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Indian Journal of Medical Microbiology, Vol. 28, No. 4, October-December, 2010, pp. 421-422 Research Snippets Research snippets P Desikan Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, India Date of Submission: 17-Sep-2010 Code Number: mb10130 As a country, we seem to be making news for all the wrong reasons. India is still experiencing a countrywide outbreak of H1N1 (2009) with active transmission and a substantial number of fatal cases in several states across the country. In order to have an overview of influenza transmission patterns, influenza transmission zones have been identified across the world. The influenza transmission zones join geographically related countries or territories to larger areas that have similar influenza transmission patterns. India is a part of the Southern Asia Influenza transmission zone, which has 21-30% of respiratory samples testing positive for influenza. ( http://www.who.int/csr/disease/influenza/2010_09_10_GIP_surveillance/en/index.html ) If that were not enough, we have notoriety in relation to dengue virus infections as well. A report summarising information about dengue cases reported to CDC through two CDC-maintained passive surveillance systems, the ArboNET surveillance system and a system maintained by the CDC Dengue Branch (MMWR Morb Mortal Wkly Rep. 2010 Jun 18;59(23):715-9), found that the highest proportion of laboratory confirmed and probable cases with known travel histories were in persons who reported travel to the Dominican Republic (121; 20%), Mexico (55; 9%), and India (43; 7%). The report recommends that dengue be considered in the differential diagnosis of patients with a history of travel to these endemic areas within 14 days of onset of fever. In an attempt to evaluate two commercially available kits for laboratory diagnosis of Japanese Encephalitis, samples from children presenting to a site in rural India, with acute encephalitis syndrome, were tested (Trop Med Int Health. 2010 Jul;15(7):811-8. Epub 2010 May 11). The kits evaluated were Japanese Encephalitis-Dengue IgM Combo ELISA (Panbio Diagnostics, Australia) and JEV-CheX IgM capture ELISA (XCyton Diagnostics Limited, India). It was concluded that specificities were excellent for both the kits but sensitivities were only reasonable. A classic trade-off between sensitivity and specificity perhaps. In order to characterise an environmental niche driving the distribution of Crimean-Congo haemorrhagic fever (CCHF) in Turkey, a geo-referenced collection of cases reported between 2003 and 2008 and a set of climate and vegetation features were studied (Epidemiol Infect. 2010 Aug;138(8):1194-203. Epub 2009 Nov 2). Neither single climate or vegetation variable nor any individual seasonal component accounted for the delineation of areas with disease. Coherent and significant differences between disease-containing and disease-free sites were found when habitat fragmentation and connectivity were examined. High fragmentation and connectivity were unambiguously associated with sites where disease is reported, and accounted for the spatial spread of cases in 2003-2008. CCHF cases were always associated with areas of highly fragmented and well-connected patches within the range of the tick vector, while there were no reports from areas with low fragmentation. There was a linear relationship between degree of fragmentation and case incidence. These findings add credence to the concept of disease spread through networks of connected spots with high densities of infected vectors, as well as social factors driving different human activities in sites of high fragmentation. There are news reports of the Marathon County Health Department investigating a cluster of blastomycosis cases in the village of Weston, Wisconsin, USA ( http://www.wausaudailyherald.com/article/20100912/WDH0101/9120437/Blastomycosis-outbreak-reported-in-Weston ). While blastomycosis is an endemic mycosis that occurs predominantly in North America in the north central United States and provinces of Canada, southern states, and midwestern states bordering the Mississippi River basin, the vast majority of infected persons are asymptomatic or have mild respiratory symptoms that are not diagnosed as being caused by a fungus. Though a urinary antigen test is now available to aid in diagnosis, it is not specific, and is positive in patients who have histoplasmosis as well. Antibody assays remain nonspecific, with poor sensitivity, and the confirmatory diagnostic test is still isolation of the organism in culture (Proc Am Thorac Soc. 2010 May;7(3):173-80). Sometimes, empathies appear curiously lopsided. In the middle of the war zone in Afghanistan, with massive military civilian and military casualties, the Nuristan Provincial Reconstruction Team (PRT) is fighting an outbreak of rabies in the province's Titin Valley that has claimed the lives of four Afghan citizens. The PRT is getting help from the Iowa National Guard's 734th Agri-Business Development Team which provided 300 doses of rabies vaccine. The vaccine will be used to inoculate dogs in the area and will help avoid the slaughter of Titon Valley's canines ( http://waronterrornews.typepad.com/home/2010/09/fight-rabies-save-dogs.html ). Be that as it may, a study examined plasma from 10 patients who had received rabies vaccine either intradermally (ID) or intramuscularly (IM) for 20 chemo- and cytokines (Vaccine. 2010 Jun 23;28(29):4553-7. Epub 2010 May 12). Eotaxin, interleukin (IL)-5 in the ID and IL-1 beta in the IM group were the only chemo- and cytokines that reached statistical significance (P < 0.05). It was felt that further studies are required to determine whether the presence of specific chemokines, such as eotaxin, is responsible for the production of high levels of rabies virus neutralising antibody after administration of the dose-sparing ID regimen. In a multicentre, double-blind, placebo-controlled trial undertaken in rural Matlab, Bangladesh, and urban and periurban Nha Trang, Vietnam, the clinical efficacy of live oral pentavalent rotavirus vaccine for prevention of severe rotavirus gastroenteritis in infants aged 4-12 weeks was assessed (Lancet. 2010 Aug 5 PMID: 20692031). It was concluded that in infants in developing countries of Asia, pentavalent rotavirus vaccine is safe and efficacious against severe rotavirus gastroenteritis, and that the results supported expanded WHO recommendations to promote its global use. The study was funded by PATH (GAVI Alliance grant) and Merck. Having said that, I do ask myself whether the expenses for this vaccine would not be better spent on sanitation. That would provide protection against a variety of faeco-orally transmitted diseases. I accept that it is just a point of view, though. There has been a significant increase in reports of cases of West Nile virus (WNV) infections in Northern Greece ( http://www.medicalnewstoday.com/articles/200105.php ). While the epidemiology and modes of transmission in this situation are still to be delineated, unusual modes of transmission need to be kept in mind, like, for instance, through contaminated blood transfusions. Although the risk of infection with hepatitis and human immunodeficiency viruses from blood transfusions has been reduced to negligible levels, emerging infections continue to be a cause for concern. Over the past 20 years, apprehensions for blood safety with respect to emerging infections have arisen due to the presence of variant Creutzfeldt-Jakob disease, WNV, and Babesia in blood (Clin Lab Med. 2010 Jun;30(2):499-509. Epub 2010 May 6). Immune reconstitution inflammatory syndrome (IRIS) has become a frequent and potentially severe complication after initiation of antiretroviral therapy (ART) in patients infected with human immunodeficiency virus (HIV). IRIS can unmask a previously clinically silent infection, including leprosy. A patient from Côte d'Ivoire, living in France, developed papular lesions on his skin after initiation of ART. These lesions were associated with microbiologically proven leprosy. Obviously, latent leprosy should be considered in HIV-infected patients from areas endemic for leprosy, particularly among those patients on ART (Am J Trop Med Hyg. 2010 Jul;83(1):13-4). A systematic review and meta-analysis to assess the association between BCG vaccination and childhood asthma concluded that exposure to BCG vaccine in early life may influence immune maturation and prevent development of asthma. Hence, it might have far reaching public health implications (Int J Epidemiol 2010;39:469-86). Serendipity at its best! Copyright 2010 - Indian Journal of Medical Microbiology |
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