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

Chandipura virus encephalitis outbreak among children in Nagpur division, Maharashtra, 2007

Background & objectives: An outbreak of acute encephalitis syndrome (AES) among children from Nagpur division, Maharashtra was investigated to confirm the aetiology and to describe clinico-epidemiological features. Methods: AES cases among children < 15 yr, from Nagpur division, hospitalized between June-September 2007, were investigated. Serum and cerebrospinal fluid (CSF) were tested for IgM antibodies against Chandipura virus (CHPV) and Japanese encephalitis virus (JEV) and for CHPV RNA by RT-PCR. Partial N gene sequences were used for phylogenetic analysis. Virus isolations were attempted in rhabdomyosarcoma (RD) cell line. Sandflies were collected, pooled and tested for CHPV RNA by RT-PCR. Results: A total of 78 AES cases were recorded in children < 15 yr of age. Case fatality ratio was 43.6 per cent. Male to female ratio was 1:1.2. Chandipura (CHP) was confirmed in 39 cases. CHPV RNA was detected in both CSF and serum specimens of 2 cases and in serum of 22 cases. Phylogenetic analysis showed 99.98-100 per cent nucleotide identity in the sequences studied. Anti-CHPV IgM antibodies were detected in CSF of 2 cases and in serum of 8 cases. Seroconversion to anti-CHPV IgM antibodies was observed in 5 cases. Clinical manifestations of CHP cases (n=38) were fever (100%), convulsion (76.3%), altered sensorium (34.2%), headache (23.7%), vomiting (44.7%) and diarrhoea (23.7%). CHPV RNA was detected in one of two pools of sandflies from affected locality. Interpretation & conclusions: Chandipura virus was confirmed as the aetiological agent of this acute encephalitis outbreak with high case-fatality among children

Clinical and antimicrobial profile of Coagulase Negative staphylococci in a tertiary care hospital

Background: Coagulase negative staphylococci (CoNS) are gaining importance because of their role as pathogens in certain clinical conditions and their marked resistance to antibiotics. Their species distribution and slime production has important correlation with the antimicrobial susceptibility pattern. Aim of this study was to determine clinically significant CoNS, their species distribution, slime production and antimicrobial susceptibility pattern in a tertiary care hospital.Methods: Identification, speciation and antimicrobial sensitivity testing were performed using standard microbiological techniques. Slime production was also tested by microtiter plate. Antimicrobial susceptibility testing was performed by modified Kirby Bauer method as per the CLSI guidelines.Results: A total 204 (49.88%) CoNS were found to be clinically significant. Percentage of clinical significance was high in urine isolates (88.88%) followed by pus (47.78%) and blood (45.56%). The most common CoNS infection was septicaemia (54.9%) followed by abscesses and wound infections (26.5%) and urinary tract infection (15.8%). S. epidermidis (46.1%) was the commonest species in CoNS infection followed by S. haemolyticus (22.1%), S. lugdunensis (11.8%) and S. saprophyticus (8.3%). Slime production was seen in 56.4% isolates by microtiter plate method. Maximum resistance was seen to penicillin (92.25%), followed by cotrimoxazole (73.03%), norfloxacin (73.03%), tetracycline (71.07%), gentamicin (69.6%) and cefoxitin (63.2%).Conclusions: The role of CoNS as pathogen, particularly nosocomial and opportunistic is increasing. Identification of species, slime production and antimicrobial susceptibility of CoNS is highly desirable to permit a more precise determination of host-pathogen relationship and knowledge of pathogenicity