Intestinal parasitic infestation among paediatric diarrhoea patients attending hospitals in Port Blair, Andaman and Nicobar Islands.

Acute childhood diarrhoea remains one of the leading causes of childhood morbidity and mortality in developing countries. The present study was conducted to estimate the prevalence of various intestinal parasitic infestation among children aged 5 years and less suffering from acute diarrhoea disease attending hospitals in Andaman Islands. During the period from January 2012 to December 2013, a total of 675 acute diarrhoea patients were included in the study. Among these samples, 476 (70.5, 95 % CI 66.9, 73.9) harboured ova/cyst of one or more intestinal parasites. Ova/cyst and trophozite of intestinal protozoan parasite was present in the stool samples of 390 (57.8, 95 % CI 54.0, 61.5) children whereas ova of helminth parasite was observed in the stool samples of 105 (15.6, 95 % CI 12.9, 18.5) children. Among all the parasites, Giardia lamblia trophozite had the highest prevalence of 30.5 % followed by Entamoeba histolitica cyst (21.0 %). The high prevalence of intestinal protozoan parasites is an indicator of a probably high carrier rate of these parasites in the community. The study is two issues that are important from public health points of view. Protozoan infestations could be the cause of diarrhoea, particularly watery diarrhoea, in a substantial proportion of the childhood diarrhoea patients attending the hospitals and anti-protozoan therapy needs to be part of the treatment regimen for watery diarrhoea among childhood diarrhoea patients. The second is the need for instituting a community based programme for controlling intestinal protozoan carriage in children as well as in adults as a step towards diarrhoea control.

Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging.

This longitudinal follow-up study of 203 patients with serologically confirmed chikungunya (CHIK) virus infection describes the clinical features of CHIK fever during the first and tenth months of illness. During the acute stage CHIK fever presents with a wide array of symptoms. The foremost chronic symptoms at the end of a month were rheumatism (75%) and fatigue (30%). During the tenth month of follow-up the symptoms/signs observed were joint pain/swelling (46%), fatigue (13%) and neuritis (6%). The cure rate at the end of 9 months was 51%. Among the patients who had joint pain, 36% (34/94) met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis. A subpopulation of the patients with joint pain (20/94) was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody, and the joints were imaged by X-ray and magnetic resonance imaging (MRI). All tested negative for RF and one tested positive for anti-CCP. A radiolucent lesion in the X-ray was seen in the bones of five patients. The MRI findings were joint effusion, bony erosion, marrow oedema, synovial thickening, tendinitis and tenosynovitis. The study proves with relative certainty that CHIK arthritis is chronic inflammatory erosive arthritis, which has implications for management of the infection.