IDUs. The coinfection of HBV and HCV was found in 12 cases (4.8%) and coinfection of HIV and HCV was found in 131 cases (52.4%). HIV and HCV were the highest among the coinfection of IDUs. The IDUs were in sexually active age group with a risk of infection to their sexual partner.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Penicillium marneffei--an indicator disease of AIDS: a case report.

Penicillium marneffei (PM), the only dimorphic species of the genus penicillium is the etiological agent of penicilliosis marneffei. This opportunistic fungal infection occurs among human immunodeficiency virus (HIV) infected and other immunocompromised patient in several regions of South-east Asia, where the infection is considered as an indicator disease of AIDS. A case of penicilliosis marneffei is reported in a patient whose HIV status was unknown and later turned to be in the late stage of AIDS. This demonstrates that it is indeed an indicator disease of AIDS. In India, penicilliosis has been reported among the inhabitants of Manipur state where the prevalence of HIV infection / AIDS is very high. The causative agent was first isolated from a captive bamboo rat. Investigation of the prevalence of the organism among bamboo rats of different countries of South East Asia revealed four species of bamboo rats to be harboring the organism. These four species of bamboo rats are Rhizomys sinensis, R. pruinosus, R. sumatrensis and Cannomys badius. In Manipur, Penicillium marneffei has been isolated from Cannomys badius. Any patient presenting with penicilliosis marneffei should be subjected to HIV counselling and testing if the HIV status is not known and further study regarding the ecology and epidemiology of the fungus is needed.

Pattern of hepatitis C virus genotypes in HIV infected patients in RIMS, Hospital, Imphal, Manipur.

The present study was carried out to find the pattern of genotype distribution of Hepatitis C virus. Twenty-three Hepatitis C virus positive serum samples in various age-groups of both sexes attending, Microbiology Department, RIMS during the period from September 2002 to December 2004 were studied for Hepatitis C genotype. These HCV positive serum samples were sent to National Institute of Cholera and Enteric Diseases, Kolkata. The serum samples were tested for HCV-RNA by qualitative RT-PCR test and then genotyped by type specific RT-PCR. Out of 23 serum samples, 22 were males. All the 23 HCV positive serum samples were also tested positive for HCV-RNA by qualitative RT-PCR. Majority of the cases belonged to the age group of 31-40 years. Higher percentage of Hepatitis C cases were Injecting Drug Users and next to it were patients with multiple sexual contacts. Among the IDUs, Hepatitis C virus 3a type was the commonest genotype (61.1%) followed by 1b (22.2%) and 3b (16.7%) respectively. Hepatitis C genotype 3a was predominant (52.2%) followed by 1b (26%) and 3b (21.8%). HCV genotype 3a occurred most commonly in the age group of 21-40 years.

Increasing trend of HIV seropositivity among commercial sex workers attending the Voluntary and Confidential Counseling and Testing Centre in Manipur, India.

A total of 1903 commercial sex workers (CSWs) attending the Voluntary and Confidential Counseling and Testing Centre at the Department of Microbiology, Regional Institute of Medical Sciences, Manipur, were screened for HIV infection over a period of five years from March 1998 to February 2003. All cases were in the age group 13-55 years. Most cases were in the age group 20-30 years (50.86%). Out of 1903 CSWs, 304 were found to be HIV-seropositive, confirmed by three tests (ELISA/RAPID/SIMPLE) of different biological antigen principles according to India's National AIDS Control Organisation guidelines. The annual rising trend in incidence of HIV seropositivity among CSWs from March 1998 (10.93%) to February 2003 (29.68%) was observed in the test site attenders, in contrast to the declining trend among injecting drug users in the state from March 1998 (76%) to February 2003 (59.82%). In all, 622 sexually transmitted infection (STI) cases were diagnosed, of which 242 (38.90%) had syphilis, which was the commonest STI, and 172 (27.65%) had ulcerative lesions. Increasing HIV seropositivity among CSWs observed in this study reflects the changing pattern of HIV transmission in Manipur.

Co-infection by human immuno deficiency virus, hepatitis B and hepatitis C virus in injecting drug users.

Injecting drug users (IDUs) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV) hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. The present study was undertaken to find out the prevalence of HIV infection, HBV infection and HCV infection among IDUs of a deaddiction centre. Serum samples from 250, injecting drug users (IDUs) from a de-addiction centre were screened for HBsAg using immunochromatography, anti HCV antibody by 3rd generation ELISA test and anti HIV antibody by ELISA test and immunochromatographic rapid test during the period August to October 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was co-infection of HIV, HBV and HCV in 15 (6%) of the IDUs. The Co-infection of HBV and HCV were found in 12 cases (4.8%) and Co-infection of HIV and HCV was found in 131 cases (52.4%). The IDUs were in sexually active age group with a risk of infection to their sexual partner. There is high prevalence of HCV and HIV infection and co-infection of both viruses among IDUs. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged. Increase coverage of needle, syringe exchange programme (NSEP) to young and new IDUs is required before they are exposed to blood borne viruses.

Pulmonary paragonimiasis.

A 27-year-old married male from Lamdeng village of Imphal West District, Manipur presented with cough, fever, haemoptysis, anorexia and weight loss, and was treated with antituberculosis drugs continuously for one year without improvement. He also had history of ingestion of raw crabs. Chest radiograph revealed right midzone lesion with cavitation. Laboratory investigations revealed peripheral blood eosinophilia, elevated erythrocyte sedimentation rate and sputum smear revealed eggs of Paragonimus westermani. He responeded well to treatment with praziquantel 25 mg/kg, three times a day for three days and is doing well on follow-up. Pulmonary paragonimiasis must be considered in the differential diagnosis of slowly resolving pneumonias, especially in the appropriate clinical setting because effective treatment with praziquantel can be rewarding.