Prevalence of Vibrio cholerae O1 serogroup in Assam, India: A hospital-based study.

BACKGROUND & OBJECTIVES: Although cholera remains to be an important public health problem, studies on reliable population-based estimates of laboratory confirmed cholera in endemic areas are limited worldwide. The aim of this hospital-based study was to evaluate the prevalence of Vibrio cholerae serogroup in Assam, India, during 2003-2013. METHODS: Stool samples/rectal swabs were collected from acute watery diarrhoea (AWD) cases during 2003-2013 and processed by standard microbiological procedures. Antibiotic sensitivity test was done following the Clinical and Laboratory Standards Institute guidelines. Year-wise epidemiological trend of cholera was analyzed. RESULTS: Cholera contributed to 3.93 per cent of AWD cases. In Assam, cholera was found to be more prevalent in the rural areas (6.7%) followed by the tea gardens (5.06%), urban slum (1.9%) and urban areas (1.4%). Highest proportion of cholera (13.7%) was observed in 0-10 yr age group. Of them, 11.5 per cent belonged to 0-5 yr age group. V. cholerae O1 El Tor serotype Ogawa was the predominant isolate. Multiple drug-resistant isolates of V. cholerae O1 Ogawa were reported in the study. INTERPRETATION & CONCLUSIONS: Emergence of resistance amongst V. cholerae towards many antibiotics is a matter of concern. Hence, continuous surveillance for diarrhoeal disorders is necessary to control the future outbreaks of cholera in this region.

Heavy Load of Intestinal Fluke in a Four-Year-Old Child with Severe Acute Malnutrition: A Case Report.

Fasciolopsiasis, a food-borne intestinal parasitosis, occurs focally, and remains a significant public health problem in endemic areas. However, due to the wide spectrum of clinical presentation and unclear diagnosis or even misdiagnosis, it often goes unreported. The correlation between trematode infection and malnutrition is also often debated. We report a case of heavy infection of Fasciolopsis buski in a 4-year-old girl with severe acute malnutrition (SAM). The patient presented with a passage of many adult worms per stool following the consumption of some herbal concoction. A wet mount of the stool revealed ova of Fasciolopsis buski. She was treated successfully with praziquantel and food supplements. It raises the possibility of unidentified cases in this region and necessitates more extensive studies in the targeted population. This will also help raise awareness of fasciolopsiasis among clinicians, especially in vulnerable populations such as malnourished children.

Prevalence and Risk Factors of Intestinal Parasitic Infection in Under-Five Children With Malnutrition: A Hospital Based Cross-Sectional Study.

Background: Intestinal parasitic infections (IPIs) and malnutrition in under-five children contribute substantially to developing countries' childhood morbidity and mortality. This study assessed the prevalence and profile of IPI in under-five children and compared them with nutritional status and other socioeconomic factors. Methods: Anthropometric indices were used for checking the nutritional status of under-five children. Malnutrition was graded into four grades (I-IV) based on the Indian Academy of Pediatrics advocated Weight-for-Age criteria. Children whose Height-for-Age and Weight-for-Height were <-2, standard deviations were regarded as stunted and wasted, respectively. Stool samples were examined by direct wet mount (normal saline and iodine) and formol-ethyl acetate concentration technique to detect parasitic cyst and ova. Stool smears were made directly from the specimen and after concentration and stained by kinyoun's stain. Subsequently, the association of undernutrition was assessed with intestinal IPI using the Chi-square test. Results: The overall prevalence of Grade I, II, III, and IV malnutrition was 52%, 31.7%, 12.2%, and 4.1% while stunting and wasting IPIs were present in 60.2% and 36.6%, respectively. IPIs were present in 47.2%, and 11.4% showed polyparasitism. Soil-transmitted helminths were found to be the commonest (Ascaris lumbricoides: 21.1%; Trichuris trichiura: 13.0%; and hookworms: 8.1%) followed by the intestinal protozoa (Enterobius vermicularis: 7.3, Giardia lamblia: 6.5, and Cryptosporidium spp.: 2.4%). Increasing age upto 5 years, improper excreta disposal, low level of maternal education, and a higher number of childrenin the family were predictors of IPIs. The prevalence of IPI was significantly associated with Grade II and III undernutrition, stunting, and wasting. Individually, Ascaris and hookworms contributed significantly to stunting and cryptosporidium spp. to wasting. Conclusion: Prevalence of IPI in malnourished under-five children is high. Joint nutritional interventional strategies, early diagnosis/treatment of under-five children, and increased awareness among masses are imperative to break the vicious cycle of malnutrition and parasitic diseases.

Seasonal predominance of atypical agents in adult community-acquired pneumonia in India's northeastern region: Is it the time to look again at empirical therapy guidelines?

Atypical agents such as Mycoplasma, Legionella, Chlamydia species, and Coxiella burnetii (Q-fever agent) are responsible for some adult community-acquired pneumonia (CAP). Insufficient studies on this topic can be blamed for the failure to include atypical pathogens in empirical management. We followed adult CAP cases for two years, and samples (respiratory and serum) were tested by culture, ELISA (IgM, IgG, and IgA), and PCR. A risk factor analysis was performed. Overall in 21.3% adult CAP patients, atypical agents found were Mycoplasma pneumoniae (51.5%), Legionella pneumophila (28.8%), and Chlamydophila pneumoniae (19.7%). However, amongst patients <60 years of age and in the summer season, the proportion of atypical agents increased significantly. There is thus a need to re-examine empirical antibiotic regimes.

A rare case of ocular onchocerciasis in India.

Onchocerca volvulus is a spirurid nematode that mainly affects the rural poor of Sub-Saharan Africa, Yemen and parts of Central and South Africa. River blindness, caused by Onchocerca volvulus, is considered to be the second commonest infectious cause of blindness worldwide. We report a rare case of ocular onchocerciasis where a live adult worm was extracted from the eye of a patient from a nonendemic region. The worm was identified as Onchocerca volvulus based on morphological features. The patient was treated with Ivermectin (0.2 mg/kg). At six months follow-up she had complete remission of symptoms.

Molecular characterization of Vibrio cholerae O1 strains circulating in Assam: a north eastern state of India.

BACKGROUND AND OBJECTIVES: Information on the genetic epidemiology of cholera in Assam, a northeastern state of India is lacking despite cholera being a major public health problem. The study aimed to determine the virulence genes and genes encoding antibiotic resistance in Vibrio cholerae isolates and to determine the prevalent genotypes based on the presence or absence of the virulence genes and ctxB genotype. MATERIALS AND METHODS: Twenty-five V. cholerae strains were subjected to conventional biotyping and serotyping followed by multiplex PCR to detect ctxA, ctxB, zot, ace, O1rfb, tcpA, ompU, ompW, rtxC, hly and toxR and antibiotic resistance genes. Cholera toxin B (ctxB) gene was amplified followed by sequencing. RESULTS: All the V. cholerae O1 isolates were El Tor Ogawa and showed the presence of the core toxin region representing the genome of the filamentous bacteriophage CTXø. The complete cassette of virulence genes was seen in 48% of the isolates which was the predominant genotype. All the isolates possessed amino acid sequences identical to the El Tor ctxB subunit of genotype 3. sulII gene was detected in 68% of the isolates, dfrA1 in 88%, strB in 48% and SXT gene was detected in 36% of the isolates. CONCLUSION: Toxigenic V. cholerae O1 El Tor Ogawa strains of ctxB genotype 3 carrying a large pool of virulence genes are prevailing in Assam. Presence of a transmissible genetic element SXT in 36% of the strains is of major concern as it indicates the emergence of multiple drug resistance among the V. cholerae isolates.

Relationship between Toxoplasma Gondii and Psychotic Disorders with Implications toward a Brain-based Diagnostic System and Novel Treatment Approaches: A Study Protocol.

What role infectious agents play in the causation of psychotic disorders? To investigate this area, we have aimed to investigate the relationship between Toxoplasma gondii and psychotic disorders. A hospital-based cross-sectional study is designed. IgM and IgG antibodies to T. gondii in patients with psychotic disorders will be measured and presented in result. Seropositivity rates will be compared with first-degree relatives and healthy volunteers. Also, types of psychotic disorders and seropositivity rate will be compared. Here, we are presenting the study protocol with implications toward a brain-based diagnostic system and novel treatment approaches.

Detection of anti-hepatitis C virus and hepatitis C virus RNA in dried blood spot specimens using Whatman No. 1 filter paper.

Purpose: Dried blood spot (DBS) specimen simplifies blood collection, processing, storage and shipment and may reduce the cost of testing for hepatitis C virus (HCV) infection. We wanted to see if DBS using a cheap filter paper is reliable alternative to serum for detection of anti-HCV and HCV RNA. Materials and Methods: At a tertiary care hospital in Northeast India, we collected 91 paired DBS and serum specimens from patients at risk of HCV infection from July 2014 to June 2015. DBS was collected on Whatman No. 1 filter paper. After processing, the specimens were subjected to anti-HCV detection by a third-generation Enzyme-Linked Immunosorbent Assay (ELISA). The reactive DBS and serum specimens were further subjected to HCV RNA detection by polymerase chain reaction. The results were analysed in paired screen-positive study design. Results: Anti-HCV was detected in 9 (9.9%) DBS specimens and 10 (10.9%) serum specimens. There was statistically significant (P < 0.0001) correlation between the optical density values of DBS and serum specimens (Pearson r = 0.9181, 95% confidence interval: 0.8781-0.9453). HCV RNA was detected in 5/9 (55.6%) reactive DBS and 9/10 (90.0%) reactive serum specimens. There was no correlation between HCV RNA levels in the DBS and the serum specimens. The relative sensitivity rate and the relative false-positive rate of DBS anti-HCV ELISA were 0.89 and 1.00, respectively. Conclusions: DBS using Whatman No. 1 filter paper is quite reliable as serum for detection of anti-HCV. It can be useful in effective surveillance. However, it is not suitable for confirmation of chronic HCV infection.

Molecular and phylogenetic evidence of chikungunya virus circulating in Assam, India.

PURPOSE: Northeast Region of India possesses an abundant number of Aedes mosquitoes, the common vector for Dengue and Chikungunya (CHIK). Dengue is reported every year from Assam, but active surveillance for CHIK virus (CHIKV) infection is lacking in this part of India. Therefore, this present study has been undertaken to detect any CHIKV infection during a dengue outbreak in Assam. MATERIALS AND METHODS: A total of 42 dengue negative samples collected from Guwahati were screened for the presence of CHIK IgM antibodies. Further, all the samples were processed for CHIKV RNA detection by reverse transcriptase-polymerase chain reaction (RT-PCR). Phylogenetic analysis was done by Maximum Likelihood method using Kimura-2 parameter model. RESULTS: No IgM positivity was found in the processed samples; however, 7 samples were positive for CHIKV by RT-PCR. Phylogenetic analysis revealed that the circulating CHIKV belonged to Eastern, Central and Southern African genotype. Sequence analysis showed two uniform nucleotide substitutions and very less amino acid substitution. CONCLUSION: Silent existence of CHIKV beside dengue is reported from this study. Therefore, CHIKV diagnosis should be included as a regular practice for active surveillance of the disease and its accomplishment before commencing an outbreak.

Clinicomycological profile of pityriasis versicolor in Assam.

BACKGROUND: Geographical variation in the distribution of Malassezia species associated with pityriasis versicolor (PV) has led to the necessity of studying epidemiological, mycological, and clinical characteristics of PV. AIMS: To study the epidemiological, mycological, and clinical characteristics of PV in a tertiary care hospital. SETTINGS AND DESIGN: The study was carried out with a cross-sectional design. MATERIALS AND METHODS: Two hundred and sixty-two consecutive PV patients were subjected to detailed history, clinical examination, and investigations. Skin scrapings were processed by direct microscopy and culture. Isolates were identified by phenotypic characteristics and polymerase chain reaction-restriction fragment length polymorphism. Association of Malassezia species with clinical and epidemiological characteristics was studied. Statistical analysis of the data was done using statistical software. RESULTS: Maximum number of PV cases (33.9%) belonged to the age group of 21-30 years with a male preponderance. 61.4% of the patients had a sedentary lifestyle, 70.2% showed the gradual onset of the disease, 51.1% presented with pruritus and in 66.4% of the patients symptoms were continuous. Most commonly involved body site was neck (27.8%), 77.09% of the lesions were bilaterally asymmetrical, 87.4% were macular, and 89.3% were hypopigmented. Malassezia furfur (77.3%) was the predominant species. Sedentary lifestyle (61.4%) and increased sweating (48%) were the most commonly associated predisposing factors. CONCLUSION: PV is more common in males. Distribution of Malassezia species varies significantly from those reported in other parts of India. M. furfur was the most common species responsible for PV in our region. Hence, further studies are required to evaluate the exact cause of this variation.

Serologic prevalence of Toxoplasma gondii in Indian women of child bearing age and effects of social and environmental factors.

BACKGROUND: Seroprevalence and incidence of toxoplasmosis in women of child bearing age has remained a contentious issue in the Indian subcontinent. Different laboratories have used different patient recruitment criteria, methods and variable results, making these data difficult to compare. AIM: To map the point-prevalence and incidence of toxoplasmosis in India. MATERIAL AND METHODS: In this cross-sectional study, a total of 1464 women of fertile age were recruited from 4 regions using similar recruitment plans. This included women from northern (203), southern (512), eastern (250) and western (501) regions of India. All samples were transported to a central laboratory in Delhi and tested using VIDAS technology. Their age, parity, eating habits and other demographic and clinical details were noted. RESULTS: Most women were in the 18-25 years age group (48.3%), followed by 26-30 years (28.2%) and 31-35 years (13.66). Few (45) women older than 35 yr. were included. Overall prevalence of anti-Toxoplasma IgG antibodies was seen in 22.40%, with significantly more in married women (25.8%) as compared to single women (4.3%). Prevalence increased steadily with age: 18.1% in the 18-25 yr. age group to 40.5% in women older than 40 yr. The prevalence was high (66%) in those who resided in mud houses. Region-wise, the highest prevalence was observed in South India (37.3%) and the lowest (8.8%) in West Indian women. This difference was highly significant (P<0.001). Prevalence was 21.2% in East India and 19.7% in North India. The IgM positivity rate ranged from 0.4% to 2.9% in four study centers. CONCLUSIONS: This pan-India study shows a prevalence rate of 22.4% with a wide variation in four geographical regions ranging from as low as 8.8% to as high as 37.3%. The overall IgM positivity rate was 1.43%, indicating that an estimated 56,737-176,882 children per year are born in India with a possible risk of congenital toxoplasmosis.

Prevalence of blaTEM , blaSHV and blaCTX-M genes in clinical isolates of Escherichia coli and Klebsiella pneumoniae from Northeast India.

AIM: This study was carried out to determine the presence of blaTEM , blaSHV and blaCTX-M genes in extended-spectrum ß-lactamase (ESBL) producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) at a tertiary care referral hospital in Northeast India. MATERIALS AND METHODS: A total of 270 E. coli and 219 K. pneumoniae isolates were recovered during the period between August 2009 and July 2010. Kirby-Bauer disk diffusion method was performed to determine the antibiotic resistance pattern. Screening and phenotypic confirmatory test for ESBL production were performed using standard disc diffusion methods. Each of the initial ESBL screening test isolate was investigated for the presence of blaTEM , blaSHV and blaCTX-M genes via polymerase chain reaction (PCR) using gene-specific primers. RESULTS: Phenotypic confirmatory test able to detect ESBL production in 73.58% of E. coli and 67.24% of K. pneumoniae. However, PCR amplification showed the presence of one or more ESBL genes in each of the initial ESBL screening positive isolate. Among three ESBL genotypes, the most prevalent genotype was found to be blaCTX-M in E. coli (88.67%) and blaTEM in K. pneumoniae (77.58%) ESBL producing isolates. Majority of ESBL producing isolates possess more than one ESBL genes. CONCLUSION: This study constituted a primer report on high prevalence of blaTEM and blaCTX-M genes in ESBL producing isolates of E. coli and K. pneumoniae and denotes the need of more extensive studies on these antibiotic genes to determine the magnitude of the problem of antibiotic resistance exiting in this locality.

Role of Gardnerella vaginalis as an etiological agent of bacterial vaginosis.

BACKGROUND AND OBJECTIVES: Bacterial vaginosis is a risk factor for obstetric infections, various adverse outcomes of pregnancy and pelvic inflammatory disease. The objectives of this study were to assess the prevalence of bacterial vaginosis in women attending Gynaecology Outpatient Department (O.P.D) and sexually transmitted disease (S.T.D.) clinic and to assess the role of Gardnerella vaginalis as an etiological agent of bacterial vaginosis. MATERIALS AND METHODS: Two hundred women attending Gynaecology O.P.D and S.T.D. clinic with symptoms suggesting lower genital tract infection were included in the study. pH of the vaginal discharge was measured and three high vaginal swabs were collected. Bacterial vaginosis was diagnosed using Amsel's criteria and Nugent's method. Gardnerella vaginalis was isolated and identified by standard methods. RESULTS: Prevalence of bacterial vaginosis using Amsel's criteria and Gram stain scoring method was found to be 51.5% and 49% respectively. Gardnerella vaginalis was isolated in only 8.7% cases of bacterial vaginosis. CONCLUSION: Our study showed a relatively high prevalence of bacterial vaginosis in the population under study. Women attending various healthcare facilities should be screened and treated properly to prevent recurrence. Low isolation rate of Gardnerella vaginalis may be attributed to factors like poor viability and fastidiousness of the organism to grow in various media.

The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in assam with special reference to MRSA.

BACKGROUND: The recent years have witnessed the increasing resistance of Staphylococcus aureus to many antimicrobial agents. The most notable example is the emergence of Methicillin-resistant Staphylococcus aureus (MRSA), which was reported just one year after the launch of methicillin. The ecological niches of the S. aureus strains are the anterior nares. The identification of Staphylococcus aureus by using a proper antibiogram and the detection of methicillin resistant Staphylococcus aureus greatly contribute towards the effective treatment of the patients. AIMS AND OBJECTIVES: To isolate Staphylococcus aureus from the nasal swabs of healthcare workers (HCWs) and to study their antimicrobial susceptibility patterns, which include methicillin resistance. MATERIALS AND METHODS: Nasal swabs were collected from the healthcare workers of various clinical departments of the hospital over a period of one year. The isolation of Staphylococcus aureus and their antimicrobial susceptibility patterns were carried out by standard bacteriological procedures. RESULTS: Staphylococcus aureus was isolated in 70 cases (22.22%). The prevalence of the S.aureus nasal carriage was higher among the male HCWs (54.28%) than among the female HCWs (45.71%). The carriage rate was the highest in the orthopaedics department, followed by those in the surgery and the gynaecology departments. All the Staphylococcus aureus isolates were sensitive to vancomycin and linezolid (100%). Penicillin and ampicillin were the most resistant, (90% and 88.6%) respectively. Methicillin resistance was seen in11.43% of the S.aureus isolates, both by the disc diffusion test and by the Oxacillin Resistance Screen Agar (ORSA) test. CONCLUSIONS: The compliance with the sanitary and the antibacterial guidelines of the health professionals is the single most important factor in preventing nosocomial infections. Simple preventive measures like hand washing before and after the patient examination, the use of sterile aprons and masks in the postoperative wards, awareness during the examination of the immunocompromised patients, and avoiding touching one's nose during work, can reduce the disease transmission rate considerably.