Natural History of Cryptosporidiosis in a Birth Cohort in Southern India

Abstract Background Cryptosporidium is a leading cause of moderate to severe childhood diarrhea in resource-poor settings. Understanding the natural history of cryptosporidiosis and the correlates of protection are essential to develop effective and sustainable approaches to disease control and prevention. Methods Children (N = 497) were recruited at birth in semiurban slums in Vellore, India, and followed for 3 years with twice-weekly home visits. Stool samples were collected every 2 weeks and during diarrheal episodes were tested for Cryptosporidium species by polymerase chain reaction (PCR). Serum samples obtained every 6 months were evaluated for seroconversion, defined as a 4-fold increase in immunoglobulin G directed against Cryptosporidium gp15 and/or Cp23 antigens between consecutive sera. Results Of 410 children completing follow-up, 397 (97%) acquired cryptosporidiosis by 3 years of age. PCR identified 1053 episodes of cryptosporidiosis, with an overall incidence of 0.86 infections per child-year by stool and serology. The median age for the first infection was 9 (interquartile range, 4–17) months, indicating early exposure. Although infections were mainly asymptomatic (693 [66%]), Cryptosporidium was identified in 9.4% of diarrheal episodes. The proportion of reinfected children was high (81%) and there was clustering of asymptomatic and symptomatic infections (P < .0001 for both). Protection against infection increased with the order of infection but was only 69% after 4 infections. Cryptosporidium hominis (73.3%) was the predominant Cryptosporidium species, and there was no species-specific protection. Conclusions There is a high burden of endemic cryptosporidiosis in southern India. Clustering of infection is suggestive of host susceptibility. Multiple reinfections conferred some protection against subsequent infection.

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Natural History of Human Immunodeficiency Virus Disease in Southern India

Clinical Infectious Diseases ◽

10.1086/344756 ◽

2003 ◽

Vol 36 (1) ◽

pp. 79-85 ◽

Cited By ~ 95

Author(s):

N. Kumarasamy ◽

Suniti Solomon ◽

Timothy P. Flanigan ◽

R. Hemalatha ◽

S. P. Thyagarajan ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Natural History ◽

Virus Disease ◽

Southern India ◽

Human Immunodeficiency Virus Disease ◽

Immunodeficiency Virus ◽

History Of

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Prevalence of Light-Chain Monoclonal Gammopathy of Undetermined Significance (LC-MGUS) among Olmsted County, Minnesota Residents Aged 50 Years or Greater.

Blood ◽

10.1182/blood.v108.11.5060.5060 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5060-5060

Author(s):

S. Vincent Rajkumar ◽

Robert Kyle ◽

Matthew Plevak ◽

Raynell Clark ◽

Dirk Larson ◽

...

Keyword(s):

Multiple Myeloma ◽

General Population ◽

Natural History ◽

Light Chain ◽

Monoclonal Gammopathy ◽

Olmsted County ◽

Serum Samples ◽

Geographic Population ◽

History Of ◽

Undetermined Significance

Abstract Background: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder that carries a 1% per year risk of progression to multiple myeloma (MM) or related malignancy. The prevalence and natural history of MGUS, in which by definition intact immunoglobulin heavy chain (IgH) is expressed, has been well described. However, up to 20% of myeloma (MM) is characterized by complete lack of IgH expression (Light-chain MM); the prevalence of a corresponding precursor entity, light chain MGUS (LC-MGUS) has not been determined. We report the first prevalence estimates of LC-MGUS in the general population from a large, well-defined geographic population using modern laboratory techniques. Methods: The cohort for this study was derived from one previously assembled by us to estimate the prevalence of MGUS (N Engl J Med2006;354:1362-9). The original cohort used to estimate the prevalence of MGUS consisted of 21,463 of the 28,038 enumerated residents aged 50 or over of Olmsted County Minnesota as of January 1, 1995. The sensitive serum free light chain (FLC) assay (The Binding Site Limited, Birmingham, U.K.) was performed on stored serum samples from these 21,463 persons. IgH expression was determined by immunofixation on all FLC results that had an abnormal kappa/lambda ratio (<0.26 or >1.65). LC-MGUS was defined as the presence of an abnormal FLC ratio and a negative immunofixation for IgH expression. Results: Adequate stored serum samples were available in 20,733 (97%) of the 21,463 persons. To date, the FLC assay has been performed and results were available for analysis on samples from 16,637 persons. An abnormal FLC ratio was observed in 572 persons. IgH expression was detected in 255 of these cases on immunofixation; these persons are considered as having MGUS, and were excluded from the estimation of LC-MGUS prevalence. This resulted in 317 persons out of 16,637 who had an abnormal FLC ratio without evidence of IgH expression, resulting in an estimated prevalence of LC- MGUS of 2%. Of the 317 cases of LC-MGUS identified in this study, 217 were kappa and 100 were lambda; in 35 cases the presence of the corresponding monoclonal light chain was apparent on immunofixation. The median age of the cohort of LC-MGUS was 62 years; males=151, females =166. The involved FLC level ranged from 0.118–270.0 mg/dL. The FLC ratio ranged from 0.014–0.253 (lambda) and 1.67–511.01 (kappa). So far, progression to multiple myeloma has occurred in 4 patients, a rate much higher than what is expected based on the prevalence of myeloma in the general population. Two additional patients have developed CLL. Conclusions: LC-MGUS is prevalent in 2% of the general population aged 50 years of age or older. The natural history of this disorder needs to be determined.

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The Changing Natural History of HIV Disease: Before and After the Introduction of Generic Antiretroviral Therapy in Southern India

Clinical Infectious Diseases ◽

10.1086/497267 ◽

2005 ◽

Vol 41 (10) ◽

pp. 1525-1528 ◽

Cited By ~ 69

Author(s):

N. Kumarasamy ◽

S. Solomon ◽

S. K. Chaguturu ◽

A. J. Cecelia ◽

S. Vallabhaneni ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Natural History ◽

Southern India ◽

Hiv Disease ◽

Before And After ◽

History Of

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Staging, classification, and natural history of HIV disease

Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health ◽

10.1093/med/9780198783497.003.0039 ◽

2019 ◽

pp. 465-468

Keyword(s):

Natural History ◽

Opportunistic Infections ◽

Classification Systems ◽

Historical Background ◽

Clinical Staging ◽

Hiv Disease ◽

Disease Staging ◽

Control And Prevention ◽

History Of ◽

Staging Classification

This chapter provides some historical background to the development of HIV disease-staging and classification systems. The illness (AIDS) was described before the discovery of HIV, the causative agent. The Centres for Disease Control and Prevention (CDC) devised a classification system, revised in 1993, based on clinical features, AIDS-defining illnesses, and CD4 counts. The revised WHO Clinical Staging of HIV/AIDS for Adults and Adolescents is based on clinical progression, and is used in 3rd world countries and as a research tool. This chapter provides description of the natural history of untreated HIV infection. Without treatment, HIV is invariably fatal, but the course is variable depending on CD4 count, host factors, and the development of conditions such as opportunistic infections and malignancies.

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Biology of Blepharida-group flea beetles with first notes on natural history of Podontia congregata Baly, 1865 an endemic flea beetle from southern India (Coleoptera, Chrysomelidae, Galerucinae, Alticini)

ZooKeys ◽

10.3897/zookeys.157.1472 ◽

2011 ◽

Vol 157 ◽

pp. 95-130 ◽

Cited By ~ 8

Author(s):

Caroline Chaboo ◽

Kaniyarikkal Prathapan

Keyword(s):

Natural History ◽

Flea Beetle ◽

Southern India ◽

Flea Beetles ◽

History Of

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The natural history of Dandy-Walker syndrome in the United States: A population-based analysis

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.143185 ◽

2015 ◽

Vol 6 (01) ◽

pp. 023-026 ◽

Cited By ~ 5

Author(s):

Shearwood McClelland ◽

Onyinyechi I. Ukwuoma ◽

Scott Lunos ◽

Kolawole S. Okuyemi

Keyword(s):

Mortality Rate ◽

Natural History ◽

Fold Increase ◽

The United States ◽

Population Based ◽

Control Group ◽

Discharge Disposition ◽

Csf Drainage ◽

History Of ◽

Neurosurgical Intervention

ABSTRACT Background: Dandy-Walker syndrome (DWS) is a congenital disorder typically manifesting with hydrocephalus. The classic anatomic hallmarks of DWS are hypoplasia of the cerebellar vermis, anterior-posterior enlargement of the posterior fossa, upward displacement of the torcula and transverse sinuses, and cystic dilatation of the fourth ventricle. Aims: Although optimal treatment of DWS typically requires neurosurgical intervention to prevent intracranial pressure increases incompatible with life, the natural history of this disorder has yet to be evaluated on a nationwide level. Settings and Design/Materials and Methods: The Kids’ Inpatient Database covering 1997-2003 was used for analysis. Children younger than age 18 admitted for DWS (ICD-9-CM = 742.3) were analyzed with a matched control group. The primary procedure codes for operative CSF drainage were coded into the analysis. The incidence of DWS was 0.136%; 14,599 DWS patients were included. Statistical Analysis Used: Multiple logistic regression models were used. Odds ratios (OR) were reported with 95% confidence intervals. Results and Conclusions: Mortality (OR = 10.02; P < 0.0001) and adverse discharge disposition (OR = 4.59; P < 0.0001) were significantly greater in DWS patients compared with controls. 20.4% of DWS patients received operative cerebrospinal fluid (CSF) drainage, 81-times more than controls (P < 0.0001). CSF drainage reduced mortality by 44% among DWS patients (P < 0.0001). Although DWS is associated with a 10-fold increase in mortality, operative CSF drainage nearly halves the mortality rate. Based on these findings (Class IIB evidence), it is likely that the increased mortality associated with DWS is directly attributable to the nearly 80% of DWS patients who did not receive operative CSF drainage for hydrocephalus. Consequently, increased access to neurosurgical intervention could reduce the mortality rate of DWS towards that of the general population.

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How is the moral stance related to the intentional stance and group thinking?

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002413 ◽

2020 ◽

Vol 43 ◽

Author(s):

Hannes Rakoczy

Keyword(s):

Natural History ◽

Social Cognitive ◽

Intentional Stance ◽

Cognitive Capacities ◽

Shared Intentionality ◽

History Of ◽

Group Thinking ◽

Moral Stance

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.

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