Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.
These findings added a new dimension in diagnosis, treatment, epidemiology and control of dengue and malaria. The possible risk of concurrent dengue and malaria infections should always be kept in mind in endemic areas for early diagnosis employing modern technology and prompt and effective treatment to avoid serious complications.
Fever of unknown origin broke out in several districts of West Bengal, from August 2007 to December 2007. The cases were suffering from high fever, severe joint pain lasting for several weeks after clinical cure and appearance of skin rashes. Patients' sera were collected at least five days after fever and were analyzed to detect specific IgM antibodies. A total of 800 patients were investigated and 321 (40.13%) were found to be reactive for Chikungunya antibodies. Of the patients, 66% were male. Predominant signs and symptoms observed in the sero-positive cases were fever (100%), arthralgia (96%) and diffuse erythematous skin rash (94%). Of the patients, 3% had haemorrhagic manifestations. Re-emerging Chikungunya virus spread in epidemic form in several districts of West Bengal after a gap of four decades.
Introduction: Cryptococcal meningitis, a leading opportunistic infection, causes significant morbidity and mortality in people with advanced human immunodeficiency virus (HIV). It accounts for an estimated 15% of acquired immune deficiency syndrome-related deaths globally. As recommended by the World Health Organization (WHO) 2018 guidelines, this invasive disease is preventable by routine cryptococcal antigen (CrAg) screening of all advanced HIV patients followed by pre-emptive antifungal therapy. An estimate of disease prevalence in antiretroviral treatment (ART)-naïve HIV-positive adult Indian population is essential to include this in routine screening strategy. We estimated CrAg prevalence as a guiding resource in a public health approach.
Material and methods:The study design was longitudinal. ART naïve HIV-seropositive patients with CD4 count ≤ 100 cells/μl, attending ART center at the School of Tropical Medicine, Kolkata, India were screened for CrAg using both latex agglutination and lateral flow assay kits. A total of 390 subjects were enrolled into the study, and evaluated for association of CrAg with age, sex, CD4, presence of opportunistic infections, WHO HIV staging, and clinical symptoms.Results: Of 390 subjects tested, the median CD4 count was 42 cells/μl in CrAg-positive and 46 in CrAg-negative patients. Median (IQR) age of all participants was 40 (range, 34-46) years. CrAg positivity was 12.56%, comparatively higher in those with CD4 ≤ 50 cells/μl. Asymptomatic patients had CrAg positivity of 4.6%. Statistically significant association was noted with male sex (p = 0.03), triad symptoms of fever, headache, vomiting (p = 0.013), and altered mental status (p = 0.033).Conclusions: This study aims to estimate CrAg prevalence in India to justify the need for routine screening and pre-emptive treatment in advanced HIV infection. Incorporating this screening would definitely reduce the risk of cryptococcus meningitis-induced mortality and morbidity, as recommended by the WHO guidelines.
After its first appearance in Kolkata (Calcutta) during 1963-1965, chikungunya occurred in epidemic form in India in 17 states and union territories. There were 13,90,322 cases suspected to be suffering from chikungunya in 2006, 59,535 in 2007 and 11,222 in 2008; in 2006, 2007 and 2008 there were 15,961, 7,837 and 262 samples, respectively, sent to the National Institute of Virology, Pune, and the National Institute of Communicable Disease, Delhi, for serological diagnosis. Of these, 2001, 1826 and 44, respectively, were confirmed as chikungunya. There were no deaths (data from the National Vector Borne Disease Control Programme, Government of India).
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