Dengue infection in central India: a 5 years study at a tertiary care hospital

Background: Dengue is one of the most important mosquito borne viral disease with wide spectrum of clinical presentation and often with unpredictable clinical evolution and outcome. Approximately 50 million infections occur annually world-wide, but what’s the real size of the problem in India?  Nobody truly knows...!!  Present study was carried out to determine seropositivity, clinical profile and seasonal variation of dengue infection in central India.Methods: Study was carried out from January 2012 to December 2016. Blood samples were collected from 15,606 patients with dengue like clinical illness and serum was separated. All the samples were subjected to IgM antibody detection by dengue MAC ELISA.Results: Prevalence of dengue in dengue suspected cases was found to be 24.49% (3,822/15,606). Maximum number of positive cases, 1,548 (40.50%) were in the age group of 0-10 years. Males (60.83%) were affected more than females (39.17%). Peak was observed in the months of August, September, October and November. Common presenting features were fever followed by myalgia, arthralgia, headache and bleeding manifestations. Significant drop in platelet count was observed in patients with dengue shock syndrome and dengue haemorrhagic fever.Conclusions: Number of dengue cases in central India are on increase and continued surveillance is essential to determine epidemiological and seasonal trend

NS1 ANTIGEN DETECTION BY ELISA IN EARLY LABORATORY DIAGNOSIS OF DENGUE INFECTION

Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world and it is known for serious life threatening complications. Detection of IgM antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tools that can detect dengue infection earlier. Aim and Objectives: To evaluate the efficacy of NS1 antigen ELISA for early diagnosis of dengue virus infection in a tertiary care hospital Methods- A total of 2106 serum samples from patients with suspected dengue infection were tested for dengue NS1 antigen and IgM antibody detection by ELISA. Results: 765 (36.32%) were positive for dengue NS1 antigen and 857 (40.69%) were positive for dengue IgM antibody. NS1 antigen was detectable in patient sera from day 1 onwards however; dengue IgM antibody was detected from day 3 onwards. Out of 765 NS1 antigen positive samples, 562 (73.46%) were positive in acute phase of illness and 203 (26.54%) were positive in convalescent phase of illness. Out of 857 MAC ELISA positive samples, 312 (36.41%) were from acute phase of illness and 545 (63.59%) were from early convalescent phase of illness. Combination of two tests resulted in increase in the positivity rate to 52.66% as against to independent positivity rate of 36.32% of NS1 ELISA and 40.69% of MAC ELISA. Conclusion: Combined use of NS1 antigen assay with MAC ELISA test could significantly improve diagnostic sensitivity of dengue infectio

NS1 ANTIGEN DETECTION BY ELISA IN EARLY LABORATORY DIAGNOSIS OF DENGUE INFECTION

Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world and it is known for serious life threatening complications. Detection of IgM antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tools that can detect dengue infection earlier. Aim and Objectives: To evaluate the efficacy of NS1 antigen ELISA for early diagnosis of dengue virus infection in a tertiary care hospital Methods- A total of 2106 serum samples from patients with suspected dengue infection were tested for dengue NS1 antigen and IgM antibody detection by ELISA. Results: 765 (36.32%) were positive for dengue NS1 antigen and 857 (40.69%) were positive for dengue IgM antibody. NS1 antigen was detectable in patient sera from day 1 onwards however; dengue IgM antibody was detected from day 3 onwards. Out of 765 NS1 antigen positive samples, 562 (73.46%) were positive in acute phase of illness and 203 (26.54%) were positive in convalescent phase of illness. Out of 857 MAC ELISA positive samples, 312 (36.41%) were from acute phase of illness and 545 (63.59%) were from early convalescent phase of illness. Combination of two tests resulted in increase in the positivity rate to 52.66% as against to independent positivity rate of 36.32% of NS1 ELISA and 40.69% of MAC ELISA. Conclusion: Combined use of NS1 antigen assay with MAC ELISA test could significantly improve diagnostic sensitivity of dengue infectio

Monitoring of hepatitis B virus surface antigen escape mutations and concomitant nucleostide analog resistance mutations in patients with chronic hepatitis B

Background: In hepatitis B virus (HBV), reverse transcriptase (RT) region of the polymerase P gene and surface S gene (HBsAg) are largely overlapped. Mutations in surface S gene may cause escape variants. In the present study, we aimed to study the prevalence and pattern of the typical HBsAg escape mutations and concomitant nucleos(t)ide analogue resistance mutation patterns in patients with chronic hepatitis B (CHB) in Indian population.Methods: The present observational study was carried out from January 2021 to June 2022 with 156 known cases of CHB infection. Hepatitis B viral load quantitation was done followed by HBV genotyping and drug resistance detection by PCR and sequencing.Results: Out of 156 cases of CHB, HBsAg escape mutations were found in 50 (32.05%) patients. Genotype D was predominant (90%). Median viral load was 4.43×105 copies/ml. Total 128 HBsAg escape mutations of 46 different patterns were observed with overall prevalence of 29.49% (46/156) in CHB infected patients. The most common substitutions were sP127T (16.67%), sA128V (14.74%), sR122K (5.13%), sY134N (3.85%), sK141R (2.56%), sS143L (2.56%) and sT126INST (1.92%). Concomitant RT mutations were detected in 20 (40%) patients. Total 68 (43.59%) RT mutations of 18 different mutation characteristics were found conferring possible or confirmed resistance to nucleos(t)ide analogues.Conclusions: The emergence of drugs resistant mutants with alteration in ‘aa’ determinant of the S protein is of some concern. The development of novel nucleos(t)ide analogues with a high barrier to resistance is warranted.  National surveillance networks should be set up