A spectrum of viral diseases in Odisha state, eastern India: An evidence-based analysis from 2010-2017

Introduction

Emerging and re-emerging viral diseases are a major threat to public health. Proper laboratory surveillance plays an important role in estimating the disease burden that helps in taking preventive measures for controlling seasonal diseases. This study focuses on the prevalence of different viral diseases in the state of Odisha, India, from 2010-2017.

Material and Methods

A total of 43,397 patients with clinical suspicion of viral diseases were screened for different viral etiology during 2010-2017. The laboratory diagnosis was conducted by serology (ELISA) and RealTime RT-PCR for 24 different viruses, i.e., Dengue, Chikungunya, Japanese Encephalitis, Hepatitis A Virus, Hepatitis E Virus, Hepatitis B Virus, Hepatitis C Virus, Rotavirus, Herpes Simplex Virus-1 and Herpes Simplex Virus-2, Epstein -Barr Virus & Cytomegalo Virus, and respiratory viruses. Patients were enrolled from sporadic hospital admissions and outbreaks under different categories as per clinical diagnosis like fever with rash, diarrhoea, encephalitis, jaundice, respiratory illness, and fever of unknown etiology.

Results

The majority of patients belonged to exanthematous group, i.e., fever with rash (32.24%). The number of males were more in all categories except fever with rash, where females (53.34%) were more. Children <16 years of age were found to be the predominant age group for suspected viral diarrhoea (85.26%), encephalitis (76.96%), fever of unknown origin (40.16%), and respiratory infections (27.23%).

Conclusion

Odisha being one of the coastal states in the country, reports many viral illnesses due to its typical geographical location. Initially, it was thought to be the only vector-borne disease that posed a threat to the state, but subsequently, other viral illnesses were also diagnosed and reported. This is the first report of laboratory confirmation and distribution of different viral diseases in the state of Odisha and neighboring regions, which will support public health management.

Epidemiological Study and Associated Risk Factors for Developing Bacterial Meningitis in Children of Odisha, India

Background: Bacterial meningitis is a leading cause of high childhood transience. It is the foremost cause of fatality in pediatric age group of 0-5 years in India accounting 0.5 to 2.6% of hospital admissions with CFR 16-30%. Based on above scenario, the study was undertaken to address the prevalence, etiology, social determinants of health factors of bacterial meningitis among under five children Odisha, India. Methods: A cross sectional study comprising of children under five years of age admitted to tertiary care hospital and teaching institutions in Cuttack with suspected clinical diagnosis of bacterial meningitis during April, 2012 to September 2013. About 634 children enrolled into the study after getting appropriate consent from parents or their legal guardians. Lumbar puncture was done and CSF was sent for biochemical analysis, cell counts, staining, culture, latex agglutination test (LAT) and real time polymerase chain reaction (RT PCR). Results: About 61 children (10.4%) were confirmed with diagnosis of bacterial meningitis by either culture, latex or RT PCR.  Male children (74.7%) were significantly more prone to bacterial meningitis than females (24.3%). The common isolated pathogens were Streptococcus pneumonia, Haemophilus influenza type b, E. coli, Pseudomonas aeruginosa, Klebseilla pneumoniae and Staphylococcus aureus. Streptococcus pneumoniae was observed to be most common pathogen (57.6%) followed by Haemophilus influenzae type b (26.2%). The risk factors analyzed showed statistically significant association (p<0.01) with low household income, mother’s education, overcrowding (more than 3 persons in a single room), smoking and poor ventilation of household. Conclusion: Strengthening early detection of bacteria meningitis by rapid diagnostic test like LATEX, RT PCR and prompt treatment of emergent case at the household level, improvement in mother’s education and awareness, transportation to local hospital and facility for treatment and care should be utmost priority in the present scenario. It is crucial to assess the burden of bacterial meningitis with its etiology is in this region as  vaccines are yet to be introduced in the child vaccine program.

Evaluation of Real-Time Polymerase Chain Reaction in Culture-Negative Cerebrospinal Fluid Samples of Bacterial meningitis Patients

Background: Meningitis is a rigorous childhood disease with high morbidity and mortality. It is the main cause of under five mortality in India. Mainly three bacteria Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae are responsible. In low economic set up country like India, documented bacterial meningitis  mainly depend on gram staining, cerebrospinal fluid (CSF) culture results or latex agglutination test resulting in less number of positive due to the prior antimicrobial intake which affects culture and latex agglutination test results. This study was taken up rapid and accurate molecular method like RT PCR to diagnose bacterial meningitis in culture-negative CSF samples. Materials and Methods: Fifty culture-negative CSF samples from suspected cases of bacterial meningitis were examined by real-time polymerase chain reaction (real-time PCR) for the presence of lytA, bexA, and ctrA genes specific for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis respectively. Results: Positive real-time PCR results for Streptococcus pneumoniae were detected in 36 (72%) of culture-negative CSF samples while 10% positive results for Haemophilus influenzae type b. Nine  (18%) samples were negative by real-time PCR for all tested organisms. Conclusion: The use of molecular techniques as real-time PCR can provide a valuable addition to the proportion of diagnosed cases of bacterial meningitis especially in settings with high rates of culture-negative results.

Association of G84A and C276T polymorphism in neuronal nitric oxide synthase (nNOS) gene with herpes simplex encephalitis in eastern Indian population

In this study, a hypothesis that genetic variations in neuronal nitric oxide synthase (nNOS) could influence the susceptibility and outcome of herpes simplex encephalitis was investigated. Polymorphic loci of nNOS gene, G84A and C276T were genotyped in 132 HSE cases (Age 8.2 ± 1.3yr) and 143 in healthy individuals (Age-9.2 ± 1.6yr) of the same ethnic background from Odisha. A significantly increased risk for HSVE was associated with the AG genotype (OR = 1.73, 95%CI = 1.03-2.9, P = 0.03) and AA genotype (OR = 2.96, 95%CI = 1.04-8.4, P = 0.04) of nNOS 84G →A locus. In case of nNOS 276C→T variation, HSVE risk was linked to CT genotype (OR = 1.79, 95%CI = 1.07-3.0, P = 0.03) and TT genotype (OR = 3.6, 95%CI = 1.2-10.8, P = 0.02). Patients with poor outcome either had homo or heterozygous genotype for both SNPs, but separate genotype analysis could not show significance. But combined genotype analysis of both SNPs confirmed that GG + CC was a risk factor for development of poor outcome. (OR = 6.3, CI-1.9-20.7, P = 0.0033). Haplotype analysis of both SNP did show that "at" haplotype was significantly higher and associated with HSVE cases (OR = 2.322,CI: 1.43-3.77, P = 0.00070). The result observed in this study suggested that variation at these loci of nNOS may have decreased its expression and caused low production of NO, which have resulted in risk of HSVE but provided good outcome in these patients.

An Investigation on the Coinfection of Measles and HSV-1 in Hospitalized Acute Encephalitis Syndrome Patients in Eastern India

Acute encephalitis syndrome (AES) is a clinical condition that occurs due to infectious and noninfectious agents- however, viruses are considered to be the dominant pathogen. agents- however, viruses are considered to be the dominant pathogen. In this study, suspected AES cases were enrolled and tested for viral etiology through serology and polymerase chain reaction (PCR)/reverse transcriptase PCR from August 2012-July 2013. During this period, 820 cases were investigated and 96 cases were diagnosed to have a viral etiology whereas 20 patients had IgM antibodies for measles in serum and HSV-1 DNA in cerebrospinal fluid. All 20 of the patients were children below 14 years of age. The median hospital stay was 15 days (IQR: 14.2-17 days) and median GCS score was 7(IQR: 6-8) and were significantly different with patients with co-infections when comapred with patients having HSV-1 infection only. It may be suspected that the measles infection may have a role in the pathogenesis and thus an impact on the prognosis of the AES when present with HSV-1.

Epidemiological and clinical profile of Influenza A(H1N1) pdm09 in Odisha, eastern India

Epidemic of flu is highly contagious and it spreads through air. In 2009 H1N1 influenza virus emerged after reassortment of North American TRIG and Eurasia Avian like virus of swine and started epidemic in Mexico. The first cases were reported from Hyderabad city on 16th May 2009 in India that spread rapidly within a short span of time. During this period large population of Odisha situated at the eastern side of India was also affected and incidences of H1N1 cases were recorded through state Government surveillance system. In this study real time RT-PCR based diagnosis was conducted for the throat swabs collected from suspected H1N1 cases in Odisha during 2009–2017. A total of 2872 throat swabs were received from 23 different Government and private hospitals and 21.1% positivity was confirmed. The disease affected mostly 46–60 years age group, males (50.6%) being more affected. The clinical features had shown that fever with cough (89.6%) was the most common symptom followed by shortness of breath (72.7%). Post monsoon was the peak season in which most of the cases were reported. Neurological signs, pregnancy, diabetes and hypertension were found to be risk factors for H1N1. The case fatality rate (CFR) was 15%.

Molecular and phylogenetic analysis of the dengue strains circulating in Odisha, India

Dengue has emerged as a major public health challenge in terms of both changing clinical pattern and epidemiological features. The state of Odisha reported first dengue epidemic in the year 2010 and this continued each year in epidemic form during post monsoon period gradually becoming an endemic phenomenon. Present study depicts the changing epidemiological and clinical pattern of dengue with reference to its serotypes and genotypes. The study included 5320 suspected dengue cases from different health facilities of the state during 2010-2017. Dengue NS1 antigen and IgM antibody was done through ELISA. Serotyping was done through RTPCR by amplifying a part of core-pre-membrane gene (CprM) followed by sequencing and phylogenetic analysis. Dengue IgM antibody in 17.7% cases and NS1 antigen in 53.20% cases was detected. Dengue serotype 2 (DEN-2) was the only serotype detected in 2010 and 2011 where as all four serotypes 1, 2, 3, 4 were detected in 2012-2017, DEN-2 being dominant but in 2017 DEN-3 was found to be dominant. Phylogenetic analysis revealed genotype IV of DEN-2 and genotype III of DEN-1 and DEN-3 circulating in this region. In 6 cases involvement of DEN-2 in clinically evident encephalitis cases is an important observation in this region and needs public health attention. High prevalence of dengue was observed without any previous reported outbreaks in the state with increased number of cases from 2010 to 2012 affecting both urban and rural areas. High incidence in 2012 was due to co-circulation of more than one serotype which continued in the following years. Severity in some cases was associated with mixed infection but in most cases it was mild indicating the endemic nature of the virus in most parts of Odisha.

Association of Rotavirus Gastroenteritis with Histo-blood Group Antigens

Association of rotavirus gastroenteritis with histo-blood group antigens in children younger than 5 years admitted with diarrhea (n=389) was studied. Distribution of blood groups in rotavirus positive (n=96) and rotavirus negative (n=51) diarrhea gastroenteritis cases did not show any susceptibility to any blood group; blood group O seemed to be protective.

Spot or early morning sample for mycobacterial culture: which?

Drug resistance studies ideally require two sputum specimens, one spot and one early morning, for culture in Löwenstein-Jensen medium. Although the type of specimen plays a major role in the detection of acid-fast bacilli using microscopy, this type of specimen collection puts unnecessary pressure on patients. Two sputum samples, one on the spot and another in the early morning, collected from 179 TB patients in cetylpyridinium chloride and processed for culture, yielded respectively 89.9% and 87.7% culture positivity, while culture positivity increased to 93.3% when both specimens were tested.

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

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

Determination of iodine nutrition and community knowledge regarding iodine deficiency disorders in selected tribal blocks of Orissa, India

AIM

To determine the status of iodine nutrition and knowledge of iodine deficiency disorders (IDD) in selected tribal mountainous blocks of Orissa, India.

DESIGN

A community-based survey was performed, adopting the 30-cluster sampling and surveillance methodology for assessment of IDD recommended by WHO/UNICEF/ICCIDD.

SUBJECTS

School-age children (6-12 years) and their mothers.

METHODS

Total goitre rate (n=623) and urinary iodine excretion of children (n=530), iodine content in edible salt (n=505) and water (n=21) were measured. Community knowledge regarding IDD and awareness of iodized salt (n 20) was assessed.

RESULTS

Total goitre rate was 23.6%, of which visible goiter was 6.9%. Prevalence of goiter increased with age in female and tribal children. Median urinary iodine was 38 Cmicro.Tl(-1) and 51.7% of children had urinary iodine values <100 pmicrogtl(-1) The mean iodine content for drinking water ranged from 1.22-3.6 pmicro.Tl(-1) Only 9.9% of salt samples had adequate iodine content (> or =5 ppm). Over 80% of respondents did not have knowledge of IDD and were not aware of salt iodization.

CONCLUSIONS

Study results show moderate iodine deficiency with poor community knowledge of iodine nutrition. There is need to strengthen the monitoring of salt iodization and intensive education activities in the tribal areas.