Immunologic profiles of HIV-infected and uninfected commercial sex workers in the Vellore region of Southern India

Female commercial sex workers (CSW) play a major role in the transmission of HIV infection in India. Their immunology has not been characterized. To determine HIV-related immunologic changes and establish baseline data for CSW, blood cell counts and serum immunoglobulin levels of 35 HIV-positive, asymptomatic CSW; 37 HIV-negative CSW, and 35 age-matched, non-CSW, healthy women controls were compared. The CSW, irrespective of their HIV status, had abnormalities that included high eosinophil, lymphocyte, and CD8 counts and low CD4:CD8 ratios. The only significant difference between the HIV-positive and HIV-negative CSW was in their neutrophil and CD8 counts (p < 0.05, ANOVA). Compared with normal controls, the CSW had significantly elevated serum IgG, IgA, and IgM levels; however, no significant difference was shown between CSW who tested positive for HIV and those who did not. These results suggest that the CSW of Vellore region in Southern India have hyperimmunoglobulinemia irrespective of their HIV status and thus highlight the need to use appropriate controls when immunologic evaluation studies are done.

Environmental isolation of Cryptococcus neoformans var. neoformans from Vellore

We have isolated C. neoformans from various environmental niches, including our hospital environment. Twenty one samples of weathered pigeon droppings and 86 samples of Eucalyptus bark and debris were collected from various sites around the hospital and college. C. neoformans var. neoformans was isolated from 14 of the 21 (67%) samples of weathered droppings of pigeons collected from the ledges of windows of wards and departmental buildings in the hospital. C. neoformans was not isolated from any of the Eucalyptus samples. These findings document for the first time the presence of C. neoformans var. neoformans in the hospital environment. Although ubiquitous in the environment, its presence in hospital surroundings stresses the need for systematic cleaning of sites inhabited by pigeons. However, we failed to isolate C. neoformans from the limited number of Eucalyptus samples examined.

Infection caused by Cryptococcus neoformans var. gattii serotype B in an AIDS patient in India

Cryptococcus neoformans is an opportunistic pathogen infecting AIDS patients. However, infection caused by C. neoformans var. gattii in AIDS patients is reportedly rare. We report herein the first culture proven C. neoformans var. gattii serotype B infection in an AIDS patient in India.

An outbreak of post-streptococcal reactive arthritis

We describe an outbreak of an illness with fever, mono-, pauci- or polyarticular arthritis, and high antideoxyribonuclease B (ADNB) titres in 11 patients. Two patients had concomitant non-purulent conjunctivitis and one had endogenous endophthalmitis. There was no clinical or echocardiographic (6 patients) evidence of carditis. Blood culture grew Group A beta haemolytic streptococci in one patient. A simultaneous synovial fluid culture in this patient and similar cultures in four more patients yielded no microorganism. Most patients recovered completely, but one developed rheumatoid factor negative spondyloarthropathy. Monoarticular arthritis in several patients, the absence of carditis, and the presence of high ADNB titres without high anti-streptolysin O titres indicate that this was not acute rheumatic fever but post-streptococcal reactive arthritis (PSRA).

Clinical signs of acute lower respiratory tract infections in malnourished infants and children

OBJECTIVES

To determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory infection (ALRI) in undernourished children.

METHODS

Three hundred twelve children with ALRI and 446 with upper respiratory infection were classified according to weight and height as normal, stunted, wasted or stunted and wasted and also as normal, underweight or marasmus. The sensitivity and specificity of tachypnea, subcostal retractions and the presence of either sign in identifying children with a clinical diagnosis of ALRI or radiologic pneumonia in each of the nutritional categories were determined and compared.

RESULTS

Among children with ALRI the mean respiratory rate in those with normal nutrition (61.5 +/- 16.1, n = 160) was not significantly different from those who were stunted (57.5 +/- 16.5, n = 59), wasted (61.3 +/- 14, n = 66) or stunted and wasted (55.4 +/- 12.8, n = 27) (P > 0.05) or from those classified as underweight (60 +/- 15.9, n = 150) or marasmus (62.5 +/- 14.5, n = 27) (P > 0.4). The sensitivity and specificity of tachypnea, subcostal retraction or the presence of either sign in detecting ALRI was also not statistically significantly different among the children in the different nutritional categories (P > 0.05). The sensitivity of tachypnea or subcostal retraction in identifying children with radiologic pneumonia was also not significantly different among children in the different nutritional categories; the sensitivity of either sign was higher in under-weight children than in children with normal nutrition (P = 0.028).

CONCLUSIONS

The data suggest that the current WHO algorithm is suitable for diagnosis of ALRI in undernourished children.

Epidemiological features of acquired immunodeficiency syndrome in southern India

AIDS was diagnosed in 187 men and 24 women (M:F = 8:1) from April 1987 till December 1994 at the Christian Medical College Hospital, Vellore. The doubling time of the occurrence of AIDS cases was 14 months; during 1987-90 there were an average of 5.7 cases per year; in 1991-93 there were 28 per year; in 1994 there were 104 cases. The mean age of patients was 33 yr for men and 31 for women. Among men, the primary mode of infection was heterosexual contact with female commercial sex workers. Among women, the most common source of infection was their husbands. There were 4 bisexuals and one homosexual subject who might have acquired infection by having sex with other men. There were 135 subjects from urban and 76 from rural communities. Most subjects belonged to the lower socio-economic classes. These data show that HIV infection had been very widespread in this region, both urban and rural.

An ethical dilemma in rabies immunisation

Rabies continues to be an important public health problem in India and many other developing countries. In India, annually some 700,000 persons are given post-exposure vaccine prophylaxis using Semple (sheep brain) vaccine. It is manufactured by government institutions and given free to the public. It is presumed to be cheap, although the actual cost of production may not be low. However, it is not a safe vaccine as it causes demyelinating central or peripheral nervous system side-effects in 1/3000-7000 persons vaccinated; this adverse reaction is occasionally fatal. Cell culture rabies vaccines are also available in India; unlike the Semple vaccine they are safe and can be used for pre-exposure vaccination, but they are more expensive. The dilemma is whether it is ethically acceptable to continue to use the Semple vaccine in humans while safer products are available. What is urgently needed is a decision tree which would enable economical use of cell culture vaccines together with the backing of professional bodies in medical practice, who will declare that cost is not the only factor in choosing a rabies vaccine-safety is also of paramount importance. We must also strive to reduce the cost of cell culture vaccines.

A case-control analysis of risk factors in HIV transmission in South India

A case-control study was done among patients attending our clinic for sexually transmitted diseases in South India to assess risk factors for human immunodeficiency virus (HIV) infection. Of 5,876 patients tested, 105 (1.79%) were HIV antibody positive (87 men, 18 women) by enzyme-linked immunosorbent assay and Western blot. They were compared with an equal number of age- and sex-matched patients without HIV antibody. Risk factors significant in the crude odds ratio analysis were occupation (truck drivers and truck cleaners), age at first exposure, and sexual contact with commercial sex workers. In the logistic regression analysis, only a history of past genital ulcer was a significant risk factor. Other important findings of this study were that (a) the spread of HIV to women is mostly from their infected husbands and (b) regular condom use was reported by less than 8% of patients and controls. Obviously, the current methods of education of the population are far from adequate.

Prevalence of pneumococcal serotypes in invasive diseases in southern India

Forty two pneumococcal strains obtained in Vellore, Tamil Nadu, from 42 patients with invasive diseases, namely pneumonia, meningitis, or peritonitis were typed. Over one-third of pneumococci in children and nearly half in adults were serotype followed by serogroups/types 5, 6 and 7 which were most common in children and adults taken together. These 4 serogroups/types accounted for 11 (79%) of 14 strains in children and 20 (71%) of 28 strains in adults. The remaining 11 strains belonged to 8 serogroups/types, namely 3, 4, 10, 11, 12, 13, 19 and 20.