Cutaneous leishmaniasis in Yemen

BACKGROUND: Cutaneous leishmainiasis is widespread in the Yemen, but has not been fully documented. METHODS: We have studied 42 cases from the Hajjah and Amran Governorates of the Yemen Republic. The clinical profile of these cases was recorded in a special protocol. The diagnosis was based on positive slit skin smear and histopathologic studies when needed. RESULTS: The age of the patients ranged between 1 and 65 years (median age, 19 years) and the duration of the disease ranged between 2 months and 12 years (median duration, 6 months). Most of the patients had a single lesion. Slit skin smear was positive for parasites in 35 cases (highly positive in 15). From the analysis of features, the disease could be classified into dry type (31 patients), wet type (seven patients), and chronic cutaneous leishmaniasis (four patients). Most of the patients required prolonged (4-6 weeks) treatment with sodium stibogluconate; the smear was still positive in eight patients, seven of whom were further treated successfully with a combination of rifampicin and isoniazid for 2-3 months. One who was treated successfully with intralesional injections of sodium stibogluconate. CONCLUSIONS: Cutaneous leishmaniasis in this region seems to be endemic, has a long chronic course, shows a highly positive smear even 1-6 years after onset, and gives an inadequate response to prolonged systemic therapy. Further epidemiologic studies and taxonomic differentiation of the species are required.     

Study on the factors affecting the MDA programme in Kerala state

The Mass Annual Single dose DEC administration (MDA) was initiated in India from 1997. In Kerala MDA was studied as a pilot project in Alappuzha and Kozhikode District from 2000-04 and the first round of MDA was launched in Kerala covering eleven endemic districts, in March 2005. On evaluation, the drug distribution coverage, compliance, etc. were found to be not satisfactory and a need to elicit the factors for poor performance of MDA is felt essential. The main reasons for poor performance of MDA in Kerala state were the lack of adequate prior information to the target population regarding the importance LF elimination programme and inadequate awareness. The fear of side reactions, antipropagonda, poor IEC activities repeated postponement of programme, insufficient time for mobilisation etc. were the other reasons for poor compliance. The purpose of the present study was to bring the observations to the notice of the authorities so that appropriate remedial measures are incorporated.     

Relationship between Plasma Interleukin-12 (IL-12) and IL-18 Levels and Severe Malarial Anemia in an Area of Holoendemicity in Western Kenya

In this study, we investigated whether levels of interleukin-12 (IL-12) and IL-18 in plasma are associated with severe malarial anemia outcomes in an area of holoendemicity in western Kenya. We compared plasma IL-12 and IL-18 levels in six groups of children grouped into the categories aparasitemic, asymptomatic, mild malaria, high-density uncomplicated malaria (UC), moderate malarial anemia (MMA), or severe malarial anemia (SMA). IL-12 levels were significantly reduced in children with SMA (P < 0.05) but not in other groups compared to children in the aparasitemic control group. IL-18, a cytokine known to be critical for the induction of gamma interferon along with IL-12, was produced more frequently (70%) in children with UC (P = 0.06) than in children in the aparasitemic control group (32%). However, in the SMA group the IL-18 response rate declined to 30%, which was similar to that in the aparasitemic control group, which showed a 32% response rate. This finding suggests that the IL-18 response may be impaired in children with SMA. In summary, the results from this study support the hypothesis that impairment of IL-12 and/or IL-18 response may contribute to the development of severe malarial anemia in areas of holoendemicity for malaria.     

Detection of Human T-Lymphotropic Virus (HTLV) tax Sequences in New York City Blood Donors Seronegative for HTLV Types 1 and 2

A potential public health concern is the reported detection of the human T-lymphotropic virus (HTLV) tax gene in the lymphocytes of up to 11% of a low-risk group of New York City blood donors (NYBD). This study aimed to independently confirm the prevalence of HTLV tax sequences in 293 NYBD. All NYBD tested negative for antibodies to HTLV types 1 and 2 and HTLV Tax. HTLV tax sequences were not detected in the NYBD lymphocytes. These data demonstrate the lack of HTLV-1 tax in this group of NYBD at low risk for HTLV infection.     

Serological detection of infection with diverse human and simian immunodeficiency viruses using consensus env peptides

Cross-species transmission has been shown to play an important role in the emergence of human retroviruses. We developed a generic enzyme immunoassay using synthetic peptides from gp41 and C2V3 consensus sequences (human immunodeficiency virus [HIV] type 1 [HIV-1] groups M, O, and N and the homologous region of simian immunodeficiency virus [SIV] strains from chimpanzees [SIVcpz], SIVcpzGAB1 and SIVcpzANT) to detect divergent HIV and SIV. A cocktail of peptides from gp41 and C2V3 (M-O) detected all HIV-1 group M and O sera and showed cross-reactivity with SIVcpz sera. Further, a mixture of C2V3 peptides (GAB1-ANT) failed to detect HIV-1 infections but reacted with all SIVcpz sera, allowing discrimination of SIVcpz from HIV-1 infections. Since most SIVcpz sera cross-reacted with HIV-1 peptides, we next evaluated SIVcpz serum reactivity with rapid tests for HIV-1/2. SIVcpzANT and SIVcpzUS sera reacted with the Sero-strip and Multispot assays. Both tests are sensitive in detecting group M (97 100%, respectively), although Multispot has lower sensitivity for group O detection (67%) than does Sero-strip (100%). The limited volume and time required to perform these assays make them a generic tool for field screening. The env peptide-based assay and rapid tests should allow for the identification of emerging variants of HIV and SIV.     

Genomic diversity in the regulatory nef gene sequences in Indian isolates of HIV type 1: emergence of a distinct subclade and predicted implications

The regulatory functional nef gene is known to mediate a cascade of events during pathogenesis in HIV infection. Variability in the nef gene sequences of HIV-1 A and B subtypes has been well documented. Reasonable data are also available on the pattern of genomic changes in the nef gene of African strains of HIV-1 subtype C, but very little is known about heterogeneity in the nef gene of Indian strains of HIV-1 subtype C, which accounts for 90% of the estimated 5.2 million cases of HIV infection in India. This is a huge number and, therefore, it is important to reveal the extent of sequence variability in the nef gene of HIV-1 subtypes circulating in different parts of India. We carried out full-length nef gene (approximately 620 bp) sequencing on a large number of clinical isolates of HIV-1 circulating in different geographic regions of India. Comparative and phylogenetic analysis revealed 88% (38/43) of cases was HIV-1 subtype C; four cases were diagnosed as subtype A and only one as subtype B. Although most of the crucial functional motifs of the nef gene were conserved, we did observe a few important variations in juxtapositions to functional domains. Interestingly, analyzed nef sequences showed an evolving pattern of segregation away from those reported from other parts of the world, to form a distinct Indian subclade. Deduced amino acid (aa) sequences used to predict HLA binding epitopes for consensus nef gene sequences of Indian strains of HIV-1 revealed two HLA subtype binding domains, GAFDLSFFL (at aa 83) and LTFGWCFKL (at aa 136), in high frequency. The findings from the present study may encourage use of nef gene in molecular diagnostics/genotyping, keeping track of the evolutionary trend and pinpointing the emergence of recombinant strains, and in the future, designing a multiepitope HIV vaccine suitable for the Indian population.     

Lymphatic filariasis in Bilaspur district, Chhattisgarh

As per earlier reports only Ratanpur PHC of the district Bilaspur of Chattisgarh was endemic for filariasis. During the present survey microfilaria infection and disease manifestations were detected in two more PHCs namely Bilha and Bilaspur. 3426 Night blood smears were collected from 24 randomly selected localities (13 rural and 11 urban) covering 25% known endemic areas and 75% reportedly non-endemic areas. Sample size was calculated taking 12% prevalence rate using standard statistical formula. Sixty-two indigenous residents (mf rate 1.80%) were found positive for W. bancrofti infection. Males (2.17%) were more affected than females (1.19%). The mf carriers were 2.05% in rural and 1.45% in urban communities, which indicates that lymphatic filariasis is prevalent in rural areas also. The mean mf density was 5.06. No infective or infected mosquitoes could be detected in Culex quinquefasciatus (544 nos.), M. annulifera (13 nos.) and M. uniformis (2 nos.). Comparing the earlier studies, in Bilaspur district the infection has been showing a declining trend and Brugia malayi infection has disappeared.