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   2011| April-June  | Volume 3 | Issue 2  
    Online since May 27, 2011

 
 
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REVIEW ARTICLE
Tuberculosis: Current situation, challenges and overview of its control programs in India
Gursimrat K Sandhu
April-June 2011, 3(2):143-150
DOI:10.4103/0974-777X.81691  PMID:21731301
Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000 years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India, historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place. Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second largest, in terms of population coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lack of political will; and, above all, corrupt administration. Multidrug-resistant TB (MDR-TB) is another emerging threat to TB eradication and is a result of deficient or deteriorating TB control program. WHO with its "STOP TB" strategy has given a vision to eliminate TB as a public health problem from the face of this earth by 2050. For this review article, data available at the official websites of WHO; and from the Ministry of Health, Government of India, were consulted, and search engines PubMed; and Google Scholar; were used.
  12 10,006 24
SYMPOSIUM ON INFECTIONS AND TRAVEL
Conquering malaria: Enhancing the impact of effective interventions towards elimination in the diverse and changing epidemiology
AY Kitua, OAT Ogundahunsi, J Lines, CS Mgone
April-June 2011, 3(2):161-165
DOI:10.4103/0974-777X.81694  PMID:21731304
Malaria remains a major global disease burden causing just under a million deaths each year, mainly of children and pregnant women in sub-Saharan Africa. It consumes up to 40% of public health expenditure of these poor countries, causing in Africa US$ 12 billion in lost GDP every year. This should not be acceptable since malaria is preventable, and there is clear evidence that optimal use of current tools can reduce much of the suffering and deaths. Three major factors allowing this to happen include: (i) inadequate funding to implement a massive initial surge, to achieve universal coverage, (ii) weak country capacities for rapid scale up of such interventions and little or no use of evidence-guided methods, and (iii) insufficient coordination of efforts between national programmes, donors and technical agencies in strategic planning for sustaining gains and in building capacity. We discuss the importance of the surge and the kind of approaches that would accelerate the pace toward elimination and eventual eradication.
  11 2,736 18
Novelties on amoebiasis: A neglected tropical disease
Cecilia Ximénez, Patricia Morán, Liliana Rojas, Alicia Valadez, Alejandro Gómez, Manuel Ramiro, René Cerritos, Enrique González, Eric Hernández, Partida Oswaldo
April-June 2011, 3(2):166-174
DOI:10.4103/0974-777X.81695  PMID:21731305
In accordance with the 1997 documents of the World Health Organization (WHO), amoebiasis is defined as the infection by the protozoan parasite Entamoeba histolytica with or without clinical manifestations. The only known natural host of E. histolytica is the human with the large intestine as major target organ. This parasite has a very simple life cycle in which the infective form is the cyst, considered a resistant form of parasite: The asymptomatic cyst passers and the intestinal amoebiasis patients are the transmitters; they excrete cysts in their feces, which can contaminate food and water sources. E. histolytica sensu stricto is the potentially pathogenic species and E. dispar is a commensal non-pathogenic Entamoeba. Both species are biochemical, immunological and genetically distinct. The knowledge of both species with different pathogenic phenotypes comes from a large scientific debate during the second half of the 20 th century, which gave place to the rapid development of diagnostics technology based on molecular and immunological strategies. During the last ten years, knowledge of the new epidemiology of amoebiasis in different geographic endemic and non-endemic areas has been obtained by applying mostly molecular techniques. In the present work we highlight novelties on human infection and the disease that can help the general physician from both endemic and non-endemic countries in their medical practice, particularly, now that emigration is undoubtedly a global phenomenon that is modifying the previous geography of infectious diseases worldwide.
  9 11,371 38
CASE REPORTS
Subcutaneous human dirofilariasis due to Dirofilaria Repens: Report of two cases
Harish S Permi, S Veena, HL Kishan Prasad, Y Sunil Kumar, Rajashekar Mohan, K Jayaprakash Shetty
April-June 2011, 3(2):199-201
DOI:10.4103/0974-777X.81702  PMID:21731311
Zoonotic filariasis due to Dirofilaria repens (D. repens) is prevalent in several regions of the world. In view of recent rise of human D. repens infections in Europe, Africa and Asia, it is considered an emerging zoonosis in these continents. Most of the documented cases of human dirofilariasis recorded in India had ocular infections, but very few subcutaneous dirofilariasis have been reported. We hereby report two cases of subcutaneous human dirofilariasis due to D.repens with varied clinical presentations.
  7 3,541 15
ORIGINAL ARTICLES
Potential activity of the purine compounds caffeine and aminophylline on bacteria
Ali Abdul Hussein S AL-Janabi
April-June 2011, 3(2):133-137
DOI:10.4103/0974-777X.81689  PMID:21731299
Background: Purine compounds are special types of alkaloids. Caffeine and aminophylline are considered the most important members of purines due to their wide use in therapeutics. Aims: To detect any potential antibacterial effects on pathogenic bacteria of the widely prescribed members of purines caffeine and aminophylline. Materials and Methods: Two species of gram-positive bacteria and five species of gram-negative bacteria were exposed to these purine agents. Antibacterial effects of the tested purines were determined using the spectrophotometer method to assess the minimum inhibition concentrations (MIC). Results: Among the strains of bacteria tested, Bacillus subtilis showed the most susceptibility to purine agents. Staphylococcus aureus and Bacillus subtilis were found to be more susceptible to caffeine than the other strains. Aminophylline showed inhibitory action on many isolates, especially at the concentration of 10mg/ml. Paracoccus yeei demonstrated resistance to all tested purine compounds up to a concentration of 10.5mg/ml. Conclusions: Caffeine and aminophylline had the ability to inhibit many strains of pathogenic bacteria.
  7 5,001 19
SYMPOSIUM ON INFECTIONS AND TRAVEL
River blindness: An old disease on the brink of elimination and control
Kevin L Winthrop, Joao M Furtado, Juan C Silva, Serge Resnikoff, Van C Lansingh
April-June 2011, 3(2):151-155
DOI:10.4103/0974-777X.81692  PMID:21731302
For decades, onchocerciasis (or river blindness) was one of the most common infectious causes of blindness in the world. Primarily an infection of Africa, with limited distribution in the new world, disease due to the nematode Onchocerca volvulus is rapidly diminishing as a result of large public health campaigns targeting at risk populations in Africa and the Americas. Existing and newly-developed treatment strategies offer the chance to eliminate onchocercal ocular morbidity in some parts of the world. This article reviews these treatment strategies, current clinical and epidemiologic aspects of onchocerciasis, and the next steps toward elimination.
  7 3,916 20
ORIGINAL ARTICLES
Genotypic characterization of Staphylococcus aureus obtained from humans and bovine mastitis samples in India
K Prashanth, K Rajender Rao, PV Vivek Reddy, R Saranathan, Abhijith R Makki
April-June 2011, 3(2):115-122
DOI:10.4103/0974-777X.81686  PMID:21731296
Aim and Background: Staphylococcus aureus is a major human pathogen that also causes important infections in cattle and sheep. The present study aimed to test genetic diversity among strains of S. aureus isolated from cattle (n=34) and humans (n=22) by DNA typing. Materials and Methods: Fluorescent amplified fragment length polymorphism (FAFLP) is the genotyping tool used in the study. The presence of the mecA and Panton-Valentine leukocidin (PVL) genes among these strain groups was also checked. Results: A dendrogram deduced from FAFLP showed that all the strains clustered into 10 groups (A-J) with a relative genetic divergence of less than 8%. Sixty-seven percent of the isolates from bovine sources clustered together in two clades (A and H), while another major cluster with 13 isolates (59%) (Cluster G) had all strains from a human host. The remaining strains from both the hosts clustered independently into smaller clusters with the exception of two strains of human origin, which clustered along with a bovine cluster. Thirteen strains belonging to cluster G were highly clonal. About 77% of strains obtained from human infections were methicillin-resistant S. aureus (MRSA), whereas only 29% of strains from bovine origin were MRSA. Only three strains from human origin showed PVL positive, while no strain from cattle had PVL genes. The complete absence of PVL genes in all the bovine strains in the study appears to be significant. Conclusions: FAFLP can be successfully applied to assess the genetic relationship of S. aureus isolates from different hosts. The study also provided the valuable epidemiological data on S. aureus from bovine sources in India, which is lacking.
  4 4,415 25
SYMPOSIUM ON INFECTIONS AND TRAVEL
Prevention of soil-transmitted helminth infection
Luciene Mascarini-Serra
April-June 2011, 3(2):175-182
DOI:10.4103/0974-777X.81696  PMID:21731306
Soil-transmitted helminths (STHs) form one of the most important groups of infectious agents and are the cause of serious global health problems. The most important STHs are roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura) and hookworms (Necator americanus or Ancylostoma duodenale); on a global level, more than a billion people have been infected by at least one species of this group of pathogens. This review explores the general concepts of transmission dynamics and the environment and intensity of infection and morbidity of STHs. The global strategy for the control of soil-transmitted helminthiasis is based on (i) regular anthelminthic treatment, (ii) health education, (iii) sanitation and personal hygiene and (iv) other means of prevention with vaccines and remote sensoring. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed, as well as the costs of the prevention of STHs, although these cannot always be calculated because interventions in health education are difficult to measure. An efficient sanitation infrastructure can reduce the morbidity of STHs and eliminates the underlying cause of most poverty-related diseases and thus supports the economic development of a country.
  4 5,511 20
Cysticercosis control: Bringing advances to the field
SE O'Neal, KL Winthrop, AE Gonzalez
April-June 2011, 3(2):156-160
DOI:10.4103/0974-777X.81693  PMID:21731303
Progress towards Taenia solium control is evident in the development of new technologies and in increasing regional coordination, yet disease eradication remains unlikely in the near future. In the meantime, translation of research advances into functioning control programs is necessary to address the ongoing disease burden in endemic areas. Multiple screening assays, effective treatments for both human and porcine infection, and vaccines blocking transmission to pigs are currently available. Strategies based on identification and treatment of T. solium adult tapeworms, as well as interventions that block cysticercosis acquisition in pigs have temporarily reduced transmission. Building on these successes with controlled community trials in varying endemic scenarios will drive progress towards regional elimination.
  3 2,521 19
ORIGINAL ARTICLES
Awareness regarding the systemic effects of periodontal disease among medical interns in India
Arpita Gur, JP Majra
April-June 2011, 3(2):123-127
DOI:10.4103/0974-777X.81687  PMID:21731297
Background: Medical curriculum does not provide required space for oral health; hence, many medical interns are unfamiliar with the oral cavity and oral health research. Aims: To study the level of awareness regarding systemic effects of periodontal disease among medical interns. Settings and design: A cross-sectional qualitative study recruiting medical interns from two medical institutions affiliated to two different universities in Southern India. Materials and Methods: Study was carried out in two medical institutions affiliated to two different universities in Southern India. A total of 143 interns participated in the study. Each participant was given a self-administered, pre-tested, multiple choice question-type questionnaire to solve on the spot. In order to summarise the awareness level, respondents were graded on a five-level scale as poor, fair, good, very good, and excellent. Statistical analysis used: Percentages, proportions. Results: A total of 67 respondents (47%) had fair; 60(42%), poor; and 18(11%), good level of awareness regarding the systemic effects of periodontal disease. Only 23(16%), 17(12%), 12(8%), 6(4%) and 4(3%) respondents were aware that the periodontal disease may be the possible risk factor for coronary heart disease, cerebral infarction, diabetes mellitus, hospital-acquired pneumonia, and preterm labour (low birth-weight infants), respectively. Only 12 respondents (8%) would seek dentist's opinion for all patients with systemic diseases related to dental disease. Conclusions: Medical interns had inadequate awareness regarding the systemic effects of periodontal disease. Therefore, an integrated teaching of medical and dental sciences is recommended.
  2 3,679 17
Nocardiosis in a tertiary care hospital in Saudi Arabia
Hamdan Al-Jahdali, Salem Baharoon, Salwa Alothman, Ziad Memish, Abdelkarim Waness
April-June 2011, 3(2):128-132
DOI:10.4103/0974-777X.81688  PMID:21731298
Background: Nocardiosis is an uncommon bacterial infection that is caused by aerobic actinomycetes of the genus Nocardia. This pathogen has emerged as an important cause of mortality and morbidity among both immunocompetent and (more commonly) immunocompromised hosts. The prevalence of nocardiosis is unknown in Saudi Arabia. Only sporadic cases of cutaneous nocardiosis have been reported. In this study, we performed a 10-year retrospective review of all cases of nocardiosis identified at the King Fahad National Guard Hospital in Riyadh. Clinical presentation, risk factors, site of disease involvement, radiological features, and outcomes of 30 patients with pulmonary and disseminated nocardiosis are presented. Materials and Methods: A retrospective chart review of all cases of nocardiosis over the last ten years. Results: Thirty cases of nocardiosis were identified. The disease was more common in males. Fever and cough was the most common presentation. Most of the patients had an underlying pulmonary disease. Consolidation was the most prevalent radiological feature. Pleural effusion was common. Unfortunately, none of the isolates were sub-speciated. Cure was possible in 40% of the cases. Ten percent of patients died, while follow-up on the rest of the patients was lost. Conclusion: Nocardiosis is not uncommon in Saudi Arabia. Cases are not restricted to the classical immunocompromised host. A database is urgently needed to better evaluate the prevalence of the illness among the Saudi population.
  2 2,444 16
INFECTION CONTROL STUDIES
Cholera in Ecuador: Current relevance of past lessons learnt
SS Malavade, A Narvaez, A Mitra, T Ochoa, E Naik, M Sharma, S Galwankar, MD Breglia, R Izurieta
April-June 2011, 3(2):189-194
DOI:10.4103/0974-777X.81699  PMID:21731309
This report analyses the trends in the cholera epidemic that hit Ecuador in 1991. The study is based on personal experiences and analysis of epidemiological databases from the Ministry of Public Health of Ecuador. The number of cases and initial attack rates in an immunologically naive population are described by province. An analysis of the Andean and coastal cholera patterns of transmission are described along with its associated risk factors. The logistical, environmental, and socio-cultural risk factors prevalent during the epidemic and the control measures implemented are also reviewed. Also, the role of the epidemic in the development of the public health and healthcare resources in Ecuador is discussed here. Current data indicate favorable conditions for another outbreak of cholera in Ecuador. In view of the existing risk factors, new strategies are proposed to prevent such an epidemic in the future.
  1 3,650 20
LETTERS TO EDITOR
Understanding the clinico-microbiological spectrum of common ear, nose and throat infections in Sikkim, India
Tsering C Dechen, Ranabir Pal, Sumit Kar
April-June 2011, 3(2):202-202
DOI:10.4103/0974-777X.81703  PMID:21731312
  1 1,662 14
A case of dengue encephalitis with intracerebral hemorrhage
Arjun Khanna, Virendra Atam, Alok Gupta
April-June 2011, 3(2):206-207
DOI:10.4103/0974-777X.81707  PMID:21731315
  1 1,622 17
ORIGINAL ARTICLES
Antigenic distribution of west nile virus in various organs of wildly infected American crows (Corvus Brachyrhynchos)
Tejbir S Sandhu, Dalbinder S Sidhu, Major S Dhillon
April-June 2011, 3(2):138-142
DOI:10.4103/0974-777X.81690  PMID:21731300
Objective: Since its discovery in the western hemisphere in 1999, West Nile virus (WNv) has caused extensive bird mortality across North America, especially in American crows (Corvus brachyrhynchos) which are highly susceptible to WNv. In this study, antigenic distribution of WNv among different organs of American crows was studied, using the immunohistochemistry technique (IHC). Materials and Methods: Dead crows reported by residents were collected, transported on ice, and were necropsied for heart, lung, brain, intestine, kidney, liver, spleen, pancreas, and gonad tissues. Gross examination was performed on brain, heart, lung, liver, kidney, spleen, bursa of fabricius, gastrointestinal tract, skeletal muscle, pancreas, reproductive tract, and skin. Gross hemorrhage of brain, splenomegaly, meningoencephalitis, myocarditis, and trauma were sporadically observed in some of the infected carcasses. Formalin-fixed paraffin-embedded tissue sections were stained with IHC technique followed by counter staining with hematoxylin and eosin. Results: WNv antigen was detected in brain, spleen, heart, kidney, liver, gonads, intestine, lung, and pancreas. The spleen was found to be positive in all infected crows, followed by kidney, liver, and duodenum (95% each). Heart and pancreas were positive in 63% while brain was positive in 36.5% of the infected crows. Conclusion: More than one tissue sample is suggested to screen WNv infection using IHC technique. IHC has the advantage of correlating the visual destruction of tissue architecture with the presence of stained WNv antigen but as compared to PCR, IHC has the disadvantage of longer turnaround time, which is critical when used as a surveillance tool.
  1 2,657 14
PICTORIAL EDUCATION
Melioidosis: A case report
Purabi Barman, Harish Sidhwa, Pinak A Shirkhande
April-June 2011, 3(2):183-186
DOI:10.4103/0974-777X.81697  PMID:21731307
Burkhloderia pseudomallei has recently gained importance as an emerging pathogen in India. It causes various clinical manifestations like pneumoniae, septicaemia, arthritis, abscess etc. Cases have been reported from Southeast Asia mainly Thailand, Malaysia, Vietnam, etc. In India, few cases have been reported mainly from the southern part of the country. Patient was a 65-year-old male and presented with fever 1 month back, cough and breathlessness for same period, swelling on both ankles from 7 days. B. pseudomallei was isolated from endotracheal secretions, blood cultures, leg wound. He was successfully treated with Imipenem and Doxycycline and put on maintenance therapy now, and is currently doing well.
  1 4,921 35
CASE REPORTS
An apple-core lesion in the colon: An infectious etiology
Tanmay S Panchabhai, Rajeev K Bais, Regan C Pyle, Charlene K Mitchell, Forest W Arnold
April-June 2011, 3(2):195-198
DOI:10.4103/0974-777X.81700  PMID:21731310
Gastrointestinal involvement occurs in about 70% to 90% of histoplasmosis cases but is usually not the initial manifestation. We present the case of a 52-yearold HIV-positive woman who presented with gastrointestinal symptoms and an apple-core lesion on CT scan of the abdomen. The patient had been diagnosed with histoplasma colitis eight months earlier and was started on long-term itraconazole therapy. However, she prematurely discontinued treatment. A colonoscopy during the present hospitalization revealed a 3.5-cm mass, biopsies of which revealed Histoplasma capsulatum. In the present report, we discuss the differential diagnosis of apple-core lesions in the colon and the importance of keeping histoplasmosis on the differential diagnosis, especially in endemic areas like the Ohio River valley. It is equally important to ensure compliance with treatment of histoplasmosis, as well as close follow-up, as progression to colonic obstruction while on medical management has been reported.
  - 4,808 17
CLINICAL EPIDEMIOLOGY
Outbreak of human buffalopox infection
Ajit S Damle, Anil A Gaikwad, Neeta S Patwardhan, Mangal M Duthade, Nazneen S Sheikh, Durgesh G Deshmukh
April-June 2011, 3(2):187-188
DOI:10.4103/0974-777X.81698  PMID:21731308
An outbreak of febrile illness with vesicular lesions on hands and forearms of six persons was investigated. There was simultaneous outbreak of similar illness in buffaloes that were milked by these persons. Buffaloes had lesions on many parts of body including udder and teats. Manual milking without gloves exposed the persons to the infection. Investigations proved that both the outbreaks were due to buffalopox virus infection. Improved dairy practices like wearing gloves while milking might help in prevention of spread of infection to other animals and humans.
  - 2,142 13
EDITORIAL
State of the globe: The unglamorous side of infectious diseases: Parasites
Van C Lansingh, Marissa J Carter
April-June 2011, 3(2):113-114
DOI:10.4103/0974-777X.81685  PMID:21731295
  - 2,396 17
LETTERS TO EDITOR
Characteristics and management patterns of patients admitted with fever and thrombocytopenia to an acute general medical unit in Sri Lanka
Shiyana Ibrahim, Charith Horadagoda, Chinthaka Maithripala, Niroshan Lokunarangoda, Gayan Ranasinghe, Thanushi Wickramarathne, Senaka Rajapakse
April-June 2011, 3(2):203-205
DOI:10.4103/0974-777X.81704  PMID:21731313
  - 1,745 13
Translation research in molecular disease diagnosis: Bridging gap from laboratory to practice
Pradyumna K Mishra, Gorantla V Raghuram, Arpit Bhargava, Neelam Pathak
April-June 2011, 3(2):205-206
DOI:10.4103/0974-777X.81705  PMID:21731314
  - 2,169 13
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