Multiplex PCR technique could be an alternative approach for early detection of leprosy among close contacts - a pilot study from India

<p>Abstract</p> <p>Background</p> <p>Implementation of Multi drug Therapy (MDT) regimen has resulted in the decline of the total number of leprosy cases in the world. Though the prevalence rate has been declining, the incidence rate remains more or less constant and high in South East Asian countries particularly in India, Nepal, Bangladesh, Pakistan and Srilanka. Leprosy, particularly that of multibacillary type spreads silently before it is clinically detected. An early detection and treatment would help to prevent transmission in the community. Multiplex PCR (M-PCR) technique appears to be promising towards early detection among contacts of leprosy cases.</p> <p>Methods</p> <p>A total of 234 paucibacillary (PB) and 205 multibacillary (MB) leprosy cases were studied in a community of an endemic area of Bankura district of West Bengal (Eastern India). They were assessed by smear examination for acid-fast bacilli (AFB) and M-PCR technique. These patients were treated with Multidrug Therapy (MDT) as prescribed by WHO following detection. A total of 110 MB and 72 PB contacts were studied by performing M-PCR in their nasal swab samples.</p> <p>Results</p> <p>83.4% of MB patients were observed to be positive by smear examination for AFB and 89.2% by M-PCR. While 22.2% of PB patients were found to be positive by smear examination for AFB, 80.3% of these patients were positive by M-PCR. Among leprosy contacts (using M-PCR), 10.9% were found to be positive among MB contacts and 1.3% among PB contacts. Interestingly, two contacts of M-PCR positive MB cases developed leprosy during the period of two years follow up.</p> <p>Conclusion</p> <p>The M-PCR technique appears to be an efficient tool for early detection of leprosy cases in community based contact tracing amongst close associates of PB and MB cases. Early contact tracing using a molecular biology tool can be of great help in curbing the incidence of leprosy further.</p

SKIN LESIONS IN LUPUS ERYTHEMATOSUS: A MARKER OF SYSTEMIC INVOLVEMENT

Background: Lupus erythematosus (LE) is an autoimmune disorder with diverse clinical manifestation ranging from mild cutaneous disorder to life-threatening systemic illness (SLE). In some patients, it remains to persist in the skin-limited form while in others it evolves into SLE. Here comes the role of identifying the markers of systemic involvement, which could determine the course and prognosis of the disease. Aim: To identify those manifestations that could be used to identify the activity of the disease SLE. Materials and Methods: An institution based, descriptive, cross-sectional study carried out over 1 year period. Sixty patients (male : female 1 : 4) with cutaneous LE were recruited for the study. The patients were classified in two groups depending on the presence or absence of ARA criteria of SLE. Detailed account of LE-specific and nonspecific lesions were noted. Statistical significance of the results was compared between the two groups using the chi-square test. Results: Among the different cutaneous manifestations, highly significant (P value <0.001) was found between SLE and nonscarring alopecia, photosensitivity, oral ulcer, malar rash (in decreasing order of odds favoring the association with SLE). Dimorphic skin lesions (P value=0.0326) also showed significant association where as discoid lesion (especially localized variant) predicted toward a skin limited form of the disease with high probability of not developing SLE (P value <0.0001). No significant association was found between SLE and papulosquamous lesions, Raynaud′s phenomenon or scarring alopecia. Conclusion: Identification of lesions with high degree of association with SLE can alert the physician of the unfavorable prognosis and allow timely intervention and institution of appropriate management strategies

Coexistence Of Psoriasis And Discoid Lupus Erythematosus

A 30 year old male patient presented with erythematous plaques over trunk and extremities for last 10 years, with silvery scales. The scales on removal gave rise to multiple bleeding point. Lesions were clinically and histopathologically consistent with psoriasis. Subsequently he developed photosensitive lesions of discoid lupus erythematosus on the face for last 2 years. He had no systemic involvement or joint pain. He was being treated with emollients, topical steroid and sun protecting agent with good result

A Preliminary Sentinel Surveillance Report on Antibiotics Resistance Trend of Streptococcus Pyogenes in Kolkata Region, India

Streptococcus pyogenes is an important cause of serious bacterial infection in both adults and school-going children. On the present scenario of emerging changes observed in drug resistant pattern of S. pyogenes, this study was undertaken, from October2008 to July2009, to evaluate the trend of resistance pattern to various antibiotics by the Kirby-Bauer method of disk diffusion in Kolkata, India. A total of 115 isolates of S. pyogenes were identified by standard procedure. All strains were susceptible to penicillin, cephotaxime, clindamycin and vancomycin. 60 isolates were resistant to tetracycline. Four isolates have been found to be resistant to erythromycin, which is a very rare occurrence in West Bengal. This finding may be alarming for emergence of resistance against this safe drug, which may complicate the treatment of patients who are allergic to penicillin

Groundwater Arsenic Contamination in the Ganga River Basin: A Future Health Danger

This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 µg/L), and in food materials (up to 3947 µg/kg), all exceeding the World Health Organization’s standards for drinking water, the United Nations Food and Agricultural Organization’s standard for irrigation water (100 µg/L), and the Chinese Ministry of Health’s standard for food in South Asia (0.15 mg/kg), respectively. Several individuals demonstrated dermal, neurological, reproductive, cognitive, and cancerous effects; many children have been diagnosed with a range of arsenicosis symptoms, and numerous arsenic-induced deaths of youthful victims are reported in the GRB. Victims of arsenic exposure face critical social challenges in the form of social isolation and hatred by their respective communities. Reluctance to establish arsenic standards and unsustainable arsenic mitigation programs have aggravated the arsenic calamity in the GRB and put millions of lives in danger. This alarming situation resembles a ticking time bomb. We feel that after 29 years of arsenic research in the GRB, we have seen the tip of the iceberg with respect to the actual magnitude of the catastrophe; thus, a reduced arsenic standard for drinking water, testing all available drinking water sources, and sustainable and cost-effective arsenic mitigation programs that include the participation of the people are urgently needed

Groundwater arsenic contamination in Ganga-Meghna-Brahmaputra plain, its health effects and an approach for mitigation

The authors’ survey of the Ganga–Meghna–Brahmaputra (GMB) plain (area 569,749 km2; population >500 million) over the past 20 years and analysis of more than 220,000 hand tube-well water samples revealed groundwater arsenic contamination in the floodplains of the Ganga–Brahmaputra river (Uttar Pradesh, Bihar, Jharkhand, West Bengal, and Assam) in India and the Padma–Meghna–Brahmaputra river in Bangladesh. On average, 50 % of the water samples contain arsenic above the World Health Organization guideline value of 10 μg/L in India and Bangladesh. More than 100 million people in the GMB plain are potentially at risk. The authors’ medical team screened around 155,000 people from the affected villages and registered 16,000 patients with different types of arsenical skin lesions. Arsenic neuropathy and adverse pregnancy outcomes have been recorded. Infants and children drinking arsenic-contaminated water are believed to be at high risk. About 45,000 biological samples analyzed from arsenic-affected villages of the GMB plain revealed an elevated level of arsenic present in patients as well as non-patients, indicating that many are sub-clinically affected. In West Bengal and Bangladesh, there are huge surface water in rivers, wetlands, and flooded river basins. In the arsenic-affected GMB plain, the crisis is not over water scarcity but about managing the available water resources.