Asian Pacific Journal of Tropical Disease

177-180

Authors: Akhtardanesh B, Ghanbarpour R, Babaei H, Nazeri M

Objective: To detect the evidences of significant exposure of dogs with Brucella canis (B. canis) and other Brucella species in southeast of Iran by serological assays. Methods: Blood samples were prepared from 62 privately owned and 33 kenneled dogs and screened by indirect immunoflorescence assay for B. canis. Rose Bengal test (RBT) and standard tube test (SAT) or wright test were used for screening the other Brucella species. Results: Serological evidences of exposure to B. canis were found in 15.8% of the studied dogs, whereas RBT and SAT showed 29.5% and 12.6% seropositivity, respectively. Conclusions: This study shows that B. canis is endemic in southeastern of Iran and canine brucellosis can be considered as a new emerging disease. Moreover, our results demonstrate that dogs will be at high risk in brucellosis-infected farms. Therefore, further investigations must be performed to evaluate the seroprevalence and zoonotic potential of this disease in different geographical parts of Iran.

187-191

Authors: N Ben Alaya-Bouafif , Chahed MK, H El Bez, Bellali H, Ayari L, Achour N

Objective: To estimate the completeness of malaria notification to the public healthcare system (PHCS) and to describe retrospectively data of malaria cases in Tunisia. Methods: We conducted a retrospective epidemiological survey using a standardized questionnaire for all cases of malaria reported to PHCS and those diagnosed in parasitological laboratory or infectious disease service between January 2002 and December 2007. To estimate the total number of cases, we used a two sources capture-recapture analysis. Results: After record-linkage and cross-validation 317 cases of malaria were identified, of whom 231 were notified, resulting in an observed undernotification of 17%. The estimated number of malaria cases using capture-recapture analysis was 366.3 (95% CI: 335.8-396.8) for the period of study with a completeness of 63.1% which increased fr om 44.8% for 2002 to 78.7% for 2007. One hundred and sixty two patients (51.1%) had been born in sub-Saharan Africa, 113 (35.6%) in Tunisia, 35 (11.0%) in North Africa and 7 (2.2%) in Europe with predominance of men (87.1% of all cases). The median age was 25.0 years (21-30) for subSaharan Africans, 38.0 years (23.5-45.5) for North Africans, 38.5 years (30.75-38.5) for Tunisian and 39.0 (26-43) for European (P<0.01). The most predominant malaria species was Plasmodium falciparum with 216 cases (72.5%), and the most frequent area of acquisition was sub-Saharan Africa. In our study, information on compliance with malaria prophylaxis was only sporadically available and 34% of infected individuals had not used any chemoprophylaxis. Our study showed delayed identification of malaria that indicated a deficit in medical awareness and management of this infection. Conclusions: Our survey has marked variety in the type and availability of key data and shown an underreporting of malaria cases. Furthermore, it demonstrates that the two different sources of malaria registration are substantially incomplete. Of particular interest is the observation that a considerable number of patients could only be found in the records of PHCS, they were unknown to the laboratories, although malaria confirmation by thick or thin smear is obligatory in Tunisia.

195-202

Authors: Grace O Gbotosho, Titilope M Okuboyejo, Christian T Happi, Akintunde Sowunmi

Objective: To evaluate the features and risk factors associated with recrudescent infections that arose following artemisinin-based combination drug treatment of the primary infections. Methods: The clinical features and risk factors associated with subsequent recrudescence of primary Plasmodium falciparum infections were evaluated in 37 of 877 children following artesunate or artemisinin-based combination treatments (ACTs). Recrudescence was determined by polymerase chain reaction. Results: Compared to children with sensitive infections, children with recrudescent infections had significantly higher gametocytaemia and proportion with parasitaemia >50 000/μL. Compared with primary infections, recrudescent infections that arose from primary infections were accompanied by significantly fewer symptoms, lower body temperatures and asexual parasitaemias. In age- and gender- matched children with and without recrudescence, declines in parasitaemias following treatment were monoexponential but elimination half-life of parasitaemia was significantly longer in children with recrudescence. In a multiple regression model, at enrolment, 3 factors were independent risk factors for subsequent recrudescence of primary infections: parasitaemia ≥50 000/μL [adjusted odds ratio (AOR)=2.63, 95% confidence interval (CI): 1.17-5.90, P=0.018], parasite clearance time ≥2 days (AOR=2.47, 95% CI: 1.24-4.90, P=0.04) and treatment with artesunate compared with ACTs (AOR=2.35, 95% CI: 1.08-5.12, P=0.03). Conclusions: Recrudescent infections following artesunate or ACTs differ significantly from the primary infections from which they arose and have implications for malaria control efforts in Sub-Saharan Africa where ACTs are now first-line treatments.

206-208

Authors: Abhiram Chakraborty, Saikat Panja, Indranil Bhattacharjee, Goutam Chandra, Amiyakumar Hati

Objective: To find out the role of CT scan in the diagnosis of neurocysticercosis (NC) and also to get an idea of the nature and extent of this disease in a definite geographical ethnic location. Methods: CT scan of the brain of altogether 4 762 persons residing in a congested area of central Kolkata, was performed between 2004 and 2010, in an imaging centre in central Kolkata (Calcutta), of whom 1 114 (23.39%) suspected patients were investigated for NC, having complaints of convulsion (472), headache (272), right sided weakness (98), loss of consciousness (84), left sided weakness (61), abnormal behavior (48), slurring of speech (34), difficulty with keeping balance (33) and dementia (12). Results: NC was detected in 45, 1, 0, 2, 1, 0, 0, 1 and 0, respectively consisting 4.48% (50/1 114) of the suspected cases varying from as low as 2 (in 2006) to as high as 23 (in 2005) in different years indicating this parasitic infection is perennial. The age of patients varied from 6 to 59 years of whom 28 (56%) were vegan. We were also able to detect 4 types of lesions viz. calcified lesions (14), small hypodense i.e. vesicle (12), bright central spot i.e. vesicular lesion with central spot (2) and ring enhancement (22). For 3 patients, further imaging investigation (MRI) was needed to confirm the diagnosis. We calculated the specificity and sensitivity of CT scan of brain diagnosing NC which was found to be 64% and 100%, respectively. Conclusions: Although, the sample may not be the representatives of the whole community, the findings suggest that cysticercosis is a significant but under-recognized public health concern in Kolkata.

212-215

Authors: Mohammad Taghi Rahimi, Meysam Sharifdini, Ayat Ahmadi, Bahram Laktarashi, Seyf Ali Mahdavi, Eshrat Beigom Kia

Objective: To determine the rate of hydatid cyst in hospitalized patients and slaughtered animals in Mazandaran province, northern Iran. Methods: In this descriptive study, files of 34 hospitalized patients who underwent surgery for hydatid cysts during 2003-2008 in Mazandaran province were analyzed. Also, 1 678 343 sheep, 815 635 goats, 451 743 cattle and 1 130 buffaloes were examined carefully for the presence of hydatid cysts in slaughterhouse of Mazandaran province, during 2003-2008. Results: In human, the highest rate of hydatidosis was related to 30-39 age group. Infection rate in females was higher than that in males (61.8% vs 31.2%). Cyst involvement of different organs was as follows: liver 76.5%, lung 13.5%, spleen 5.4%, gall bladder 2.7% and abdomen septum 2.9%. In slaughtered animals, overall, 6.38% had liver cyst and 12.70% had lung cyst. Involvement of liver and lung in sheep, goat, cattle and buffalo were 7.09% and 14.70%; 5.12% and 10.20%; 5.97% and 9.60%; and 14.90% and 13.18%, respectively. In sheep, goat and cattle the most infected organ was lung but in buffalo it was liver. Conclusions: The results show that in human, all age groups and both sexes are exposed to hydatidosis. In livestock it causes economic loss to veterinary industries. Therefore, appropriate control method is needed to prevent this zoonotic disease.

222-226

Authors: Sumaporn Makkun, Jenjeera Prueksadee, Jatuporn Chayakulkheeree, Darunee Boonjunwetwat

Objective: To determine the diagnostic accuracy of ultrasound-guided 14-gauge core-needle breast biopsy (CNB) correlation with surgical excision or long term follow-up. Methods: One hundred and fifteen breast lesions which had undergone ultrasound-guided 14-gauge core-needle breast biopsy from May 2003 to Aug 2010 in the Breast Diagnostic Center, King Chulalongkorn Memorial Hospital were included in this study. Clinical history, palpability of the lesion, site of the lesion, the prebiopsy lesion size, ultrasound characteristic, level of suspicion according to the BIRADS classification, number of samples taken and pathologic results of CNB were reviewed and correlated with pathologic results of subsequent open surgery. For benign lesions without surgery, we correlated the result of CNB with stability of the lesion at or more than two-year interval follow-up. The accuracy rate, sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were accessed. The falsenegative diagnoses of core needle biopsy were reviewed in detail. Procedural complications were also observed. Results: Among 115 lesions, 114 lesions were in female and 1 lesion was in male with their mean age of 50.87 years old (ranging from 27-72), 91 lesions were palpable (79.13%), 24 were non-palpable (20.87%). The prebiopsy size was 3.2 cm in diameter ranging from 0.5-20.0 cm. The pathologic results for the CNB were malignancy in 77.39% (89 lesions), high-risk in 0.87% (1 lesion) and benign in 21.17% (25 lesions). Five patients were negative for malignancy by core needle biopsy but positive for malignancy by surgical procedure. The sensitivity was 94.68%. The specificity was 100%. The false negative rate was 5.3%. The positive predictive value was 100%. The negative predictive value was 80.76%. The accuracy was 95.65%. There was no false positive case. Conclusions: Core needle biopsy under ultrasound guidance is a minimally invasive diagnostic tool and gives a high accuracy rate for evaluating breast lesions. This procedure reduces the surgical cases of benign breast disease. However, correlation between imaging and pathology is important for appropriate management of false negative cases.

230-231

Authors: Arya SC, Agarwal N

Objective: To detect a rapid disease diagnosis for clinical management and preventive measures of chikungunya virus infection. Methods: The utility of a point-of-care test that could be used in field and health care centers was investigated employing a commercially available diagnostic kit at a tertiary care, multidisciplinary hospital in the Indian capital metropolis during 2010. Results: During the 2010 spurt of chikungunya cases in Delhi, India, the performance of the OnSite chikungunya IgM Combo Rapid Test kit (CTK Biotech, San Diego, USA) well matched with the chikungunya IgM capture ELISA kits (National Institute of Virology, Pune, India). The sensitivity and specificity of the rapid test in relation to the IgM capture ELISA were 0.71 (95% CI: 0.30 to 0.94) and 1.00 (95% CI: 0.46 to 2.10), respectively. The respective positive and negative predictive values were 1.0 (95% CI: 0.46 to 1.00) and 0.7 (95% CI: 0.30 to 0.94). Conclusions: Commercial assay kits to detect chikungunya IgM antibody are essential in health care centers which lack facilities for cell culture or enzyme immunoassay. Hence, it should be possible for health centers even in poorer countries to use the OnSite Chikungunya IgM Combo Rapid Test kit as a matter of routine to early diagnosis and to initiate control measures for chikungunya.

235-238

Authors: Igbiks Tamuno

Objective: To evaluate the prescription pattern of clinicians in private health care facilities in Kano, Northwestern Nigeria. Methods: One thousand prescriptions from ten private health facilities in Kano were evaluated retrospectively using WHO prescribing indicators. Results: Average number of drugs per encounter in these health facilities was 3.20. Generic prescribing was low at 55.40% while encounters with antibiotic prescription were high at 43.80%. About 91.20% of prescribed drugs were listed in the national essential drug list while 83.30% of the drugs for treatment of common health problems were available in these facilities. Nearly 18% of encounters had at least one injection prescribed while antihypertensives, analgesics, antimalarials, vitamins and anxiolytics were prescribed in 11.80%, 61.30%, 30.20%, 21.50% and 12.30% of encounters, respectively. Conclusions: Polypharmacy, overuse of antibiotics and injections, and low rate of generic prescribing occur in private health facilities in Kano. Therefore, there is a need to draw attention to the educational intervention.

241-244

Authors: Chhabra S, Goyal D, Kakani A

Objective: To explore the incidence, types, profiles, gestation, therapies, maternal-fetoneonatal outcomes with special reference to conservative eclampsia management in preterm cases with live baby. Methods: A critical analysis of eclampsia cases over two decades was performed to explore outcomes with different therapies. Results: Of 64 014 deliveries, 416 cases of eclampsia were managed, giving an incidence of 0.65% of births with decreasing trends (0.79% in Block A and 0.56% in Block E). 132 (31.73%) had lytic cocktail, (58.69% in Block A and 2.66% in Block E), 76 (18.27%) had magnesium sulphate (MgSO4) and pethidine or diazepam (30.43% in Block A and 5.33% in Block E), 208 (50.00%) received MgSO4 and nifedipine (10.86% in Block A and 92.00% in Block E). Mean induction delivery interval with lytic cocktail was 23.2 hours (shortest), and MgSO4 with sedatives, 48 hours, and MgSO4 with nifedipine, 72 hours (longest). In 33 cases, induction could be postponed if babies were live, preterm and mothers’ convulsions could be controlled. Lytic cocktail perinatal mortality rate (PMR) was 765.15. PMR of MgSO4 with sedatives was 500. PMR of MgSO4 with nifedipine was 346. Conclusions: Though some babies died in utero, in carefully selected cases with close supervision, pregnancy may be continued with eclampsia to increase fetal maturity without risk to mother, in settings where resources are scarce for very very low birth weight babies. Conservative management improves perinatal outcome but a careful balance of maternal wellbeing is essential.

247-250

Authors: Nnadi Nnaemeka Emmanuel, Nimzing Loha, Okolo Mark Ojogba, Onyedibe Kenneth Ikenna

Landscape epidemiology describes how the temporal dynamics of host, vector, and pathogen populations interact spatially within a permissive environment to enable transmission. It also aims at understanding the vegetation and geologic conditions that are necessary for the maintenance and transmission of a particular pathogen. The current review describes the evolution of landscape epidemiology. As a science, it also highlights the various methods of mapping and modeling diseases and disease risk factors. The key tool to characterize landscape is satellite remote sensing and these data are used as inputs to drive spatial models of transmission risk.