Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis.

Enterobius vermicularis infection remains one of the most common parasitic infections, particularly prevalent in children. Enterobiasis, although not usually dangerous, may cause significant morbidity. Elimination of the parasite from a family or an institution often poses problems, either because of an incomplete cure or re-infection. While there have been limited reports of ectopic enterobiasis throughout the world, ours is probably one of the rarest reports of recurrent vaginal E. vermicularis infection in the absence of any gastrointestinal symptoms despite complete treatment. A 4-year-old girl presented with recurrent episodes of vulval itching on 3-4 occasions over 2 years. There was no pruritis ani nor urinary/gastrointestinal complaints. The vulva was inflamed with 4-5 living worms, 6-7 mm in length, emerging from the anterior vaginal fornix, but with no vaginal discharge. Direct microscopic examination of vaginal swabs revealed adult worms of Enterobius but no eggs. Repeated stool samples from the patient, parents and a sibling were negative. The patient was treated orally with 100 mg of mebendazole for 3 days followed by two more courses at 3-week intervals over a period of 3 months. Recurrent vaginal enterobiasis despite complete treatment and in the absence of any gastrointestinal involvement suggests that the vagina is a potential reservoir for E. vermicularis, which supports the theory of rare ectopic enterobiasis through the ascending pathway of the female genital tract.

Evaluation of quantitative buffy coat (QBC) assay and polymerase chain reaction (PCR) for diagnosis of malaria.

A prospective study was undertaken to compare the Polymerase Chain Reaction (PCR) and Quantitative Buffy Coat (QBC) assay with conventional Giemsa technique for diagnosis of malaria. A total of 104 samples were taken for the purpose. They comprised of fever cases suggestive of malaria (n=74) and control group, fever cases other than malaria (n=30). Peripheral blood smears were prepared by Giemsa staining and QBC assay was performed as per standard protocol. From the stored blood samples, parasite DNA was extracted and PCR was performed using P. falciparum and P. vivax specific sets of primers. The QBC assay was 100% in agreement with the Giemsa stain. Specificity of the PCR detection of P. falciparum parasites was 100%. However, sensitivity for detection of P. falciparum and P. vivax by PCR was 64.28% and 82.35% respectively. In mixed cases of malaria (n=2), PCR results were in 100% agreement with that of Giemsa. The lower sensitivity of PCR for P. falciparum could probably be due to inaccessibility of target DNA, presence of PCR inhibitors in samples and parasite strain variations.

Isosporiasis in children.

The clinical, laboratory and therapeutic data of patients with diarrhea in Human immunodeficiency virus (HIV) antibody positive, immunocompromised and immunocompetent individuals were studied especially to look for prevalence of intestinal coccidiosis. During a study period of one decade, Isospora belli were identified in the stool samples of seven children with diarrhea. Diarrhea persisted for a little longer period in HIV-seropositive children compared to sero-negatives but the clinical picture did not differ significantly in either HIV infected or HIV uninfected individuals.

Plasmodium ovale malaria in Delhi.

A case of ovale malaria in a child from Delhi is reported. Urban malaria ecotypes caused by P. ovale has never been seen before. Characteristic morphological features of the parasite in stained blood film confirmed its identification.

Quantitative buffy coat: a special adjunct for diagnosis of malaria.

Quantitative buffy coats (QBC) technique was compared with conventional blood film technique for the diagnosis of malaria in a tertiary care hospital. The QBC technique was found to be a rapid technique with a sensitivity of 83% and specificity of 94%. Malaria species identification was also possible. It was essentially very useful to detect parasites below < or = 100 parasites/ul of blood by QBC technique. However, quantification of parasitaemia could not be made using this technique. Many cases of carriers having very few gametocytes in their blood were also identified. It is therefore, concluded that the QBC technique, may be appropriate for screening populations for malaria and for detection of asymptomatic carriers to control further transmission of the disease in the community.

Bone marrow examination for identifying malaria in fever of unknown origin.

To determine the utility of bone marrow examination for the diagnosis of malaria in patients with persistent fever for prolonged duration, we prospectively studied individuals undergoing diagnostic bone marrow examinations between January 1992 to December 1996. All marrow examinations of patients were examined microbiologically and resulted in diagnosis of malaria in 6.6% of the total patients studied. No case of bacterial, mycobacterial or fungal infection was diagnosed. The diagnostic efficacy of bone marrow for evidence of malaria was very useful in febrile individuals for whom the diagnosis was otherwise unknown.

Trichuris vulpis infection in slum children.

Trichuris vulpis was identified in two children from urban slums. Both of them had nonspecific abdominal pain and one had episodes of diarrhea. Clinical recovery was good after treatment with mebendazole.

Acute clonorchiasis in a child.

Clonorchiasis usually presents with chronic gastrointestinal disturbances or cholangiocarcinoma. We describe a rare acute presentation of clonorchiasis in a child with diarrhea and liver abscess.

Vector potential of hospital houseflies with special reference to Klebsiella species.

The vector potential of houseflies (Musca domestica) for Klebsiella spp. was investigated. Klebsiella spp. (mostly Klebsiella pneumoniae) were isolated from 36.7% of hospital flies and 28.1% of infected wounds of patients. Antibiograms of Klebsiella spp. showed that 82.0% of isolates from hospital flies and 96.3% from infected wounds were resistant to four or more commonly used antimicrobials. In contrast, from the control group, only 8.7% klebsiella isolates showed similar antimicrobial resistance pattern (P less than 0.001). Similar strains of Klebsiella spp. were encountered among patients and hospital houseflies. The results indicate that flies in the hospital environs are potential vectors of hospital resistant strains of Klebsiella spp.

Nosocomial infections: cockroaches as possible vectors of drug-resistant Klebsiella.

The possibility that hospital cockroaches may act as vectors of drug-resistant Klebsiella spp. was investigated during Nov 1985 to April 1989, at the All India Institute of Medical Sciences (AIIMS) hospital. Klebsiella spp. (majority Klebsiella pneumoniae) were isolated from 28.3% of hospital cockroaches and 28.1% of infected wounds of patients. Most of Klebsiella isolates from patients (96.3%), and hospital cockroaches (85.9%) showed multiple drug resistance to four or more antimicrobials. Similar strains of Klebsiella spp. were encountered among patients and hospital cockroaches. These findings suggest that hospital cockroaches may act as vectors of drug-resistant Klebsiella spp. and may contribute to the epidemiology of nosocomial infections.

Effect of giardia infection on nutritional status of preschool children.

Nutritional status of 34 children aged 24-72 months and infected with giardia was compared with that of 92 children matched for age, sex and income and 34 children matched for age, sex, income as well as birth order. Children without giardiasis were found to have better nutritional status in both comparisons. The difference was more pronounced in the second instance. Of the seven anthropometric parameters used for comparison, four were significantly lower (weight, weight for age, midarm circumference and midarm circumference for age), while two (height for age and weight for height) showed nonsignificant childhood malnutrition and that matching for birth order enhances the utility of case-control studies in children.

Cockroaches as vectors of pathogenic bacteria.

One hundred and thirty two cockroaches of species Blattella germanica--96 from hospital ward (test group) and 36 from residential areas (control group) were caught during Nov. 1985 to Nov. 1986. A variety of pathogenic and non-pathogenic bacteria were isolated from test and control group of insects. Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus faecalis, and Micrococci were isolated only from the test group of cockroaches. A high percentage (98.95 per cent) of test cockroaches were found to be carriers of various microorganisms as compared to the control group (80.55 per cent), the difference being statistically significant (p less than 0.001). Quantitative analysis in this study revealed that higher number of microorganisms are carried by test group of insects in the hospital environment. This, thereby suggests that these insects can play an important role in the etiology of hospital acquired infections.