Regional Medical Research Centre Research Articles

Human metapneumovirus (hMPV): an associated etiology of severe acute respiratory infection in children of Eastern Uttar Pradesh, India.

Acute respiratory infections (ARIs) are a serious public health concern across the world, causing considerable morbidity and mortality. Every year, around 13 million children under the age of five die. Approximately 95% of them are from developing nations, and ARIs are responsible for one-third of all deaths. Human Metapneumovirus (hMPV) is one of the causative agents associated with respiratory tract infections. There is lack of information about hMPV from the eastern region of Uttar Pradesh. At Indian Council of Medical Research- Regional Medical Research Centre, Gorakhpur (ICMR-RMRC, Gorakhpur) in Uttar Pradesh, India; we tested respiratory pathogens in under-five patients presenting with ARI and severe acute respiratory illness (SARI) through semi nested PCR. A total of 100 nasal and throat specimens were collected from the outdoor and indoor patient Departments (OPD) and (IPD) of Department of Paediatrics, BRD Medical College, Gorakhpur during February to April 2022. Out of 100 enrolled paediatric patients, 4(4%) were found to be hMPV positive. Among the patients who tested positive for hMPV, 25%(1/4) unfortunately died. The phylogenetic analysis of hMPV showed the close resemblance with the clade of Singapore and USA hMPV isolates. The study underlines the importance of hMPV as the cause of acute respiratory infections in children and the highlight the need for routine testing for this virus in laboratories. Further more comprehensive detailed study on various aspects of hMPV in this area is needed.

Possible threat of the Omicron subvariant BF.7 to FIH Hockey World Cup 2023 in particular and the South-East Asia Region in general.

Possible threat of the Omicron subvariant BF.7 to FIH Hockey World Cup 2023 in particular and the South-East Asia Region in general.

Outbreak of tomato flu in India raising concerns: is it a false alarm or are we welcoming a new pandemic?

Outbreak of tomato flu in India raising concerns: is it a false alarm or are we welcoming a new pandemic?

Leptospirosis One of the Risk Factor for Kidney Diseases

The disease leptospirosis is threatening both animals and humans. Leptospirosis can cause complications in multiple organs, including the kidneys early on, most often manifesting as tubulo-interstitial nephritis and tubular dysfunction. More than a million people are infected with leptospirosis every year, making it the most widespread zoonosis. Hotspots of leptospirosis and CKD are the agricultural intensive areas that are prone to flooding. Pallabi Pati Senior Research Fellow(SRF) Molecular Biology Division Regional Medical Research Centre(ICMR),Bhubaneswar. Lack of prompt treatment for acute leptospirosis can lead to chronic kidney damage and ultimately kidney failure. Because of the insidious nature for progression of CKD, the germs that cause it may be present in the kidney without causing any symptoms. Tubulointerstitial nephritis, interstitial fibrosis, and tubular atrophy are histologic findings of leptospirosis renal disease. Leptospirosis in adult male workers is associated with proximal tubule dysfunction, hypokalemia, and chronic kidney disease (CKD).

Perception of Medical Professionals from Tertiary Care Teaching Institutes towards the Specialty of Community Medicine and its Specialists amid the COVID-19 Pandemic

International Journal of Medicine and Public Health,2022,12,2,71-75.DOI:10.5530/ijmedph.2022.2.14Published:April 2022Type:Original ArticlePerception of Medical Professionals from Tertiary Care Teaching Institutes towards the Specialty of Community Medicine and its Specialists amid the COVID-19 PandemicImran Ahmed Khan, MD. Abu Bashar, Harish Chandra Tiwari, and Mahendran M Reddy Imran Ahmed Khan1, MD. Abu Bashar2,*, Harish Chandra Tiwari1, Mahendran M Reddy3 1BRD Medical College, Gorakhpur, Uttar Pradesh, INDIA. 2AIIMS, Gorakhpur, Uttar Pradesh, INDIA. 3Indian Council of Medical Research- Regional Medical Research Centre(ICMR-RMRC), Gorakhpur, Uttar Pradesh, INDIA. Abstract:Background: Community Medicine specialists play a crucial role in the prevention and control of communicable and non-communicable diseases, monitoring and surveillance, healthcare planning and management and research but the awareness about the speciality even among the medical fraternity is limited. Aim: To determine the perceptions of Medical Professionals from Tertiary care teaching institutes towards the specialty of community medicine and its specialists. Materials and Methods: This was a web based cross-sectional survey conducted in October- November, 2021 among Medical professionals of Tertiary Care Teaching Institutes in the state of Uttar Pradesh, North India using a semi structured, pretested questionnaire circulated as google forms using WhatsApp and personal email ids. Results: A total 406 participants consented and completed the survey questionnaire out of the 456 contacted eligible individuals (response rate 89.04%) of which 231 (57.0%) were males and 175 (43.0%) were females. Majority (83.0%) of the participants agreed that the ‘information and knowledge gained in Community Medicine by them would certainly help in their future medical practice” and an overwhelmingly majority (91.1%) agreed to the statement that ‘a physician can’t effectively control most infectious disease without adequate knowledge of Epidemiology’. Around 70% of the participants agreed that Community Medicine Specialists have good work life balance and 87.4% agreed that speciality of Community Medicine offers adequate scholarly and research opportunities. Further, 77.6% of the participants agreed that Community Medicine has enough opportunities for direct public contact compared to other specialty and around 64% agreed that the speciality offers the opportunity to utilize newer technologies, Artificial Intelligence and Machine Learning. Around 61% of the participants agreed that COVID-19 pandemic will affect the choice of specialty among the PG aspirants. Conclusion: Majority of the Medical professionals have positive perceptions towards the speciality of Community Medicine and its specialists. The COVID-19 pandemic may be an important cause for the changing perception towards the speciality among the medical fraternity. Keywords:Community medicine, COVID-19, Medical Professionals, Pandemic, perception, SpecialityView:PDF (118.15 KB)

Study of Prevalence and Pattern of Infections in Acute Exacerbations of Obstructive Airway Disease

Objective: To study the prevalence and pattern of infections causing exacerbations of obstructive airway diseases.
 Methods: A prospective cross sectional study which included 126 consecutive obstructive airway disease patients were enrolled for the study. All the included patients were subjected to detailed history, clinical examination and routine investigations including sputum Gram’s stain and aerobic culture after obtaining a written informed consent. Pharyngeal swab was collected and sent in Viral Transport Medium(VTM, Himedia) within 24hrs to Regional Medical Research Centre (ICMR),Bhubaneswar for detection of respiratory viruses. Samples were tested by Real Time reverse-transcription polymerase chain reaction (RT-PCR).
 Results: Among patients with COPD, Flu A/H3N2(9.375%) was found in highest number of patients followed by rhinovirus(7.3%). In bronchial asthma patients,virus was isolated only in 3 cases(13.6%).No virus was detected in bronchiectasis patients. Isolated bacterial infection was detected in 26 cases (20.63%).Acinetobacter baumanii and Klesiella pneumoniae were most common bacterial pathogens detected.Bacterial pathogens were commonly isolated among COPD patients.Co-infection with both bacteria and virus was detected in 12 patients (9.52%)of which 11 were diagnosed with COPD. Only 1 case of bronchial asthma reported a co-infection.Among cases with co-infection with both bacteria and virus,Acinetobacter baumanii and Pseudomonas aeruginosa were found to be most common bacterial pathogens.There was no typical pattern in viral infection among the cases throughout the year.
 Conclusion: The risk of exacerbation due to viral etiology is perennial but might be self limiting. Recovery from exacerbation takes a long time and patients with exacerbations have an impaired quality of life, diminished exercise capacity and loss of lung function.

First Line Anti-TB Drug Resistance in an Urban Area of Odisha, India.

Drug resistance is a major cause for increasing the global burden of Tuberculosis (TB). However in countries with larger geographical areas and different climatic conditions like India the prevalence of drug resistance varies from place to place. Information on anti-TB drug resistance patterns particularly among newly diagnosed cases is crucial for planning an effective TB control program. To determine the prevalence of resistance against first line anti-TB drugs and Multi Drug Resistance (MDR) in Mycobacterium tuberculosis isolates. The prospective study was carried out in National Reference Laboratory (NRL) of Regional Medical Research Centre (RMRC), Bhubaneswar. During this period from January to September 2014, sputum specimens were collected from 850 suspected pulmonary TB patients attending Designated Microscopy Center (DMC) of Capital Hospital, Bhubaneswar, Odisha. Sputum specimens were subjected to Acid Fast Bacilli (AFB) smear microscopy and further processed for isolation on solid Lowenstein Jensen (LJ) medium. Drug Susceptibility Testing (DST) on isolates with first line anti-TB drugs was performed as per Revised National Tuberculosis Control Programe (RNTCP) guidelines. Out of all the 850 suspected pulmonary TB patients subjected to AFB microscopy and solid LJ culture, isolation of Mycobacterium tuberculosis was successful only in 161 (117 new and 44 previously treated) pulmonary TB patients. On DST by the RNTCP approved proportion method, prevalence of MDR- TB among 0.85% new and 4.54% previously treated cases was observed. Prevalence of mono resistance to streptomycin, isoniazid, rifampicin and ethambutol observed among new and previously treated cases were 3.41%, 2.56%, 0, 0.85% and 2.27%, 13.6%, 2.27%, 0 respectively. Only one patient from each category showed resistance to both streptomycin and isoniazid in previously treated as well as in new case. The study reports an unchanged low level of MDR-TB prevalence among new cases in an urban area of Odisha over a decade. This could be due to the success of Directly Observed Treatment Short-course (DOTS) in effective treatment of drug-susceptible TB in the state and non-transmission from primary Drug Resistance (DR) TB cases.

Medicinal Plants Used by the Nicobarese Inhabiting Little Nicobar Island of the Andaman and Nicobar Archipelago, India.

This study is an attempt to document the medicinal plants used by the tribal community of Little Nicobar Island. Despite modern healthcare facilities, tribals often consume medicinal herbs, with traditional knowledge practitioners (TKPs) serving as local medical experts. The aim is to conduct an ethnomedicinal survey among the Nicobarese, whose medicinal practices are yet to be documented. Field research was conducted in all five villages of Little Nicobar Island, situated in the southernmost part of the Andaman and Nicobar Archipelago, during 2012-2013. Seven TKPs were interviewed using a questionnaire-guided ethnomedicinal survey protocol. The data obtained were analyzed using the informant consensus factor (ICF) and use value. Voucher specimens of all the cited plant species were deposited at the Regional Medical Research Centre (Indian Council of Medical Research), Port Blair. Uses of 34 medicinal plant species, belonging to 23 families encompassing 32 genera, were recorded during the survey. These 34 species are employed to treat a total of 16 ailments. The highest ICF (1.00) was obtained for respiratory diseases. The Euphorbiaceae family exhibited the highest number of citations, and plants with the highest use values were Glochidion calocarpum Kurz, Senna occidentalis (L.) Link, Ocimum tenuiflorum L., and Passiflora suberosa L. Of the medicinal plants reported, the most common growth form was herbs. Remedies were generally prepared using water. The medicinal plant preparations were administered topically or orally. Traditional knowledge of herbal medicines is handed down orally through generations. These plants attained a significant role under the healthcare of the Nicobarese residing in Little Nicobar Island. Efforts to ensure their documentation are necessary in order to prevent its loss, either because of natural calamities or lack of interest among younger generations in carrying out their tradition.

Chemical Composition of Leucas Stelligera

oxygenated monoterpenes (5.9%), and monoterpene hydrocarbons (5.5%). The major components of the oil were -caryophyllene (18.2%), -elemene (13.5%), -gurjunene (8.7%), trans--bergamotene (4.9%), and -selinene (3.6%). Plant Material and Isolation Procedure. The aerial parts of Leucas stelligera were collected in November 2012 from Amboli, Maharashtra, India. A voucher specimen (RMRC-554) has been deposited in the herbarium of Regional Medical Research Centre, Belgaum. The oil was obtained by hydrodistillation of fresh aerial parts of this species using a Clevenger-type apparatus for 3 h. The yield of oil was 0.3% (w/w). The oil was dissolved in n-hexane, dried over anhydrous sodium sulfate, and stored at –4C. Identification of the Oil Components. The oil was analyzed using a Varian 450 chromatograph with a CP-Sil 8 CB capillary column (30 m 0.25 mm; 0.25 m film thicknesses) with an FID under the experimental conditions reported earlier [2] and a Thermo Scientific Trace Ultra GC interfaced with a Thermo Scientific ITQ 1100 mass spectrometer fitted with a TG-5 MS (Thermo Scientific) fused silica capillary column (30 m 0.25 mm; 0.25 m film thicknesses). The oven temperature 60–220C was programmed at 3C/min using helium as carrier gas at 1.0 mL/min. The injector temperature was 230C; injection volume 0.1 L; sample prepared in n-hexane; split ratio 1:50. Mass spectra were taken at 70 eV with mass range 40–450 m/z, and characterization was done on the basis of the retention index, by the MS Library Search (NIST and Wiley), and by comparison with the mass spectral data [3].

Ethnomedicinal knowledge among Karens of Andaman & Nicobar Islands, India

Ethnopharmacological relevanceThis study documents the use of medicinal plants by Karens of Middle Andaman, of the Andaman and Nicobar Islands. In spite of the availability of modern medicines, Karens preferred herbal remedies provided by the Traditional Knowledge Practitioners (TKPs), who served as their healers. Hence, the aim of this study was to collect information from TKPs and determine the significance of plants utilized for medicinal purposes. The informant consensus factor (ICF) in relation to medicinal plants used was also estimated and analysed. Materials and methodsField research was conducted in three villages of Middle Andaman, inhabited by Karens, during October 2010 – February 2013. TKPs were interviewed with a questionnaire-guided ethno-medical survey protocol. The data obtained were analysed using the informant consensus factor (ICF) and use value (UV). Voucher specimens of all the cited plants were deposited at Regional Medical Research Centre (ICMR), Port Blair. ResultsUse of 78 medicinal plant species belonging to 71 genera encompassing 48 families was recorded during the survey. These plants were used to treat 38 different ailments, and divided into ten categories of use. The highest ICF value (0.79) was observed for infections and infestations. The Zingiberaceae and Fabaceae families exhibited the highest number of species, and the plants with the highest use values were Typha angustifolia L., Millingtonia hortensis L. f. and Piper betle L. The most common growth form observed were herbs (42%). Among the several plant parts used, leaves were mostly preferred for preparation of medicines. Water was the main excipient used for mixing the herbs. ConclusionsThis study documents the use of medicinal plants by Karens of the Andaman and Nicobar Islands. Phytochemical and pharmacological aspects of these plants need to be studied, to confirm their efficacy and safety, and determine their potential use in modern medicine.

Ethno medicine and healthcare practices among Nicobarese of Car Nicobar – An indigenous tribe of Andaman and Nicobar Islands

Ethnopharmacological relevanceThis study is an attempt to document the use of medicinal plants by Nicobarese tribe from the Car Nicobar Island of Andaman and Nicobar Islands. Inspite of the availability of modern healthcare facilities tribal people often take herbal medicines and Traditional Knowledge Practitioners (TKPs) serve as the local medical experts in Car Nicobar Island. Aim of the study: The present study was to conduct an ethnomedicinal survey among the TKPs of Nicobarese tribe of the inhabitants of Car Nicobar Island, Andaman and Nicobar Islands, India. Materials and methodsField research was conducted in 15 villages of Car Nicobar Island during March 2011–February 2012. TKPs were interviewed with a questionnaire-guided ethnomedical survey protocol. The data obtained were quantitatively analysed using the informant consensus factor (ICF) and use value (UV). Voucher specimens of all cited plants were collected and deposited at Regional Medical Research Centre (ICMR), Port Blair. ResultsUse of 150 medicinal plant species, belonging to 122 genera encompassing 59 families were recorded during the survey. These 150 species are employed to treat 47 different medicinal uses, divided into nine categories of use. The highest ICF (0.68) was obtained for the gastrointestinal system. The Euphorbiaceae family exhibited the highest number of citations, and the species with the highest UVs were Morinda citrifolia L., Tabernaemontana crispa Roxb. and Colubrina asiatica (L.) Brongn. Of the medicinal plants reported, the most common growth form was shrubs (28%). Among several parts of individual plant species which are used, leaves constitute the major portion in preparation of medicines. Remedies were generally prepared using water as the excipient. ConclusionsThis study is an attempt to document the use of medicinal plants from the Car Nicobar Island of the Andaman and Nicobar Islands. Future phytochemical and pharmacological studies are needed to confirm the efficacy and safety of the identified plants.

Low levels of anti TB drug resistance in Rayagada district of Odisha, India

A study was conducted at Rayagada district of Odisha, India, among smear-positive tuberculosis (TB) patients to determine the resistance pattern to first-line drugs. Sputum samples were collected from 405 new and 37 previously treated patients and were tested at Regional Medical Research Centre, Bhubaneswar. Resistance to any anti-tubercular drug was observed to be 5.2% among new cases and 16.1% among previously treated patients, while multidrug-resistant tuberculosis (MDR-TB) was found to be 0% in new and 8.1% in previously treated cases. Such a low level of resistance may be due to the limited use of TB drugs outside the ongoing program.

First report of detection and molecular confirmation of Plasmodium ovale from severe malaria cases in central India

We report for the first-time detection of Plasmodium ovale in central India. From 2010, all hospitalised suspected malaria cases at the malaria clinic of the Regional Medical Research Centre for Tribals in Bastar district, central India, were screened. Plasmodium species were identified by microscopy and species-specific nested PCR of 18s rRNA. Of 256 enrolled cases of confirmed P. falciparum malaria by microscopy, P. ovale infection was detected in three cases (1.2%) by PCR and sequencing. Of these three cases, one had cerebral malaria and another had severe malaria anaemia. In both of these cases, P. ovale infection was mixed with P. falciparum, while in third case the infection was mixed with both P. falciparum and P. vivax. Phylogenetic analysis revealed that these isolates showed closed homology with West African genotypes. All three hospitalised patients were originally residents of remote inaccessible forest villages and never moved out of their residence. This finding also has implications in malaria control and elimination as P. ovale causes relapses. This study highlights the need of molecular diagnosis of malaria species for appropriate treatment and control.

Malaria in a tertiary health care facility of Central India with special reference to severe vivax: implications for malaria control

Plasmodium vivax is now recognized as a cause of severe and fatal infection in many parts of the world. This prospective observational study was undertaken in a tertiary health setting to understand the spectrum of the disease burden and associated complications due to P. vivax malaria in central India. A malaria clinic under Regional Medical Research Centre for Tribals is operational at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur in central India, where all fever cases and cases with history of fever were referred for screening of malaria parasite by microscopy and rapid diagnostic test kits. Confirmation of all the cases was done by PCR targeting 18s ribosomal RNA gene of the parasite to exclude mixed infection with P. falciparum. Severe vivax malaria was found in 22 (11·1%) out of 198 vivax patients. Cerebral malaria, seizures, severe malaria anaemia, and respiratory distress each were observed in 32% subjects. Multi-organ dysfunction syndrome was common (36%). Mortality was recorded in two patients and neurological sequelae were also observed in two patients at the time of discharge. This is the first report from Central India where P. vivax has been shown to be associated with severe signs of malaria. Severe vivax malaria is a relatively new clinical entity and further studies from different parts of the world are needed to understand clinical spectrum and burden of P. vivax not only for successful treatment, but also for designing and developing effective malaria control measures.

An outbreak of hand, foot and mouth disease in bhubaneswar, Odisha

To describe the epidemiology and clinical features of cases in an outbreak of Hand, Foot and Mouth Disease (HFMD). Descriptive epidemiological study. Hospitals and community in urban areas of Bhubaneswar city, Odisha. Upon clinical suspicion of the first case as HFMD, local pediatricians and dermatologists were sensitized for case referral to Dermatology department of Institute of Medical Science and SUM hospital (IMS and SH) for evaluation and follow up. Community survey was undertaken by household visit by the team from Regional Medical Research Centre, Bhubaneswar in an outbreak area through hospital case tracing. Blood samples were tested for hematological counts and RT PCR assay done in a subset of samples for confirmation. Seventy eight cases of HFMD were detected between September 7 and November 6, 2009. Mean age (SD) was 5.13 (4.94) years (range 4 mo-31 yrs) and both sexes were equally affected. Fever and rash were the most common presenting symptoms with the rash distributed mostly over buttocks (83.3%), knees (77.5%), both surfaces of hands and oral mucosa (78.2%). Lesions healed in Mean (SD) 8.6 (1.5) days (range 7-15 d). Recovery was complete with minimal supportive treatment but, nail shedding was noted in three children within 4-5 weeks. CA16 was confirmed as the viral agent. Children (5-14 yrs) were majorly affected and complete recovery without neurological complications were noted. The characteristic clinical features described will be useful for early clinical diagnosis where laboratory confirmation is not feasible.

Ethnomedicinal plants used to treat bone fracture from North-Central Western Ghats of India

Ethnopharmacological relevanceNorth Central Western Ghats in India comprises rich bio-cultural diversity and is also home to varied ethnomedicinal practices. The study was taken up for documentation and analysis of traditional knowledge regarding the practice and use of plants in the treatment of bone fracture. This is an effort to preserve the vanishing wealth of traditional knowledge. Materials and methodsKey informants identified in a preliminary survey and collection of information was through semi structured, open ended interviews. The details on age, place of practice, experience of key informants and learning of practice, disease they treat and mode of diagnosis, storage and usage of plants were collected. The identity of plants and their information was confirmed through repeated guided transect walks in different seasons with the informants and focus group discussions. Identified plants were deposited at the herbaria of Regional Medical Research Centre, Belgaum. ResultsForty four key informants providing treatment for bone fracture in this region were identified. Thirty eight plant species belonging to 24 families have been documented in the present study. Highest number of species representation is found in families Euphorbiaceae and Fabaceae. The habit of the species showed that 45% of the herbal drugs were obtained from trees, followed by herbs, shrubs and climbers and majority of plants used were collected from wild (76%). The stem or stem bark (33%) was most commonly used plant part to prepare medicine. Twenty six formulations of 30 plant species were directly used in treating bone fracture, where Cissus quadrangularis has the highest use-value (0.14). Eleven plants were found to be administered for bone strengthening, pain relieving, inflammation reduction and speedy recovery and Gmelina arborea has the highest use value (0.27). ConclusionsThe results indicated the importance of traditional herbal practices in community for their health needs. Both conservational strategies and further validation studies are the need of the hour for better utilization and sustenance of the documented knowledge.

Field and laboratory comparative evaluation of rapid malaria diagnostic tests versus traditional and molecular techniques in India

BackgroundMalaria presents a diagnostic challenge in most tropical countries. Microscopy remains the gold standard for diagnosing malaria infections in clinical practice and research. However, microscopy is labour intensive, requires significant skills and time, which causes therapeutic delays. The objective of obtaining result quickly from the examination of blood samples from patients with suspected malaria is now made possible with the introduction of rapid malaria diagnostic tests (RDTs). Several RDTs are available, which are fast, reliable and simple to use and can detect Plasmodium falciparum and non-falciparum infections or both. A study was conducted in tribal areas of central India to measure the overall performance of several RDTs for diagnosis of P. falciparum and non-falciparum infections in comparison with traditional and molecular techniques. Such data will be used to guide procurement decisions of policy makers and programme managers.MethodsFive commercially available RDTs were tested simultaneously in field in parallel with peripheral blood smears in outbreak-affected areas. The evaluation is designed to provide comparative data on the performance of each RDT. In addition, molecular method i.e. polymerase chain reaction (PCR) was also carried out to compare all three methods.ResultsA total of 372 patients with a clinical suspicion of malaria from Bajag Primary Health Centre (PHC) of district Dindori and Satanwada PHC of district Shivpuri attending the field clinics of Regional Medical Research Centre were included in the study. The analysis revealed that the First Response Malaria Antigen pLDH/HRP2 combo test was 94.7% sensitive (95% CI 89.5-97.7) and 69.9% specific (95% CI 63.6-75.6) for P. falciparum. However, for non-falciparum infections (Plasmodium vivax) the test was 84.2% sensitive (95% CI 72.1-92.5) and 96.5% specific (95% CI 93.8-98.2). The Parascreen represented a good alternative. All other RDTs were relatively less sensitive for both P. falciparum and non-falciparum infections.ConclusionsThe results in this study show comparative performance between microscopy, various RDTs and PCR. Despite some inherent limitation in the five RDTs tested, First Response clearly has an advantage over other RDTs. The results suggest that RDTs could play and will play an important role in malaria diagnosis.

Emergence of Chikungunya Virus Infection in Orissa, India

From September through October 2006, an unknown disease characterized by acute onset of fever, joint pain with or without swelling, and maculopapular rash along with fatigue was reported from three villages of Cuttack and one village of Kendrapara district of Orissa, India, by the State Health Department. Upon learning this, a team from Regional Medical Research Centre (Indian Council of Medical Research), Bhubaneswar, Orissa, conducted an epidemiological investigation in the area. Household survey was carried out and clinical examination of the symptomatic individuals (n = 1289: Kendrapara, 752; Cuttack, 537) undertaken. Based on the recorded chikungunya (CHIK) fever symptoms, a vector-borne viral disease was considered for provisional diagnosis. Blood samples were collected from 217 symptomatic individuals; to confirm the diagnosis, sera were tested for anti-CHIK antibody (immunoglobulin M), which revealed 63% (64/101) and 40% (47/116) seropositivity in the samples from Kendrapara and Cuttack district, respectively. The illness was managed with analgesics like paracetamol. No death was recorded due to the illness. Entomological survey in the areas revealed the presence of Aedes mosquitoes: aegypti, albopictus, and vittatus. The per-man-hour density of Aedes vectors ranged from 0.8 to 7.6. High larval indices, house index >17% and Breteau index >70%, also indicated Aedes breeding in the area. The investigation documented circulation of CHIK in Orissa, India, and helped to take preventive steps in the outbreak area, with the suggested vector control measures.

An Ogawa Cholera Outbreak 6 Months After the Inaba Cholera Outbreaks in India, 2006

Cholera has been reported in the state of Orissa, India during the last decades. An explosive outbreak of diarrhea occurred in Central Cuttack Ward 22 of Orissa (population approximately 10,621), between March 12-23, 2006. This outbreak was investigated by a team from the Regional Medical Research Centre of Bhubaneswar to identify the causative agents and to determine the antimicrobial susceptibility pattern and associated virulent genes. Clinical and epidemiological data were collected from 100 hospitalized patients with diarrhea from the Sriram Chandra Bhanja Medical College, Cuttack, Orissa. Rectal swabs and water samples were collected and tested for diarrheagenic enteropathogens. Isolated Vibrio cholerae were subjected to antibiotic susceptibility tests and polymerase chain reaction analysis for the detection of virulent genes. Of the 23 rectal swabs collected, 19 (82.6%) were positive for V. cholerae serogroup O1, serotype Ogawa. All strains were uniformly susceptible to ampicillin, gentamicin, chloramphenicol, ciprofloxacin, norfloxacin, neomycin, and tetracycline, but resistant to co-trimoxazole, furazolidone, nalidixic acid, and streptomycin. Polymerase chain reaction revealed that all strains had ctxA, tcpA (biotype El Tor), zot, and ace genes, suggesting their possible role in the outbreak. This is the first localized outbreak of V. cholerae O1, serotype Ogawa, in the state of Orissa in 2006 after a gap of 6 months dominated by Inaba strains.

Environmental Vibrio Cholerae O139 May Be the Progenitor of Outbreak of Cholera in Coastal Area of Orissa, Eastern India, 2000: Molecular Evidence

Cholera has been reported in the state of Orissa, India during the past decades. An outbreak of diarrheal disease occurred during November 1 to November 9, 2000 in Rusipada village near Puri, which was inhabited by a population of approximately 560. During the outbreak, Vibrio cholerae O139 strains were isolated from clinical specimens collected from patients with acute diarrhea admitted to the infectious diseases (ID) hospital in Puri and from environmental samples collected from multiple bodies of water in the village. The index case with acute diarrhea was a 60-year-old female resident of Rusipada who had not visited any known outbreak-related areas, including an outbreak 1 week prior to her symptom onset in a nearby village. All the isolated strains were positive for ctxA, tcpA, ace, and zot genes, produced cholera toxin, and exhibited a similar antibiogram pattern. Comparison of DNA fingerprinting analysis by randomly amplified polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE) method and dendrogram constructed from RAPD revealed that genetic homogeneity exist between the clinical and environmental O139 strains. Epidemic and endemic cholera is a major public health problem in many developing countries and continues to be an important cause of morbidity in many areas of Asia, Africa, and Latin America. Among more than 200 serogroups of V. cholerae so far identified, 1 only O1 and recently identified O139 serogroup 2–5 are capable of causing epidemic cholera. It is now widely accepted that O139 Bengal like O1 and non-1 and non-O139 Vibrio may survive better in aquatic environments 6–8 and environmental water is the reservoir for infectious V. cholerae. 7,9 In this report we investigated the clonal relationship between strains of V. cholerae collected both from stool specimens from persons with acute diarrhea and from environmental sources of water. During the outbreak of diarrhea, 23 non-randomly selected rectal swabs were collected from the hospitalized diarrhea patients in ID hospital, Puri in Cary-Blair Transport (CBT, DIFCO,USA) medium and transported to the Microbiology Department of Regional Medical Research Centre (RMRC), Bhubaneswar and bacteriologically analyzed following standard technique. 10 Subsequently after the isolation of V. cholerae O139 as the etiological agent of the outbreak, 20 water samples non-randomly selected were collected from water bodies situated at various distances in that village to determine the source of contamination following a previous method. 11 Presumptive identification of 10 and 6 V. cholerae were isolated from rectal swabs and water samples respectively and the strains were agglutinated with monoclonal O139 antiserum supplied by NICED, Kolkata, India and were confirmed to belong to V. cholerae serogroup O139. To investigate the similarities of clinical and environmental strains of V cholerae O139, drug susceptibility test, cholera toxin assay, detection of virulent genes by polymerase chain reaction (PCR) assay, RAPD finger printing assay, and PFGE were performed. A monosialoganglioside (GM1) enzyme-linked immunosorbent assay (ELISA) was used to examine cholera toxin production in V. cholerae O139 strains by the method Svennerholm and Holmgren. 12 Drug susceptibility test was performed following the method described elsewhere, 13 with the antibiotics (Hi-media Laboratories, Bombay, India) ampicillin (A, 10 g), chloramphenicol (C, 30 g), co-trimoxazole (Co, 25 g), ciprofloxacin (Cf, 5 g), furazolidone (fz, 100 g), gentamicin (G, 10 g), neomycin (N, 30 g), nalidixic acid (Na, 30 g), norfloxacin (Nx, 10 g), streptomycin (S, 10 g) and tetracycline (T, 30 g). Characterization of strains as susceptible or resistant was based on size of the inhibition zone around each disc according to manufacturer’s instructions, which matched interpretive criteria recommended by the WHO. 14 Strains showing an intermediate zone of inhibition were interpreted as resistant to that drug on the basis of previous MIC studies conducted with V. cholerae. 15