Mkk Rao

PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS IN HOSPITALIZED POPULATION SUBSETS

Prevalence of antibodies to hepatitis C virus (anti-HCV antibody) was ascertained in different subsets of hospitalized patients. Anti-HCV antibody testing was done using a third generation test The anti-HCV positivity in the sera of 308 tuberculosis patients, who had been given streptomycin, was 12.3 per cent It was 7.1 percent among 84 cardiac patients undergoing invasive cardiac procedures, 15.6 per cent in 77 patients on haemodialysis and 41.2 per cent patients with surgical jaundice. It is surmised that hospitalization, particularly parenteral therapy and invasive procedures during hospitalization, puts patients at higher risk of contracting HCV infecticn.

Surveillance of Scrub Typhus in the fringe areas around Pune : Potential for Transmission does exist

A field based epidemiological study was undertaken to assess the potential of transmission of scrub typhus in the sylvatic and transitional (fringe) areas at ten different locations around Pune. Parameters studied included rodent trapping and identification, entomological parameters, immunological studies on rodent sera, and rodent organ impression smears. The study revealed that Rattus r rufescence, Rattus meltada, Suncus murinus and Rattus blanfordi were the predominant sylvatic rodent species. All the species showed mild to moderate infestation with trombiculid mite larvae, with Rr rufescence and S murinus showing even higher levels of infestation. Pooled rodent sera showed mild rise of OX2 in 13.9%, OX19 in 5.6% and OXK in 9.8% of the pooled sera. The rise in titres was appreciable among rodents from Lonavala, Khadakvasla, Panchet, Singhgadh and Kondhwa areas. Based on the findings of the study, certain recommendations on prevention, surveillance and epidemic investigations of scrub typhus in the Armed Forces have been submitted.

BETA-2-MICROGLOBULIN LEVELS IN HUMAN-IMMUNODEFICIENCY VIRUS INFECTED SUBJECTS

We studied beta-2 microglobulin (β-2M) levels in 44 HIV infected subjects belonging to 3 clinical stages as well as in 25 healthy controls. The method used was a competition enzyme immunoassay. In this study, levels of β2-M were measured in two groups of HIV infected individuals, the asymptomatic and those with progressive and advanced disease, in order to affirm its role as a surrogate prognostic marker. It was found that mean β-2M levels were 1.28 mg/L in the controls (normal range 0-2.4 mg/L), 11.41 mg/L in the HIV infected subjects, 2.69 mg/L in the asymptomatic HIV infected, 12.14 mg/L in those with persistent generalized lymphadenopathy (PGL) and 39.29 mg/L in the patients with acquired immunodeficiency syndrome. It was concluded that β-2M levels were significantly higher in the HIV infected as compared to the controls. Further, the levels were much higher in the HIV infected with progressive diseasc/PGL and highest in those who had developed AIDS. β-2M is an important surrogate serological marker useful in prognostication of disease process in the HIV infected. Advantages of measuring β-2M levels over p24 antigen detection and CD4 counts were highlighted.

TOXOPLASMA ENCEPHALITIS (TE): A REPORT ON THREE FATAL CASES

Toxoplasma gondii is a ubiquitous protozoan parasite. Humans are accidental dead end hosts, cat being the definitive host. Since the advent of AIDS, the impact of infection with this protozoan has been fully appreciated [1]. Toxoplasmosis and toxoplasma infection are two different terminologies, the former describes an active disease process whereas the latter is defined by the mere presence of viable organisms [2]. Chronic or latent infection is present in all those infected since the parasite resides in the cystic stage in some tissues without any clinical disease. Reactivation occurs in immunocompromised patients [3]. The parasite is acquired per-orally, transplacentally or rarely, parenterally in laboratory accidents, by transfusion, or from a transplanted organ. Individuals with HIV infection/AIDS frequently develop toxoplasmosis; the disease usually involves CNS and is often fatal [1]. Toxoplasma Encephalitis (TE) is the most common presentation of toxoplasmosis in AIDS patients [4]. About one third of the patients with AIDS who are latently infected with the parasite will develop TE [5]. Congenital infection is considered to occur only when primary infection is acquired during gestation [6]. Immunocompromised women who acquire the primary infection within 6-8 weeks before conceiving are an exception to the above [7]. The risk of infection to the fetus varies with the trimester of gestation when the mother becomes infected, and increases with the period of gestation. We report below the 3 fatal cases of toxoplasmosis, including a case of congenital toxoplasmosis, to highlight the multiorgan disease, dominant CNS involvement and fatality caused therefrom, in the HIV infected group. Fatal Case No.1 A 39-year-old male presented with dry cough and fever of 2 weeks and cervical lymphadenopathy of 4 weeks duration FNAC of the lymph node showed evidence of tuberculosis. After one month of ATT, he developed eighth nerve palsy on the left side. CT scan of the brain revealed a large irregular ring enhancing lesion 3 cms in diameter in the left parietal region. Within a week after CT scan he developed signs of meningoencephalitis. A repeat CT scan revealed a space occupying lesion with compressed lateral ventricles, reported as tuberculoma of the brain. CSF showed raised proteins (80 mg/dL) with pleocytosis (20 lymphocytes/cmm). At this juncture, serum was tested for HIV and was positive for anti-HIV antibodies. Serum and CSF were strongly positive for toxoplasma IgG antibodies and borderline positive for IgM antibodies. He was put on therapy for toxoplasmosis and ATT was continued. He progressed in to coma and died. Autopsy was not carried out.

ENZYME LINKED IMMUNOSORBENT ASSAYS REVISITED

Enzyme linked immunosorbent assay (ELISA) has now gained wide acclaim in the immunodiagnosis of infectious diseases. ELISA is continuously evolving with newer and sensitive formulations being added to it. The basic tenets of ELISA are discussed. The role of ELISA in two important issues facing us today, namely tuberculosis and human immunodeficiency virus infection are reviewed.

SOLITARY RECTAL ULCER: CLINICO PATHOLOGICAL PROFILE OF A STUDY

Eighteen rectal biopsies of eleven patients were histologically diagnosed as solitary rectal ulcer (SRU) during a period of three years. Their clinical and sigmoidoscopic features were analysed. Correct clinical diagnosis of SRU was made in only two out of eleven cases, the rest were diagnosed after sigmoidoscopy and biopsy. Presenting features were protean predominated by an altered bowel habit or bleeding per rectum. Sigmoidoscopically the location of the lesion varied from 6 to 12 cm from the anal verge. Anterior rectal wall was more commonly affected (10 out of 11 cases). Single rectal ulcer was found in 7 patients, other 4 showing multiple ulcers or polypoidal non-ulcerative lesions. Three patients required multiple biopsies. Prominent histological findings were obliteration of lamina propria by fibromuscular strands, splaying and hypertrophy of muscularis musosae as well as infiltrate in both these layers. The necessity of biopsy to diagnose SRU is stressed.

SUBACUTE SCLEROSING PANENCEPHALITIS (A Report on Two Cases)

We report two cases of subacute sclerosing panencephalitis (SSPE) which is a rare, late neurological sequel, of measles infection acquired in childhood. The diagnosis was reached by adopting criteria defined by Dyken. Past history of measles was present in both the cases and they showed high titres of measles specific antibody in CSF and serum by quantitative ELISA.