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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 10 | Issue 1
Page Nos. 1-68

Online since Wednesday, May 20, 2020

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EDITORIAL  

Parasitology: What's new, what's unusual? Highly accessed article p. 1
Subhash Chandra Parija
DOI:10.4103/tp.TP_48_20  
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REVIEW ARTICLE Top

Plasmodium knowlesi-mediated zoonotic malaria: A challenge for elimination Highly accessed article p. 3
Durgadas Govind Naik
DOI:10.4103/tp.TP_17_18  
Malaria, a mosquito-transmitted parasitic disease, has been targeted for elimination in many parts of the world. For many years, Plasmodium vivax, Plasmodium falciparum, Plasmodium ovale and Plasmodium malariae have been known to cause malaria in humans. Now, Plasmodium knowlesi is considered to be an important cause of malaria, especially in Southeast Asia. The emergence of P. knowlesi with zoonotic implication is a challenge in the elimination efforts of malaria in Southeast Asia. P. knowlesi is known to cause severe complicated malaria in humans. P. knowlesi parasite is transmitted between humans and wild macaque through mosquito vectors. It appears that the malaria disease severity and host immune evasion depend on antigenic variation exhibited at the surface of the infected erythrocyte. P. knowlesi is sensitive to antimalarial drug artemisinin. Identification of vector species, their biting behavior, timely correct diagnosis, and treatment are important steps in disease management and control. There is a need to identify and implement effective intervention measures to cut the chain of transmissions from animals to humans. The zoonotic malaria definitely poses a significant challenge in elimination and subsequent eradication of all types of malaria from this globe.
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SYMPOSIUM Top

Lophomonas blattarum: A new flagellate causing respiratory tract infections p. 7
Abhijit Chaudhury, Subhash Chandra Parija
DOI:10.4103/tp.TP_81_19  
Lophomonas blattarum is a flagellate protozoan parasite which was originally described as a commensal in the gut of cockroaches. From the 1990s, reports started coming out of peoples Republic of China about its possible role in bronchopulmonary infections, and this was followed by reports from some other parts of the world as well. There had been some skepticism regarding the misidentification of bronchial ciliated epithelial cells as L. blattarum, but recent use of molecular diagnosis has come as an aid in clearing the controversy. This review focuses on the various aspects of the parasite including its biology, epidemiology, clinical manifestations, laboratory diagnosis, and the treatment aspects. Molecular diagnosis has recently been employed and more reports concerning its validation is needed. More basic research concerning the genomic and proteomic analysis is necessary to develop reliable molecular and serological tests for this parasite in future.
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Parasitic keratitis – An under-reported entity p. 12
Sumeeta Khurana, Megha Sharma
DOI:10.4103/tp.TP_84_19  
Parasitic keratitis (PK) is unique entity among parasitic infections where corneal involvement could result from direct inoculation of the parasite via exogenous environment or spread via endogenous neighboring organs or as a result of immune-mediated damage secondary to a systemic parasitic infection. Most cases of PK are caused by Acanthamoeba spp. and Microsporidia spp. though few other parasitic agents can also lead to corneal involvement. Mimicking as other infectious and non-infectious causes of keratitis, PK often escapes detection. This review summarizes the predominant causes of PK along with the epidemiological, clinical and microbiological details of each. Though several gaps exist in our understanding of the prevalence of PK, the one thing for sure is that PK is on the rise. With advanced diagnostic modalities and enough literature on optimal management of cases of PK, it is now imperative that a strong clinical suspicion of PK is kept when examining a case of corneal pathology and adequate investigations are ordered.
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ORIGINAL ARTICLES Top

Study on the prevalence of intestinal parasitic infections and the assessment of the efficacy of albendazole in soil-transmitted helminths in school-going children in East Sikkim p. 18
Sunu Hangma Subba, T Shantikumar Singh
DOI:10.4103/tp.TP_62_18  
Background: The problem of intestinal parasitic infections (IPIs) in children is one of the most worrisome problems worldwide. The latest estimates indicate that more than 880 million children are in the need of treatment for these parasites. Objective: The aim of this study was to measure the prevalence of IPIs in school-going children in East Sikkim, India, and to assess the efficacy of single-dose albendazole (ALB) in children infected with soil-transmitted helminths (STHs). Subjects and Methods: A total of 300 stool samples were collected from the schoolchildren of government schools of East Sikkim. Samples were processed for the identification of IPIs by direct microscopy and formalin-ether concentration method. Fecal egg counting was carried out for STH by Stoll's egg counting technique, pre- and posttreatment with single-dose ALB. The second stool samples were collected 10–14 days posttreatment of ALB. Cure rate (CR) and the fecal egg reduction rate (ERR), the two most widely used indicators for assessing the efficacy of an anthelmintic, were used in this study. The data were analyzed and the results were interpreted statistically. Results: The overall prevalence of the IPIs was 33.9%. Helminthic infection was 4.6% and protozoan infection was 29.3%. Among helminthes Ascaris lumbricoides and among protozoans Entamoeba spp. were the dominant intestinal parasites. For drug efficacy, A. lumbricoides had CR 55.5% and ERR 81.4%. Moreover, for Trichuris trichiura, CR and ERR was 100%. The study has shown less efficacy against A. lumbricoides infections compared to T. trichiura. Conclusion: The study provides useful insight into the current prevalence of IPIs in school-going children in government schools in East Sikkim region. Keeping in view of less efficacy of ALB, it is necessary to keep the monitoring of development of drug resistance simultaneously.
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Asymptomatic malaria carriers and their characterization in hotpops of malaria at Mangalore p. 24
Akash Ramaswamy, Chakrapani Mahabala, Sridevi Hanaganahalli Basavaiah, Animesh Jain, Ravi Raj Singh Chouhan
DOI:10.4103/tp.TP_71_18  
Objective: This study aimed to identify asymptomatic malaria carriers and study the differences in local and migrant population in Mangalore. Materials and Methods: This study was conducted using two-stage cluster sampling. In the first stage, wards were randomly selected. The sample size for each cluster (wards) was determined using the probability proportionate to size method. In the second stage, required number of households was selected using a simple random sampling technique from each cluster. From the selected clusters, samples from 140 participants were collected. Results: Of the 140 cases, 106 (75.7%) were male and 34 (24.3%) were female. Six cases (4.3%) of the 140 cases were positive for malarial parasites, of which gametocytes of Plasmodium falciparum were noted in three cases and schizonts of Plasmodium vivax in three cases. From the total number of cases, 56 (40%) constituted the migrant population and the remaining 84 (60%) were the local population. All the six patients with asymptomatic carriers belonged to the migrant population. Conclusion: A more sound malaria elimination strategy needs to be implemented, for which active surveillance for cases would form a backbone. This study shows that the migrant population seems to show a predilection for asymptomatic malaria, thus targeting malaria elimination programs to areas with a high migrant population would help.
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Endothelial dysfunction in acute acquired toxoplasmosis p. 29
Azhar H Al-Kuraishi, Salah D Al-Windy, Hayder M Al-Kuraishy, Ali I Al-Gareeb
DOI:10.4103/tp.TP_26_19  
Background: Acute toxoplasmosis (AT) which is caused by Toxoplasma gondii (T. gondii) leads to induction of pro-inflammatory and/or oxidative stress changes through activation of host immune response. Therefore, the endeavor of the present study was to assess endothelial dysfunction(ED) and oxidative stress in patients with acute toxoplasmosis. Methods: This study involved 21 patients with AT compared with 20 healthy controls. Serum immunoglobulin levels [IgG], IgM, IgA), Interleukin-6 (IL-6), endothelin-1 (ET-1), and human malondialdehyde (MDA) serum levels were evaluated. Results: IgM, IgG, and IgA levels were high patients with AT as compared with the control (P < 0.01). IL-6, MDA, and ET-1 serum levels were high in patients with AT compared with control (P < 0.01). In patients with AT, IgM serum level was significantly correlated with other immunoglobulin, and with the biomarker of oxidative stress, lipid peroxidation, and ED (P = 0.0001). Conclusion: AT is linked with oxidative stress and pro-inflammatory changes which together provoke ED.
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Soil transmitted helminth infections among school going age children of slums from Bhubaneswar, Odisha p. 34
Ashoka Mahapatra, Nimisha Mohanty, Binod Kumar Behera, Sagarika Dhal, Ashok Kumar Praharaj
DOI:10.4103/tp.TP_30_19  
Objective: The objective is to determine prevalence and risk factors for soil-transmitted helminth (STH) infection among school-going age children from slums of Bhubaneswar. Design: Cross-sectional observational study. Setting: Microbiology laboratory of a tertiary care hospital, Bhubaneswar, during May 1–October 30, 2015 (6 months) including 360 children of 3–15 years from two populated slums of Bhubaneswar, assuming STH prevalence - 50%, confidence interval 95% and 10% relative precision. Purposively sampling by house to house visit was adopted to collect stool samples along with risk factors through questionnaires from each child after written informed consent of parents/guardians. Materials and Methods: Direct saline mount and egg counting by Kato-Katz (KK) method for STH-positive samples was done. Results: STH prevalence was 13.3%, more in males (68.8%), and significantly high (62.5%. P < 0.05) in school-going children between 6 and 12 years of age. Predominant STH was Ancylostoma duodenale(56.2%), 15% of parents were illiterate, 80% of houses had toilets, 70% were washing hand with soap and using footwear. STH infection was much less (12.5%) in those practicing handwashing with soap. Fifty percent of children had STH infection even after receiving deworming within the past 6 months. More egg counts - 216 eggs/gram of feces were found in 29 cases by KK method. Entamoeba histolytica (56.5%) was predominant among non-STH infections. Conclusion: STH prevalence of Bhubaneswar slums was minimum (13.3%), school-going children of 6–12 years were more affected and handwashing habit with soap was the key factor to prevent STH infection. The proportion of participants having toilet facility and using footwear regularly had no role in STH prevention.
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DISPATCHES Top

Eristalis tenax intestinal myiasis: An electron microscope study p. 39
Mona Mohamed Tolba
DOI:10.4103/tp.TP_40_19  
Myiasis is the infestation of live vertebrates (humans or animals) with dipterous larvae. Eristalis tenax, belonging to order Diptera and family Syrphidae, seldom causes accidental myiasis, usually due to ingestion of contaminated food or water by humans. Here, we report a case of intestinal myiasis in a male from Alexandria, Egypt, complaining of frequent passage of small worms in his stool. A larva and a pupa were presented to the laboratory and examined macroscopically, and then studied by a scanning electron microscope. E. tenax (rat-tailed maggots) were diagnosed. Rarely diagnosed worldwide, a case of E. tenax accidental intestinal myiasis was found in a middle-aged adult male from Egypt. A larva and a pupa were identified and studied macroscopically and by scanning electron microscope.
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Microfilaria in achylous hematuria: Can it imitate urolithiasis? p. 44
Tanish Mandal, Suneeta Meena, Rachna Singh, Chandra Shekhar Azad
DOI:10.4103/tp.TP_27_19  
Wuchereria bancrofti is the major species resulting in filarial cases in India. Filariasis may present with various clinical presentations: asymptomatic, microfilaremia, lymphedema, acute adenolymphangitis and chronic lymphatic disease. Microfilariae of W. bancrofti have been detected in various clinical samples, but incidental detection of microfilaria in achylous urine is a rare finding with unexplained pathology. We report a case of microfilaria in achylous urine of a 30-year-old female who presented with pain abdomen and ureteric calculus on ultrasonography.
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Metastatic amebic brain abscess: A rare presentation p. 47
Nitesh Kumar Bauddh, Ranveer Singh Jadon, Piyush Ranjan, NK Vikram
DOI:10.4103/tp.TP_29_19  
Amebiasis is an endemic protozoal infection in developing countries. Extra-intestinal involvement in the form of abscess is frequently seen in liver and lungs. The occurrence of amebic brain abscess is a rare and life-threatening presentation of systemic amebiasis. Here, we report a case of a young male who simultaneously presented with amebic liver and brain abscesses. He was successfully managed with intravenous metronidazole, other antibiotics, and drainage of both brain and hepatic abscesses along with supportive measures. The rare occurrence of this simultaneous presentation of amebic hepatic and brain abscess, prompted us to report this case.
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Pancytopenia induced by secondary hemophagocytic lymphohistiocytosis: A rare, overlooked dreadful complication of Plasmodium vivax p. 50
Sonam Sharma, Leelavathi Dawson
DOI:10.4103/tp.TP_44_19  
Hemophagocytic lymphohistiocytosis (HLH) is an unusual multifaceted clinicopathological entity that often remains misdiagnosed and can be fatal if not timely detected or treated. It can be familial or associated with different types of infections, autoimmune disorders, and malignancies. Parasitic infection-associated HLH has been rarely documented in the literature with only a handful of them being reported due to Plasmodium vivax infection. We describe an extremely rare case of pancytopenia induced by HLH resulting from P. vivax infection in a 7-year-old girl, which posed as a diagnostic challenge and led to a therapeutic delay.
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Coinfection with Hymenolepis nana and Hymenolepis diminuta infection in a child from North India: A rare case report p. 56
Charu Singh, Bhawna Sharma, Aradhana Aneja, Sadhna B Lal, Sumeeta Khurana
DOI:10.4103/tp.TP_47_19  
Hymenolepiasis is considered the most common tapeworm infection throughout the world infecting 50–75 million people. Hymenolepis diminuta infection is not commonly reported in human beings as compared to Hymenolepis nana because it is primarily a parasite of rats and mice. There are few case reports of H. diminuta in the Indian population. To the best of our knowledge, not a single case of coinfection with H. nana and H. diminuta has been reported from India. We present here a rare case report of coinfection of H. nana and H. diminuta in a 4-year-old male child from a semirural area of India who presented with acute and severe colitis.
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Lymphatic filariasis presenting as retroperitoneal cyst p. 59
Prachi M Sancheti, Rahul R Naikwade
DOI:10.4103/tp.TP_73_19  
Filariasis is endemic in the tropical and subtropical regions of the world. Lymphatic filariasis presents commonly as hydrocele, lymphocele, lymphadenopathy, pitting edema, elephantiasis, or subclinical microfilaremia. Here, we present a case of filariasis presenting as a retroperitoneal cyst, which was diagnosed on identification of microfilaria in the cyst fluid and cyst wall.
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LETTERS TO EDITOR Top

Laboratory experience with the development of Fasciolopsis buski eggs p. 62
Arvind Achra, Stuti Kansra, Anuradha Shulania
DOI:10.4103/tp.TP_61_19  
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FACE TO FACE Top

Migratory parasites esp larva migrans and its changing patterns p. 65

DOI:10.4103/tp.TP_20_20  
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CALENDAR OF UPCOMING EVENTS Top

Upcoming event: TROPACON 2020 p. 68
AC Phukan, SC Parija
DOI:10.4103/2229-5070.284613  
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