Frequency of Dengue Virus Serotype 1 in Lahore by In-house assay.

Dengue is an important systemic viral infection that is caused by the dengue virus. Ribonucleic acid (RNA) from dengue NS1 positive samples, collected randomly during dengue epidemic from October 2016 to October 2017 at Chugtai Lab, was extracted for nucleic acid. Both the detection and serotyping of dengue samples were performed using real-time PCR on Rotor Gene Q. From the 70 NS1 positive samples, 57 (81.4%) samples were confirmed to be positive for dengue virus RNA, while the remaining 13 (18.6%) were negative. Serotype 1 (DEN-1) was verified among all samples by in-house assay and using commercial kit FTD (Fast Track Diagnostics) dengue differentiation; it was concluded that our in-house assay is in 100% concordance with commercial kit. Serotype 2 (DEN-2) and serotype 3 (DEN-3) have been documented in Pakistan since 1994. But recent detection of serotype 1 in Pakistan is indicative of more severe dengue haemorrhagic fever in future due to reinfection.

Acute Thrombocytopenia, Leucopenia, and Multiorgan Dysfunction: The First Case of SFTS Bunyavirus outside China?

We report a 57-year-old man with acute thrombocytopenia, leucopenia, and multiorgan dysfunction. Patient was from North Korea and was temporarily working in Dubai, United Arab Emirates, when he fell ill in March 2009. At the same time and unknown to us, many patients with similar clinical manifestations were admitted to hospitals in China. The Chinese cases-identified between March and July 2009-were recently reported to have been infected with a tick-born strain of bunyavirus, a new disease. The virus infection was documented in patients from central China and the region that shares the border with North Korea. The clinical manifestations, the time of disease onset, and geographical link of the patient with the region in which the disease is endemic suggest that the patient had SFTS bunyavirus infection.

Dengue fever outbreak: a clinical management experience.

OBJECTIVE: To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The Combined Military Hospital, Malir Cantt., Karachi, from August 2005 to December 2006. PATIENTS AND METHODS: All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. RESULTS: Out of 5200 patients with febrile illness, 107(2%) presented with typical features of DF, 40/107(37%) were Dengue-proven while 67/107(63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-1050C (mean 1010C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1(0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count<4x109 /L) was noted in 73%, platelet count<150 x109 /L in 84% and ALT>40 U/L in 57% cases. CONCLUSION: Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection; the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM .

Onset of adult varicella in relation to rural or urban origin and its complications.

OBJECTIVES: To determine area of origin of adult varicella patients, whether rural or urban, to compare the mean interval between leaving the area of origin and onset of varicella in adults of rural origin in comparison with those of urban origin and to observe its complications. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Abbottabad, from January to December 2006. PATIENTS AND METHODS: All patients over the age of 18 years, presenting with acute illness clinically, suggestive of varicella were included in the study. A specially designed proforma was filled for each patient separately, which included demographic features as well as area of origin, whether rural or urban, and the age at which they left the area of origin. These patients were examined, treated and assessed clinically on regular basis for the progress of the disease as well as for its possible local or systemic complications. Data analysis was done by using statistical programme SPSS-10. RESULTS: Out of 9155 adult patients, 156 (1.70%) had varicella, including 128 (82.1%) males and 28 (17.9%) females. Origin was rural in 125 (80.1%) and urban in 31 (19.9%) patients. Mean interval between leaving area of origin and developing varicella in those of rural origin was 01.79+/-01.78 years and that in patients of urban origin was 03.37+/-05.72 years (p+/-0.009). None of the patients developed any complication of the disease. CONCLUSION: Varicella in adults is generally a benign illness. It is more common among adult males of rural origin and the interval between leaving the area of origin and onset of varicella in these patients is significantly less as compared to that in adults of urban origin.

Successful allogeneic stem cells transplantation in severe aplastic anaemia complicated by dengue Fever.

Aplastic anaemia is characterized by severe compromise of haematopoiesis and hypocellular bone marrow. Haemorrhagic episodes in patients with aplastic anemia occur usually secondary to thrombocytopenia and require frequent support with platelet concentrates and other blood products. Infection with dengue virus (particularly dengue sero type-2 of South Asian genotype) is associated with dengue haemorrhagic fever. Dengue infection further worsens the disease process in patients with aplastic anaemia due to uncontrolled haemorrhagic diathesis and major organ failure, which may prove fatal in these already immunocompromised patients, if not treated in time. Recent epidemics of dengue haemorrhagic fever has not only affected the southern region of our country but also spread to other areas of the country. With this background, we report a case of aplastic anaemia complicated by dengue haemorrhagic fever who achieved successful engraftment after allogeneic stem cell transplantation from sibling brother and is having normal healthy post transplant life.

A crimean - congo haemorrhagic Fever outbreak in northern balochistan.

OBJECTIVE: To describe the clinical characteristics, epidemiology, predictors of fatal outcome (PFO), and management effects of Crimean-Congo haemorrhagic fever (CCHF) patients during an outbreak in Northern Balochistan. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Fatima Jinnah Hospital and Combined Military Hospital, Quetta, from June to October, 2001. PATIENTS AND METHODS: Patients presenting with a fever of less than 2 weeks duration and bleeding manifestations were included. Clinical history was recorded and patients were placed on oral ribavirin, and hematological support. Diagnosis was established by PCR for CCHF or detection of CCHF specific IgM and IgG. RESULTS: Eighty-four patients were received, 34 (40.5%) were suspected of suffering from classical CCHF. All 34 (100%) patients presented with a history of fever and bleeding (epistaxis, gum bleeding, melena or haematuria). Mean platelet count was 30 x 109/L and mean ALT (alanine transferase) was 288 U/L. Among fatal cases, the mean platelet count was 18.4 x 109/L and ALT was 781 units/L. PCR for CCHF viral RNA performed on 10 patients was positive in 3 (30%) patients. CCHF specific IgM and IgG was positive in 17.6% (6/34). Four patients were brought in moribund condition and expired before treatment could be started, 4 patients expired during treatment and 76.5% (26/34) were cured. The overall mortality was 23.5% (8/34). Main predictors of fatal outcome were ALT Z 150 units/L, activated partial thromboplastin time(aPT) Z 60 seconds, prothrombin time (PT) Z 34 seconds, aspartate transferase (AST) Z 200 units/L, platelets 20 x 109/L, and fibrinogen 110 mg/dL. CONCLUSION: In this series of CCHF occurring in Northern parts of Balochistan, gastrointestinal tract bleeding was the worst prognostic factor associated with fatal outcome. Providing education to healthcare workers and at risk populations, hematological support, anti-viral drugs, and barrier nursing may help reduce mortality.

Neurological manifestations as presenting feature in dengue Fever.

Dengue fever (DF), caused by dengue viruses, presents classic dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. A young man presented with 5 days history of fever, body aches, headache, vomiting and one day history of drowsiness and a generalized tonic clonic fit. He was afebrile and hypotensive with platelets count of 24 x 109/l, and serum IgM DENV positive. Computerized tomography scan of the brain revealed intracerebral haemorrhages in both cerebral hemispheres. He was managed with supportive care and 20% mannitol infusion, his headache and drowsiness rapidly improved. Platelet count rose to 60 x 109/l on 2nd day and 199 x 109/l on 7th day of admission. He remained afebrile during hospital stay and was discharged from hospital on 8th day of admission, when he was almost asymptomatic.

Dengue fever in malaria endemic areas.

OBJECTIVE: To determine the clinical presentation and frequency of dengue fever in patients presenting with acute febrile illness. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Attock in collaboration with Armed Forces Institute of Pathology, Rawalpindi from November 2003 to October 2004. PATIENTS AND METHODS: Patients presenting with acute febrile illness were screened for clinical features of dengue fever (DF). Dengue specific IgM was performed in clinically suspected cases. In addition, peripheral smear for malarial parasites and complete blood counts were performed. RESULTS: Eight hundred patients with fever of less than 2 weeks duration were encountered. Twenty-two (2.75%) presented with the characteristic features of DF. Dengue specific IgM was detected in 11 patients (50%). Nine out of 11 (81.8%) dengue specific IgM positive patients were also positive for malarial parasites on peripheral smear. Out of 11 DF patients, 8 patients (78%) were cured and 3 (28%) died. CONCLUSION: Dengue fever should be suspected if patient presents with bleeding manifestations, retrobulbar headache, severe myalgias and/or thrombocytopenia. Malaria and dengue may co-exist; dengue should be excluded in clinically suspected cases by laboratory investigations. Furthermore, surveillance strategies, preventive measures and healthcare workers' education is critical for curtailing this problem.

Understanding the HIV/AIDS context in Pakistan.

The social context of sexual relations is important in understanding the AIDS epidemic. So far, HIV in Pakistan has spread by heterosexual contact and blood transfusions. The magnitude of the problem is difficult to assess but health authorities estimate between 10,000 to 12,000 HIV infected people. This paper outlines that rapid urbanization, together with single migrant workers, deported HIV infected expatriates, exploitation of women and easy availability of narcotic drugs, especially in the metropolis of Karachi, are some important factors that may be responsible for the spread of HIV in Pakistan (Venereology 1995;8 [3]:160-3).

Chicken pox associated thrombocytopenia in adults.

OBJECTIVE: To determine the frequency and magnitude of thrombocytopenia associated with chicken pox in adults. DESIGN: Observational descriptive study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Attock, from July 2003 to June 2004. PATIENTS AND METHODS: All patients of age 15 years and above with history of fever, followed by appearance of the typical vesicular chicken pox rash, were inducted after informed consent. Two milliliters of whole blood was collected on day 1 of admission, and blood counts were performed. Patients were admitted and given 800 mg oral acyclovir, 5 times/day, for 7 days, in addition to symptomatic treatment. Patients were followed till 8 weeks. RESULTS: A total of 410 patients of chicken pox were received, out of which 270 were included. Age of patients ranged between 15 and 40 years with median age of 21 years. Platelet count on the day of admission ranged between 29 x 10(9)/L to 513 x 10(9)/L, mean platelet count 178 x 10(9)/L. Platelet count < 150 x 10(9)/L was detected in 80/270 (30%) patients. Platelet count in thrombocytopenia patients was from 29 x 10(9)/L to 149 x 10(9)/L with mean 121 x 10(9)/L. Thrombocytopenia recovered within 02 weeks in 78/80 (97%) patients. In 2 patients, thrombocytopenia recovered in 3 weeks. None of the patients developed purpuric spots, ecchymosis or bleeding manifestations. CONCLUSION: Thrombocytopenia in chicken pox is a common entity. Platelet count remains above 25 x 10(9) /L, which is usually not associated with bleeding manifestations. None of the patients in this series developed purpura. No specific pattern of total leukocyte counts was predictive of the progression or regression in platelet count.

Significance of occult HBV infection in patients with chronic hepatitis C.

OBJECTIVE: To determine the frequency of occurrence of occult Hepatitis B infection in chronic hepatitis C patients and its impact (if any) on the effectivity of standard chronic hepatitis C treatment. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Medicine, Military Hospital, Rawalpindi, and Virology Department, Armed Forces Institute of Pathology, Rawalpindi, for a period of nine months from January 2003 to September 2003. PATIENTS AND METHODS: This study was conducted on 30 HBsAg negative patients with chronic hepatitis C liver disease who were receiving combination therapy with interferon and ribavirin. Occult hepatitis B infection was assessed by carrying out HBV DNA by polymerase chain reaction (PCR) in the sera of these patients. Markers of previous hepatitis B infection i.e; anti-HBs and total anti-HBc antibodies were also tested. Response to treatment for hepatitis C (with interferon and ribavirin) was assessed at the end of six months of therapy by measuring ALT levels and HCV RNA by PCR in the serum. RESULTS: In our study only one patient (3.33%) was found to be harbouring HBV DNA in the serum detectable by PCR, with markers of previous HBV infection (both anti HBc antibodies and anti HBs antibodies were positive). A total 14 patients (46.67%) had markers of previous HBV infection, while 16 patients (53.33%) had no such seromarkers. Twenty-five out of 30 patients (83.33%) responded to treatment and 5 (16.66%) turned out to be non-responders. The single case of occult hepatitis B detected in this study responded to hepatitis C treatment. CONCLUSION: Occult hepatitis B is not a common occurrence in chronic hepatitis C patients and it did not alter the outcome of treatment for hepatitis C in our study.

Winter peak of respiratory syncytial virus in Islamabad.

A study was carried out on 391 cases of bronchiolitis and pneumonia from different paediatric units in Rawalpindi/Islamabad, Pakistan. A clear winter spike of respiratory syncytial virus (RSV) was noted. It was found that there was a substantial increase of 30-50% in the positivity of RSV from December to February.

Treatment response in HCV related chronic hepatitis.

OBJECTIVE: To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. MATERIAL AND METHODS: Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction (PCR) between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response (ETR). Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response (SVR). The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor (Roche) for qualitative detection of HCV RNA. RESULTS: Out of 229 cases tested for end-of-treatment response, 198 (86.5%) had no detectable HCV RNA (responders) and 31(13.5%) were PCR positive (non-responders). Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. CONCLUSION: The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions.

Correlation of HBV DNA PCR and HBeAg in hepatitis B carriers.

OBJECTIVE: To correlate hepatitis B HBV DNA polymerase chain reaction (PCR) results with HBeAg and serum alanine transferase (ALT) in carriers. DESIGN: Non-interventional descriptive study. PLACE AND DURATION OF STUDY: The study was carried out at Virology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from January 2001 to September 2002. MATERIALS AND METHODS: Fifty hepatitis B carriers, with known HBsAg positive serostatus, raised serum ALT and detectable HBV DNA, were selected out of the patients reporting at AFIP for their blood test for HBV DNA. HBV DNA testing in these cases was carried out using PCR kit of Accugen-USA. After confirmation of their carrier status and raised serum ALT levels, the sera were tested for HBeAg and results of HBeAg testing were correlated with those of HBV DNA testing. RESULTS: Out of the total 50 HBV DNA PCR positive hepatitis B carriers, 48 samples were positive for HBeAg. All the 50 HBV DNA positive cases had raised serum ALT levels. CONCLUSION: In case of non-availability of facility for HBV PCR, detectable HBeAg should be taken as a surrogate marker for HBV DNA in hepatitis B carriers with raised serum ALT.