Developing consensus of evidence to target case finding surveys for podoconiosis: a potentially forgotten disease in India.

BACKGROUND: Podoconiosis is a non-infectious geochemical lymphoedema of the lower legs associated with a significant burden of morbidity. There are historical reports of podoconiosis in India, but its current endemicity status is uncertain. In this investigation we aimed to prioritise the selection of districts for pilot mapping of podoconiosis in India. METHODS: Through a consultative workshop bringing together expert opinion on podoconiosis with public health and NTDs in India, we developed a framework for the prioritisation of pilot areas. The four criteria for prioritisation were predicted environmental suitability for podoconiosis, higher relative poverty, occurrence of lymphoedema cases detected by the state health authorities and absence of morbidity management and disability prevention (MMDP) services provided by the National Programme for Elimination of Lymphatic Filariasis. RESULTS: Environmental suitability for podoconiosis in India was predicted to be widespread, particularly in the mountainous east and hilly southwest of the country. Most of the districts with higher levels of poverty were in the central east and central west. Of 286 districts delineated by state representatives, lymphoedema was known to the health system in 189 districts and not recorded in 80. Information on MMDP services was unavailable for many districts, but 169 were known not to provide such services. We identified 35 districts across the country as high priority for mapping based on these criteria. CONCLUSIONS: Our results indicate widespread presence of conditions associated with podoconiosis in India, including areas with known lymphoedema cases and without MMDP services. This work is intended to support a rational approach to surveying for an unrecognised, geographically focal, chronic disease in India, with a view to scaling up to inform a national strategy if required.

Prevalence of Neglected Tropical Diseases (Leishmaniasis and Lymphatic Filariasis) and Malaria Among a Migrant Labour Settlement in Kerala, India.

Neglected tropical diseases (visceral leismaniasis, lymphatic filariasis) and malaria are endemic in northern states of India. Kerala has become a hub of construction activities employing a large number of migrants from these endemic states. Studies on morbidity pattern among migrants in Kerala are lacking. It is essential to look into the burden of these infections among migrant laborers who can act as reservoirs and are a threat to native population. A cross sectional study was done among migrant laborers in Ernakulam district, Kerala. After getting informed consent, a questionnaire was administered to each participant to collect sociodemographic details and 5 ml of blood was collected for detection of antigens using rapid diagnostic tests (RDT). Of the 309 migrants tested, none of them were positive for leishmaniasis, while 3.8% were positive for malaria and 3.6% for filariasis. With 2.5 million migrant laborers in Kerala, the magnitude of the problem in absolute numbers is enormous. Active surveillance and treatment is needed to prevent the reemergence of these diseases in Kerala.

Lymphatic filariasis in western Ethiopia with special emphasis on prevalence of Wuchereria bancrofti antigenaemia in and around onchocerciasis endemic areas.

Lymphatic filariasis is known to be endemic in Gambella Region, western Ethiopia, but the full extent of its endemicity in other regions is unknown. A national mapping program for Ethiopia was initiated in 2008. This report summarizes initial data on the prevalence of Wuchereria bancrofti antigenaemia based on surveys carried out in a sampled population of 11685 individuals living in 125 villages (112 districts) of western Ethiopia. The overall prevalence rate was 3.7%, but high geographical clustering and variation in prevalence (ranging from 0% to more than 50%) was found. The prevalence of hydrocele (in males) and lymphoedema of limbs was 0.8% and 3.6% respectively. Significantly higher (χ(2)=49.6; P<0.01) prevalence of antigenaemia was noted in known onchocerciasis endemic districts (4.7%) compared to non-onchocerciasis endemic districts (2.3%). Thirty-four of the 112 districts, with a population of 1547685 in 2007, were found to be endemic. Of these, the numbers of districts with prevalence rates of >20%, 10-20% and 5-9% were nine, 14 and 20 respectively. Twenty-nine of these 34 endemic districts were found in three regions: Gambella Region (seven districts), Beneshangul-Gumuz Region (13 districts), and Southern Nations, Nationalities and Peoples' Region (SNNPR) (nine districts). The other five were from Amhara (two districts) and Oromia (three districts) regions. A tentative distribution map has been drawn to facilitate the launching of the Ethiopia LF elimination program.

Parasitological and clinico-epidemiological features of onchocerciasis in West Wellega, Ethiopia.

Onchocerciasis is a disease of public health and socio-economic importance in Ethiopia. The aim of this study was to assess parasitological and clinico-epidemiological features of onchocerciasis in the Anfilo District, West Wellega, prior to implementation of Community Directed Treatment with Ivermectin (CDTI) to generate epidemiological and parasitological data for use in control program of the disease and subsequent evaluation of CDTI. A cross-sectional study was conducted in Anfilo District of West Wellega zone during a period of 1 month: from mid-August to mid-September 2006. Data on socio-demographic characteristics were collected using a standardized questionnaire prepared for this purpose. All persons were examined clinically for skin signs and symptoms of onchocerciasis. Two skin snips, one from each side of the gluteal fold were taken using blood lancet and sterilized razor blade and examined for microfilaria. All data were categorized, coded, entered in a data base and analyzed using SPSS version 15.0. for windows. A total of 1114 individuals ≥15 years were examined for microfilariae (mf) of Onchocerca volvulus and onchocercal skin disease (OSD). The prevalence of onchocercal (mf) carrier was 74.8% (833/1114). In both genders, the prevalence of onchocerciasis showed direct correlations with the age of individuals (R (2) = 0.79, P < 0.05). The infection rate varied with the occupation of the study subjects, with preponderance among farmers. Among the subjects with onchocerciasis, the mf density ranged from 1.0 to 711.0 per mg of skin snip with a mean density (SD) and median values of 32.1 (61.5) and 10.4 respectively. The overall community microfilariae load (CMFL), the most sensitive parasitological indicator of onchocerciasis was 19.6. The pervasiveness of OSD among the study subjects was 26.4%. OSD was more frequent in males (32.4%) than their female counterparts (20.8%, P < 0.05). The overall prevalence of onchocercal nodule carrier, the symptom opted for determining the community-wide prevalence of onchocerciasis was 12.1%. Leopard skin, the proxy of longstanding infection of onchocerciasis in the community, was also relatively high (19.1%). The abundance of mf in skin would definitely lead to high transmission potential in the Anfilo District. The situation in the Anfilo District should call for continued CDTI, owing to success of similar recommendations for such programmes in other parts of the country and elsewhere.

Chemopreventive effect of orange oil on the development of hepatic preneoplastic lesions induced by N-nitrosodiethylamine in rats: an ultrastructural study.

Orange peel oil is used extensively as an approved flavour enhancer in fruit drinks, carbonated beverages and as a scenting agent in soaps and cosmetics. Limonene, which is a monocyclic monoterpene is present in orange peel oil from 90 to 95% (w/w). Monoterpenes have been shown to be very effective chemopreventive agents against several rodent tumors and are currently in clinical trials. However, not much information is available regarding the ultrastructural changes associated with the chemopreventive effects of the monoterpenes. The effect of orange oil on the suppression of preneoplastic hepatic lesions during N-nitrosodiethylamine (DEN) induced hepatocarcinogenesis was studied electron microscopically. Rats were administered 200 ppm DEN through drinking water for a period of 1 month. After an interval of 2 weeks, the animals were administered orange oil by gavage for a period of 5 1/2 months. The chemopreventive effect of orange oil was monitored on the basis of liver weight profile, histological pattern by light microscopy and ultrastructural alterations by electronmicroscopy. Orange oil administration following DEN treatment showed decreased liver weights, increased intercellular gap junctional complexes, cell density and polarity when compared with only the DEN treated rats. In the present study chemopreventive effect of orange oil on DEN-induced hepatic preneoplasia in rats which is associated with the restoration of the normal phenotype and upregulation of junctional complexes has been demonstrated.

Susceptibility status of Mansonia annulifera to Brugia malayi parasites in Cherthala, Alappuzha district, Kerala.

Laboratory studies conducted on Ma. annulifera collected from Cherthala region, Kerala, endemic for Brugian filariasis indicated that this species is highly susceptible to B. malayi parasites. The experimental infection index of this species was relatively higher (2.74). No significant loss of larvae during development was recorded. The extrinsic incubation period was estimated to be 8 days.

Efficacy of diethylcarbamazine-medicated salt for microfilaraemia of Brugia malayi.

BACKGROUND: Pilot studies in India and abroad have demonstrated the benefit of cooking salt fortified with diethylcarbamazine citrate (DEC) for the control of lymphatic filariasis. In India, DEC-medicated salt has been introduced on a commercial basis in the Cherthala region of Kerala, which is endemic for Brugia malayi (B. malayi). We studied the efficacy of DEC-medicated salt in the clearance of microfilaraemia of B. malayi. METHODS: Eighteen cases of microfilaraemia (11 men; 7 women) were selected; 14 in the experimental group (i.e. treated with 0.2% w/w DEC-medicated salt) and the rest as the control group who were given a placebo. The consumption of salt and the status of parasitaemia were monitored till all the microfilaria carriers became negative. RESULTS: There was a significant reduction in the density of microfilariae (intensity) among the treated individuals over a period of time. The duration required for the clearance of microfilariae ranged from 9 to 30 [mean (SD) 19.4 (1.7)] weeks. All microfilaraemics except one reported side-effects which were mild-to-moderate and persisted for a maximum period of one month. CONCLUSION: DEC-medicated salt effectively clears microfilariae within 30 weeks in parasitaemic individuals. No 'endemic normals' reported any side-effects, though these were common among the microfilaria carriers.

Current status of filariasis in Chavakad taluk, Trichur district, Kerala.

A sample survey using parasitological, clinical and entomological indicators was carried out in all the 18 administrative units of Chavakad taluk, Trichur district, Kerala, India to assess the current filariasis situation. Cluster sampling procedure was followed to screen individuals. Both Wuchereria bancrofti and Brugia malayi species were found to be prevalent in this taluk. Microfilaria (mf) carriers with W. bancrofti were detected in eight areas while B. malayi was recorded only from one area. The two species were found to co-exist in another area. The highest infection rate registered for W. bancrofti was 1.51 while it was 0.3 for B. malayi. Infection due to W. bancrofti constituted 87.88% of the total 33 microfilaria cases. Prevalence of B. malayi was very low. Cases with clinical manifestation of filariasis were recorded in all the four areas surveyed. The present trend in the prevalence of infection (mf) and disease showed a decline in both the species when compared to earlier surveys of 1960s. At least 11 areas are still endemic for filariasis in this taluk. Although prevalence of mf was recorded for the first time in one of the areas viz., Elavalli, the rate was only 0.16%. Entomological surveys revealed the presence of 14 mosquito species, of which Culex quinquefasciatus contributed 84.85% and Mansonia 0.77%. While C. quinquefasciatus was recorded in all the 18 areas, Mansonia spp were found only in 8 areas. Only C. quinquefasciatus was found to harbour different developmental stages of W. bancrofti, with overall infection and infectivity rates of 1.94 and 0.97 respectively. The possible reason for the decline in vector density and infection in man are postulated.

Mattancherry urban agglomeration, a diminishing focus of lymphatic filariasis in Kerala.

Parasitological survey conducted recently in Mattancherry, Kerala showed a low prevalence of microfilariae (mf), with a mf rate of 1.81%, compared to that of 1956 when the mf rate was 14.7%. No brugian infection was encountered in the present investigation, though both bancroftian and brugian infections were reported earlier. Culex quinquefasciatus, the vector of bancroftian filariasis was the most predominant (93.3%) mosquito species, and its infection and infectivity rates were 0.76% and 0.54% respectively. Mansonioides spp., the vectors of brugian filariasis constituted only 0.2% of the total mosquitoes and with no infection. The overall reduction in the prevalence of mf cases and vector infection rates over the years is attributed to the continued activities of the National Filaria Control Programme. The disappearance of brugian filariasis could mainly be due to the drastic reduction in the Mansonioides breeding habitats, as a result of rapid urbanization coupled with improved socio economic conditions.

Brackish water mosquito problem of Vypeen Island, Cochin, Kerala.

A preliminary study has shown that the marshy terrain and brackish water bodies associated with mangrove forests contributed profuse breeding of mosquitos in Vypeen island, causing a severe menace to the island population. A total of 14 species belonging to four genera viz, Aedes, Anopheles, Armigeres and Culex was recorded from different habitats. Culex sitiens was found to be the predominant mosquito in all the perennial breeding habitats. The extent of different habitats in the production of mosquitos, and its possible abatement, using environmental and/or biocontrol methods are discussed.

Response of gravid Phlebotmus papatasi females to an oviposition attractant/stimulant associated with conspecific eggs.

Oviposition response of gravid P. papatasi females to conspecific eggs was studied in laboratory colonized sandflies. It was observed that significantly higher number of eggs were laid in the vicinity of conspecific eggs. However, a certain minimum number of eggs were required to be placed on the substratum to influence the rate of oviposition. The fecundity of females (mean = 56.5 +/- 4.9 eggs) exposed to conspecific eggs was significantly higher (P < 0.05) than that of blank control group. Perhaps, the chemical substances/pheromone of egg origin stimulated the oviposition rate. In an attempt to isolate the active ingredient, solvent washing of the conspecific eggs were tested. No increase in the rate of oviposition was noticed when the test site was treated with distilled water extract, whereas, significantly larger number of eggs were laid at the site treated with di-ethyl ether extract. This indicated that the oviposition attractant associated with the eggs dissolved in the organic solvent, but not in water. The possible application of this attractant for wild sandflies in nature and for regulating the site of oviposition on the substratum in the laboratory colonized sandflies needs to be explored.

Emblica officinalis: a novel therapy for acute pancreatitis--an experimental study.

Acute necrotising pancreatitis is associated with an unacceptably high mortality for which no satisfactory remedy exists. Emblica officinalis (E.o.) is a plant prescribed in Ayurveda, the Indian traditional system of medicine, for pancreas-related disorders. This study was carried out to evaluate the protective effect of E.o. against acute necrotising pancreatitis in dogs. Pancreatitis was induced by injecting a mixture of trypsin, bile and blood into the duodenal opening of the pancreatic duct. Twenty eight dogs were divided into 4 groups (n = 6-8 each): GpI--control, GpII--acute pancreatitis, GpIII--sham-operated, GpIV--pretreatment with 28 mg E.o./kg/day for 15 days before inducing pancreatitis. Serum amylase increased from 541.99 +/- 129.13 IU/ml to 1592.63 +/- 327.83 IU (p <0.02) 2 hrs after the induction of pancreatitis in GpII. The rise in serum amylase in both GpIII and GpIV was not significant. On light microscopic examination, acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group as compared to GpII. Electron microscopy confirmed this and showed an increased amount of smooth endoplasmic reticulum and small, condensed granules embedded in a vacuole. More studies are needed to explore the clinical potential of E.o. and its mechanism of action.

Aquatic vegetation and their natural hospitability to the immatures of Mansonia mosquitos, the vectors of Brugia malayi in Shertallai, Kerala, India.

Prevalence of various aquatic vegetation and their role in supporting vector breeding were studied by drawing plant samples from natural fresh water habitats in Shertallai region which is endemic for Brugia malayi. As many as 30 aquatic plant species were identified in addition to the most abundant and preferred host plants such as Pistia stratiotes, Salvinia molesta and Eichhornia crassipes which are of major concern due to their contribution for vector proliferation. Fallow lands and paddy fields recorded relatively a higher number of plant species. Natural breeding of Mansonia, the vector mosquitos was observed in 16 of them. Using the data on the prevalence, proportion of samples positive for Mansonia breeding and immature density, two indices viz, natural hospitability Index (NH) and Mansonia host plant Index (MHI) were developed for each plant species. Ranking of these plants in relation to Mansonia breeding was done based on these indices. Monochoria vaginalis has been identified to be one of the most important auxiliary host plant. Three grasses viz, Hygrorhiza aristata, Sacciolepis interrupta and Leersia hexandra were found to support all the three species of Mansonia viz, Ma. annulifera, Ma. uniformis and Ma. indiana with considerable immature density. The inclusion of these plants for weed/vector control is emphasized.

Observation on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid

Investigations were carried out on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid. This gregarious female parasitoid infected and or oviposited in only one host and caused 100 por cento mortality of the infected host. However, increase in parasitoid density decreased the progeny production and influenced the sex ratio. The progenies produced were male biased. When host preference was tested by offering oothecae of different species of cockroaches, T. hagenowii showed a predilection towards the oothecae of P. americana, suggestings its host specificity.

Ultrastructural changes in mild gastroesophageal reflux disease: results of a pilot study.

Few studies have examined the ultrastructural changes in mild reflux esophagitis. Endoscopic esophageal biopsies were obtained from 10 patients with reflux symptoms and mild endoscopic esophagitis (grade 0:3 patients, grade I: 7 patients) and 9 patients with erosive esophagitis (grade II-IV), at least 5 cm above the Z line. The biopsies were evaluated by light and transmission electron microscopy. Ultrastructural changes were present in one patient with grade 0, 7 with grade I and 9 with grade II-IV esophagitis. Four of the 10 patients with grade 0-I esophagitis and 6 of 9 with grade II-IV esophagitis had light microscopic abnormalities. The ultrastructural abnormalities in patients with mild esophagitis were seen in the cell membrane, cytoplasmic organelles, desmosomes, and nuclei of all the three layers of esophageal mucosa and the basal lamina. Ultrastructural studies by transmission electron microscopy on endoscopic pinch biopsies may be a sensitive research tool to study the pathogenesis of mild reflux esophagitis.

Observation on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid.

Investigations were carried out on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid. This gregarious female parasitoid infected and or oviposited in only one host and caused 100% mortality of the infected host. However, increase in parasitoid density decreased the progeny production and influenced the sex ratio. The progenies produced were male biased. When host preference was tested by offering oothecae of different species of cockroaches. T. hagenowii showed a predilection towards the oothecae of P. americana, suggesting its host specificity.

Relative potency of DEPA as a repellent against the sandfly Phlebotomus papatasi.

The insect repellent N,N-diethylphenylacetamide (DEPA) was compared with two commercial repellents, N,N-diethyl-m-toluamide (DEET) and dimethyl phthalate (DMP), for protection against 3-day-old unfed females of the sandfly Phlebotomus papatasi (Scopoli) under laboratory conditions, using host rabbits. Both DEPA and DEET were found to be more effective than DMP, but there was no significant difference between the efficacy of DEPA and DEET.

Laboratory observations on the biology of the phlebotomid sandfly, Phlebotomus papatasi (Scopoli, 1786).

Investigations on the biology of Phlebotomus papatasi were carried out under laboratory conditions at 28 +/- 2 degrees C and 80 +/- 1% RH. Fecundity of the female varied between 61 and 48 (mean 56.2 +/- 5.46) and the incubation period of eggs ranged from 7-9 (mean 7.81 +/- 0.61) days. The developmental duration of larvae and pupae varied from 24 to 31 (mean 28.57 +/- 2.71) and 9 to 11 (mean 10.38 +/- 1.51) days, respectively. The rate of insemination, determined from the females that laid fertile eggs, was found to be maximum when the females were three days old. Autogeny was observed from female sandflies, emerged from the larvae fed on animal liver powder. The duration of first and second gonotrophic cycles under ambient conditions was shortest in summer and longest in winter. Studies on adult longevity showed that the females fed on mouse blood survived for 6 to 27 days (mean 14 +/- 12.5 days).