Prevalence study of tuberculous infection over fifteen years, in a rural population in Chingleput district (south India)

As in the earlier BCG trial against tuberculosis conducted in Chingleput district in south India (in 1969), the entire study population was tuberculin tested (Survey I), a study was undertaken subsequently to see whether in this population there was any change in the tuberculosis situation in terms of prevalence of infection in children. For this purpose, in two of the panchayat unions, in a random sample of panchayats, tuberculin testing was repeated twice at an interval of 10 yr (Survey II) and 15 yr (Survey III) after the initial testing in children aged 1-9 yr. High coverages were obtained for tuberculin testing and reading. Data from 8,703 and 9,709 children at Surveys I and II respectively was used for comparing the prevalence of infection over a period of 10 yr and from 4.808, 4,965 and 4,889 children at Surveys I, II and III respectively for comparing the prevalence of infection over a period of 15 yr. The results showed that although the prevalence of infection varied in the two panchayat unions, within each panchayat union it did not differ significantly at the three surveys. The overall prevalence of infection at the three surveys was 9.0, 10.2 and 9.1 per cent respectively. The average annual risk of tuberculous infection was estimated to be 1.7, 1.9 and 1.7 per cent at the three surveys respectively. Thus, the results clearly showed that, over a period of 15 yr, there was no change in the tuberculosis situation, in terms of prevalence of infection, in the study population

Use of mebendazole in combination with DEC in bancroftian filariasis

A pilot study was conducted in an endemic village for bancroftian filariasis to find out the compliance and antifilarial action of large doses of mebendazole (30 mg/kg/day). Thirty eight patients with early clinical filariasis and 16 with asymptomatic microfilaraemia were treated, under supervision. ‘The compliance for drug consumption was high and there were no serious adverse reactions. Majority of the side effects were gastrointestinal and mild. The drug, in combination with diethylcarbamazine (DEC), showed microfilaricidal effect, but the effect was similar to that seen with DEC alone. In as many as 5 of the 13, who were followed at 1 yr, microfilaria persisted at the end of 1 yr, though with a reduced density. Prolonged (1 yr) treatment with mebendazole in combination with DEC did not have a beneficial effect in most patients with clinical disease

IgG antibodies against antigens of various mycobactrial species in children and in pre & Post BCG young adults

IgG antibodies against antigens of various mycobacteria were estimated by ELISA in serum samples collected (a) from 36 children (mean age 4.4 years) belonging to Koppur village in the south Indian BCG Trial area, (b) before and after BCG vaccination of 13 young individuals (mean age 16.5 years) belonging to Trivellore in the same area and (c) before and after BCG vaccination from 20 young British subjects (mean age 14.5 years). In the Koppur children, the antibody levels were highest against M. scrofulaceum and M. avium and lowest against M. bovis and M. tuberculosis H37Rv. In these children, there was no correlation between antibody levels and tuberculin reactivity. In the Trivellore subjects, antibody levels were highest against M. bovis BCG and M. gordonae, and lowest against PPD RT22 and M. terrae and none of the differences in the antibody levels against individual antigens between the preand post-BCG serum samples was statistically Significant (p >.05). The British subjects had the highest levels against M. tuberculosis 7219 while the lowest levels were against M. kansasii and M. tuberculosis 51; after BCG v a c c i n a t i o n t h e a n t i b o d y l e v e l s w e r e selectively increased against M. tuberculosis 7219, M. flavescens and M. gordornae (p <0.05)

Experiences with Mycobacterium leprae soluble antigens in a leprosy endemic population

Rees and Convit antigens prepared from armadillo-derived Mycobacterium leprae were used for skin testing in two leprosy endemic villages to understand their use in the epidemiology of leprosy. In all, 2602 individuals comprising 202 patients with leprosy detected in a prevalence survey, 476 household contacts and 1924 persons residing in non-case households were tested with two antigens. There was a strong and positive correlation ( r = 0.85) between reactions to the Rees and Convit antigens. The distribution of reactions was bimodal and considering reactions of 12 mm or more as ‘positive’, the positivity rate steeply increased with the increase in age. However. the distributions of reactions to these antigens in patients with leprosy. their household contacts and persons living in non-case households were very similar. These results indicate that Rees and Convit antigens are not useful in the identification of M. leprae infection or in the confirmation of leprosy diagnosis in a leprosy endemic population with a high prevalence of nonspecific sensitivity

Prevalence survey of filariasis in two villages in Chingleput district of Tamil Nadu

A baseline survey of filariasis was conducted in two endemic villages in Chingleput district of Tamil Nadu, to obtain the prevalence rate of microfilaraemia and that of clinical filarial disease along with its various clinical patterns. Of the 2921 dejure population registered, in 2735 a comprehensive clinical examination for filariasis was carried out by a physician. In 2658 persons of those clinically examined, night blood samples were collected by finger prick. The results of the survey confirmed that the two village were highly endemic for filariasis, the prevalence rates of clinical disease and microfilaraemia being 20 and 12 per cent respectively. The endemicity rate was 31 per cent. Nocturnally periodic Wuchereria bancrofti was the only species identified. The major manifestations of clinical disease were lymphadenitis in the acute phase, hydrocele and oedema of the lower limbs in the chronic phase and involvement of the lower limbs in the elephantiasis phase. Among males with disease in the chronic phase, genital involvement was more than that of the lower limbs. The distributions of the patients by age in the three phases, although overlapping, suggested that the disease generally progressed with age from acute to chronic to elephantiasis phase. The microfilarial rate among persons with clinical disease was lower as compared to that among persons without disease. An entomological survey of one of the villages showed that Culex quinquefasciatus was the vector with high infection and infectivity rates

Bacteriology of Acute Respiratory Infections in Children

Bacteriological investigations were carried out on 151 children (80 males and 71 females) suffering from acute respiratory infections (ARI) to And out bacteria associated with ARI. Fifty one children presenting with upper respiratory infections (URI) and 100 with lower respiratory infections (LRI) seen at the outpatient department of the Institute of Child Health and Hospital for Children, Madras, were included in this study. In all, 56% of the children yielded any one or a mixture of bacteria that could be potential or probable pathogens of ARI. Nonfermenting gram negative bacilli (NFGNB) were the predominant organisms isolated (27%) followed by non-typable ampicillin resistant Haemophilus influenzae (13%) and b. haemolytic streptococci groups C and G (11%). The other bacteria isolated in this study were Klebsiella pneumoniae (7%), Streptococcus pneumoniae (3%), Neisseria sps. pure (3%) and Staphylococcus aureus (1%). The isolation rate of NFGNB was maximum (47%) when the duration of illness exceeded 7 days. Mixed infections of potential or probable pathogens were observed in 11 patients which included NFGNB + K. pneumoniae (2); H. influenzae + NFGNB (2); b- haemolytic streptococci + H. influenzae (2); b- haemolytic streptococci + K. pneumoniae (1) ; S. aureus + K. pneumoniae (1) ; Neisseria sp. + K. pneumoniae (2) and NFGNB + b- haemolytic streptococci + H. influenzae (1)

Tuberculosis prevalence survey in Kashmir valley

A tuberculosis prevalence survey was conducted in about 18,000 persons in Kashmir valley situated about 1650 m above the mean sea level. All persons were tested with 3 IU of PPD-S and 10 units of PPD-B. Persons aged 5 yr and above were X-rayed (70 mm X-ray), and from such persons whose photofluorograms were interpreted as abnormal two specimens of sputum were collected and bacteriologically examined. In addition, a large X-ray of the chest was taken for children aged 0-4 yr who had reactions of 10 mm or more to PPD-S. They were then clinically examined by a paediatrician, taking into account all available data, for evaluation for any evidence of tuberculosis. The results of the survey showed that the prevalence of non-specific sensitivity (59%) in the Kashmir valley is significant. The prevalence of tuberculous infection was 38 per cent. The prevalence of culture positive tuberculous patients (3 per 1000) and that of abacillary X-ray positive patients (14 per 1000) were found to be similar in the two sexes contrary to the usual experience of a higher prevalence among males. Results from studies of phage typing, susceptibility to thiophen-2-carbonic acid hydrazide (TCH) and virulence in the guineapig of strains obtained from patients diagnosed in the survey showed that most of these strains belonged to phage type A, were resistant to TCH and were not of low virulence. Regional variations in the prevalence rates were seen, the- problem of tuberculosis appeared to he more in the Baramulla district as compared to Srinagar and Anantnag districts. A comparison of results obtained from the present survey with those obtained from the BCG trial in Chingleput (Tamil Nadu) revealed that the tuberculosis situation in the two areas was quite different

A tuberculosis prevalence survey based on symptoms questioning and sputum examination

A sample survey was undertaken in Raichur district of Karnataka State to estimate the prevalence of bacteriologically positive pulmonary tuberculosis among symptomatics aged 15 years and above. A population of 72,448 persons was registered in a representative sample of 57 villages and 21 enumeration blocks. Of the 42,580 persons aged 15 years and above eligible for symptoms questioning, 40,657 (95.5%) were examined and 3,846 (9.5%) were found to be symptomatics and eligible for sputum examination. Sputum was collected from 3,685 (95.8%) of the 3,846 symptomatics, and subjected to bacteriological examination i.e., smear, culture and drug susceptibility. Certain important findings were as follows: (i) the number of symptomatics increased with increase in age, more often among males (11.9%) than among females (7.1%), (ii) the prevalence of tuberculosis, as assessed by smear and/or culture was 10.9 per 1,000 in population aged 15 years and above, (iii) the prevalence increased with age and was 3 times higher among males as compared to females, (iv) cough was found to be the predominant symptom among the symptomatics (87%) as well as among the cases detected (92%), (v) the prevalence rate based on smear examination of the sputum specimens, using the two microscopy methods (Ziehl-Neelsen and Fluorescence) was 7.6 per 1,000, (vi) culture examination of these specimens yielded 3.3 per 1,100 additional cases, (vii) both the microscopy methods were equally efficient in detecting smear positives, (vii) of the 355 culture positive cases, 17.7% were resistant to Streptomycin, 29.6% to Isoniazid and 7.6% to Rifampicin either alone or in combination with other drugs

Non-fermenting Gram Negative Bacilli Associated with Acute Respiratory Infections in Children in Madras

Non-fermenting Gram negative bacilli (NFGNB) were isolated as the most predominant organism from children suffering from acute respiratory illness (ARI) and accounted for 40 out of 151 children reported in the study. Five of the NFGNB were isolated in pure culture and all of them were from children having lower respiratory infection. The isolation of NFGNB was higher when the duration of illness exceeded 7 days (44 per cent) as compared to 22 per cent with less than 7 days duration (P= 0.03). Detailed identification studies on 61 isolates of NFGNB showed that 56 (92 per cent) of them belonged to Pseudomonas pseudoalkaligenes alkaligenes group. Four strains were identified as Ps. pseudomallei group and one as Ps. stutzeri. The majority of the NFGNB isolates showed multidrug resistance