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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 12 | Issue 1
Page Nos. 1-65

Online since Sunday, June 26, 2022

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EDITORIAL  

From microbes to molecules Highly accessed article p. 1
Subhash Chandra Parija
DOI:10.4103/tp.tp_34_22  
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PRESIDENTIAL ORATION Top

Climate adaptation impacting parasitic infection Highly accessed article p. 3
Subhash Chandra Parija
DOI:10.4103/tp.tp_32_22  
The steady and ongoing change in climatic patterns across the globe is triggering a cascade of climate-adaptive phenomena, both genetic and behavioral in parasites, and influencing the host–pathogen–transmission triangle. Parasite and vector traits are now heavily influenced due to increasing temperature that almost dissolved geospatial boundaries and impacted the basic reproductive number of parasites. As consequence, continents unknown to some parasites are experiencing altered distribution and abundance of new and emerging parasites that are developing into a newer epidemiological model. These are posing a burden to healthcare and higher disease prevalence. This calls for multidisciplinary actions focusing on One Health to improve and innovate in areas of detection, reporting, and medical countermeasures to combat the growing threat of parasite emergence owing to climate adaptations for better public health outcomes.
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ORIGINAL ARTICLES Top

Molecular characterization of Giardia intestinalis assemblages in children among the rural and urban population of Pondicherry, India Highly accessed article p. 8
Dashwa Langbang, Rahul Dhodapkar, Subhash Chandra Parija, KC Premarajan, Nonika Rajkumari
DOI:10.4103/tp.TP_52_20  
Introduction: Giardiasis is one of the greatest public parasitic infections causing diarrheal and also known to be associated with high morbidity and mortality, among the children's particularly in developing countries with less cleanliness practices. Thus, studying genomic variety of Giardia intestinalis aids to improve our perspective related to the variability in the genome of the parasite. Materials and Methods: In this cross-sectional study, 1006 stool samples were collected from the rural (n = 500) and urban settings (n = 506) from the children (<15 years) with and without symptoms and were screened for the presence of G. intestinalis by polymerase chain reaction (PCR) targeting triosephosphate isomerase gene. Further, all PCR-positive amplicons were subjected to restriction fragment length polymorphism using RsaI restriction enzyme. Results: Of the total 1006 stool samples, 500 samples from rural screened by PCR 108 (21%) were found to be positive for assemblage A, 116 (23.2%) belong to assemblage B, and 5 (1%) were mixed assemblages (A + B). Whereas in urban, of the 506 samples screened by PCR, 92 (18.1%) were found to be positive for assemblage A, 93 (18.3%) assemblage B, and 10 (1.9%) were mixed assemblages (A + B). No significant difference was found between the G. intestinalis assemblages with clinical details of symptomatic and asymptomatic in children. Conclusions: This signifies the first study inspection in our location to shed lights and delivers some preliminary data on assemblages and subassemblages. The results suggest that anthroponotic transmission could be a foremost transmission path for giardiasis among the study population.
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High prevalence of neurocysticercosis among patients with epilepsy in a tertiary care hospital of Assam, India Highly accessed article p. 15
K Rekha Devi, Debasish Borbora, Narayan Upadhyay, Dibyajyoti Goswami, SK Rajguru, Kanwar Narain
DOI:10.4103/tp.TP_72_20  
Background: Neurocysticercosis (NCC) is a parasitic disease of the central nervous system, which is caused by the metacestode of the pork tapeworm, Taenia solium. The present unicentric, hospital-based, cross-sectional study was undertaken to assess the contribution of NCC as a cause of active epilepsy among patients attending a tertiary health care center in Assam, India. Materials and Methods: Over a period of 2 years, 152 active epilepsy patients were investigated based on clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography), and immunological techniques to establish the diagnosis of NCC. A precoded questionnaire was administered to patients and/or guardians to collect detailed medical history. Results: Ninety-three cases (61.2%) fulfilled either definitive or probable diagnostic criteria for NCC. Anti-cysticercus immunoglobulin G antibodies were detected by ELISA and enzyme electro-immune transfer blot in 69 (45.4%) active epilepsy patients. Seroprevalence was higher in males, 46.6% (54/116); than in females, 41.7% (15/36), and increased significantly with age; peaking in the 20–39 years age group (36/76; χ2 = 5.64; P = 0.02). Among the seropositive cases, 54 (78.3%) were diagnosed with NCC. A significantly higher number of seropositive individuals were diagnosed with NCC in the 20–39 years age group as compared to the 40 years and above age group (χ2 = 6.28; P = 0.01). The association between seropositivity for NCC, and the number of lesions in the brain was statistically significant (χ2 = −8.33; P = 0.003). Conclusions: This study indicates that NCC is a major cause of active epilepsy in Assam. A high prevalence of pediatric NCC is also a major concern.
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Impact of oxidative stress in response to malarial infection during pregnancy: Complications, histological changes, and pregnancy outcomes p. 21
Valleesha N Chandrashekhar, Kishore Punnath, Kiran K Dayanand, Srinivas B Kakkilaya, Poornima Jayadev, Suchetha N Kumari, Rajeshwara N Achur, D Channe Gowda
DOI:10.4103/tp.TP_18_20  
Background and Objectives: Pregnancy malaria is a major underestimated global public health problem. To understand the involvement of oxidative stress (OS) in the pathophysiology of placental malaria, OS biomarkers, malondialdehyde (MDA), uric acid (UA), and superoxide dismutase (SOD) levels were analyzed and correlated to placental histopathological changes and pregnancy outcomes. Methods: A hospital-based study was conducted in Mangaluru, Karnataka, India, to analyze the changes in hematological parameters and the serum OS biomarker levels. Histological analysis of placenta, associated complications, and pregnancy outcomes were compared using Kruskal–Wallis test, and pairwise comparison between two groups was made by Mann–Whitney U-test. Correlations were calculated by Pearson's and Spearman's rank correlations. Results: Among 105 pregnant women, 34 were healthy controls and the infected group comprised of Plasmodium Vivax (Pv) (n = 48), Plasmodium falciparum (Pf) (n = 13), and mixed (n = 10) malaria infections. Of 71 infected cases, 67.6% had mild malaria, whereas 32.4% had severe malaria. The white blood cell and C-reactive protein levels were found to increase, whereas hemoglobin, red blood cell, and platelet levels decreased during both types of malarial infections. The MDA and UA values increased and SOD levels decreased particularly during severe Pf infections. Histological changes such as syncytial knots, syncytial ruptures, and fibrinoid necrosis were observed particularly during Pf infections and leukocyte infiltration was observed in Pv malaria Conclusion: Evaluation of MDA, UA, and SOD levels can serve as an indicator of OS during pregnancy malaria. The OS during pregnancy may lead to complications such as severe anemia, pulmonary edema, intra uterine growth retardation, premature delivery, and low birth weight, not only during Pf but also in Pv malaria. It is important to create awareness among rural and immigrant population residing in Mangaluru and its surroundings about required preventive measures and free government-supported antenatal care services.
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Scabies infection among boarding school students in Medan, Indonesia: Epidemiology, Risk Factors, and Recommended Prevention p. 34
Hemma Yulfi, Muhammad Farid Zulkhair, Ariyati Yosi
DOI:10.4103/tp.tp_57_21  
Introduction: Scabies has been a continuous health concern in residential institutions including boarding schools in Indonesia. The disease easily spreads in overcrowding residences. Using one of several boarding schools in Medan, Indonesia, as study site, we conducted this study to better understand the underlying factors behind scabies incidence in boarding schools. We hoped to be able to promote more effective preventive measures toward the disease. Materials and Methods: We included all of 220 students (115 males and 105 females) in a cross-sectional descriptive analytical study, whose ages were ranging from 10 to 18 years. The diagnosis of scabies was made based on interview and physical examination. Skin scraping followed by microscopic assessment was carried out upon finding scabies-related lesion. Data on risk factors were collected using a set of pretested questionnaire and direct observation. Data were analyzed using bivariate and multivariate analysis the with Chi square and logistic regression. Results: We found a high prevalence clinical scabies, i.e., 81 (36.8%) students, yet only one came out positive with skin scraping and microscopic examination. The factors associated with the infection were found to be younger age (odds ratio [OR]: 2.95, 95% confidence interval [CI] 0.97–6.09), sharing clothes (OR: 8.22, 95% CI 2.37–28.48), sharing bed (OR: 17.53, 95% CI 5.55–56.02), and unhygienic bedroom condition (OR: 8.18, 95% CI 3.30–20.28). Conclusions: The results imply the need for better strategies to prevent the transmission of astigmatid mites within the risky populations. We promote six recommendations for a more applicable approach toward scabies prevention in boarding schools and other institutional facilities alike.
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Comparison of gdh polymerase chain reaction-restriction fragment length polymorphism and tpi assemblage-specific primers for characterization of Giardia intestinalis in children p. 41
Heba Elhadad, Sarah Abdo, Aziza I Salem, Mostafa A Mohamed, Hend A El-Taweel, Eman A El-Abd
DOI:10.4103/tp.tp_28_21  
Background: Giardia is a diarrheagenic eukaryotic parasite that consists of at least eight morphologically identical but genetically distinct genotypes. Human giardiasis is caused mainly by A and B assemblages. Aim and objectives: The study aimed to compare the performance of gdh polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and tpi assemblage-specific primers in genotyping of G. intestinalis. Materials and Methods: Stool samples of 315 children were microscopically screened for G. intestinalis. Positive samples were genotyped using tpi assemblage-specific primers and gdh semi-nested PCR-RFLP techniques. Results: The prevalence of Giardia was 18.1%. The detected genotypes using tpi and gdh approaches were assemblage A (15.8% vs. 12.7%) and assemblage B (36.8% vs. 74.5%) as single infections and mixed assemblages A and B (47.4% vs. 12.7%). The two approaches showed a moderate agreement (kappa index = 0.413, P < 0.001). PCR-RFLP of gdh gene revealed that sub-assemblages BIII and BIV were equally detected (30.9% each). The remaining samples were equally divided between sub-assemblage AII, mixed BIII and BIV, and mixed AII and BIII (12.7% each). A significant association was detected between the retrieved sub-assemblages and the presence of symptoms. Conclusions: Although both approaches confirmed the predominance of assemblage B, the use of assemblage-specific primers is more effective in elucidating the true picture of mixed assemblage infection.
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Internal transcribed spacer region 1 as a promising target for detection of intra-specific polymorphisms for Strongyloides stercoralis p. 48
Yasmin Sultana, Fanrong Kong, Mandira Mukutmoni, Laila Fahria, Aleya Begum, Rogan Lee
DOI:10.4103/tp.tp_13_21  
Background: Strongyloides stercoralis, the causative agent of strongyloidiasis, is a parasitic worm that has larvae capable of reinfecting the same host. This nematode infection is therefore difficult to treat and to achieve total cure. Information about genetic variation and differences in drug susceptibility between strains is needed to improve treatment outcomes. Aim: To develop a polymerase chain reaction (PCR) to identify the intra-species variation among 13 S. stercoralis isolates collected from Bangladesh, USA and Australia. Material & Methods: PCR assays were designed by using primers targeting S. stercoralis internal transcribed spacer (ITS) regions 1 and 2. Sequence data generated by these PCR products were compared to the existing ITS1/2, 18S and 28S rRNA gene sequences in GenBank for phylogenetic analysis. Results: Intra-species single nucleotide polymorphisms (SNPs) were identified in ITS1 and in the 5.8S rRNA gene. The generated phylogram grouped the 13 isolates into dog, Orangutan and human clusters. Conclusion: This method could be used as an epidemiological tool to study strain differences in larger collections of S. stercoralis isolates. The study forms the basis for further development of an ITS-based assay for S. stercoralis molecular epidemiological studies
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Utility of smear examination, culture, and serological tests in the diagnosis of visceral leishmaniasis/post-kala-azar dermal leishmaniasis at National Centre for Disease Control, Delhi p. 54
Monil Singhai, Neeru Kakkar, Naveen Gupta, Manju Bala, Ram Singh, Sujeet K Singh
DOI:10.4103/tp.tp_7_21  
Introduction: A range of assays have been developed to detect specific antileishmanial antibody, such as rK 39 immunochromatographic test (ICT), KE 16 ICT, ELISA test, and indirect immunofluorescent antibody test (IFAT), which play a crucial role in serological diagnosis of visceral leishmaniasis (VL). However, limited published reports are available on the utility of serological test (IFAT test/rk 39), smear examination, and culture in the diagnosis of VL and post-kala-azar dermal leishmaniasis (PKDL) in our country. Materials and Methods: We present utility of serological test (IFAT test/rK 39), smear examination for Leishmania donovani (LD) bodies, and culture in 2589 samples from 2294 VL/PKDL suspected patients (January 2009–December 2019) tested in Centre for Arboviral and Zoonotic diseases, National Centre for Disease Control, New Delhi, India, for laboratory diagnosis of VL/PKDL. Results: A total of 80/553 (14.4%) cases were confirmed of VL (74/522 cases by demonstration of LD bodies in bone marrow smear examination, 5/12 in splenic smear examination 1/19 by culture) and 4/21 (19.0%) cases were confirmed of PKDL (demonstration of LD bodies in slit skin smear examination. In our study 197/1368 (14.4%) cases were diagnosed positive by IFAT, 34/646 (5.2%) cases by rk 39 ICT for VL/PKDL by demonstration of specific antileishmanial antibodies. Conclusion: As the goal of elimination of VL as a public health problem is approaching, apart from serological tests such as rk 39 and IFAT, direct methods of detection such as (parasitic demonstration in BM smear, culture, and molecular tests) for Leishmania may play a crucial role for achieving a correct diagnosis and treatment. We also concluded that IFAT though not field-friendly, its optimal use as an adjunct test with BM smear in all stages of infections may be required. Further rk39 is a simple, reliable, noninvasive, and field-friendly test for diagnosis VL, especially in endemic areas.
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DISPATCHES Top

Breast filariasis masquerading as carcinoma: Cytologic diagnosis in two cases p. 59
Malvika Shastri, Annu Nanda
DOI:10.4103/tp.TP_11_20  
Filariasis is a common public health problem in the Indian subcontinent. Microfilariae are usually detected in the peripheral circulation; however, the clinical manifestations are related to the lymphatic system primarily. The breast is an uncommon site for filariasis, and the lesion clinically mimics malignancy. We should consider filariasis in the differential diagnoses of breast lumps, especially in endemic areas. Fine-needle aspiration cytology from the breast lump allows easy detection of filarial infection, and this can be managed by medical treatment, thereby avoiding surgical procedures.
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Human dicrocoeliosis with urticaria: A case report from India p. 62
Niharika Lall, Abhijit Babanrao Deshmukh, Sandhya V Saoji
DOI:10.4103/tp.TP_39_19  
Human dicrocoeliosis caused by Dicrocoelium dendriticum is reported sporadically from various parts of the world. D. dendriticum, a liver fluke has a complex life cycle with two intermediate hosts‒the land snail and the ant. True human infection occurs by ingestion of the second intermediate host, but spurious infections have occurred after consumption of undercooked animal liver. We report a case of a 20-year-old female who presented with abdominal pain, diarrhea, and itchy skin rashes all over the body. Stool microscopy revealed numerous eggs of D. dendritricum. A brief discussion of the medical literature is presented.
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LETTERS TO EDITOR Top

Relationship between incidence of lymphatic filariasis and incidence of COVID-19: An observation from endemic area p. 65
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/tp.tp_39_21  
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