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Chandy S, Kumar H, Pearl S, Basu S, M G, Sankar J, Manoharan A, Ramaiah S, Anbarasu A. Whole genome analysis reveals unique traits of SARS-CoV-2 in pediatric patients. Gene 2024; 919:148508. [PMID: 38670399 DOI: 10.1016/j.gene.2024.148508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to challenge the global healthcare with emerging variants and higher infectivity as well as morbidities. This study investigated potential age-related variations through genomic characterization of the virus under common clinical settings. A cohort comprising 71 SARS-CoV-2 strains from both infected infants and accompanying adults, diagnosed via RT-PCR at a tertiary pediatric hospital and research center, underwent Illumina paired-end sequencing. The subsequent analysis involved standard genomic screening, phylogeny construction, and mutational analyses. The analyzed SARSCoV- 2 strains were compared with globally circulating variants. The overall distribution revealed 67.61 % Delta, 25.7 % Omicron, and 1 % either Kappa or Alpha variants. In 2021, Delta predominated at ∼ 94 %, with Alpha/Kappa accounting for around 5 %. However, in 2022, over 94 % of the samples were Omicron variants, signifying a substantial shift from Delta dominance. Delta variants constituted 69.5 % of infections in adults and 78.5 % in infants, while Omicron variants were responsible for 31 % of cases in infants and 18 % in adults. The Spike region harbored the majority of mutations, with T19R being the most prevalent mutation in the Delta lineage. Notably, the frequencies of this mutation varied between infants and adults. In Omicron samples, G142D emerged as the most prevalent mutation. Our dataset predominantly featured clade 21A and lineage B.1.617.2. This study underscores the differential clinical presentations and genomic characteristics of SARS-CoV-2 in pediatric patients and accompanying adults. Understanding the dynamic evolution of the SARS- CoV-2 in both pediatric and adults can help in strengthening prophylactic measures.
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Affiliation(s)
- Sara Chandy
- The CHILDS Trust Medical Research Foundation (CTMRF), 12-A, Nageswara Road, Nungambakkam, Chennai 600034, Tamil Nadu, India
| | - Hithesh Kumar
- Department of Bio-Sciences, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore 632014, India; Medical and Biological Computing Laboratory, SBST, VIT, Vellore 632014, India
| | - Sara Pearl
- Medical and Biological Computing Laboratory, SBST, VIT, Vellore 632014, India; Department of Integrative Biology, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore 632014, India
| | - Soumya Basu
- Medical and Biological Computing Laboratory, SBST, VIT, Vellore 632014, India; Department of Biotechnology, NIST University, Berhampore 761008, India
| | - Gurumoorthy M
- The CHILDS Trust Medical Research Foundation (CTMRF), 12-A, Nageswara Road, Nungambakkam, Chennai 600034, Tamil Nadu, India
| | - Janani Sankar
- The CHILDS Trust Medical Research Foundation (CTMRF), 12-A, Nageswara Road, Nungambakkam, Chennai 600034, Tamil Nadu, India
| | - Anand Manoharan
- Kanchi Kamakoti CHILDS Trust Hospital (KKCTH), 12-A, Nageswara Road, Nungambakkam, Chennai 600034, Tamil Nadu, India
| | - Sudha Ramaiah
- Department of Bio-Sciences, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore 632014, India; Medical and Biological Computing Laboratory, SBST, VIT, Vellore 632014, India
| | - Anand Anbarasu
- Medical and Biological Computing Laboratory, SBST, VIT, Vellore 632014, India; Department of Biotechnology, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore 632014, India.
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Vijayakumar S, Kumar H, Basu S, Chandy S, Anbarasu A, Manoharan A, Ramaiah S. Changing Landscape of Antimicrobial Resistance in Neonatal Sepsis: An in silico Analyses of Multidrug Resistance in Klebsiella pneumoniae. Pediatr Infect Dis J 2024:00006454-990000000-00838. [PMID: 38621154 DOI: 10.1097/inf.0000000000004358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Neonatal sepsis poses a critical healthcare concern, as multidrug-resistant Klebsiella pneumoniae (K. pneumoniae) infections are on the rise. Understanding the antimicrobial susceptibility patterns and underlying resistance mechanism is crucial for effective treatment. OBJECTIVES This study aimed to comprehensively investigate the antimicrobial susceptibility patterns of K. pneumoniae strains responsible for neonatal sepsis using in silico tools. We sought to identify trends and explore reasons for varying resistance levels, particularly for β-lactams and fluoroquinolone. METHODS K. pneumoniae isolated from neonates at Kanchi Kamakoti CHILDS Trust Hospital (2017-2020) were analyzed for antimicrobial resistance. Elevated resistance to β-lactam and fluoroquinolone antibiotics was further investigated through molecular docking and interaction analysis. β-lactam affinity with penicillin-binding proteins and β-lactamases was examined. Mutations in ParC and GyrA responsible for quinolone resistance were introduced to investigate ciprofloxacin interactions. RESULTS Of 111 K. pneumoniae blood sepsis isolates in neonates, high resistance was detected to β-lactams such as cefixime (85.91%, n = 71), ceftriaxone (84.9%, n = 106), cefotaxime (84.9%, n = 82) and fluoroquinolone (ciprofloxacin- 79.44%, n = 107). Molecular docking revealed low β-lactam binding toward penicillin-binding proteins and higher affinities for β-lactamases, attributing to the reduced β-lactam efficiency. Additionally, ciprofloxacin showed decreased affinity toward mutant ParC and GyrA in comparison to their corresponding wild-type proteins. CONCLUSION Our study elucidates altered resistance profiles in neonatal sepsis caused by K. pneumoniae, highlighting mechanisms of β-lactam and fluoroquinolone resistance. It underscores the urgent need for the development of sustainable therapeutic alternatives to address the rising antimicrobial resistance in neonatal sepsis.
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Affiliation(s)
- Santhiya Vijayakumar
- From the Department of Integrative Biology
- Medical and Biological Computing Laboratory
| | - Hithesh Kumar
- Medical and Biological Computing Laboratory
- Department of Bio-Sciences, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore
| | - Soumya Basu
- Department of Biotechnology, NIST University, Brahmapur
| | - Sara Chandy
- Department of Research, The CHILDS Trust Medical Research Foundation and Kanchi Kamakoti CHILDS Trust Hospital, Chennai
| | - Anand Anbarasu
- Medical and Biological Computing Laboratory
- Department of Biotechnology, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore, India
| | - Anand Manoharan
- Department of Research, The CHILDS Trust Medical Research Foundation and Kanchi Kamakoti CHILDS Trust Hospital, Chennai
| | - Sudha Ramaiah
- Medical and Biological Computing Laboratory
- Department of Bio-Sciences, School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore
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Balasubramanian S, Sankar J, Dhanalakshmi K, Raj SL, Nandakumar D, Ramanan AV, Chandy S. Differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) and Its Mimics - A Single-Center Experience From a Tropical Setting. Indian Pediatr 2023; 60:377-380. [PMID: 36896750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Identifying clinical and laboratory indicators that differentiate multisystem inflam-matory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting. METHODS Review of hospital records done in a tertiary care exclusive children's hospital for children admitted from April, 2020 till June, 2021. Laboratory values, severe acute respiratory syndrome coronavirus (SARS-CoV-2) serological status, and clinical signs and symptoms of patients with MIS-C, and those with similar presentations were analyzed. RESULTS 114 children fulfilled the inclusion criteria (age group of 1 mo-18 y) for whom a diagnosis of MIS-C was considered in the emergency room based on the clinical features. Among them, 64 children had the final diagnosis of MIS-C, and the remaining 50 children had confirmatory evidence of infections mimicking MIS-C such as enteric fever, scrub typhus, dengue and appendicitis. CONCLUSION Older age group, presence of muco-cutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.
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Affiliation(s)
- S Balasubramanian
- Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - Janani Sankar
- Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - K Dhanalakshmi
- Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - S Lakshan Raj
- Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India. Correspondence to: Dr S Lakshan Raj, Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, 12A Nageswara Road, Nungambakkam, Chennai, Tamil Nadu 600 034.
| | - Divya Nandakumar
- Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - A V Ramanan
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Sara Chandy
- Molecular Laboratory, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
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Sehgal A, Mehta S, Sahay K, Martynova E, Rizvanov A, Baranwal M, Chandy S, Khaiboullina S, Kabwe E, Davidyuk Y. Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention. Viruses 2023; 15:v15020561. [PMID: 36851775 PMCID: PMC9966805 DOI: 10.3390/v15020561] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Hemorrhagic Fever with Renal Syndrome (HFRS) is the most frequently diagnosed zoonosis in Asia. This zoonotic infection is the result of exposure to the virus-contaminated aerosols. Orthohantavirus infection may cause Hemorrhagic Fever with Renal Syndrome (HRFS), a disease that is characterized by acute kidney injury and increased vascular permeability. Several species of orthohantaviruses were identified as causing infection, where Hantaan, Puumala, and Seoul viruses are most common. Orthohantaviruses are endemic to several Asian countries, such as China, South Korea, and Japan. Along with those countries, HFRS tops the list of zoonotic infections in the Far Eastern Federal District of Russia. Recently, orthohantavirus circulation was demonstrated in small mammals in Thailand and India, where orthohantavirus was not believed to be endemic. In this review, we summarized the current data on orthohantaviruses in Asia. We gave the synopsis of the history and diversity of orthohantaviruses in Asia. We also described the clinical presentation and current understanding of the pathogenesis of orthohantavirus infection. Additionally, conventional and novel approaches for preventing and treating orthohantavirus infection are discussed.
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Affiliation(s)
- Ayushi Sehgal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Sanya Mehta
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Kritika Sahay
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Ekaterina Martynova
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Albert Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Sara Chandy
- Childs Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai 600034, India
| | - Svetlana Khaiboullina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Emmanuel Kabwe
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
- Kazan Research Institute of Epidemiology and Microbiology, Kazan 420012, Russia
| | - Yuriy Davidyuk
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
- Correspondence:
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Mørch K, Manoharan A, Chandy S, Singh A, Kuriakose C, Patil S, Henry A, Chacko N, Alvarez-Uria G, Nesaraj J, Blomberg B, Kurian S, Haanshuus CG, Antony GV, Langeland N, Mathai D. Clinical features and risk factors for death in acute undifferentiated fever: A prospective observational study in rural community hospitals in six states of India. Trans R Soc Trop Med Hyg 2023; 117:91-101. [PMID: 36130240 PMCID: PMC9890314 DOI: 10.1093/trstmh/trac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/08/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Acute undifferentiated fever (AUF) ranges from self-limiting illness to life-threatening infections, such as sepsis, malaria, dengue, leptospirosis and rickettsioses. Similar clinical presentation challenges the clinical management. This study describes risk factors for death in patients hospitalized with AUF in India. METHODS Patients aged ≥5 y admitted with fever for 2-14 d without localizing signs were included in a prospective observational study at seven hospitals in India during 2011-2012. Predictors identified by univariate analysis were analyzed by multivariate logistic regression for survival analysis. RESULTS Mortality was 2.4% (37/1521) and 46.9% (15/32) died within 2 d. History of heart disease (p=0.013), steroid use (p=0.011), altered consciousness (p<0.0001), bleeding (p<0.0001), oliguria (p=0.020) and breathlessness (p=0.015) were predictors of death, as were reduced Glasgow coma score (p=0.005), low urinary output (p=0.004), abnormal breathing (p=0.006), abdominal tenderness (p=0.023), leucocytosis (p<0.0001) and thrombocytopenia (p=0.001) at admission. Etiology was identified in 48.6% (18/37) of fatal cases. CONCLUSIONS Bleeding, cerebral dysfunction, respiratory failure and oliguria at admission, suggestive of severe organ failure secondary to systemic infection, were predictors of death. Almost half of the patients who died, died shortly after admission, which, together with organ failure, suggests that delay in hospitalization and, consequently, delayed treatment, contribute to death from AUF.
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Affiliation(s)
- Kristine Mørch
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Anand Manoharan
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, 632004, Vellore, India
| | - Sara Chandy
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, 632004, Vellore, India
| | - Ashita Singh
- Baptist Christian Hospital, 784001, Tezpur, Assam, India
| | - Cijoy Kuriakose
- Christian Fellowship Hospital, 624619, Oddanchatram, Tamil Nadu, India
| | - Suvarna Patil
- B.K.L. Walawalkar Hospital, 415612, Ratnagiri, Maharashtra, India
| | - Anil Henry
- Christian Hospital, Mungeli, 495001, Chhattisgarh, India
| | | | | | - Joel Nesaraj
- Bethesda Hospital, 635802, Ambur, Tamil Nadu, India
| | - Bjørn Blomberg
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Siby Kurian
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, 632004, Vellore, India
| | - Christel Gill Haanshuus
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway
| | - George Vasanthan Antony
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, 632004, Vellore, India
| | - Nina Langeland
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
| | - Dilip Mathai
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, 632004, Vellore, India
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Manoharan A, Ramya M, Chandy S, Ranjitha P, Hameed A, Nachiyar GS, Balasubramanian S. Evaluation of real-time PCR with serology for diagnosis of community acquired pneumonia caused by Mycoplasma pneumoniae. Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Balasubramanian S, Dhanalakshmi K, Lakshan Raj S, Chandy S. MIS-C Triggered by Omicron Variant of SARS-CoV-2. Indian Pediatr 2022. [PMID: 35567320 PMCID: PMC9160844 DOI: 10.1007/s13312-022-2526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chandy S, Manoharan A, Hameed A, Jones LK, S Nachiyar G, Ramya M, Sudhakar A, A S, Balasubramanian S. A study on pediatric respiratory tract infections in hospitalised children from Chennai. Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ekstrand ML, Heylen E, Pereira M, Chandy S, Srinivasan K. Anxiety and Worry About COVID-19 Infection are Associated with Less Confidence in Ability to Engage in Treatment: Results from a South India Cohort of People Living with HIV (PLWH). J Int Assoc Provid AIDS Care 2022; 21:23259582221080303. [PMID: 35229681 PMCID: PMC8891242 DOI: 10.1177/23259582221080303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maria L Ekstrand
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, USA
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Elsa Heylen
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, USA
| | - Matilda Pereira
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Sara Chandy
- St John's Medical College Hospital, Medicine, Bangalore, India
| | - Krishnamachari Srinivasan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
- Department of Psychiatry, St John’s Medical College, Bangalore, India
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Balasubramanian S, Chandy S, Peter R, Nachiyar GS, Sudhakar A, Sumanth A, Manoharan A. Utility of a multiplex real-time polymerase chain reaction for combined detection and serotyping of dengue virus in paediatric patients hospitalised with severe dengue: A report from Chennai. Indian J Med Microbiol 2020; 38:288-292. [PMID: 33154237 DOI: 10.4103/ijmm.ijmm_20_249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Molecular detection and serotyping are rapid, sensitive and accurate techniques for early diagnosis of paediatric dengue. The present study evaluates multiplex real-time polymerase chain reaction (PCR) for diagnosis of dengue virus in children hospitalised with severe dengue (SD) and attempts to establish an association of clinical severity with specific serotypes. Methods Four hundred and eighty-five samples were received from hospitalised paediatric patients with suspected dengue from March 2019 to February 2020. Multiplex real time PCR was employed for diagnosis. An in-house real-time PCR that combined diagnosis and serotyping was established. Non-structural protein 1 (NS1) assay and real-time PCR were assessed for their accuracy in diagnosing severe paediatric dengue. Results Three hundred and twenty-five (67%) patients were positive for dengue RNA by real-time PCR. All four serotypes were identified throughout the year; dengue serotype 2 (DEN-2) was predominant (61%) followed by DEN-3, 20%. Compared to the commonly used NS1 testing, multiplex real-time PCR showed greater sensitivity in diagnosing SD. Conclusions Compared to NS1, multiplex real-time PCR is a rapid and accurate diagnostic test for children hospitalised with SD. DEN-2 was the predominant serotype in severe cases. Continued surveillance of serotypes should be carried out year-round in endemic areas.
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Affiliation(s)
- S Balasubramanian
- Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - Sara Chandy
- Department of Pediatrics, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Robinson Peter
- Department of Pediatrics, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Gothai S Nachiyar
- Department of Pediatrics, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Amullya Sudhakar
- Department of Pediatrics, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - A Sumanth
- Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | - Anand Manoharan
- Department of Pediatrics, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
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Heylen E, Chandy S, Shamsundar R, Nair S, Ravi Kumar BN, Ekstrand ML. Correlates of and barriers to ART adherence among adherence-challenged people living with HIV in southern India. AIDS Care 2020; 33:486-493. [PMID: 32172599 DOI: 10.1080/09540121.2020.1742862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suboptimal adherence to Antiretroviral Therapy (ART) regimens can lead to the development of drug resistance, virologic and clinical failure, and, on the community level, the spread of drug-resistant HIV. To design effective interventions, it is crucial to understand locally specific barriers to optimal adherence. Self-report data from a cross-sectional sample of 527 adherence-challenged people living with HIV (PLWH) in the South-Indian state of Karnataka showed that they took on average 68% of prescribed doses in the past month. Large majorities of participants encountered individual (95%), social/structural (88%), and clinic/regimen (80%) adherence barriers. Multivariate linear regression analyses of past month adherence showed that disclosure to all adults in the household was positively related to adherence, as was employing a larger number of adherence strategies, perceiving more benefits of ART, and having been on ART for longer. Fears of stigmatization upon disclosure of HIV-status to friends and people at work were negatively related to adherence. These results suggest that some barriers, especially individual-level barriers like forgetfulness are very common and can be targeted with relatively simple individual-level strategies. Other barriers, related to fear of stigma and lack of disclosure may require family- or community-level interventions.
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Affiliation(s)
- Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sara Chandy
- Department of Medicine, St. John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
| | - Ranjani Shamsundar
- Department of Microbiology, St. John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
| | - Shoba Nair
- Department of Pain and Palliative Medicine, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
| | - B N Ravi Kumar
- Karnataka State AIDS Prevention Society, Bangalore, India
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
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13
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Shobha V, Desai A, Chandy S, Pakalomattom S. Prevalence of thyroid dysfunction in patients with systemic lupus erythematosus: A descriptive cross sectional study. Indian J Rheumatol 2020. [DOI: 10.4103/injr.injr_165_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Sutcliffe CG, Shet A, Varghese R, Veeraraghavan B, Manoharan A, Wahl B, Chandy S, Sternal J, Khan R, Singh RK, Santosham M, Arora NK. Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among children in India prior to the introduction of pneumococcal conjugate vaccines: a cross-sectional study. BMC Infect Dis 2019; 19:605. [PMID: 31291902 PMCID: PMC6621985 DOI: 10.1186/s12879-019-4254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/03/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. India introduced the 13-valent pneumococcal conjugate vaccine (PCV) in several states in 2017, and is expected to expand to nationwide coverage in the near future. To establish a baseline for measuring the impact of PCV in India, we assessed overall and serotype-specific nasopharyngeal carriage in two pediatric populations. METHODS A cross-sectional study was conducted in Palwal District, Haryana, from December 2016 to July 2017, prior to vaccine introduction. Children 2-59 months of age with clinical pneumonia seeking healthcare and those in the community with no clear illness were targeted for enrollment. A nasopharyngeal swab was collected and tested for pneumococcus using conventional culture and sequential multiplex PCR. Isolates were tested for antimicrobial resistance using an E test. Children were considered colonized if pneumococcus was isolated by culture or PCR. The prevalence of pneumococcal and serotype-specific colonization was compared between groups of children using log-binomial regression. RESULTS Among 601 children enrolled, 91 had clinical pneumonia and 510 were community children. The proportion colonized with S. pneumoniae was 74.7 and 54.5% among children with clinical pneumonia and community children, respectively (adjusted prevalence ratio: 1.38; 95% confidence interval: 1.19, 1.60). The prevalence of PCV13 vaccine-type colonization was similar between children with clinical pneumonia (31.9%) and community children (28.0%; p = 0.46). The most common colonizing serotypes were 6A, 6B, 14, 19A, 19F, and 23F, all of which are included in the PCV13 vaccine product. Antimicrobial resistance to at least one drug was similar between isolates from children with clinical pneumonia (66.1%) and community children (61.5%; p = 0.49); while resistance to at least two drugs was more common among isolates from children with clinical pneumonia (25.8% vs. 16.4%; p = 0.08). Resistance for all drugs was consistently higher for PCV13 vaccine-type serotypes compared to non-vaccine serotypes in both groups. CONCLUSION This study provides baseline information on the prevalence of serotype-specific pneumococcal colonization among children prior to the introduction of PCV in India. Our results suggest a role for pneumococcal vaccines in reducing pneumococcal colonization and antimicrobial resistant isolates circulating in India.
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Affiliation(s)
- Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Rosemol Varghese
- Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | | | - Anand Manoharan
- The CHILDS Trust Medical Research Foundation, 12-A Nageswara Road, Nungambakkam, Chennai, 600034, India
| | - Brian Wahl
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sara Chandy
- The CHILDS Trust Medical Research Foundation, 12-A Nageswara Road, Nungambakkam, Chennai, 600034, India
| | - Jack Sternal
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Raziuddin Khan
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India
| | - Rakesh Kumar Singh
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India
| | - Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Narendra K Arora
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India.
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15
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Chandy S, Heylen E, Ravikumar BN, Ekstrand ML. Examining engagement in care of women living with HIV in South India. Health Care Women Int 2019; 41:553-566. [PMID: 31242078 DOI: 10.1080/07399332.2019.1623799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10 years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided.
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Affiliation(s)
- Sara Chandy
- Department of Medicine, St. John's Medical College, Bangalore, India
| | - Elsa Heylen
- Department of Medicine, University of California, San Francisco, CA, USA
| | - B N Ravikumar
- Karnataka State AIDS Prevention Society, Bangalore, India
| | - Maria L Ekstrand
- Department of Medicine, University of California, San Francisco, CA, USA.,St. John's Research Institute, Bangalore, India
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16
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Kini S, Kalal BS, Chandy S, Shamsundar R, Shet A. Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India. World J Clin Pediatr 2019; 8:33-42. [PMID: 31065544 PMCID: PMC6477150 DOI: 10.5409/wjcp.v8.i2.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of lower respiratory infections among children.
AIM To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.
METHODS Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections (ALRI), admitted between August 2011-August 2013, were included. Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.
RESULTS Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9% (130/383) had evidence of viral infection, and RSV was detected in 24.5% (94/383). Co-infections with RSV and other respiratory viruses (influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5% (21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season. Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.
CONCLUSION Our study provides evidence of a high proportion of RSV and other virus-associated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.
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Affiliation(s)
- Sandesh Kini
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Bhuvanesh Sukhlal Kalal
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, Karnataka, India
| | - Sara Chandy
- Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Thiruvalla 689101, Kerala, India
| | - Ranjani Shamsundar
- Department of Microbiology, St. John’s Medical College, Bengaluru 560034, Karnataka, India
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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Abstract
Hantaviruses are known to cause haemorrhagic fever with renal syndrome in Eurasia and hantavirus cardiopulmonary syndrome in the Americas. They are globally emerging pathogens as newer serotypes are routinely being reported. This review discusses hantavirus biology, clinical features and pathogenesis of hantavirus disease, its diagnostics, distribution and mammalian hosts. Hantavirus research in India is also summarised.
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Affiliation(s)
- Sara Chandy
- International Clinical Epidemiology Network (INCLEN), INCLEN Trust International, New Delhi, India
| | - Dilip Mathai
- Apollo Medical College and Research Center, Hyderabad, Telangana, India
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18
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George S, Jagan OA, Bai S, Chandy S. Genetic Diversity of Rotavirus Strains in the Era of Vaccination: A Pilot Study from Central Kerala, India. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/35403.11964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Jagan OA, Manoj G, Jayaprakash NS, Nair RM, Chandy S. Molecular Diversity of Hepatitis B Virus X Gene in Central Kerala, Southern India. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/33935.11572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Mørch K, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S, Henry A, Nesaraj J, Kuriakose C, Singh A, Kurian S, Gill Haanshuus C, Langeland N, Blomberg B, Vasanthan Antony G, Mathai D. Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy. BMC Infect Dis 2017; 17:665. [PMID: 28978319 PMCID: PMC5628453 DOI: 10.1186/s12879-017-2764-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/25/2017] [Indexed: 01/04/2023] Open
Abstract
Background The objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods. Methods During April 2011–November 2012, 1564 patients aged ≥5 years with febrile illness for 2–14 days were consecutively included in an observational study at seven community hospitals in six states in India. Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals. Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available. Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR. Results Malaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test. Conclusions Malaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India.
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Affiliation(s)
- Kristine Mørch
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Anand Manoharan
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Sara Chandy
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | | | | | - Suvarna Patil
- B.K.L. Walawalkar Hospital, Ratnagiri, Maharashtra, India
| | - Anil Henry
- Christian Hospital, Mungeli, Chhattisgarh, India
| | | | - Cijoy Kuriakose
- Christian Fellowship Hospital, Oddanchatram, Tamil Nadu, India
| | - Ashita Singh
- Baptist Christian Hospital, Tezpur, Assam, India
| | - Siby Kurian
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Christel Gill Haanshuus
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - George Vasanthan Antony
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Dilip Mathai
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
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21
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Verma R, Chandy S, Jayaprakash NS, Manoharan A, Vijayalakshmi MA, Venkataraman K. Diagnostic potential of monoclonal antibodies developed against C-terminal polypeptide of P. falciparum Histidine Rich Protein2 (PfHRP2) in malaria infected patients from India. Pathog Glob Health 2017; 111:297-305. [PMID: 28777043 DOI: 10.1080/20477724.2017.1358846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Malaria, caused by Plasmodium falciparum has become a major health burden in most tropical and developing countries. P. falciparum Histidine Rich Protein2 (PfHRP2), which exhibits polymorphism, is being widely used as a diagnostic marker. Recently, we reported the development of monoclonal antibodies against conserved C-terminal 105 amino acids of PfHRP2 for malaria diagnosis. Now, in this study, the diagnostic performance of two anti-C-terminal PfHRP2 mAbs (b10c1 and Aa3c10) were evaluated with 100 blood samples from clinically identified malaria patients from seven different geographical centers in India. Sandwich ELISA, polymerase chain reaction (PCR) and statistical tools were used for the evaluation of the performance of the anti-C-terminal PfHRP2 mAb. These mAbs detected P. falciparum (mean OD value 1.525 ± 0.56) malaria with great accuracy with no cross reactivity with P. Plasmodium vivax (mean OD value 0.285 ± 0.051) and normal healthy control samples (mean OD value 0.185 ± 0.06) in Sandwich ELISA assay. The samples which were RDT negative for P. falciparum were also reactive in Sandwich ELISA with mean OD value of (1.303 ± 0.532). The amount of PfHRP2 antigen in the patients' blood sample was quantified and categorized into three distinct groups having the HRP2 antigen in high, intermediate and low amounts. The presence of Pfhrp2 gene was also confirmed by PCR analysis. The sensitivity and specificity of the mAb were found to be 95 and 96% respectively. These data strongly suggest that the anti-C-terminal PfHRP2 mAbs b10c1 and Aa3c10 have merits for improvising the existing malarial diagnostics.
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Affiliation(s)
- Reena Verma
- a Centre for BioSeparation Technology (CBST) , VIT University , Vellore , India
| | - Sara Chandy
- b Benjamin Pulimood Laboratory for Infection, Inflammation and Immunity (BMPLIII), Department of Medicine-1 , Christian Medical College (CMC) , Vellore , India
| | - N S Jayaprakash
- a Centre for BioSeparation Technology (CBST) , VIT University , Vellore , India
| | - Anand Manoharan
- b Benjamin Pulimood Laboratory for Infection, Inflammation and Immunity (BMPLIII), Department of Medicine-1 , Christian Medical College (CMC) , Vellore , India
| | - M A Vijayalakshmi
- a Centre for BioSeparation Technology (CBST) , VIT University , Vellore , India
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22
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Chandy S, Kirubanandhan L, Hemavathy P, Khadeeja AM, Kurian SJ, Venkataraman K, Mørch K, Mathai D, Manoharan A. Serovar prevalence of Leptospira in semirural India and the development of an IgM-based indirect ELISA. J Infect Dev Ctries 2017; 11:234-241. [DOI: 10.3855/jidc.8067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 10/31/2022] Open
Abstract
Introduction: Leptospirosis is a major public health problem in India. However, it has been underreported and under-diagnosed due to a lack of awareness of the disease, a functional surveillance system, and appropriate laboratory diagnostic facilities. Methodology: This multicenter study aimed to understand the Leptospira serovars causing leptospirosis in seven secondary-level hospitals in six states in India. Since early and accurate diagnosis of leptospirosis is one of the challenges faced by clinicians in India due to the poor specificity and sensitivity of commercially available diagnostic systems, an in-house indirect enzyme-linked immunosorbent assay (ELISA) was developed. Genomic DNA from L. interrogans serovar Canicola was used for polymerase chain reaction amplification, cloning, and expression of the lipL32 gene in E. coli to amplify, clone, and express the lipL32 gene. Results: Australis was the common serovar seen at all the study centers. Serovar Icterohaemorrhagiae was seen in samples from Tamil Nadu and Assam. In-house ELISA was standardized using the purified recombinant LipL32 polypeptide and was used to evaluate serum. Subsequently, acute serum samples from leptospirosis patients (n = 60) were screened. Compared to the gold standard, the microscopic agglutination test, sensitivity and specificity of the in-house ELISA was 95% and 90%, respectively. Conclusions: Understanding Leptospira serovars circulating in leptospirosis-endemic areas will help to formulate better vaccines. LipL32-based ELISA may serve as a valuable tool for early diagnosis of leptospirosis.
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Nair V, Madan H, Sofat S, Ganguli P, Jacob MJ, Datta R, Bharadwaj P, Sarkar RS, Pandit AJ, Nityanand S, Goel PK, Garg N, Gambhir S, George PV, Chandy S, Mathews V, George OK, Talwar KK, Bahl A, Marwah N, Bhatacharya A, Bhargava B, Airan B, Mohanty S, Patel CD, Sharma A, Bhatnagar S, Mondal A, Jose J, Srivastava A. Authors' response. Indian J Med Res 2016; 143:833. [PMID: 27748312 PMCID: PMC5094127 DOI: 10.4103/0971-5916.192081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- V Nair
- Army Hospital (Research & Referral), New Delhi, India
| | - H Madan
- Army Hospital (Research & Referral), New Delhi, India
| | - S Sofat
- Army Hospital (Research & Referral), New Delhi, India
| | - P Ganguli
- Army Hospital (Research & Referral), New Delhi, India
| | - M J Jacob
- Army Hospital (Research & Referral), New Delhi, India
| | - R Datta
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - P Bharadwaj
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - R S Sarkar
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - A J Pandit
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - S Nityanand
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P K Goel
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - N Garg
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Gambhir
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P V George
- Christian Medical College, Vellore, India
| | - S Chandy
- Christian Medical College, Vellore, India
| | - V Mathews
- Christian Medical College, Vellore, India
| | - O K George
- Christian Medical College, Vellore, India
| | - K K Talwar
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bahl
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - N Marwah
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bhatacharya
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - B Bhargava
- All India Institute of Medical Sciences, New Delhi, India
| | - B Airan
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mohanty
- All India Institute of Medical Sciences, New Delhi, India
| | - C D Patel
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Biotechnology, Government of India, New Delhi, India
| | - S Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Mondal
- Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - J Jose
- Christian Medical College, Vellore, India
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Haanshuus CG, Chandy S, Manoharan A, Vivek R, Mathai D, Xena D, Singh A, Langeland N, Blomberg B, Vasanthan G, Sitaram U, Appasamy J, Nesaraj J, Henry A, Patil S, Alvarez-Uria G, Armstrong L, Mørch K. A High Malaria Prevalence Identified by PCR among Patients with Acute Undifferentiated Fever in India. PLoS One 2016; 11:e0158816. [PMID: 27389396 PMCID: PMC4936667 DOI: 10.1371/journal.pone.0158816] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022] Open
Abstract
Background Approximately one million malaria cases were reported in India in 2015, based on microscopy. This study aims to assess the malaria prevalence among hospitalised fever patients in India identified by PCR, and to evaluate the performance of routine diagnostic methods. Methods During June 2011-December 2012, patients admitted with acute undifferentiated fever to seven secondary level community hospitals in Assam (Tezpur), Bihar (Raxaul), Chhattisgarh (Mungeli), Maharashtra (Ratnagiri), Andhra Pradesh (Anantapur) and Tamil Nadu (Oddanchatram and Ambur) were included. The malaria prevalence was assessed by polymerase chain reaction (PCR), routine microscopy, and a rapid diagnostic test (RDT) with PCR as a reference method. Results The malaria prevalence by PCR was 19% (268/1412) ranging from 6% (Oddanchatram, South India) to 35% (Ratnagiri, West India). Among malaria positive patients P. falciparum single infection was detected in 46%, while 38% had P. vivax, 11% mixed infections with P. falciparum and P. vivax, and 5% P. malariae. Compared to PCR, microscopy had sensitivity of 29% and specificity of 98%, while the RDT had sensitivity of 24% and specificity of 99%. Conclusions High malaria prevalence was identified by PCR in this cohort. Routine diagnostic methods had low sensitivity compared to PCR. The results suggest that malaria is underdiagnosed in rural India. However, low parasitaemia controlled by immunity may constitute a proportion of PCR positive cases, which calls for awareness of the fact that other pathogens could be responsible for the febrile disease in submicroscopic malaria.
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Affiliation(s)
- Christel Gill Haanshuus
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sara Chandy
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Anand Manoharan
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
- * E-mail:
| | - Rosario Vivek
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Dilip Mathai
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Deepika Xena
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Ashita Singh
- Baptist Christian Hospital, Tezpur, Assam, India
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - George Vasanthan
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | - Usha Sitaram
- Infectious Diseases Training and Research Center, Department of Medicine Unit-1 and Infectious Diseases, Christian Medical College, Vellore, India
| | | | | | - Anil Henry
- Christian Hospital, Mungeli, Chhattisgarh, India
| | - Suvarna Patil
- B.K.L. Walawalkar Hospital, Ratnagiri, Maharashtra, India
| | | | | | - Kristine Mørch
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
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O A J, Gopi M, N S J, Thomas K G, Chandy S. Molecular diversity of Hepatitis B virus (HBV) x gene: A preliminary report from Kerala. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3–5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.
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Affiliation(s)
- D Gupta
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
| | - S Chaturvedi
- Department of Pediatric Nephrology, Christian Medical College and Hospital, Vellore, India
| | - S Chandy
- Department of Cardiology, Christian Medical College and Hospital, Vellore, India
| | - I Agarwal
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
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Haanshuus CG, Vivek R, Xena D, Chandy S, Mathai D, Manoharan A, Langeland N, Blomberg B, Mørch K. Malaria prevalence among patients with acute undifferentiated fever in secondary hospitals in India. Malar J 2014. [PMCID: PMC4179341 DOI: 10.1186/1475-2875-13-s1-p40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mørch K, Vivek R, Xena D, Chandy S, Manoharan A, Haanshuus C, Langeland N, Blomberg B, Mathai D. Serological profile among patients with malaria in secondary community hospitals in India - a multicenter cross sectional study. Malar J 2014. [PMCID: PMC4179415 DOI: 10.1186/1475-2875-13-s1-p63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chandy S, Ramanathan K, Manoharan A, Mathai D, Baruah K. Assessing effect of climate on the incidence of dengue in Tamil Nadu. Indian J Med Microbiol 2014; 31:283-6. [PMID: 23883717 DOI: 10.4103/0255-0857.115640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Incidence of dengue is reported to be influenced by climatic factors. The objective of this study is to assess the association of local climate with dengue incidence, in two geographically distinct districts in Tamil Nadu. The study uses climate data, rainfall and mean maximum and minimum temperature to assess its association if any, with dengue incidence in two districts of Tamil Nadu, South India. According to this study while precipitation levels have an effect on dengue incidence in Tamil Nadu, non-climatic factors such as presence of breeding sites, vector control and surveillance are important issues that need to be addressed.
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Affiliation(s)
- S Chandy
- Department of Medicine, Unit 1 and Infectious Diseases, Christian Medical College, Vellore, India
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Gopinath KG, Chrispal A, Boorugu H, Chandy S, Prakash JJ, Abraham AM, Abraham OC, Thomas K. Clinico-epidemiological profile of seven adults with spotted fever from a tertiary care hospital in South India. Trop Doct 2013; 44:89-91. [PMID: 24334402 DOI: 10.1177/0049475513515478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spotted fever (SF), a tick-borne rickettsial infection, is being increasingly reported from mainly northern Indian states. A lack of awareness and confirmatory laboratory tests underestimate the incidence of this infection which, in India, is predominantly seen during the rainy season. Many patients diagnosed with viral exanthematous illnesses may be suffering from SF, which is treatable if detected early. There is very little data on SF in adults in southern India. We present seven patients with SF treated between January 2007 and January 2008 in a tertiary care hospital in South India. All presented during the rainy season, with rash (100%) and generalized oedema (71%) being the most common features. There was one death due to type I respiratory failure. Renal failure, shock, aseptic meningitis and hepatitis were other significant abnormalities detected in these patients. Clinicians need to be aware of SF and suspect it in appropriate patients.
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Affiliation(s)
- Kango Gopal Gopinath
- Associate Professor of Geriatrics, Department of Geriatrics and Internal Medicine Unit 3, Christian Medical College, Vellore, India
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Abstract
Scrub typhus is an emerging infectious disease in India. Among its protean clinical manifestations, central nervous system involvement is common. In this prospective observational study, altered sensorium, headache, seizures and aseptic meningitis were found to be common central nervous system manifestations. Prompt treatment with doxycycline reduces morbidity and mortality.
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Affiliation(s)
- Harikishan Boorugu
- Assistant Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
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Ekstrand ML, Shet A, Chandy S, Singh G, Shamsundar R, Madhavan V, Saravanan S, Heylen E, Kumarasamy N. Suboptimal adherence associated with virological failure and resistance mutations to first-line highly active antiretroviral therapy (HAART) in Bangalore, India. Int Health 2013; 3:27-34. [PMID: 21516199 DOI: 10.1016/j.inhe.2010.11.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This study was conducted to examine the relationship between adherence, viral load (VL) and resistance among outpatients receiving highly active antiretroviral therapy (HAART) in Bangalore, India. In total, 552 outpatients were recruited and VL testing was conducted for all study participants. HIV-1 genotypic resistance testing was performed for 92 participants with a VL ≥ 1000 copies/ml. Interpretation of resistance mutations was performed according to the Stanford database. Past-month adherence and treatment interruptions for >48 h were assessed via self-report. At baseline, 34 participants (6%) reported <95% past-month adherence and 110 (20%) reported a history of >48 h treatment interruptions. Combining the two adherence measures, 22% of participants were classified as 'suboptimally adherent'. In total, 24% of study participants (n = 132) had a detectable VL. Among the 92 samples sent for resistance testing, 68% had at least one nucleoside reverse transcriptase inhibitor (NRTI) mutation, with M184V being the most common (62%) and with 48% having thymidine analogue mutations. Moreover, 72% had at least one non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation and 23% had three or more NNRTI mutations. Both adherence measures were significantly associated with VL (P < 0.001). Suboptimal adherence was significantly associated with resistance mutations (P < 0.02). The findings illustrate for the first time the strong association between suboptimal adherence, treatment failure and drug resistance to first-line HAART in India. The predictive value of standard adherence measures was improved by including treatment interruption data. The observed mutations can jeopardise future treatment options, especially in light of limited access to second-line treatments. To develop effective adherence interventions, research is needed to examine culturally-specific reasons for treatment interruptions.
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Affiliation(s)
- Maria L Ekstrand
- University of California-San Francisco, Department of Medicine, 50 Beale Street, S-1300, San Francisco, CA 94105, USA
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Neogi U, Heylen E, Shet A, Chandy S, Shamsunder R, Sönnerborg A, Ekstrand ML. Long-term efficacy of first line antiretroviral therapy in Indian HIV-1 infected patients: a longitudinal cohort study. PLoS One 2013; 8:e55421. [PMID: 23383185 PMCID: PMC3559582 DOI: 10.1371/journal.pone.0055421] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/22/2012] [Indexed: 11/18/2022] Open
Abstract
Background Short term efficacy of combination antiretroviral therapy (cART) in resource-constrained settings is comparable to that found in western studies. However, long term data are limited. India has the third largest HIV infected population in the world but the long-term outcome of first line therapy according to the national guidelines has not been evaluated yet. Therefore, we conducted a long-term longitudinal analysis of the efficacy of the national first-line therapy in India from an observational cohort of Indian patients in two different clinical settings. Methodology/Principal Findings A total 323 patients who had been on ART for a median of 23 months and achieved virological suppression <100 copies/ml by their study baseline visit, were included and followed for two years. Blood samples were collected every six months for viral load and CD4 count. Drug resistance genotyping was performed when the viral load was >2000 copies/mL. Adherence and treatment interruptions (>48 h) were assessed via self-report. In the studied patients, the median duration of viral suppression was 44 months; 15.8% of patients showed viral rebound, and 2.8% viral failure. Viral rebound or failure was significantly negatively related to perfect adherence (100% adherence and no treatment interruption >48 hrs). Virological re-suppression in the subsequent visit was observed in three patients without any change in therapy despite the presence of key mutations. Conclusion/Significance Our study reports for the first time, a good long-term response to the first line therapy for a median of nearly four years although a less than perfect adherence increases the risk for treatment failure and subsequent drug resistance development. The empirical findings in this study also indicate the overall success of the Indian ART program in two different settings which likely are representative of other clinics that operate under the national guidelines.
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Affiliation(s)
- Ujjwal Neogi
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Schultz C, Wiloughby S, Kumar S, Nair S, Srivastava A, Chandy S, John B, Sanders P. Improvements in Left Atria and Vascular Function 24h Following the Reversal of Chronic Atrial Stretch. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vijayaraghavan PM, Chandy S, Selvaraj K, Pulimood S, Abraham AM. Virological investigation of hand, foot, and mouth disease in a tertiary care center in South India. J Glob Infect Dis 2012; 4:153-61. [PMID: 23055646 PMCID: PMC3459432 DOI: 10.4103/0974-777x.100572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Hand, foot, and mouth disease (HFMD) remains a common problem in India, yet its etiology is largely unknown as diagnosis is based on clinical characteristics. There are very few laboratory-based molecular studies on HFMD outbreaks. Aim: The aim of this study was to characterize HFMD-related isolates by molecular techniques. Settings and Design: Between 2005 and 2008, during two documented HFMD outbreaks, 30 suspected HFMD cases presented at the Outpatient Unit of the Department of Dermatology, Christian Medical College (CMC), Vellore. Seventy-eight clinical specimens (swabs from throat, mouth, rectum, anus, buttocks, tongue, forearm, sole, and foot) were received from these patients at the Department of Clinical Virology, CMC, for routine diagnosis of hand, foot, and mouth disease. Materials and Methods: Samples from these patients were cultured in Vero and rhabdomyosarcoma (RD) cell lines. Isolates producing enterovirus-like cytopathogenic effect (CPE) in cell culture were identified by a nested reverse transcription–based polymerase chain reaction (RT-PCR) and sequenced. The nucleotide sequences were analyzed using the BioEdit sequence program. Homology searches were performed using the Basic Local Alignment Search Tool (BLAST) algorithm. Statistical Analysis used: The statistical analysis was performed using Epi Info version 6.04b and Microsoft Excel 2002 (Microsoft Office XP). Results: Of the 30 suspected HFMD cases, only 17 (57%) were laboratory confirmed and Coxsackievirus A16 (CVA16) was identified as the etiological agent in all these cases. Conclusions: Coxsackievirus A16 (CVA16) was identified as the virus that caused the HFMD outbreaks in Vellore between 2005 and 2008. Early confirmation of HFMD helps to initiate control measures to interrupt virus transmission. In the laboratory, classical diagnostic methods, culture and serological tests are being replaced by molecular techniques. Routine surveillance systems will help understand the epidemiology of HFMD in India.
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Affiliation(s)
- Pavithra M Vijayaraghavan
- Department of Clinical Virology, Christian Medical College, Dr. Ida Scudder Road, Vellore, Tamil Nadu, India
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Chandy S, Ulrich RG, Schlegel M, Petraityte R, Sasnauskas K, Prakash DJ, Balraj V, Abraham P, Sridharan G. Hantavirus infection among wild small mammals in Vellore, south India. Zoonoses Public Health 2012; 60:336-40. [PMID: 22856552 DOI: 10.1111/j.1863-2378.2012.01532.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Wild indigenous small mammals including 83 rodents (bandicoot and black rats, and house mice) and a shrew captured from multiple sites in Vellore, south India, were tested for serological and molecular evidence of hantavirus infection. Indirect immunofluorescence assay (IFA) using Hantaan virus (HTNV) antigen indicated hantavirus-reactive antibodies in 16 (19.3%) of 83 rodents (bandicoot and black rats). Western blot (WB) using Thailand virus (THAIV) antigen confirmed hantavirus-reactive antibodies in nine of the 16 HTNV IFA-positive rodents. Reverse transcription polymerase chain reaction (RT-PCR) of lung and kidney tissue of captured mammals resulted in the detection of partial S segment sequence in a bandicoot rat. This study complements our earlier reports on hantavirus epidemiology in south India and documents first laboratory evidence for rodent-associated hantaviruses in south India.
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Affiliation(s)
- S Chandy
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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Willoughby S, Scultz C, Kumar S, Priya S, Nair S, Srivastava A, Joseph G, George O, Pati P, Chase D, Chandy S, John B, Sanders P. Rheumatic Mitral Stenosis is Associated with Elevated Endothelin-1 Levels. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schultz C, Willoughby S, Kumar S, Shenbaga P, Joseph G, Chandran S, Srivastava A, Chandy S, John B, Sanders P. Acute Reversal of Chronic Atrial Stretch is Associated Left Atrial Endothelial Dysfunction. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schultz C, Willoughby S, Kumar S, George O, Kumar Pati P, Nair S, Srivastava A, Chandy S, John B, Sanders P. Impact of the Atrial Arrhythmia and Underlying Substrate in the Development of Left Atrial Inflammation: Potential Link to Thrombotic Risk. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vallabhaneni S, Chandy S, Heylen E, Ekstrand M. Reasons for and correlates of antiretroviral treatment interruptions in a cohort of patients from public and private clinics in southern India. AIDS Care 2011; 24:687-94. [PMID: 22107044 DOI: 10.1080/09540121.2011.630370] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Understanding the prevalence and correlates of treatment interruptions (TIs) in resource-limited settings is important for improving adherence. HIV-infected adults on highly active antiretroviral therapy (HAART) in Bangalore, India, were enrolled into a prospective cohort study assessing HAART adherence. Participants underwent a structured interview assessing adherence, including occurrence of TI > 48 hours since HAART initiation, length of TI, and self-reported reasons for TI. Serum HIV viral load (VL) and CD4 was measured at 6-month intervals. Baseline data are presented in this article. For the 552 participants mean age was 37.8, 32% were female, 70% were married, 45% earned < $2/day. Eighty-four percent were on nevirapine-based antiretroviral therapy; median duration on HAART was 18 months (range: 1-175) and median CD4 count was 318 cells/µl (IQR: 195-460) at time of study enrollment. Twenty percent (n=110) reported at least one TI; of these, 33% (n=36) reported more than one TI. Median length of most recent TI was 10 days (range: 2-1095). TI was associated with a higher probability of having VL > 400 copies/ml (43% versus 12%; p<0.001). After controlling for time on HAART, TI was more likely among those who were unmarried (OR: 1.9; CI: 1.2-3.1), those treated in a private clinic setting (OR: 2.7; CI: 1.6-4.6 compared with public, and OR: 4.1; CI: 1.9-9.0 compared with public-private setting), and those on efavirenz-based therapy (OR: 2.0; CI: 1.1-3.6). The most common self-reported reason for TI was "side effects" (n=28; 25%), followed by cost of therapy (n=24; 22%). We discuss implications for both individual and structural level interventions to reduce TIs.
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Affiliation(s)
- Snigdha Vallabhaneni
- Center for AIDS Prevention Studies, University of California, San Francisco, USA.
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Shet A, DeCosta A, Heylen E, Shastri S, Chandy S, Ekstrand M. High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems. BMC Health Serv Res 2011; 11:277. [PMID: 22004573 PMCID: PMC3204232 DOI: 10.1186/1472-6963-11-277] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 10/17/2011] [Indexed: 11/12/2022] Open
Abstract
Background The massive scale-up of antiretroviral treatment (ART) access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India. Methods Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months). In addition, CD4 count and viral load (VL) were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml). Results A total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center). Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p < 0.05). Treatment interruptions were lowest among public participants (1%, 10%, 5% respectively, p < 0.001). Although longer clinic waiting times were experienced by more public participants (48%, compared to private 27%, public-private 19%, p < 0.001), adherence barriers were highest among private (31%) compared with public (10%) and public-private (17%, p < 0.001) participants. Viral load was detectable in 13% public, 22% private and 9% public-private participants (p < 0.05) suggesting fewer treatment failures among public and public-private settings. Drug resistance mutations were found more frequently among private facility patients (20%) compared to those from the public (9%) or public-private facility (8%, p < 0.05). Conclusions Adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can enhance the success of national ART programs.
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Affiliation(s)
- Anita Shet
- Department of Pediatrics, St John's National Academy of Health Sciences, Bangalore, India.
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Chandy S, Singh G, Heylen E, Gandhi M, Ekstrand ML. Treatment switching in South Indian patients on HAART: what are the predictors and consequences? AIDS Care 2011; 23:569-77. [PMID: 21293988 DOI: 10.1080/09540121.2010.525607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Early identification and management of treatment failure on highly active antiretroviral therapy (HAART) is crucial in maintaining a sustained response to therapy in HIV infection. However, HIV viral load (VL) and resistance testing, and second-line HAART regimens, are unaffordable to many patients in India, leaving them with limited treatment options. Predictors and reasons for antiretroviral switching, therefore, are likely to differ in settings of varying resources. A one-year, observational study of patients receiving antiretroviral therapy was conducted in a private, non-profit hospital in Bangalore. This paper examines the predictors and consequences of antiretroviral treatment switching in this setting and explores reasons for switching in a subset of patients. Data on demographics, drug regimens, adherence, and physical and psychosocial outcomes were collected quarterly. Tests of VL and CD4 cell counts were performed every six months. One-third of the patients switched therapy during the study period. Baseline predictors of switching included lower CD4 cell counts and more physical symptoms. Contrary to studies in other settings, a high VL did not predict treatment switching, and only a minority of those experiencing drug failure were switched to second-line regimens. Both groups (switchers and non-switchers) improved significantly over time with respect to CD4 counts and psychological well-being, and showed a reduction in physical and depressive symptoms. Any differences between the groups were no longer significant at the end of the study, once we controlled for baseline levels. Clinical, policy, and research implications of these findings are discussed within the context of resource-limited settings.
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Affiliation(s)
- Sara Chandy
- Department of Medicine, St John's Medical College and Hospital, Bangalore, India
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Steward WT, Chandy S, Singh G, Panicker ST, Osmand TA, Heylen E, Ekstrand ML. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. PSYCHOL HEALTH MED 2011; 16:74-85. [PMID: 21218366 DOI: 10.1080/13548506.2010.521568] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence), and internalized stigma (personal endorsement of stigma beliefs). We examined whether this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIV-infected individuals from Southern India who were followed up for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And, enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental well-being.
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Affiliation(s)
- Wayne T Steward
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
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Schultz C, Willoughby S, Lim H, John B, Chandy S, Lau D, Roberts-Thomson K, Young G, Sanders P. Transseptal Puncture and Thrombotic Risk. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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John B, Roshan J, Joseph G, Jose J, George O, Chandy S, Sanders P. Therapy Directed at Stretch Reduces the Frequency of Clinical Atrial Fibrillation: A Long Term Study in Patients With Mitral Stenosis. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schultz C, Willoughby S, Lim H, John B, Chandy S, Lau D, Roberts-Thomson K, Young G, Sanders P. Is Rapid Atrial Pacing Associated with Thrombogenesis in Normal Hearts? Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, Thomas EM, Abraham AM, Abraham OC, Thomas K. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India. Trop Doct 2010; 40:230-4. [PMID: 20870680 DOI: 10.1258/td.2010.100132] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization. Blood cultures, malarial parasites and febrile serology (acute and convalescent), in addition to clinical evaluations and basic investigations were performed. Comparisons were made between each disease and the other AFIs. A total of 398 AFI patients were diagnosed with: scrub typhus (47.5%); malaria (17.1%); enteric fever (8.0%); dengue (7.0%); leptospirosis (3.0%); spotted fever rickettsiosis (1.8%); Hantavirus (0.3%); alternate diagnosis (7.3%); and unclear diagnoses (8.0%). Leucocytosis, acute respiratory distress syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminaemia were independently associated with scrub typhus. Normal leukocyte counts, moderate to severe thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated serum transaminases were associated with malaria. Rash, overt bleeding manifestations, normal to low leukocyte counts, moderate to severe thrombocytopenia and significantly elevated hepatic transaminases were associated with dengue. Enteric fever was associated with loose stools, normal to low leukocyte counts and normal platelet counts. It is imperative to maintain a sound epidemiological database of AFIs so that evidence-based diagnostic criteria and treatment guidelines can be developed.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine Unit 2, Christian Medical College, Vellore, Tamil Nadu, India.
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Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, Thomas K, Abraham AM, John GT. Acute kidney injury in tropical acute febrile illness in a tertiary care centre--RIFLE criteria validation. Nephrol Dial Transplant 2010; 26:524-31. [DOI: 10.1093/ndt/gfq477] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Chrispal A, Boorugu H, Gopinath KG, Prakash JAJ, Chandy S, Abraham OC, Abraham AM, Thomas K. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct 2010; 40:129-33. [PMID: 20360426 DOI: 10.1258/td.2010.090452] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine Unit 2, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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Schultz C, Willoughby S, Lim H, John B, Chandy S, Alasady M, Dimitri H, Lau D, Laborerie J, Roberts-Thomson K, Young G, Sanders P. Endothelial Dysfunction and Vascular Inflammation in Patients with Atrial Fibrillation. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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