Anaemia & expression levels of CD35, CD55 & CD59 on red blood cells in Plasmodium falciparum malaria patients from India.

BACKGROUND & OBJECTIVES: Severe anaemia in Plasmodium falciparum (Pf) associated malaria is a leading cause of death despite low levels of parasitaemia. In an effort to understand the pathogenesis of anaemia we studied expression level of RBC complement regulatory proteins, CR1 (CD35), CD55 and CD59 with haemoglobin status in a group of malaria cases from Assam, Goa and Chennai, and in healthy controls. METHODS: Flowcytometry was used to study expression of CR1, CD55 and CD59 in 50 Pf cases and 30 normal healthy volunteers. Giemsa stained thick and thin blood films were used for microscopic detection and identification of malarial parasites and parasite count. RESULTS: No correlation was found between degree of expression of RBC surface receptors CR1, CD55 and CD59 with haemoglobin level. However, expression of CD55 was less in malaria cases than in healthy controls. INTERPRETATION & CONCLUSIONS: The present findings indicate that malaria infection changes the expression profile of complement regulatory protein CD55 irrespective of severity status of anaemia. Further studies are needed to explore the pathophysiology of anaemia in malaria cases in Assam where expression of RBC complement receptors appears to be low even in normal healthy population.

A randomized trial comparing the efficacy of four treatment regimens for uncomplicated falciparum malaria in Assam state, India.

A four-arm drug sensitivity study compared chloroquine, sulfadoxine-pyrimethamine (SP), mefloquine and mefloquine-artesunate in Sonitpur and Karbi Anglong districts in Assam state, India. Two criteria were used to ascertain outcome: success of clinical treatment and parasitologic cure. In Sonitpur, at 14 days, there were 36/56 early and late treatment failures plus late parasitologic failures to chloroquine and 16/56 for SP. In Karbi Anglong, combined treatment failure at 14 days was 16/56 to chloroquine and 8/60 to SP. Mefloquine and mefloquine-artesunate demonstrated 93.9% and 93.6% sustained responses respectively at 42 days. High failure rates to both chloroquine and SP preclude the use of these drugs as first-line treatment for uncomplicated falciparum malaria in this region. A mefloquine-artesunate combination presents an effective alternative utilizing the currently recommended higher dose of mefloquine.

Prevalence of Trichuris trichiura in relation to socio-economic & behavioural determinants of exposure to infection in rural Assam.

BACKGROUND & OBJECTIVES: Stunting, anaemia, and the poor level of mental development are known to be associated with Trichuris trichiura infections. However, no information is available on the socio-environmental predictors relevant to Trichuris infection in rural communities. Whilst geohelminthic infections per se is an inevitable consequence of poor personal hygiene and household sanitation, the importance of specific factors in the epidemiology of Trichuris infection have not been formally investigated. The objective of this study was to explore, quantify and study different socio-environmental risk factors and find out their possible interaction vis-a-vis T. trichiura infection. METHODS: The study population consisted of 244 children (aged 15 yr and below) and 336 adults selected from 144 randomly selected households belonging to three villages of upper Assam. The prevalence rate ratio (PRR; = relative risk) and 95 per cent confidence interval (CI) were calculated. Univariate, multivariate analysis using Cox's proportional hazards regression assuming constant risk period and a tree-based risk factor analysis, were used. RESULTS: In the overall multivariate model, open field defaecation, large family size, and three or more children in the household were found independently associated with Trichuris infection. Gender specific analysis revealed that in females the age was also independently associated with increased risk of infection whereas in males, earth flooring was the most significant risk factor independently associated with the risk of Trichuris infection. Tree-based risk factor analysis indicated interaction between defaecating habits of people and the source of drinking water. INTERPRETATION & CONCLUSIONS: Installation of pit latrines (if not sanitary latrines) together with provision for safe drinking water and the construction of cement floors would probably reduce community prevalence of T. trichiura effectively.

Hypertension and its risk factors in tea garden workers of Assam.

BACKGROUND: Hypertension is emerging as a major public health problem in India. The diversity and heterogeneity of distribution of the population makes it difficult to arrive at the precise prevalence. In Assam, reports from hospitals in tea gardens reveal a high prevalence of hypertension among workers in tea gardens. However, no systematic study has been carried out in this population. METHODS: We selected, by systematic sampling, 1015 individuals (512 men and 503 women) 30 years or more in age, who were interviewed and clinically examined for hypertension. Blood pressure of all the study participants was measured using a standardized technique. Crude and adjusted odds ratios were estimated by unconditional simple and multiple logistic regression analyses. Mantel-Haenszel chi2 analysis was also used to test for the association of potential risk factors with hypertension after controlling for co-variables in a stratified analysis. Risk factors considered for hypertension included age, gender, marital status, occupation, alcohol consumption (locally prepared), extra salt intake, smoking history, khaini (a form of tobacco quid containing a mixture of tobacco and lime) intake, body mass index and waist-hip ratio. RESULTS: The overall prevalence of hypertension was 60.8%. Increasing age, consumption of locally prepared alcohol, intake of extra salt in food and beverages and the habit of taking khaini were found to increase the risk of hypertension. Multivariate logistic regression models showed that the independent determinants of hypertension were age, gender, consumption of locally prepared alcohol and intake of extra salt. Gender-specific and age-stratified analyses showed the association of increased risk with intake of khaini in women only, while consumption of locally prepared alcohol was an important risk factor for hypertension in both men and women. CONCLUSION: The disease burden of hypertension among workers in tea gardens is large, despite the community not being obese. Interventions directed at these workers as well as studies to determine the reasons for the high prevalence of hypertension are required.

Risk factors for cancer nasopharynx: a case-control study from Nagaland, India.

BACKGROUND: A high incidence of nasopharyngeal carcinoma has been reported from Nagaland, though it is considered to be a rare neoplasm in India. No case-control study to identify the risk factors of cancer nasopharynx has been conducted in this region. This study was undertaken to identify dietary and environmental risk factors for nasopharyngeal carcinoma relevant to this region. METHODS: A matched case-control study using neighbourhood controls was conducted. For each of the 47 cases identified, 2 apparently healthy neighbourhood controls were matched for age, sex and ethnicity. All information on dietary, environmental, social and demographic factors was collected. Univariate and multivariate logistic regression analysis using maximum likelihood method was used to analyse data. RESULTS: Consumption of smoked meat was found to be the risk factor for nasopharyngeal carcinoma (adjusted odds ratio = 10.8; 95% CI 3.0-39.0). History of using herbal nasal medicine was also found to be associated with nasopharyngeal carcinoma (OR = 21.9, CI = 6.8-71.4). However, exposure to a smoky atmosphere, betel-nut chewing, use of smokeless tobacco products, smoking and drinking habits were not found to be associated with nasopharyngeal carcinoma. CONCLUSION: This study reveals an association of nasopharyngeal carcinoma with consumption of smoked meat in Nagaland. The use of herbal nasal medicine seems to be an additional risk factor for nasopharyngeal carcinoma in Nagaland and needs further assessment.

Risk factors of malaria in the fringes of an evergreen monsoon forest of Arunachal Pradesh.

BACKGROUND: The forested hilly and foothill regions of north-east India are highly endemic for malaria and have a distinct epidemiological pattern. Nearly half the reported cases of malaria are from these areas. A knowledge of the risk factors in this eco-geographic entity may be helpful in formulating a specific control strategy. Hence, we conducted a community-based epidemiological study in a hilly, forested terrain of Arunachal Pradesh and examined different socio-demographic factors to identify those predisposing to the occurrence of malaria, especially Plasmodium falciparum infection, in such areas. METHODS: Four epidemiological surveys were carried out during 1997 in 7 villages located at the fringes of a forest (total population: 1177) under Nompong Primary Health Centre of Changlang district, Arunachal Pradesh. Blood slides were collected randomly from the inhabitants, irrespective of their fever status, ensuring at least 50% coverage. One hundred and thirty-four microscopically confirmed Plasmodium falciparum cases were identified and 536 controls were randomly selected from the list of uninfected inhabitants. Relevant socio-demographic information was obtained from both cases and controls. The data were analysed by simple and multiple logistic regression using the unconditional maximum likelihood method. RESULTS: Factors which were found to be strongly associated with Plasmodium falciparum malaria on univariate analysis were age, ethnicity, village of residence and accessibility to the nearest health care facility. However, in multiple regression analysis, after controlling for the effects of confounding variables, the only risk factor identified was accessibility to the nearest health care facility (adjusted odds ratio: 4.5; 95% CI: 1.8-11.3; p < 0.0001 for those at a distance of 2-8 km and adjusted odds ratio: 11.1; 95% CI: 4.1-30.0; p < 0.0001 for those > 8 km away). CONCLUSION: Distance, particularly non-motorable distance, from the place of residence to the nearest health care facility was a major risk factor for malaria in this hilly forested terrain. This indicates the need for special efforts to detect cases early and institute treatment promptly in such areas of the north-eastern region, so as to reduce the morbidity and mortality of malaria.

Hypertension in the native rural population of Assam.

BACKGROUND: Recent studies have reported an increasing prevalence of hypertension in India. However, there are few epidemiological data with regard to the occurrence of hypertension in the native population of Assam. METHODS: Three thousand one hundred and eighty individuals (1441 men and 1739 women), > or =30 years of age and from 25 villages of 5 districts in Assam were selected by the stratified random sampling method. They were interviewed and their blood pressure measured along with other anthropometric variables. Hypertension was defined according to the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VI). RESULTS: The overall prevalence of hypertension was 33.3%. Among the patients with hypertension, 21.6% were aware of their illness. The determinants of hypertension were age, intake of extra salt in the diet, body mass index and waist-hip ratio (derived by multiple logistic regression analysis with backward elimination of non-significant factors). Multivariate analysis showed that females had a higher risk of hypertension than males. CONCLUSION: The prevalence of hypertension in the native population of Assam is high. Implementation of an effective awareness programme with lifestyle modifications is necessary to control the cardiovascular disease burden in this population.

Transmission of bancroftian filariasis in tea agro-ecosystem of Assam, India.

Tea industry is a labor intensive agro-industry and filariasis is mostly localized among the tea garden workers in Assam. The workers live inside the gardens in colonies. Studies conducted in two cosecutive years revealed that among the host seeking Culex quinquefasciatus average infection rate was 4.6% and with 2.1 larvae per mosquito. The overall prevalence of infective mosquitos was 0.8% with average L3 load of 2.0 per mosquito. The probability of infected mosquitos surviving to have complete development of filarial larvae (13 days) was 0.17. The expectation of infective life was 1.416 days for man biting Cx. quinquefasciatus and the estimated adult survival rate of was 87.6%. It has been estimated that a total of 22,569 mosquito bites were received/man/year in tea garden environment out of which 182 bites/man/year were infective (0.806%). The monthly biting rate varied from 310-4,758.5 bites per man (mean 1,846 +/- 1,389.7 SD). Monthly transmission index of W. bancrofti filaria showed two periods of transmission. In both the year no infection was detected during February and March and infection rate remained low up to May (average infection in April 0.72% and in May 0.48%).

Cure and reinfection patterns of geohelminthic infections after treatment in communities inhabiting the tropical rainforest of Assam, India.

Mass de-worming targeted at socio-economically poor communities can be considered as an option for communities living in the tropical forests of Assam who do not have access to safe drinking water and proper sanitation, and consequently have a higher risk of suffering from geohelminthic infection and associated morbidity. A random sample of 265 subjects was included in this study (134 males and 131 females). The chemotherapeutic regimen followed was a single dose of albendazole 400 mg. Stools samples were collected in 10% formol-saline for detection of infection before treatment. Post-treatment stool samples were collected 10 to 14 days after treatment to determine the cure rate. Stool samples were again collected 3 to 6 months post-treatment to study the rate of reinfection. Multiple logistic regression was used to find possible associations between age, sex and treatment failure. The chi-square test was used wherever appropriate. The cure rates for Ascaris lumbricoides, Trichuris trichiura and hookworms were 70.8%, 68.7% and 93.0%, respectively. Logistic regression revealed that age was associated with treatment failure in A. lumbricoides infection. Re-infection rates after 3 months of successful treatment were 19.6% for A. lumbricoides, 30.9% for T. trichiura and 11.3% for hookworms. Six months post-treatment, the prevalence of re-infection was highest with T. trichiura (43.6%); followed by A. lumbricoides (35.3%). The rate of reinfection with hookworms was lower (11.3%) six months post-treatment. The rates of re-infection with A. lumbricoides and T. trichiura was higher in children below 15 years of age, compared with adults. Hookworm reinfection was higher in the adult age group (15 to 39 years). The rates of new infection in previously uninfected subjects were lower compared with the rates for re-infection.

Temporal variations in biting density and rhythm of Culex quinquefasciatus in tea agro-ecosystem of Assam, India.

Temporal changes in the biting density and host-seeking periodicity of Culex quinquefasciatus, the vector of bancroftian filariasis, were studied for two years in the tea agro-ecosystem of Assam, India. Average biting density of the vector varied from 0.8/hour in December to 13.3/hour in March. Minimum temperature was found to have a limiting effect on the biting density of the vector mosquitos. Multiple regression analysis showed that the rainfall and minimum temperature were significant factors influencing biting density of this vector mosquito. The biting rhythm of Cx. quinquefasciatus was found to be nocturnal with two distinct peak periods of biting activity. The first peak was around 19.00 to 20.00 hours and the second peak period was around 22.00 to 23.00 hours. Biting activity however was seen throughout the night with declining trend as the night proceeded.

Role of some environmental factors in modulating seasonal abundance of potential Japanese encephalitis vectors in Assam, India.

Temporal changes in the abundance of host-seeking, potential Japanese encephalitis (JE) vector mosquitos and the role of some ecological factors that are modulating the abundance of vector mosquitos were studied. Vector surveillance was conducted for one year in 4 JE prone villages of Dibrugarh, Assam. Among potential JE vectors, the most abundant mosquito was Culex vishnui s.s. comprising about 22.32%. Maximum density of the mosquito was found during the month of April and another peak was observed in the month of September. The influence of meteorological factors on the abundance of JE vectors was found to vary from species to species. The final multiple regression equations (after variables were selected using STEPWISE procedure) consisted of a combination of linear, quadratic, cubic and interactive ecological variables and accounted for 25-98% of the variations in the abundance of JE vector mosquitos. Complex interactions among environmental factors, such as minimum and maximum temperature, rainfall and flood level are involved in modulating the seasonal abundance of mosquitos. A time lag is involved before a cause and effect relationship is established between environmental parameters (independent variables) and entomological variables (dependent variables). Inundation caused by flooding is favorable for mansonioid mosquito species whereas it has an adverse effect on non-mansonioid mosquito species.

Heterophyid eggs in human stool samples in Assam: first report for India.

Two cases from a Muslim family in upper Assam were found to pass trematode eggs morphologically similar to the members of the family Heterophyidae Odhner, 1914. The eggs characteristically yellowish brown in colour, ovoid, have a thick shell and are operculate. They measured 31.5 +/- 2.0 um SD x 22.4 +/- 1.9 um SD with well developed miracidium. This is the first record of human heterophyid infection from India.

Incrimination of Schistosoma spindale as a causative agent of farmer's dermatitis in Assam with a note on liver pathology in mice.

Cercarial dermatitis of paddy field workers in Assam is very common. However, it is not known which species of animal schistosomes, is its causative agent in Assam. Studies in two dermatitis affected villages of Dibrugarh district revealed that cercariae of Schistosoma spindale were involved in its aetiology. Indoplanorbis exustus was the only snail species found infected with apharyngeate brevifurcate schistosome cercarie. Experimental infection of the laboratory animals with the dermatitis causing schistosome cercariae revealed that duckling and chicken were refractory to infection. However, Swiss albino mice were successfully infected. The number of adult flukes per infected mice ranged from 6-321 (mean intensity = 68.1; S.D. = +/- 112.96). Histopathological study of infected mice liver revealed that there was mild inflammation of infected portal triads towards the presence of male flukes in the intra hepatic portal vessels. Kuppffer cells showed hyperplasia and contained large amounts of black pigment. No eggs or egg granulomas were detected in the liver parenchyma. There was no evidence of thrombophlebitis, septal fibrosis or pipe stem fibrosis.

Paddy field dermatitis in Assam: a cercarial dermatitis.

Rice field dermatitis is an occupational health problem in Assam. The afflicted paddy field workers develop exanthema on the exposed parts of their skin mainly legs and arms when they come in contact with water in rice fields. Itching sensations start after 30 minutes to 1 1/2 hours after initial exposure. After 6-12 hours there is intensely pruritic macular eruption and in a few cases secondary skin infection may also develop. The clinical course of the disease is suggestive of cercarial dermatitis. Numerous gastropod snails belonging to families Lymnaeidae, Bulinidae and Planorbidae were collected from paddy fields and were investigated for cercarial infection. It was found that planorbid snails were infected with animal schistosome cercariae. These cercariae were able to invade human skin and caused dermatitis in human volunteers after repeated exposure.

Human distomatosis due to Fasciola hepatica infection in Assam, India.

A seven year old girl in a rural area of Upper Assam was found to be infected with Fasciola hepatica. The girl gave history of eating watercress. Besides the presence of eggs in the stools, her liver was enlarged and tender. Liver function tests revealed hepato-biliary involvement with increase in serum AKP and ALT. Ultrasonography revealed presence of adult fluke in gall bladder, and a marginal thickening of gall bladder wall. However, the echo pattern of her liver parenchyma was normal. The case is reported for its public health significance and is a maiden report from north eastern India.

Biting behaviour and biting rhythm of potential Japanese encephalitis vectors in Assam.

Studies on biting behaviour and biting cycles of medically important mosquitoes were carried out in Madhupur village and Tarajan tea estate of upper Assam. Collections were made off human baits outdoors and indoors and off cattle bait outdoors from August 1991 to July 1992. Human bait collections were performed using the 'stationary direct bait' technique. A total of 9,072 adult host seeking female mosquitoes representing 26 species and 5 genera were collected off baits of which 36.9% were collected off human baits and the rest from cattle. All mosquitoes were primarily zoophilic, although significant numbers were collected biting man outdoors. Biting preferences of important Japanese encephalitis (JE) vectors for man and cattle were studied using outdoor man:outdoor cattle ratio (attraction ratio = AR). Culex quinquefasciatus was attracted towards human baits the most (AR = 8.1:1), followed by Cx. bitaeniorhynchus (AR = 1.6:1) and Mansonia annulifera (AR = 1.3.1). The hourly biting activity of important JE vectors throughout the night on two bait types was also studied using three point moving averages. Hierarchical agglomerative cluster analysis was used to compare and classify mosquitoes on the basis of their similarity in biting rhythms.

Differences in blood pressure level and hypertension in three ethnic groups of northeastern India.

A cross sectional study on hypertension was done on 294 subjects aged 30 years and above. 150 households were selected randomly representing 50 households from each locality inhabited exclusively by the rural Mizos, indigenous rural Assamese and the tea-garden workers respectively, in the northeastern region of India. Blood pressure was measured by sphygmo-manometer in sitting posture. Anthro-pometric measurements were taken using standard procedure for measuring height, weight, waist and hip girth. Information on age, sex, ethnicity, literacy, alcohol intake, smoking pattern, physical activity, occupation, amount of salt consumption was collected using a standard and pre-tested questionnaire. Significant differences were observed in both the systolic and diastolic blood pressure levels among the three different ethnic groups selected for this study (p < 0.0001). Multiple regression analyses indicated that in Mizos, age, waist circumference and alcohol intake were independently associated with increase in systolic blood pressure whereas smoking was found to be negatively associated with systolic blood pressure (R2 = 0.391, p < 0.001). Factors, which were the best predictors of diastolic blood pressure, were age and body mass index [(kg/m2) (R2 = 0.227, p < 0.001)]. In the rural Assamese population, the best predictors of systolic blood pressure were age and waist circumference (R2 = 0.263, p = 0.018). For the diastolic blood pressure, age, alcohol intake and body mass index were important correlates (R2 = 0.131, p < 0.001). In the tea garden community, important predictors of systolic blood pressure were age, gender and marital status (R2 = 0.187, p < 0.001). On the other hand, age and alcohol intake were best predictors for diastolic blood pressure (R2 = 0.09, p < 0.001).

Direct and early detection of Mycobacterium tuberculosis complex and rifampicin resistance from sputum smears.

SETTING: Four district DOTS centres in Sikkim, India. OBJECTIVE: Direct and early detection of Mycobacterium tuberculosis complex and rifampicin (RMP) susceptibility using the INNO-LiPA Rif.TB assay. DESIGN: DNA was extracted from 44 inactivated acid-fast bacilli-positive sputum slides using the Gen Elute bacterial genomic DNA kit. Eluted DNA were ethanol precipitated. The LiPA kit detected RMP susceptibility by detection of mutation in the 81 base pair (bp) rpoB gene. Culture of sputum from the same person was used for drug susceptibility testing for RMP using the proportion method. RESULTS: Amplification of 88.6% (39 slides) was achieved from DNA extracted using kits (66.7% for 1+, 81.8% for 2+ and 100% for 3+ slides). Hybridisation using the LiPA kit was applied to 31 amplified products. There was a concordance of 96.8% (24 RMP-resistant and 6 RMP-susceptible samples) and discordance of 3.2% (one sample resistant using the proportion method and susceptible on LiPA) between LiPA and the proportion method. CONCLUSION: LiPA proved useful on DNA extracted from smear-positive slides. Appropriate treatment regimen could be decided early. Slide smear preparation could replace sputum transport in cetylpyridinium chloride, reducing biohazard and thereby controlling the transmission of multidrug-resistant tuberculosis in the community.