Seroprevalence of Dengue IgG Antibodies among Healthy Adult Population in Lahore, Pakistan

Background. Dengue is a mosquito-borne flavivirus infection prevalent in tropical and subtropical regions around the world. Aim of this study was to determine seroprevalence of anti-dengue IgG antibodies in healthy adult population of Lahore and also describe risk factors in relation to dengue seropositivity. Methods. In this cross-sectional study, 274 healthy adult individuals aged 15 years and above were randomly selected using multistage sampling technique. These individuals were interviewed between July–September 2012, using a semistructured questionnaire, followed by drawing 3 mL of their venous blood for dengue IgG test. Nova Tech ELISA kit with sensitivity and specificity of 96.5% and 97.5%, respectively, was used for serology. Results. Out of 274 participants, 184 (67.2%) were found to be positive for dengue IgG antibodies. Seroprevalence was higher among individuals with poor awareness about potential breeding sites for dengue mosquito (63.6%), followed by the subjects who had poor knowledge about dengue signs/symptoms and complications (52.2% and 68.5%, resp.). Conclusion. About two-third of healthy population of Lahore was also seropositive for anti-dengue IgG during July–September 2012, indicating a considerable burden of subclinical dengue infection in the city. Males were predominantly affected than the females. We found no statistical association between dengue IgG seropositivity and socioeconomic status, occupation, and knowledge about the disease.

Does Comorbidity Increase the Risk of Dengue Hemorrhagic Fever and Dengue Shock Syndrome?

Background. Dengue fever is an emerging public health problem in Pakistan. The aim of this study was to determine the relationship between comorbid conditions in individuals suffering from dengue fever and the development of dengue hemorrhagic fever or dengue shock syndrome. Methods. In this age- and sex-matched case control study, total of 132 cases of dengue hemorrhagic fever/dengue shock syndrome and 249 randomly selected controls were recruited from two major teaching hospitals of Lahore, Pakistan. A semistructured questionnaire was used to collect data through interview and by reviewing clinical records. SPSS version 18 was utilized for statistical analysis including conditional logistic regression. Results. Odds of developing dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) among diabetics are higher than in controls, but this association was not found statistically significant (OR. 1.26; 95% CI. 0.78–2.03; P=0.34). Similarly, no association was observed in individuals suffering from hypertension (OR. 0.93; 95% CI. 0.57–1.49; P=0.76). Odds of developing DHF and DSS were higher for bronchial asthma (adjusted OR. 1.34) and pulmonary tuberculosis (adjusted OR. 1.41); however P values were insignificant. Conclusion. Presence of diabetes mellitus, hypertension, ischemic heart disease and bronchial asthma among patients contracted dengue fever will not increase the risk of dengue hemorrhagic fever and dengue shock syndrome.

Prevalence of Toxoplasma gondii and Associated Risk Factors among People Living with HIV at Gondar University Hospital, Northwest Ethiopia

Background. Toxoplasma gondii is an obligate intracellular protozoan parasite and is a major opportunistic pathogen in immune-compromised hosts. This study assessed the prevalence of T. gondii and associated risk factors among people living with HIV. Methods and Materials. A cross-sectional study was carried out among people living with HIV attending Gondar University Hospital. A structured and pretested questionnaire was used to collect sociodemographic factors, and 10mL of venous blood was collected for anti-Toxoplasma antibody test and determination of CD4 levels. Serum was tested in duplicate for anti-Toxoplasma antibody using rapid slide agglutination test. Results. A total of 170 study subjects were enrolled in the study. Seroprevalence of T. gondii among the study participants was 76.5% (95% CI: 69.0–82.8). High proportions of seropositive individuals (64.7%) were found under the child bearing age groups. The mean CD4+ lymphocyte count of HIV monoinfected participants was cells/mm3 while coinfected study participants had mean CD4+ lymphocyte count of cells/mm3 with value of 0.01. Conclusion. The seroprevalence of T. gondii among people living with HIV was high. Cautious followup of HIV-positive patients is needed to prevent development of toxoplasmic encephalitis and other related complications.

Detection and Enumeration of the Commonest Stool Parasites Seen in a Tertiary Care Center in South India

The aim of this study was to identify common stool parasites in patients attending a tertiary care centre in South India. We evaluated 2355 stool samples and parasites were detected in 7.9% of samples. 41.1% of our patients were in the 45–58-year age group. Protozoal infections were the commonest seen in 7.8% of samples. Entamoeba histolytica was the commonest protozoa (4.6%) followed by Entamoeba coli (1.2%) and Giardia (0.8%). Entamoeba histolytica and Entamoeba coli were together seen in 0.63%, and they were the commonest organisms seen in samples with multiple-organism infection. Both were equally detected in diarrheal samples.

Soluble ST2 Does Not Regulate TNF-α and IL-6 Production in Dengue Virus-Infected Human Monocytes

Dengue virus (DENV) produces an acute infection that results in the overproduction of proinflammatory cytokines. Although increased levels of the immunoregulator soluble ST2 (sST2) protein have been reported in the serum of patients with dengue, its importance during DENV infection remains unclear. The purpose of this study was to evaluate the effect of a recombinant human sST2 protein on the production of TNF-α and IL-6 in an in vitro model of DENV infection. Peripheral blood mononuclear cells (PBMCs) were permissive to in vitro DENV infection since viral antigen was detected in CD14+ monocytes by flow cytometry (median, 1%; range, 0–2.2), and in their supernatants TNF-α and IL-6 were detected. However, sST2 protein was not detected. Using multiple staining on infected PBMC we found that only CD14+ cells produced TNF-α and IL-6. Treatment with human recombinant sST2 protein decreased lipopolysaccharide-induced monocyte TNF-α and IL-6 production. However, this effect was not observed when the monocytes were pretreated with sST2 and later infected with DENV-2. These results suggest that sST2 has different roles in the regulation of TNF-α and IL-6 expression in human monocytes stimulated with LPS and DENV-2.

How Reliable Are Hematological Parameters in Predicting Uncomplicated Plasmodium falciparum Malaria in an Endemic Region?

Background. Malaria remains endemic in Sub-Saharan Africa. Hematological changes that occur have been suggested as potential predictors of malaria. This study was aimed at evaluating the diagnostic relevance of hematological parameters in predicting malaria. Methods. A cross-sectional study involving 370 patients with signs and symptoms of malaria was conducted at Mulago Hospital, Kampala, from May, 2012 to February, 2013. Thin and thick blood films were prepared for each patient and stained with Giemsa to aid the detection of malaria parasites. Patients’ hematological parameters were determined. Results. Out of the 370 patients, 61 (16.5%) had malaria. Significant differences in the hematological parameters between P. falciparum malaria parasitemic patients and nonparasitemic patients were only observed in mean (±SD) of the differential monocyte count (10.89 ± 6.23% versus 8.98 ± 5.02%, P=0.01) and the platelet count (172.43 (± 80.41) ×103 cells/µl versus 217.82 ± (95.96) ×103 cells/µl P=0.00). The mean (±SD) values of the red blood cell indices (hemoglobin count, MCV, MCH, and MCHC), the differential neutrophil and lymphocyte counts, and the mean platelet volume (MPV) did not significantly differ between the two groups. Conclusion. Hematological changes are unreliable laboratory indicators of malaria in acute uncomplicated Plasmodium falciparum malaria.

Pain and Its Consequences in Quality of Life: A Study with WHOQOL-Bref in Leprosy Patients with Neuropathic Pain

Chronic neuropathic pain emerges as a challenge in the treatment of leprosy patients after multidrug therapy discharge. The aim of this study was to determine the quality of life and its repercussions in leprosy patients with chronic pain. We studied male and female patients with chronic neuropathic pain in the last year. Neuropathic pain was confirmed using Douleur Neuropathique en 4 (DN4) and its intensity evaluated by visual analogue scale (VAS). A general questionnaire was applied to evaluate quality of life (WHOQOL-bref). Statistical analyses were composed by descriptive and central tendency. Spearman correlation was used to identify the relation between pain intensity, quality of life domains, and facets. Multiple linear regressions were performed to verify the influence of pain intensity on each facet. Neuropathic pain patients scored worst in physical and environment domains. The low facets were related to pain and discomfort, thinking and concentration, sexual activity, and recreation opportunities. Pain intensity has a high negative influence on psychological domain and recreation opportunities. These findings should contribute to the development of rehabilitation programs considering patients needs to improve their quality of life and true social reintegration.

Current Bancroftian Filariasis Elimination on Thailand-Myanmar Border: Public Health Challenges toward Postgenomic MDA Evaluation

From regional and global perspectives, Thailand has progressed toward lymphatic filariasis transmission-free zone in almost entire endemic provinces, being verified by WHO by the end of 2012 after the 5-year implementation of mass drug administration (MDA) with diethylcarbamazine and albendazole as part of the National Program to Eliminate Lymphatic Filariasis (PELF) (2002–2006) and a 4-year expansion of post-MDA surveillance (2007–2010). However, Thai PELF has been challenging sensitive situations of not only border crossings of local people on Thailand-Myanmar border where focal distribution of forest- and forest fringe-related border bancroftian filariasis (BBF) is caused by nocturnally subperiodic Wuchereria bancrofti in local people living in pockets of endemic villages, but also intense cross-border migrations of Mon and Tanintharyi workers from Myanmar to Thailand who harbor nocturnally periodic W. bancrofti microfilaremic infection causing the emergence of imported bancroftian filariasis (IBF). Thus, this paper discusses the apparent issues and problems pertaining to epidemiological surveillance and postgenomic MDA evaluation for 2010–2020 convalescent BBF and IBF. In particular, the population migration linked to fitness of benzimidazole-resistant W. bancrofti population is a topic of interest in this region whether the resistance is associated with pressure of the MDA 2 drugs and the vulnerabilities epidemiologically observed in complex BBF or IBF settings.

The Burden of New Leprosy Cases in India: A Population-Based Survey in Two States

Objectives. To assess the burden of new leprosy cases in India and the efficiency of case detection work by ASHA in general health system. Methods. A sample survey of 804,536 persons was undertaken in 8 districts during 2009-2010: 4 each in Haryana (low endemic for leprosy) and Uttar Pradesh (high endemic for leprosy). About 20% population was covered from urban areas. Results. The survey suggested that burden of new case detection rate of leprosy in India per 10,000 population could be 4.41 in comparison to 1.09 as per government records. When present observation is adjusted to team performance in rural area, the NCDR increased to 10.64 per 10,000. This leads to suggest that NCDR in India could further increase to 9.76 times when adjusted to team performance. This data suggest that large numbers of early leprosy cases do not reach the health facilities where leprosy treatment is provided, although some chronically ill patients reach late, and thus multibacillary disease is found more in passive reporting. This could also be an indicator of a large number of established cases not being sufficiently self-motivated or lacking knowledge to utilize the free diagnosis and treatment services. Thus, the programme needs to be designed to meet these objectives effectively to better utilize the available services to reduce the leprosy burden. Conclusion. Active survey detected many folds higher leprosy cases in community, and this suggests that the information, education, and communication based approaches have a very minimal effect. If the programme continues to be based on IEC activities, the information should be designed in such a way that most persons suspected to have leprosy can know about free treatment, place of availability, and its effectiveness. However, leprosy elimination campaign surveys may be used as a tool to filter large pool of cases from community.