Typhoid hepatitis: report of two cases.

Early appearance of clinical jaundice is rare presentation in enteric fever. Although abnormal biochemical tests suggestive of hepatic involvement has already been suggested in 23-60 per cent of cases. The early hepatic changes have been attributed to generalised bacteraemia, persistence of hepatomegaly and hepatic lesion during pyrexial stage. But the typhoid hepatitis has been ignored as a clinical entity. In this report the importance of typhoid hepatitis and its clinical significance for the diagnosis of enteric fever is highlighted, particularly at places where viral hepatitis and hepatic amoebiasis are usually common and enteric fever is endemic.

Problems and prospects of a traditional source of potable water in hilly terrains.

During epidemic investigation, water sources were tested for quality for drinking purpose. Out of 30 khatris tested, water of 86.7% khatris was fit for human consumption and fecal coliform was not found in any of them. Modification of these khatris was stressed by respondents.

Seroprevalence of HIV antibodies, Australia antigen and VDRL reactivity in Himachal Pradesh.

3000 subjects from four high risk groups--patients attending STD clinics, hospital personnel, blood donors and foreign nationals were screened for the presence of HIV antibodies HBsAg and VDRL reactivity. No evidence of HIV infection was found in Himachiali population. However, there of the 150 foreign nationals screened were found positive for HIV antibodies. Overall HBsAg positivity and VDRL reactivity was found to be 5.53 per cent and 9.07 per cent respectively. The importance of circumspected and unswerving machinery for the surveillance of HIV antibodies in the high risk population of the state is emphasised.

PIP: Between September 1987 and September 1990, health workers in Himachal Pradesh State in India collected serum samples from 1305 patients at sexually transmitted disease (STD) clinics, 1274 blood donors, 271 hospital staff handling blood products, and 150 foreigners to screen high-risk populations for reactivity to HIV, hepatitis B virus (HBV), and syphilis. Most of the samples were from males (2373 males vs. 626 females and 1 eunuch). None of the cases from India tested HIV positive, while 3 foreign national cases did. 2 of the foreign nationals were Canadian and the other was Kenyan. 2 foreigners tested positive for both HBV and HIV. Overall, 5.53% tested positive for HBV and 9.07% for syphilis. 9.4% of the Indian individuals tested positive for syphilis, which was higher than an earlier study in Himachal Pradesh. Most people who tested positive for HBV and syphilis were 21-30 years old. 2.14% of the STD patients tested positive for syphilis and HBV, while only 0.37% of hospital personnel. 0.67% of foreigners, and none of the blood donors did. STD patients also had the highest percentage of syphilis-positive (19.69%) and HBV-positive results (8.73%). HBV-positive incidence was about 3 times greater in people who also tested positive for syphilis. Since reactivity to syphilis was associated with poverty, poor hygiene, polyandry, polygamy, and illiteracy, citizens living in Himachal Pradesh were at great risk of acquiring HIV from a foreigner. Therefore, the microbiologists who examined these samples recommended more intensive and continuous screening of high-risk populations in Himachal Pradesh.

Intestinal parasitism in Himachal Pradesh.

A total of 1629 cases were included in the study for the presence of intestinal parasites during 12 mobile camps in different areas of Himachal Pradesh. 47.08% were positive for parasites. The prevalence rate of helminthic parasites was 32.41% and that of protozoal parasites was 20.81%. The parasitic prevalence has been discussed in the light of peculiar geographical situation of the area.

Seroprevalence of HIV infection in Himachal Pradesh.

Serum samples from 2645 individuals representing all the twelve districts of Himachal Pradesh were screened for antibodies to Human immunodeficiency virus (HIV), employing ELISA test. These were categorised into four major high risk groups, viz, patients attending STD clinics (1305), voluntary blood donors (1012), hospital staff dealing with blood and blood products (200) and foreign nationals (128). No evidence of HIV infection was found in Himachali population. Two foreign nationals were repeatedly found positive for HIV antibodies by ELISA test and these were confirmed by Western Blot technique.

PIP: Between November 1986-March 1990, microbiologists from the Indira Gandhi Medical College in Shimla in Himachal Pradesh, India used the ELISA technique to test 2645 serum samples for HIV. HIV positive samples were confirmed with the Western Blot technique. The samples were classified into 4 groups: individuals at sexually transmitted disease clinics, voluntary blood donors, hospital staff who handle blood and blood products, and foreign nationals. 77% were males. 1 individual sampled was a eunuch. Only 2 people tested positive for HIV. Both were male Canadians. 1 was a heterosexual with multiple partners and had been in Africa, China, France, Nepal, and Tibet. He went to the outpatient department of the Indira Gandhi Hospital in Shimla with a 4 month history of bloody diarrhea. Hospital staff found lymphadenopathy and consolidation of the right paracardiac border. The 2nd HIV positive foreign national presented at the District Hospital in Kullu with loss of appetite and weight. He later developed persistent diarrhea. Clinicians had earlier diagnosed cancer of the stomach, gross malnutrition, and peripheral neuropathy. Hospital staff did not follow up on these 2 Canadians. Even though none of the people from Himachal Pradesh tested positive for HIV, the fact that 2 foreign tourists were HIV positive poses a potential threat for the spread of HIV among these people. Other studies has shown the HIV infection has indeed been introduced in India from foreign nationals from USA, Canada, Germany, and Africa.

Incidence of australia antigen (HBs Ag) in Himachal Pradesh.

2405 high risk subjects (1193 patients attending STD clinics, 1012 blood donors and 200 hospital personnel) and 500 apparently healthy individuals representing all the twelve districts of the State of Himachal Pradesh were screened for HBs Ag employing reverse passive haemagglutination (RPHA) technique. HBs Ag positivity was found to be 6.77 per cent in test groups and 3.6 per cent in the control group. Maximum positivity was found in STD patients (9.55 per cent) followed by hospital personnel (8 per cent) and blood donors (3.26 per cent). The highest incidence was noticed in district Kullu and no positive case was found in Lahaul and Spiti district of Himachal Pradesh. Remedial measures for prevention of Hepatitis-B virus infection have been emphasized.