Oral manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome and their correlation to cluster of differentiation lymphocyte count in population of North-East India in highly active antiretroviral therapy era.

BACKGROUND: The human immunodeficiency virus (HIV) infection which manifests as acquired immunodeficiency syndrome (AIDS) is a disease involving the defects of the T-lymphocyte arm of the immune system. Certain laboratory parameters such as the cluster of differentiation (CD4) count and clinical parameters have long been used as markers of disease progression. In industrialized countries, many studies show a highly correlation between the incidence of oral lesions and immunosuppression and hence, can be used as a marker of immunosuppression. This might not be applicable to a developing country like India. In this study, efforts have been made to supplement the present knowledge on various aspects of oral manifestations in HIV patients in the Indian subcontinent. AIMS: To correlate the oral manifestations in HIV/AIDS patients to the level of circulating CD4+ T-lymphocyte count and their effect in anti-retroviral therapy (ART). SUBJECTS AND METHODS: A total of 104 HIV positive patients were examined for oral lesions. The CD4 count estimated on the same day by fluorescent activated cell sort count machine was then correlated with various oral lesions. RESULTS: Oral manifestations appeared when CD4 count decreased below 500 cells/mm3. Moreover, oral lesions found at different stages showed very strong correlation to their respective CD4 count. Furthermore, there was considerable decline in the incidence of oral manifestations in patients undergoing highly active ART. CONCLUSIONS: Oral manifestations are highly predictive markers of severe immune deterioration and disease progression in HIV patients.

Information Education and Communication can Improve Adherence to Artemether-Lumefantrine Combination in Patients of Uncomplicated Falciparum Malaria.

BACKGROUND: Early diagnosis and prompt treatment with Artemisinin combination therapy (ACT) is vital to improve mortality in Falciparum Malaria. Information education and communication (IEC) is a strong tool that can improve drug adherence. AIM: To explore if IEC in the form of designed drug bags with verbal communication can improve ACT adherence in Falciparum Malaria patients. MATERIALS AND METHODS: A prospective, interventional, controlled study was conducted in OPD patients of both SCB Medical college, Cuttack and district headquarter hospital Cuttack district of Odisha. IEC material in the form of well designed drug bag and verbal communication was used for intervention. Control group received ACT combinations but were not given IEC. RESULTS: Adherence to IEC was significantly higher (81%) in patients receiving IEC compared to controlled patients not receiving IEC. Educational status and the geographical area of the patient were found out to affect adherence to IEC to a significant extent. CONCLUSION: IEC in the form of designed drug bags, supplemented by verbal communication can improve ACT adherence in Falciparum Malaria.

An outbreak of Japanese encephalitis after two decades in Odisha, India.

Sudden deaths in children due to acute encephalitis syndrome (AES) from a tribal dominated district of Malkangiri in Odisha, India, was reported during September-November, 2012. The investigation was carried out to search for the possible viral aetiology that caused this outbreak. Clinico-epidemiological survey and seromolecular investigation were carried out to confirm the viral aetiology. Two hundred seventy two suspected cases with 24 deaths were observed. The patients presented with low to moderate grade fever (87%), headache (43%), vomiting (27%), cold (18%), cough (17%), body ache (15%), joint pain (15%), rash (15%), abdomen pain (9%), lethargy (5%), altered sensorium (8%), convulsion (2%), diarrhoea (3%), and haematemesis (3%). Laboratory investigation showed Japanese encephalitis virus (JEV) IgM in 13.8 per cent (13/94) in blood samples and JEV RNA in one of two cerebrospinal fluid (CSF) samples. Paddy fields close to the houses, high pig to cattle ratio, high density (33 per man hour density) of Culex vishnui mosquitoes, low socio-economic status and low health awareness in the tribal population were observed. This report confirmed the outbreak of JEV infection in Odisha after two decades.

Anopheles culicifacies sibling species in Odisha, eastern India: First appearance of Anopheles culicifacies E and its vectorial role in malaria transmission.

OBJECTIVE: To identify the Anopheles culicifacies sibling species complex and study their vectorial role in malaria endemic regions of Odisha. METHODS: Mosquitoes were collected from 6 malaria endemic districts using standard entomological collection methods. An. culicifacies sibling species were identified by multiplex polymerase chain reaction (PCR) using cytochrome oxidase subunit II (COII) region of mitochondrial DNA. Plasmodium falciparum (Pf) sporozoite rate and human blood fed percentage (HBF) were estimated by PCR using Pf- and human-specific primers. Sequencing and phylogenetic analysis were performed to confirm the type of sibling species of An. culicifacies found in Odisha. RESULTS: Multiplex PCR detected An. culicifacies sibling species A, B, C, D and E in the malaria endemic regions of Odisha. An. culicifacies E was detected for the first time in Odisha, which was further confirmed by molecular phylogenetics. Highest sporozoite rate and HBF percentage were observed in An. culicifacies E in comparison with other sibling species. An. culicifacies E collected from Nawarangapur, Nuapara and Keonjhar district showed high HBF percentage and sporozoite rates. CONCLUSION: An. culicifacies B was the most abundant species, followed by An. culicifacies C and E. High sporozoite rate and HBF of An. culicifacies E indicated that it plays an important role in malaria transmission in Odisha. Appropriate control measures against An. culicifacies E at an early stage are needed to prevent further malaria transmission in Odisha.

Development and evaluation of a single-step multiplex PCR to differentiate the aquatic stages of morphologically similar Aedes (subgenus: Stegomyia) species.

OBJECTIVE: To develop a single-step multiplex PCR to differentiate the aquatic stages of Aedes aegypti, Aedes albopictus and Aedes vittatus collected from different breeding spots in arbovirus endemic/epidemic areas and to detect the most abundant species by the multiplex PCR. METHODS: Aquatic stages of different mosquito species were sampled by inspecting artificial and natural breeding sites in domestic and peridomestic areas. DNA was isolated from different stages of the three Aedes species. Using novel primers based on 18S rDNA sequence, a single-step multiplex PCR was developed to clearly distinguish the three Aedes species. It was then evaluated in the aquatic stages of Aedes species collected from different areas. RESULTS: A total of 1150 aquatic stages were collected from 294 breeding spots, of which 156 contained Aedes species. Discarded tires were the major breeding spots of Aedes species. The aquatic stages were clustered into 230 pools; Ae. albopictus was detected in the largest number of pools, followed by Ae. aegypti and Ae. vittatus. CONCLUSIONS: The Multiplex PCR clearly differentiated the aquatic stages of the three Aedes species and detected that Ae. albopictus was most profuse in different breeding spots surveyed, hence indicating to be the main vector in this region. So control measures can be designed against Ae. albopictus at an early stage to prevent any arboviral outbreak. This method is a convenient tool for precise identification of Aedes vectors during entomological surveys in arbovirus endemic/epidemic areas where several species coexist.

Emergence of chikungunya virus infection in Orissa, India.

From September through October 2006, an unknown disease characterized by acute onset of fever, joint pain with or without swelling, and maculopapular rash along with fatigue was reported from three villages of Cuttack and one village of Kendrapara district of Orissa, India, by the State Health Department. Upon learning this, a team from Regional Medical Research Centre (Indian Council of Medical Research), Bhubaneswar, Orissa, conducted an epidemiological investigation in the area. Household survey was carried out and clinical examination of the symptomatic individuals (n = 1289: Kendrapara, 752; Cuttack, 537) undertaken. Based on the recorded chikungunya (CHIK) fever symptoms, a vector-borne viral disease was considered for provisional diagnosis. Blood samples were collected from 217 symptomatic individuals; to confirm the diagnosis, sera were tested for anti-CHIK antibody (immunoglobulin M), which revealed 63% (64/101) and 40% (47/116) seropositivity in the samples from Kendrapara and Cuttack district, respectively. The illness was managed with analgesics like paracetamol. No death was recorded due to the illness. Entomological survey in the areas revealed the presence of Aedes mosquitoes: aegypti, albopictus, and vittatus. The per-man-hour density of Aedes vectors ranged from 0.8 to 7.6. High larval indices, house index >17% and Breteau index >70%, also indicated Aedes breeding in the area. The investigation documented circulation of CHIK in Orissa, India, and helped to take preventive steps in the outbreak area, with the suggested vector control measures.

Multiplex PCR assay for the detection of Anopheles fluviatilis species complex, human host preference, and Plasmodium falciparum sporozoite presence, using a unique mosquito processing method.

A multiplex PCR assay has been developed for detection of Anopheles fluviatilis cryptic species, their human host preference, and Plasmodium falciparum presence in the mosquito. PCR conditions were optimized using primer sets specific for A. fluviatilis cryptic species, Homo sapiens, and P. falciparum and evaluated with field-collected mosquitoes. A unique mosquito processing method was used for screening P. falciparum carrying capacity and human host preference of A. fluviatilis mosquitoes in first-round multiplex PCR. The vectorial status of the mosquito for P. falciparum parasite was confirmed in second-round PCR. Of the 121 collected mosquitoes, 92 were of S type, 26 of T type, and 3 were of other types. Human host preference was dominant in S type, of which 4% were P. falciparum sporozoite positive. This assay and processing method can also be used to evaluate vector competence of other anophelines.