Epidemiology of scrub typhus in a tertiary care hospital of Southern Odisha: a cross sectional study.

PURPOSE: Scrub typhus, is a mite-borne disease caused by bacteria named Orientia tsutsugamushi. In recent years the incidence of scrub typhus is increasing day by day. The disease is easily missed because of low sensitization among clinicians and non-specific clinical manifestation. The disease can be fatal in untreated cases. With the availability of testing methods, it can be easily diagnosed and treated. This study aims to depict the epidemiology of scrub typhus in southern Odisha. METHODS: A total of 170 blood samples were collected from clinically suspected acute undifferentiated febrile illness (AUFI) cases. Samples were tested serologically for antibodies against Orientia tsutsugamushi by commercially available Immunochromatography test (ICT) and enzyme-linked immunosorbent assay (ELISA) kit as per the manufacturer's instruction. Molecular diagnosis was done by nested polymerase chain reaction (N-PCR) and Sanger sequencing was done to know the circulating strains. RESULTS: Out of 170 cases of AUFI, 74 cases were diagnosed scrub typhus by IgM ELISA and 67 were positive by ICT. Males were affected more and cases were more clustered in the Ganjam district. The disease followed a typical seasonal i.e. more cases were seen in cooler months of the year. Sequencing revealed the strains were Gilliam and Karp like. CONCLUSIONS: The burden of scrub typhus was 43.5% among the study population. Determining the serotypes in endemic areas is important for basic research on the classification of Orientia tsutsugamushi, the development of vaccines, and the definitive diagnosis of scrub typhus. Expanding the panel of antigens used to test scrub typhus and to take into account of local antigenic diversity would improve the sensitivity of serological diagnosis.

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 Ig m0 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.

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.

Seroprevalence of chikungunya in southern odisha.

BACKGROUND: The emergence of chikungunya (CHIK) infection was observed in Odisha, India in 2006. Thereafter many cases with symptoms suggestive of CHIK were reported from different districts of Southern-Odisha. This study was aimed to know the seroprevalence, clinical presentations and seasonal trends of CHIK infection in this region. MATERIALS AND METHODS: This study was conducted in a tertiary hospital of this region. Serum samples received in the Department of Microbiology from various districts of Southern-Odisha from April 2011 to March 2012 were included in the study. The samples were tested for CHIK and dengue Immunoglobin M (IgM) antibodies by enzyme-linked immunosorbent assay and malaria parasite by immunochromatographic test (ICT) method. RESULTS: Out of the 678 serum samples tested, 174 were positive for CHIK, 15 for dengue and two samples were positive for both CHIK and dengue IgM antibodies. The most affected age group was 16-45 years. Females were more affected than males. CONCLUSION: The seroprevalence of CHIK among the suspected cases was 25.7%. Co-infection with CHIK and dengue was found to be 1.15%. The infection had spread to new areas during this outbreak.

Changing pattern of human group A rotaviruses: emergence of G12 as an important pathogen among children in eastern India.

BACKGROUND: Rotavirus genotypes, G1-G4 and G9 are associated with childhood diarrhoea throughout the world. In our previous study, we detected G1, G2, G4 and three G12 strains from Kolkata, India. OBJECTIVES: To study the prevalence of G- and P-genotypes of rotaviruses associated with dehydrating diarrhoea in children admitted to two leading hospitals in eastern India. STUDY DESIGN: An active surveillance was conducted for elucidation of rotavirus infection in two leading hospitals in Kolkata, West Bengal and Berhampur (GM), Orissa, India, separated by 603km from January 2003 to April 2005. The rotaviruses were detected by RNA electrophoresis in polyacrylamide gels. G- and P-typing of the positive samples were accomplished by amplifying VP7 and VP4 genes by RT-PCR and genotyped by seminested multiplex PCR methods. Sequencing, sequence analysis and phylogenetic analysis of VP7 genes of G12 strains were carried out to understand the variations between the strains isolated from different parts of the world. RESULTS: The genotypic distribution varied remarkably from our earlier study period (1998-2001) with G1 (53.8%) being the most predominant strain followed by G2 (22.5%), G12 (17.1%), G9 (2.1%) and not a single G3 or G4 isolate was detected separately. 35.2% samples exhibited mixed P-types followed by P[4] (31.7%), P[8] (21.8%) and P[6] (9.8%). The phylogenetic analysis of G12 strains revealed that the G12 strains detected from different parts of the world clustered into three different lineages. Though VP7 sequences of G12 strains isolated from Kolkata and Berhampur are conserved, their P-types were different. CONCLUSION: During this study period we reported emergence of G12 strains as an important pathogen among children in eastern India, thus necessitating its inclusion in future polyvalent vaccine to control rotavirus diarrhoea.

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.

A longitudinal study to monitor chloroquine-resistant P. falciparum malaria in Bokajan and Manja PHC areas of Karbi Anglong District, Assam.

In-vivo as well as in-vitro studies were carried out at regular intervals from 1979 to 1988 to monitor chloroquine resistance in P. falciparum in Bokajan and Manja PHC of Karbi Anglong district, Assam. The results showed no significant change in resistance status in the area. Intensified antivector measures, withdrawal of chloroquine pressure and prompt detection and treatment of P. falciparum cases with alternative drugs helped bring down the higher grades of resistant parasites by 1984, which however could not be maintained. The results of in-vitro tests correlated well with those of in-vivo tests. The Karbis seemed to have better immunity against the strain of P. falciparum than the non-Karbis residing in the area. However, there was no difference in the rate of sensitive and resistant cases detected amongst the two groups.

Problem of antimalarial drug resistance in Plasmodium falciparum in Mizoram.

Studies conducted in Mizoram during 1981 to 1990 have shown areas with increasing RIII level of chloroquine resistance. These foci need urgent liquidation. Sulfalene-pyrimethamine drug combination was found suitable for treatment of P. falciparum cases in these areas with only 5.3 per cent cases showing RI level of Plasmodium response. Quinine combined with sulfalene-pyrimethamine showed 100 per cent success. Amodiaquine however was similar in response to chloroquine though the mean parasite clearance time with amodiaquine was slightly better.

Management of admitted malaria cases in four major hospitals of Delhi: a case study.

A hospital-based retrospective case study of admitted patients was undertaken in four major hospitals of Delhi during 1991, with a view to assessing (i) recording and reporting system of malaria cases, (ii) diagnostic criteria being followed, (iii) management of complicated and severe malaria cases, and (iv) availability of life-saving antimalarials. The study showed that none of the hospitals either followed the international coding system for recording or adopted the National Malaria Eradication Programme guidelines for diagnostic criteria malaria, i.e. by blood smear examination. Diagnosis of malaria in three out of four hospitals was not preceded by blood examination in all cases. Only 55% of the 283 clinically suspected malaria cases were screened for malaria parasite with overall positivity of 20.14 per cent and of 38.25 per cent in examined cases. Age and sex break-up indicated that males suffered more and 65 per cent of the patients belonged to 16-40 years' age groups as compared to 38.4 per cent population falling in this age group according to 1981 census. Out of 263 recovered study cases, 13 per cent came from adjoining states while this percentage went up to 35 per cent (7 out of 20 cases) in the case of malaria deaths. Over 80 per cent of the clinically suspected cases presented with signs and symptoms of fever or fever with rigour, chills or vomiting. In 38 per cent of the cases there was a definite time lag in reporting of the cases to hospitals but most of the cases (91 per cent) were administered antimalarials within 24 h of admission.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

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.

Epidemic of malaria in Barmer district (Thar desert) of Rajasthan during 1990.

Barmer district of Rajasthan in Thar desert and hitherto a hypoendemic area for malaria came in the grip of a severe malaria epidemic during 1990. The epidemic occurred as an aftermath of floods, preceded by normal rains during 1988 and 1989 after a prolonged drought phase. The epidemic was spread over the whole district including Barmer town. Annual Parasite Incidence (API) and Annual falciparum Incidence (AFI) for the district touched record figures of 17.20 and 5.83 respectively while for the Barmer town they were 36.5 and 14.0 respectively. Out of the eight PHCs, Baitu PHC was the worst affected where the two indices touched all-time high figures of 55.3 and 19.6 per cent respectively. A total of 122 infants were reported positive for malaria, of which 103 were contributed by Baitu PHC alone. Eighty per cent infant positivity was spread over September and November, indicating a high rate of transmission. A total of 47 deaths due to cerebral malaria were reported. However, in view of the high infectivity among infants and paediatric groups there was a strong possibility of deaths among these groups which could not be verified. Entomological findings revealed that a sudden increase in An. culicifacies densities due to extensive breeding potential, as a sequel to floods, activated the transmission, which was maintained at a low level by An. stephensi, predominant in this desert region. Other factors which contributed to the intensity and extent of epidemic were the return of drought-migrated population from malarious areas, low cattle density, malaria non-immune population, inadequate and poor spray coverage and delayed radical treatment. Insecticide adult susceptibility tests revealed a high degree of resistance in An. stephensi against DDT and dieldrin.