BackgroundEchinococcosis is a human and animal health problem in many endemic areas worldwide. There are numerous reports and hospital-based studies from Kashmir, North India, yet there has been no epidemiological study conducted in Kashmir, the apparently endemic area for human hydatidosis. This study was designed to determine the seroprevalence of hydatid infection in Kashmir Valley and to find out association of risk factors for acquisition of this infection.MethodologyFourteen hundred and twenty-nine samples were collected from different districts in the Kashmir region (North India) using systematic random sampling. The 130 control samples included were from apparently healthy blood donors (100), patients with other parasitic infections (20), surgically confirmed hydatidosis patients (5), and apparently healthy subjects excluded for hydatidosis and intestinal parasitic infections (5). Hydatid-specific IgG antibody was detected by enzyme-linked immunosorbent assay, and seropositive samples were analysed further by Western blotting.ResultsOut of 1,429 samples, 72 (5.03%) were IgG positive by ELISA. The percentage occurrence of the highly immunoreactive antigenic fractions in IgG ELISA positive samples was 57 kDa (72.2%) followed by 70 kDa (66.7%) and 39kDa (58.3%) by immunoblotting. Samples with other parasitic infections were reactive with the cluster of 54-59 kDa antigenic fractions. Age <15 years, male gender, contact with dog, and rural residence were the most significant factors associated with the seropositivity.ConclusionThe study revealed that 72 (5.03%) out of 1,429 subjects asymptomatic for hydatidosis were seropositve to E.granulosus antigen by ELISA. Western blot analysis of 72 ELISA seropositive samples showed that 66.7% and 58.3% of samples were immunoreactive with 70 and 39kDa specific antigenic fractions, respectively. The seropositivity was significantly higher (5.79%) in the younger age group (<15 years) as compared to the 16-55 years (4.07%) and > 55 years (3.05%) age groups, suggesting ongoing transmission of this infection in the younger age group. The number of seropositive males was significantly higher as compared to females. The risk factors identified were rural residence and contact with dogs. The study suggests the presence of asymptomatic infection in subjects in Kashmir, North India, and efforts need to be made for implementation of effective prevention measures to reduce the infection burden, which may otherwise lead to symptomatology and complications in the infected subjects.

Serological diagnosis of cystic echinococcosis (CE) is usually made by detecting specific antibodies in serum samples. However, collection of blood samples is difficult and may be hazardous and unsafe. Thus, it is important to assess alternative simple methods of sampling body fluids that give similar results. Saliva and urine have been suggested as possible alternatives to detect specific antibodies for the diagnosis of various diseases. To the best of our knowledge, there has been no previously published study regarding the detection of CE-specific immunoglobulin (Ig) G subclass antibodies (IgG1-4) in urine. Therefore, the present study was designed to assess the value of hydatid-specific antibodies of IgG, IgM, IgE and IgG subclass in urine and serum samples for the diagnosis of CE. Serum and urine samples of 41 surgically confirmed patients of CE, 40 patients with other diseases and 16 healthy subjects were included in the study. CE-specific total IgG, IgE and IgG4 in sera and total IgG, IgG4 and IgG1 in the urine of CE patients were the most important specific antibodies for the diagnosis of CE. However, total IgG usually persists for an extended period and has a very high cross-reactivity. The diagnostic sensitivity of hydatid-specific IgM in serum and urine samples was very low and therefore cannot be used as a diagnostic marker. There was no significant difference between IgG1 and IgG4 in serum and urine and both showed the best correlation for the diagnosis of CE. These considerations suggest that detection of antibodies in urine could provide a new approach in the diagnosis of CE.

Introduction: Arthritis is the initial manifestation of many joint disorders. Synovial fluid analysis helps in this aspect. An analysis of synovial fluid has long been recommended as a routine procedure to assist in the diagnosis of arthritis. Objective: To analyse the gross, microscopic and biochemical variations in the synovial fluid in various causes of joint effusions and to assess the synovial fluid cytology with biochemical parameters in various types of arthritis to increase the accuracy of diagnosis. Materials and Methods: In the present cross sectional study, the synovial fluid of 477 cases was analysed in the Department of Biochemistry in collaboration with the Department of Pathology at SKIMS Medical College & Hospital, Bemina, Srinagar, India. Gross examination was done to find total volume, clarity, viscosity of the synovial fluid and it was equally divided into two halves. One half of synovial fluid was sent for biochemical analysis and the other half for microscopic examination. Results: Out of 477 synovial fluid samples analysed, joint involvement was seen in patients between the age of 16 and 75 years which included 182 males and 295females.Total leucocyte count was found to be highest in septic arthritis and lowest in osteoarthritis. Neutrophils were highest in septic arthritis (95%) and lowest in osteoarthritis (24%). Sugar level in synovial fluid was highest in osteoarthritis and gouty arthritis (70-90 mg/dL each) and lowest in septic arthritis. Proteins were highest in rheumatoid arthritis and traumatic arthritis (4.1-6.5 gm/dL and 4.2-6.4 gm/dL respectively) and lowest in osteoarthritis (1.2-2.4 gm/dL). Out of 290 positive cases in synovial C-reactive protein levels, the highest were found in rheumatoid arthritis (130), rheumatoid factor was found positive in 143 cases while it was negative in 127 cases of osteoarthritis. Conclusion: Biochemical analysis of synovial fluid for proteins and sugar contributes in diagnosis of different types of arthritis. RF in synovial fluid proves to be of value in diagnosis of monoarticular arthritis. C-reactive protein levels in synovial fluid were elevated in rheumatoid arthritis and can be used for the diagnosis of this disease in addition to other tests available.

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