Objectives: The objectives of this report were to document the potential presence of Mayaro virus infection in Ecuador and to examine potential risk factors for Mayaro virus infection among the personnel of a military garrison in the Amazonian rainforest. Materials and Methods: The study population consisted of the personnel of a garrison located in the Ecuadorian Amazonian rainforest. The cross-sectional study employed interviews and seroepidemiological methods. Humoral immune response to Mayaro virus infection was assessed by evaluating IgM- and IgG-specific antibodies using ELISA. Results: Of 338 subjects studied, 174 were from the Coastal zone of Ecuador, 73 from Andean zone, and 91 were native to the Amazonian rainforest. Seroprevalence of Mayaro virus infection was more than 20 times higher among Amazonian natives (46%) than among subjects born in other areas (2%). Conclusions: Age and hunting in the rainforest were significant predictors of Mayaro virus infection overall and among Amazonian natives. The results provide the first demonstration of the potential presence of Mayaro virus infection in Ecuador and a systematic evaluation of risk factors for the transmission of this alphavirus. The large difference in prevalence rates between Amazonian natives and other groups and between older and younger natives suggest that Mayaro virus is endemic and enzootic in the rainforest, with sporadic outbreaks that determine differences in risk between birth cohorts of natives. Deep forest hunting may selectively expose native men, descendants of the Shuar and Huaronai ethnic groups, to the arthropod vectors of Mayaro virus in areas close to primate reservoirs.

Objective: This study was designed to compare diagnosis of trichomoniasis by culture, wet smear examination, and Giemsa stain. A modified technique was used to transport and prepare the specimen to ensure parasite viability prior to Giemsa staining. Materials and Methods: A clinic-based prospective study was carried out in association with the National STD/AIDS Control Programme over a period of 18 months. Three swabs were collected from the posterior fornix of 346 newly registered female patients for diagnosis of trichomoniasis. A wet smear was prepared using the first swab. The second swab was placed in 5 mL of 0.9% saline with three drops of 5% glucose at room temperature and centrifuged twice at a low speed prior to preparation of a Giemsa stained smear. The third swab was for culture. The three tests were performed independently. The specificity and sensitivity of the wet smear and Giemsa stain were compared to culture. Results: With culture, the prevalence of trichomoniasis was 6.9% (95% CI: 4.1-9.3%). The Giemsa-stained smear was found to be highly sensitive (100%, 95% CI: 86.2-100%) and specific (99.69%, 95% CI: 98.26-99.95%) compared to culture. The wet smear was less sensitive (95.83%, 95% CI: 79.76-99.26%) but equally specific (100%, 95% CI: 98.82-100%). Conclusion: In developing countries, facilities for using culture are limited and wet smear examination in the field is also difficult due to the immediate need for laboratory facilities. Our study demonstrated that, in this setting, using a transport medium prior to Giemsa staining is a feasible alternative, with a high-diagnostic yield.

Background: In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO), which often evade diagnosis. Objective: The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India. Materials and Methods: This is a prospective study of inpatients, with regard to both clinical signs and investigations. Results: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern. Interpretation: In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO. Conclusion: Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.

Background: Human immunodeficiency virus (HIV), the pathogen responsible for the acquired immunodeficiency syndrome and the most significant emerging infectious disease is causing health, social, and developmental problems to mankind. Aims, Setting and Design: This is a cross-sectional study to evaluate the socio-demographic characteristics of adults screened for HIV infection in Ahoada Community in Rivers State in the Niger Delta of Nigeria. Materials and Methods: HIV antibodies were detected using "Determine" (Abbott Laboratories, Japan), Start-Pak (Chembio Diagnostics, USA) and SD Bioline HIV-1/2 kits (Standard Diagnostics, Korea). All test procedures were carried out according to the manufacturers' instructions. Subjects included 152) consecutively recruited adults consisting of 955 females and 566 males aged 18-54 years with a mean age of 36.25΁7.02 years. Statistical Analysis: Data were entered and analyzed using statistical package SPSS version 9. A P-value ≤0.05 were considered statistically significant in all statistical comparisms. Results and Conclusion: Out of a total of 1521 persons screened for HIV infection, 162 persons tested positive for HIV (10.6%). HIV infection was higher among females (10.9%) compared to males (10.1%) and in the 25-34 and 45-60 years age groups (11.1%) (P= 0.08). HIV-1 was the predominant subtype (74%) compared to 26% for dual HIV-1 and 2. This study indicates the urgent need for both government and non-governmental organizations to intensify awareness campaign programme to reduce the spread of the HIV infection in the area with emphasis on behavioral change and economic empowerment of the people as well as provision of universal access to antiretroviral therapy for those with HIV infection.

Background: There are number of patients who are unable to expectorate sputum specimens. In this study, we used gastric lavage (GL) test for diagnosis of tuberculosis (TB) in patients who were unable to produce sputum. Materials and Methods: Patients who were unable to produce sputum specimens were included in the study to confirm TB disease. Gastric lavage sampling was performed and sent for acid fast bacillus smear and culture under special laboratory conditions and sterilized methods. Further bronchoscopy for broncho-alveolar lavage was done on patients with negative GL smear results. Drug susceptibility tests were performed on 48 GL culture positive cases. Results: Eighty-five patients were included in the study; who were hospitalized at our referral center for suspected TB. GL smears were reported to be positive in 37 cases (66.07%) and culture in 85.7%. The total number of smear and culture-positive cases in this study was 48 (85.7%). Forty cases (87%) of drug-sensitive, 1 case (2.2%) of isoniazid and rifampin-resistant TB (multi-drug resistant; MDR), and 5 cases of resistant to one drug were detected. There have not been observed any complications after the GL method. Conclusion: It seems that regarding the high number of positive GL cultures (85.7%), GL can be effective for diagnosis of patients who have suspicious tuberculosis symptoms and are unable to produce sputum especially in resource limited areas.

Background: Abdominal tuberculosis remains the great mimic despite years of experience and awareness. Reliable epidemiological data on abdominal tuberculosis are lacking in India. Objectives: To define the most suggestive clinical features of abdominal tuberculosis, to evaluate the usefulness of the normally available investigations, and the response of anti-tuberculous drugs. Study Design: Retrospective study. Materials and Methods: Out of 110 patients attending our hospital between July 2000 and June 2002, with clinical suspicion of abdominal tuberculosis, 46 patients had confirmed abdominal tuberculosis. Their clinico-radiological and cyto / histopathological profiles, side effects of anti-tuberculous drugs, and the outcome of the treatment were analyzed. Results: Weight loss, abdominal pain, and bowel disturbances were the most common symptoms. Anemia and under- nutrition, abdominal tenderness, ascites, and hepato / splenomegaly were the most common findings. Chest radiography showed active or healed tuberculous focus in 16. Ultrasonography revealed abdominal lymphadenopathy, ascites, and mass lesions in 26, 12, and four patients, respectively. Barium examination showed abnormality in eight patients out of 18, among whom it was performed. An ascitic fluid study done in 12 patients showed high adenosine deaminase in all, and positive acid fast bacilli in one. Laparoscopic peritoneal biopsy was done in18 patients, and 13 showed tuberculous granuloma. Treatment success was achieved in 38 patients with anti-tuberculous drugs. Most patients tolerated the anti-tuberculous drugs well. Conclusion: With good clinical examination and appropriate investigations definitive diagnosis of abdominal tuberculosis can be reached in a significant number of patients. Strongly suggestive clinical and laboratory data are also indications for anti-tuberculous therapy in an endemic country like India. Anti-tuberculous drugs are well tolerated and highly effective.

Objective : Chronic granulomatous disease (CGD) is an inherited disorder of the Nicotinamide adenine dinucleotide phosphate reduced oxidase complex characterized by recurrent bacterial and fungal infections. Disseminated infection by combination of opportunistic agents is being increasingly reported in CGD patients. We presented in the retrospective review of medical records, the etiology, presentation, clinical characteristics the infections detected, predisposing condition and outcome of nocardiosis and actinomycosis involved in a group of pediatric patients diagnosed with CGD. Materials and Methods: The clinical presentation of CGD-related infections was reviewed retrospectively from the medical records of all 12 patients with CGD. We studied respectively 12 patients between 2001 and 2008, and we analyzed two pediatric patients with CGD who acquired Nocardia and Actinomyces infections, and their clinical and microbiological characteristics were described. The material for investigations was collected from scrapings, crusts, pus from subcutaneous abscesses or exudation from sinus tracts, surgical debridement, and biopsy specimens. The microbiological diagnosis was determined by biochemical tests, histology, microscopy, and culture of clinical samples. Results: The medical records of 12 diagnosed CGD patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomycosis and one patient with nocardiosis. Patients consisted of seven males and five females with ranging ages of 3 to 18 years. Nocardiosis and actinomycosis isolated in the two patients were confirmed by histology and culture methods. Neutrophil oxidative burst were absent (NBT=0) in both patients. The most common manifestations of CGD due to fungal infections, actinomycosis, and nocardiosis were osteomyelitis (42.8%), pulmonary infections (28.6%), lymphadenopathy (14.3%), and skin involvement (14.3%) during their illness. Conclusion: Nocardiosis and actinomycosis in children indicate the need for evaluation for an underlying immunological deficiency. Early diagnosis remains critical for decreased morbidity and occasional mortality. Physicians caring for patients with CGD should maintain a high index of suspicion for nocardiosis and actinomycosis especially if work up for TB and fungal infections are negative.

Background: Several nucleic acid amplification techniques are available for detection of Mycobacterium tuberculosis (MTB) in pulmonary and extrapulmonary samples, but insufficient data are available on the diagnostic utility of these techniques in tubercular meningitis where bacilli load is less. The success of final amplification and detection of nucleic acid depends on successful extraction of DNA from the organism. Aims: We performed this study to compare four methods of extraction of MTB DNA from cerebrospinal fluid (CSF) samples so as to select one method of DNA extraction for amplification of nucleic acid from clinical samples. Materials and Methods: Four methods of extracting MTB DNA from CSF samples for testing by real-time polymerase chain reaction (PCR) were compared: QIAGEN ^R protocol for DNA purification using QIAamp spin procedure (manual), AMPLICOR ^R respiratory specimen preparation kit, MagNA Pure ^R kit extraction, combined manual DNA extraction with automated extraction by MagNA Pure ^R . Real-time PCR was performed on COBAS TaqMan 48 Analyzer ^R with known positive and negative controls. Results: The detection limit for the combined manual and MagNA Pure ^R extraction protocol was found to be 100 copies of MTB DNA per reaction as against 1,000 copies of MTB DNA per reaction by the QIAGEN ^R , AMPLICOR ^R , and the MagNA Pure ^R extraction protocol. Conclusion: The real-time PCR assay employing the combination of manual extraction steps with MagNA Pure ^R extraction protocol for extraction of MTB DNA proved to be better than other extraction methods in analytical sensitivity, but could not detect less than 10 ² bacilli /ml.

Context: Candida species are opportunistic yeasts that cause infections ranging from simple dermatosis to potentially life-threatening fungemia. The emergence of resistance to antifungal drugs has been increased in the past two decades. Aim: the present study we determined to find out the susceptibility profiles of clinical isolates of Candida species against four antifungal drugs, including amphotericin B, ketoconazole, fluconazole and itraconazole. Materials and Methods: Antifungal susceptibility testing of the yeasts was done in accordance with the proposed guidelines for antifungal disk diffusion susceptibility testing of yeasts based on the CLSI document M44-A. Results: A total of 206 yeast isolates were assessed. Among the evaluated Candida species, the highest rates of resistance to ketoconazole were seen in Candida glabrata (16.6%) and Candida albicans (3.2%). Susceptibility and intermediate response to fluconazole were seen in 96.6% and 3.4% of the Candida isolates, respectively. A total of 19 (9.2%) yeast isolates showed petite phenomenon including 11 C. glabrata, 3 C. albicans, 2 Candida dubliniensis and one isolate of each Candida krusei and Candida parapsilosis. Conclusion: The high number of petite mutation in the isolated yeasts should be seriously considered since it may be one of the reasons of antifungal treatment failure.

Background: Health care problems faced by migrant construction workers are always neglected. Fifteen patients were admitted with the complaints of loose motion and pain in the abdomen from a labor settlement at a construction site near our city. Three stool samples revealed darting motility. Objectives: To find out more number of cases, the source of infection and to recommend necessary actions to control the outbreak. Study Design: A cross-sectional epidemiological study. Materials and Methods: Pre-tested, pre-designed epidemiological case sheet was used. Sanitary survey and assessment of ecological correlation was also done. Stool samples of all the admitted patients and seven water samples from the site were collected for laboratory analysis. Results: Out of 99 inhabitants, 69 were suffering from the same complaints. Male sufferers were more in number. The age groups affected prominently were 1-4 years and 15-44 years. Peculiar epidemic curve with one peak was noted down. There was a history of heavy rains 2 days before the complaints had started. The construction site was situated on the plateau. The source of the water - dug well - was situated on a slope. The water from the site while moving along the slope was getting mixed into the well. Considering the person, time, place distribution and the peculiar symptoms, presumptive diagnosis of outbreak (point source) of acute gastroenteritis was made. The well water was thought to be the source of infection. Three stool samples and three water samples including the sample from drinking well water grew Vibrio cholerae O1. These results support an earlier hypothesis. The timely interventions were done. Conclusion: The impending outbreak can be brought under control with the rapid and simple field epidemiological investigation (shoe leather epidemiology).

Background: Peptic ulcer disease can lead to serious complications including massive hemorrhage or bowel perforation. The modern treatment of peptic ulcer disease has transitioned from the control of gastric acid secretion to include antibiotic therapy in light of the identification of Helicobacter pylori as a causative infectious organism. We sought to determine trends related to this discovery by using a national database. Materials and Methods: Patient discharges with peptic ulcer disease and associated sequelae were queried from the Nationwide Inpatient Sample, 1993 to 2007, under the auspices of a data user agreement. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. Standard error was calculated using SUDAAN software (Research Triangle International, NC, USA). Results: Decreases in the incidences of gastrointestinal perforation, gastrointestinal hemorrhage, and surgical procedures most specific to peptic ulcer disease were statistically significant over the study period [range of P value (two tailed) = 0.000 - 0.00353; significant at P < 0.001 to < 0.01]. The incidence of H. pylori rose dramatically, peaking at an estimated 97,823 cases in 1998 [SE = 3155; 95% CI = 6,184]. Since that time it has decreased and then stabilized. Conclusions: The identification of H. pylori as the causative agent in the majority of peptic ulcer disease has revolutionized the understanding and management of the disease. Medical conditions and surgical procedures associated with end-stage peptic ulcer disease have significantly decreased according to analysis of selected index categories. Resident physician education objectives may need to be modified in light of these trends. Review Criteria: We reviewed patients with peptic ulcer disease. The database used was the Nationwide Inpatient Sample, 1993 to 2007. Message for the Clinic: Medical therapy has resulted in decreased morbidity from H. pylori infection as it is the causative agent in the majority of peptic ulcer disease. Aggressive screening and treatment of this infection will lead to further reduction in morbidity.

Background and Objectives: Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective PPTCT interventions. NACP III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, drop-outs, interventions efficacy with other determinants. Materials and Methods: At ICTCs, registered ANCs are counseled and tested for HIV. HIV+ve ANCs are linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV+ve ANCs since 2004 subsequently delivered till December 2009 and their exposed children in PPTCT-VSGH constituted study cohort. Results: 29281 ANCs registered, 69.7% were counseled pre-test, 100% of them tested, 94.9% were counseled post-test. 60.5% were detected in 3 ^rd trimester. CD4 testing was carried out in 71.6% HIV+ve ANCs. 81 ANCs were detected HIV+ve inclusive of 11 unregistered cases. 72 pregnancy outcomes reported institutionally, 77.6% were caesarian sections. Out of 59 live births, 56 sdNVP-MB-Pair were given. 88.1% children were traced till 18 months, 76.3% of live births were alive, 40.7% of live births were tested. 1 was found HIV+ve with history of adherence to all prescribed PPTCT guidelines. Conclusions: PMTCT services - counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.

Background: Leprosy a chronic infectious affliction, is a communicable disease that posses a risk of permanent and progressive disability. The associated visible deformities and disabilities have contributed to the stigma and discrimination experienced by leprosy patients, even among those who have been cured. Aims and Objectives: 1) To assess the knowledge, attitude and belief about leprosy in leprosy patients compared with community members. 2) To find the perceived stigma among leprosy patients. 3). To evaluate the quality of life in leprosy patients as compared to community members using WHO Quality of Life assessment questionaire (WHOQOL- BREF). Materials and Methods: A cross sectional study was conducted at Leprosy Rehabilitation Centre, Shantivan, Nere in Panvel Taluka, district Raigad from October - December 2009. A pre-designed and pre-structured questionaire was used to evaluate knowledge, attitude and perceived stigma among leprosy patients and community members. WHO Quality of life questionaire (WHOQOL-BREF) was used to assess quality of life in leprosy patients and controls. Data analysis was done with the help of SPSS package. Result: Among the cases and control, 43.13% of cases were aware that leprosy is an infectious disease compared to 20.69% of control. 68.62% of cases had knowledge of hypopigmented patches being a symptom of leprosy compared to the 25.86% in control. There was overall high level of awareness about disease, symptoms, transmission and curability in leprosy patients as compared to control. Among control group, 43.10% of population said that they would not like food to be served by leprosy patients as compared to 13.73% in study group. It was seen that the discrimination was much higher in female leprosy patients as compared to male leprosy patients. The mean quality of life scores for cases was significantly lower than those for control group in physical and psychological domain but not in the social relationship and environmental domain. The mean quality of life scores for male cases were lower in each domain as compared to male control group but the difference was not significant except in the physical and enviornmental domain. The mean quality of life scores for female cases were lower in each domain as compared to female control group and the difference was not significant except in the psychological domain. Conclusions: There was a significant difference in physical domain in male leprosy patients and psychological domain in female leprosy patients as compared with their respective gender controls. The leprosy patients were more aware about the infectious nature of the disease, symptoms, transmission, and curability than the control group. A negative attitude was seen towards the leprosy patients in the society.

Asymptomatic bacteriuria and urinary tract infection are common complications after kidney transplantation. In this population, if urinary tract infection occurred in the first six months post procedure, it carries a grave impact on both graft and patient survival. Renal transplant recipients with urinary tract infection are often clinically asymptomatic as a consequence of immunosuppression. Urinary tract infection, however, may progress to acute pyelonephritis, bacteremia and the full blown picture of urosepsis. PubMed and Cochrane databases were searched. The purpose of this review is to discuss the screening and treatment of urinary tract infection and asymptomatic bacteriuria in renal transplant recipients and to evaluate the guidelines on the basis of a review of published evidence.

Brucellosis is an infectious disease caused by gram-negative bacteria of the genus Brucella. Involvement of the gastrointestinal, hepatobilliary, and skeletal systems has been reported frequently in the literature. Involvement of the nervous system is relatively uncommon and has been reported in only 3%-25% of cases of generalized brucellosis. Guillain-Barré syndrome is a prototypical postinfectious autoimmune disease. We report a case of Guillain-Barré syndrome in a 26-year-old woman as an uncommon presentation of neurobrucellosis.

Myiasis is an opportunistic infestation of human and vertebrate animals with dipterous larvae. Oral myiasis is a rare condition associated with poor oral hygiene, mental disability, halitosis and other conditions. We present a case report of an adult mentally challenged woman with extensive necrotic oral lesion burrowing into the hard palate through which three live maggots (larvae) were seen emerging out. The larvae were removed using forceps and the patient was treated with oral ivermectin. The maggots were identified as larvae of the Chrysomya bezziana fly.

Candida albicans is found frequently as a commensal organism in the gastrointestinal tract. Despite this, it is rarely found in pancreatic abscesses, there being only a few cases in the literature and in most of these cases the significance of Candida spp. as a pathogen was not initially recognized at the time of diagnosis. In most of the earlier reported pancreatitis associated with candida, C. albicans was the commonest isolate. We report the case of a patient in whom computed tomography was used initially to diagnose a pancreatic abscess, aspiration of which showed growth of Candida tropicalis and Escherichia coli on culture. The patient was started on amphotericin B and imipenem, but the condition of the patient deteriorated, for which the patient underwent surgical necrosectomy and continued treatment with imipenem and amphotericin B led to the satisfactory recovery of the patient.

A 24-year-old previously healthy girl presented with persistent fever, headache, and jaundice. Rapid-test anti-dengue virus IgM antibody was positive but anti-dengue IgG was nonreactive, which is suggestive of primary dengue infection. There was clinical deterioration during empiric antibiotic and symptomatic therapy. Bone marrow examination demonstrated the presence of hemophagocytosis. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was made according to the diagnostic criteria of the HLH 2004 protocol of the Histiocyte Society. The patient recovered with corticosteroid therapy. A review of literature revealed only a handful of case reports that showed the evidence that this syndrome is caused by dengue virus. Our patient is an interesting case of hemophagocytic syndrome associated with classic dengue fever and contributes an additional case to the existing literature on this topic. This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome.

Focal infection is an uncommon complication of Salmonella septicemia, particularly in immunocompetent patients. The localization of Salmonella infection to breast tissue is regarded as a rare event. We report a case of bilateral breast abscesses due to Salmonella enterica serotype Typhi in a nonlactating female and highlight the fact that Salmonella spp. should be included in differential diagnosis of abscesses in individuals coming from endemic areas with the history of recent typhoid fever and should be treated accordingly.