A case of neonatal tetanus presented within 24 hours of life.

Neonatal tetanus is still prevalent in developing countries such as India. Generally, neonatal tetanus is seen in babies of unimmunized mothers beyond the second day of life. A neonate presented to us on the 4th hour of birth with a periumbilical ulcer. The baby's antenatal and birth history was uneventful. The mother had been immunized against tetanus. At presentation, the baby was active, alert and sucking normally. A very small ulcer was noted below the umbilicus. Subsequently, the baby developed rigidity and a tonic spasm of its body with recurrent seizures from the 18th hour of its birth and by 21st hour. It also had a full blown clinical picture of neonatal tetanus including: masseter spasm; generalized rigidity; a high pitched cry: and intermittent opisthotonos posturing. An ulcer gradually enlarged to 5 × 4 cm and a swab from ulcer showed Clostridium tetani (both on Gram staining and culture). A review of the published literature did not reveal any case that had presented so early. Therefore, this is probably the first case of neonatal tetanus being reported within the 21st hour of birth.

Oncogenic HPV among HIV infected female population in West Bengal, India.

BACKGROUND: Prevalence of both cervical cancer and Human Immunodeficiency Virus (HIV) infection are very high in India. Natural history of Human Papilloma Virus (HPV) infection is known to be altered in HIV positive women and there is an increased possibility of persistence of HPV infections in this population. Therefore, this study was conducted to understand the epidemiology and circulating genotypes of oncogenic HPV among HIV positive and negative female population in West Bengal, India. METHODS: In this hospital-based cross-sectional study, 93 known HIV positive females attending a pre-ART registration clinic and 1106 HIV negative females attending a Reproductive and Child Health Care Clinic were subjected to study. Cervical cell samples collected from the study population were tested for the presence of HPV 16, 18 using specific primers. Roche PCR assay was used to detect other specific HPV genotypes in the cervical cells specimens of HIV positive cases only. RESULTS: Prevalence of HPV 16, 18 among HIV positive females (32.2%; n = 30) was higher than HIV negative females (9.1%; n = 101). About 53% (23/43) of cases with oncogenic HPV were infected with genotypes other than 16, 18 either as single/multiple infections. HPV 18 and HPV 16 were the predominant genotypes among HIV positive and HIV negative subjects respectively. Oncogenic HPV was not found to be associated with age and duration of sexual exposure. But the presence of HIV was found to a statistically significant predictor oncogenic HPV. CONCLUSION: The currently available HPV vaccines offer protection only against HPV 16 and 18 and some cross- protection to few associated genotypes. These vaccines are therefore less likely to offer protection against cervical cancer in HIV positive women a high percentage of who were infected with non-16 and non-18 oncogenic HPV genotypes. Additionally, there is a lack of sufficient evidence of immunogenicity in HIV infected individuals. Therefore, prevention of cervical cancer in HIV positive women must be focused towards early detection of oncogenic HPV & cervical cytological abnormality followed by an appropriate treatment.