Pulmonary cryptosporidiosis in HIV negative, immunocompromised host.

Cryptosporidia are intestinal spore forming protozoa, which cause intracellular infections, predominantly in the epithelial cells of the intestine. Extra-intestinal infections with Cryptosporidium parvum have been rarely reported. However, a few reports of pulmonary cryptosporidiosis in HIV/AIDS cases have been mentioned in literature. In immunocompromised individuals who do not have HIV-related disease, Cryptosporidiosis has been rarely reported. We present a case of respiratory infection caused by C. parvum. The patient was a 10-year-old child with nephrotic syndrome and was receiving corticosteroids for 6 months. The child had history of low-grade fever, breathlessness and cough with expectoration of 3 months duration. The patient was nonreactive for HIV, and there was no evidence of primary immunodeficiency. Major serum immunoglobulins (IgG, IgA, and IgM) were in normal range. Simultaneous gastrointestinal involvement with C. parvum was observed.

Prevalence of methicillin-resistant Staphylococcus aureus nasopharyngeal carriage in children from urban community at Nagpur.

There has been a rise in the hospital acquired as well as the community acquired Methicillin Resistant Staphylococcus Aures (MRSA) infections in the recent years. We conducted a study to detect colonization rate of staphylococci in the nasopharynx in children and prevalence of MRSA nasopharyngeal carriage in pediatric population. The study included 1300 nasopharyngeal swabs collected from school going children between six to ten years age from Nagpur urban community and inoculated on blood agar for isolation of staphylococci. Isolates were subjected to antimicrobial testing and staphylococcus aureus isolates were also Phage typed at Maulana Azad Medical College, New Delhi. Staphylococci were isolated from nasopharynx of 138 (10.62%) children. Nasopharyngeal carriage of staphylococcus aureus was detected in 7.38% children. Methicillin Resistant Staphylococci constituted 4.16% of the Staphylococcus aureus strains. Colonization rate of MRSA in the pediatric population in the community was detected to be 0.31%. Methicillin Resistant Staphylococcus aureus nasopharyngeal carriage, though not at very high rate, is prevalent in the pediatric population in the community.

Respiratory tract infection due to Arcanobacterium haemolyticum--a case report.

A case of respiratory tract infection due to Arcanobacterium haemolyticum is reported. A female of 26 years presented with cough with expectoration and fever off and on for a duration of six weeks. Mycobacterium tuberculosis and Arcanobacterium haemolyticum were isolated. Arcanobacterium haemolyticum was isolated on three separate occasions.

Protective effect of Bacillus Calmette Guerin (BCG) against leprosy: a population-based case-control study in Nagpur, India.

A population-based pair-matched case-control study was carried out in an urban community, Nagpur, India, to estimate the effectiveness of BCG vaccination in the prevention of leprosy. The study included 212 cases of leprosy (diagnosed by WHO criteria), below the age of 35 years, detected during a leprosy survey conducted by the Government of Maharashtra over a population of 20,03,325. Each case was pair-matched with one neighbourhood control for age, sex and socioeconomic status. A significant protective association between BCG and leprosy was observed (OR = 0.40, 95% CI = 0.23-0.68). The overall vaccine effectiveness (VE) was estimated to be 60% (95% CI = 32-77). The BCG effectiveness against multi-bacillary and paucibacillary leprosy was 72% (95% CI = 35-88) and 45% (95% CI = 3-73), respectively. Vaccine was more effective during the first decade of life, among females and in lower socioeconomic strata. The overall prevented fraction was 39% (95% CI = 16-58). In conclusion, this first ever population-based case control study performed in Central India, identified a beneficial role of BCG vaccination in prevention of leprosy in study population.

Dehydrational crisis from severe diarrhoea and risk of age-related cataract.

A group matched hospital based case-control study of 463 cases and equal number of controls was carried out at Government Medical College and Hospital, Nagpur to evaluate role of severe dehydrational crisis in age-related cataract development. The overall relative risk of age related cataract in relation to dehydrational crisis from severe diarrhoea was estimated to be 3.10 (2.28-4.20). The overall estimates of attributable risk per cent and population attributable risk per cent were calculated to be 0.67 (0.56-0.76) and 0.26 (0.18-0.35) respectively. In conclusion this study identified significant role of dehydrational crisis from severe diarrhoea in cataractogenesis.

A prediction model for moderate or severe dehydration in children with diarrhoea.

A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.

Virulence factors in uropathogenic E. coli.

Escherichia coli isolates from urinary tract infections often exhibit characters different from those isolated from normal faecal samples. Adherence to uroepithelial cells, nature of lipopolysaccharide O antigen and mannose resistant haemagglutination of human erythrocytes are some of the important virulence factors proposed in the pathogenesis of urinary tract infections caused by E. coli. In the present study a total of 100 strains of E. coli isolated from symptomatic cases of urinary tract infections (with significant bacteriuria) were studied for these properties. Faecal isolates of E. coli from adult healthy individuals were also studied as controls. As many as 58 uropathogenic strains showed high affinity for attachment to uroepithelial cells while 28 strains showed adherence at moderate degree. Agglutination of human erythrocytes was induced by as many as 70 uropathogenic strains while in 32 strains haemagglutination was not affected by D-mannose. In control group, adherence was observed in eight strains while 28 strains were haemagglutinating. Of these 28 strains, D-mannose resistant haemagglutination was observed in only one faecal strain. In uropathogenic group O4 was isolated with maximum frequency (12%) followed by O101, O135 and O6.

Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of childhood pulmonary tuberculosis: a case control study in Nagpur, India.

A hospital-based, pair matched, case control study was carried out to estimate the effectiveness of BCG vaccination in the prevention of childhood pulmonary tuberculosis. The study included 126 incident cases of pulmonary tuberculosis (diagnosed by WHO criteria) below/equal the age of 12 years. Each case was pair matched with one control for age, sex, socio-economic status. Controls were selected from subjects attending study hospital for conditions other than tuberculosis and leprosy. The significant protective association between BCG and childhood pulmonary tuberculosis was observed (OR = 0.39, 95% CI = 0.22, 0.68). The overall vaccine effectiveness was 61% (95% CI = 32%, 78%). BCG was nonsignificantly more effective in underfives, among males and in upper-middle socioeconomic strata. The overall prevented fraction was estimated to be 47.53% (95% CI = 21.41%, 67.25%). Results of this study thus demonstrated a moderate effectiveness of BCG vaccination in prevention of childhood pulmonary tuberculosis in a Central India population.

Risk factors and protective factors of pelvic inflammatory disease: a case-control study.

Risk factors and some protective factors for pelvic inflammatory disease (PID) in women were assessed in a case control study. Use of intrauterine device (OR = 3.98, p < 0.0001), sexual activity with multiple partners and younger age (ORs = 3.97, 1.9 and p = 0.0003, 0.0034, respectively), history of previous PID (OR = 4.08, p = 0.004) and history of minor gynecologic operation (OR = 3.07, p = 0.0158) were significant risk factors for PID. Pregnancy was a significant protective factor (OR = 0.25, p = .0074). Sterilisation had a significant protective effect (OR = 0.37, p = 0.0443) on multivariate analysis but not significant on univariate analysis. The results indicated that, almost half of the PID load on the population can be reduced by proper handling of four risk factors namely, use of IUD, sexual activity with multiple partners, history of previous PID and history of minor gynecologic operation (PARP = 0.2146, 0.1101, 0.0824 and 0.0794, respectively).

Effectiveness of bacillus Calmette-Guerin (BCG) vaccination in the prevention of leprosy; a case-finding control study in Nagpur, India.

A hospital-based, pair-matched, casecontrol study was carried out at Government Medical College Hospital in Nagpur in central India to estimate the effectiveness of BCG vaccination in the prevention of leprosy. The study included 314 incidence cases of leprosy [diagnosed by World Health Organization (WHO) criteria] below the age of 32 years. Each case was pair matched with one control for age, sex and socioeconomic status. Controls were selected from subjects attending this hospital for conditions other than tuberculosis and leprosy. A significant protective association between BCG and leprosy was observed (OR 0.29, 95% CI 0.21-0.41). The vaccine effectiveness (VE) was estimated to be 71% (95% CI 59-79). The BCG effectiveness against multibacillary and paucibacillary leprosy was 79% (95% CI 60-89) and 67% (95% CI 45-78), respectively. It was more effective during the first decade of life (VE 74%; 95% CI 38-90), among females (VE 82%; 95% CI 64-90), and in the lower socioeconomic strata (VE 75%; 95% CI 32-92). The prevented fraction was calculated to be 51% (95% CI 38-62). In conclusion, this study has identified a beneficial role of BCG vaccination in the prevention of leprosy in central India.

Effectiveness of Bacillus Calamette Guerin (BCG) vaccination against genital tuberculosis: a case-control study.

A hospital-based pair-matched case-control study was performed at Government Medical College Hospital, Nagpur, to estimate the effectiveness of Bacillus Calmette Guerin (BCG) vaccination against genital tuberculosis. The study included 48 cases of genital tuberculosis in the age group of 21-34 years and an equal number of controls, matched for age and socioeconomic status. The estimates of vaccine effectiveness and prevented fraction were higher for the subjects in the age group of 21-30 years and subjects from middle strata of socioeconomic class. The overall vaccine effectiveness and prevented fraction was estimated to be 75 (38.85-89.79) and 49.99 (17.46-74.55) per cent respectively. Results of this study thus indicate that BCG vaccination is effective against genital tuberculosis.

Study of suspected plague cases for isolation and identification of Yersinia pestis.

A total of 62 suspected patients of plague were investigated for evidence of Yersinia pestis, by blood culture, lymph node aspirate culture, sputum culture, animal inoculation and serology for f1 antibodies against f1 antigen of Yersinia pestis. None of the samples was positive by direct smear examination and culture for Yersinia pestis, as well as for serology. The non positivity of the cultures is discussed.

Effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis: a case-control study.

A hospital-based pair-matched case-control study was carried out at Government Medical College Hospital, Nagpur to estimate the effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis. The study included 92 cases of tuberculous meningitis in the age group of 0-12 years and equal number of controls, matched for age, sex and socio-economic status. The protective effectiveness and prevented fraction were higher for the subjects in the age group of 0-6 years, males and subjects from upper strata of socio-economic class. The overall vaccine effectiveness and prevented fraction were estimated to be 86.54% (70.38-93.88%) and 65.54% (39.22-80.64%) respectively. Results of this study thus indicated that BCG vaccination was highly effective against tuberculous meningitis and played significant role in its prevention, in this population.

Effectiveness of bacillus Calmette Guerin (BCG) vaccination against extra-pulmonary tuberculosis: a case-control study.

A hospital-based pair-matched case-control study was carried out at Govt. Medical College Hospital, Nagpur, to estimate the effectiveness of BCG vaccination against extra-pulmonary tuberculosis. The study included 125 cases of extra-pulmonary tuberculosis in the age group of 0-30 years and 375 tuberculosis free control. Each case was pair matched against three separate controls for age, sex and socioeconomic status. The protective effectiveness and prevented fraction were higher for the subjects in the age group of 0-10 years, males and subjects from middle and upper strata of socio-economic class but it was statistically nonsignificant. The overall vaccine effectiveness and prevented fraction was estimated to be 80.86 (72.68-86.60) and 53.20 (41.97-63.73) per cent respectively. Results of this study thus indicated that BCG vaccination was highly effective against extra-pulmonary tuberculosis and played a significant role in its prevention in this population.

Chlamydia trachomatis in pelvic inflammatory disease.

The prevalence of genital Chlamydia trachomatis infection and some epidemiologic factors associated with it were studied in 273 pelvic inflammatory disease (PID) patients attending Gynaecologic clinic, Government Medical College, Nagpur. For detection of chlamydial antigen Pharmacia Diagnostics Chlamydia EIA test was used. This study revealed an overall positivity rate of 33% for C. trachomatis infection in PID patients. Of the hypothesised risk factors low socioeconomic status, history of sexual contacts with multiple partners and use of intrauterine devices (IUD) were significantly associated with C. trachomatis infections. However, use of oral contraceptives, barrier contraceptives and increasing age were found to be protective factors for C. trachomatis infection. Thus considering the significant contribution of C. trachomatis in etiology of PID and its independent association with some epidemiologic risk factors, extensive epidemiologic measures are recommended for prevention of these infections.

PIP: The prevalence of genital Chlamydia trachomatis infection and some epidemiologic factors associated with it were studied in 273 pelvic inflammatory disease (PID) patients attending the Gynaecologic Clinic, Government Medical College, Nagpur. For the detection of chlamydial antigen, Pharmacia Diagnostics Chlamydia EIA test was used. This study revealed an overall positivity rate of 33% for C. trachomatis infection in PID patients. Of the hypothesized risk factors, low socioeconomic status, history of sexual contacts with multiple partners, and use of IUDs were significantly associated with C. trachomatis infections. However, use of oral contraceptives, barrier contraceptives, and increasing age were found to be protective factors for C. trachomatis infection. Thus, considering the significant contribution of C. trachomatis in etiology of PID and its independent association with some epidemiologic risk factors, extensive epidemiologic measures are recommended for prevention of these infections.