Resurgence of diphtheria in rural areas of North Karnataka, India.

BACKGROUND: A diphtheria outbreak was identified from Vijayapura (formerly Bijapur) district in the South Indian state of Karnataka in 2011. There was a surge in the number of throat swab samples received under the Integrated Disease Surveillance Programme (IDSP) in North Karnataka since then. OBJECTIVES: A microbiological study was undertaken to generate information on the status of resurgence of the disease in the region. MATERIALS AND METHODS: Throat swabs from 432 suspected cases of diphtheria during 2012-2015 were obtained from government hospitals and primary health centres of 8 districts in North Karnataka and were processed for the culture and identification of Corynebacterium diphtheriae. Polymerase chain reaction for the presence of toxin gene (toxA and toxB) was carried out on the isolates. Antibiotic sensitivity tests were performed on the isolates with a panel of 14 antibiotics. RESULTS: Thirty-eight (8.79%) out of 432 samples yielded C. diphtheriae on culture. All isolates possessed the diphtheria toxin gene. Out of the 38 confirmed cases, whereas 21 (55.26%) were between 1 and 5 years of age, 14 (36.84%) were aged between 5 and 10 years. Male children were three times more than females in confirmed cases. No information was available on the immunisation status of the cases. Emergence of resistance to penicillin was found with minimum inhibitory concentration reaching up to 6.00 µg/ml. CONCLUSION AND DISCUSSION: Our study identified an upsurge in cases of diphtheria in North Karnataka, particularly in Vijayapura District, and to the best of our knowledge, reports the emergence of penicillin resistance for the first time in India. The study calls for enhanced surveillance for the disease, making antidiphtheritic serum available in key hospitals in the region and serves to provide a baseline for future assessment of the impact of the recently launched 'Mission Indradhanush' programme in strengthening Universal Immunisation Programme (UIP).

Twin outbreak of cholera in rural North Karnataka, India.

BACKGROUND & OBJECTIVES: Successive outbreaks of acute watery diarrhoea occurred in Talikoti and Harnal, located in Bijapur District of the southern Indian s0 tate of Karnataka, in July and August 2012, respectively. These outbreaks were investigated to identify the aetiology and epidemiology. METHODS: Information was collected from the local population and health centres. Stool and water samples were collected from the admitted patients and their drinking water sources. Standard microbiological and PCR techniques were employed for isolation and characterization of the pathogen. RESULTS: While 101 people (0.38%) were affected in Talikoti, 200 (20.94%) were affected in Harnal which is a small remote village. All age groups were affected but no death occurred. While the outbreak was smaller, longer and apparently spread by person to person contact in Talikoti, it occurred as a single source flash outbreak at Harnal. A single clone of toxigenic Vibrio cholerae O1 Ogawa biotype El Tor was isolated from the two stool samples obtained from Talikoti and subsequently from three of five stool samples obtained from Harnal indicating village to village spread of the aetiological agent. Striking similarity in antibiotic resistance profiles of these isolates with a particular strain isolated from the city of Belgaum, 250 km away, in 2010, prompted tracking the lineage of the V. cholerae isolates by DNA fingerprinting. Random amplified polymorphic DNA (RAPD) fingerprinting assay helped confirm the origin of the incriminating strain to Belgaum. INTERPRETATION & CONCLUSIONS: Our study reported the first twin outbreak of cholera in two remote areas of Bijapur district, Karnataka, south India. It also indicated the need for immediate preparedness to deal with such emergencies.

Comparison of a novel immunocapture assay with standard serological methods in the diagnosis of brucellosis.

BACKGROUND: Microbiological culture methods and immunological assays currently available are technically challenging, difficult to interpret even in non-endemic areas. They are also time consuming leading to misdiagnosis, treatment delay, and severe morbidity and mortality. Therefore, the development of a simple and accurate diagnostic assay which could be performed even in small laboratories is a pressing need. This has prompted us to evaluate an assay based on the immunocapture technique in a region where brucellosis is prevalent. METHODS: The immunocapture test was evaluated for diagnostic efficacy on 211 patients with suspected brucellosis. Standard tube agglutination test (SAT), 2-mercaptoethanol (2-ME) agglutination, Coombs, immunocapture tests, and blood cultures were performed on these 211 blood samples. 190 sera belonging to healthy blood donors of endemic and non-endemic areas and 43 sera obtained from non-brucellosis patients were also subjected to SAT, 2-ME, Coombs, and immunocapture tests. A total of 15 blood cultures belonging to blood donors of endemic area and non-brucellosis cases were done. RESULTS: SAT picked up only 21 (9.9%), Coombs established the diagnosis in 69 (32.7%), while the immunocapture test confirmed the diagnosis in 76 (36%; p < 0.001)) patients with brucellosis, including 48 culture-confirmed cases. Sensitivity and specificity of the immunocapture technique were 97.29% and 97.08% respectively. SAT could not exclude the diagnosis in 55 cases as they were confirmed in most cases by the Coombs test and in all by immunocapture. CONCLUSIONS: Our results clearly show that immunocapture is superior to SAT in all stages of illness but is not significantly superior to Coombs. It also seems to be a useful tool in diagnosing a relapse. Immunocapture and Coombs tests were found to be more sensitive eliminating the ambiguity in the interpretation of the results for diagnosing brucellosis. The Coombs test is laborious, subjective in interpretation and demanding on skills. The immunocapture technique does not have the subjective reading errors, is simple to perform, and the results of the immunocapture technique seem to be reproducible. Thus we recommend the immunocapture technique especially for brucellosis-endemic countries. The Coombs, immunocapture, and 2-ME tests may also be considered useful tools in assessing treatment outcome.

Splenic Abscess due to Brucella Melitensis - A Rare Pediatric Complication.

Splenic abscess due to Brucella species is an extremely rare complication especially in acute illness. Here we report a case of splenic abscess caused by Brucella melitensis biotype 1 in a child with acute infection who was successfully treated with only antibiotics.