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   Table of Contents - Current issue
Coverpage
July-December 2017
Volume 7 | Issue 2
Page Nos. 61-132

Online since Monday, September 25, 2017

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EDITORIAL  

Intestinal helminths – An old foe revisited p. 61
Subhash Chandra Parija
DOI:10.4103/tp.TP_53_17  
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ETHICS IN SERIES Top

Ethics of translational medical research p. 62
Jharna Mandal, Dinoop Korol Ponnambath, Subhash Chandra Parija
DOI:10.4103/tp.TP_47_17  
Translational research is the science of application of basic research knowledge to develop novel methods of improving public health outcome. This review briefly discusses the various phases involved and the hurdles faced in the translational pathway, how translational science originated, and the infrastructures consigned for translational research. Translational research also faces numerous diverse ethical issues similar to those observed in biomedical research. The various types of ethical issues faced whereas conducting translational research are discussed briefly in this review to help researchers identify and prevent unethical practices while conducting or regulating translational research.
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REVIEW ARTICLES Top

Use of evidence for clinical practice guideline development p. 65
Soumyadeep Bhaumik
DOI:10.4103/tp.TP_6_17  
Clinical practice guidelines provide a framework against which quality of care is measured. Recommendations contained within guidelines are used for decision-making not only within the clinical domain but also other related issues within the health systems. As such the use of research evidence for formulating recommendations contained in a guideline is a global standard to ensure guideline quality. The paper briefly reviews how the need for and use of evidence in guideline development shaped up historically and then provides an overview of the four typologies of guideline development mechanisms at the country level.
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Cryptosporidiosis: A mini review p. 72
K Vanathy, Subhash Chandra Parija, Jharna Mandal, Abdoul Hamide, Sriram Krishnamurthy
DOI:10.4103/tp.TP_25_17  
Cryptosporidium spp. was first described in mice in 1907. The first human case was reported in an acquired immune deficiency syndrome patient after which it gained importance. It is one of the emerging protozoan parasites according to the Centre of Disease Control and Prevention. The special structure which is present in them such as rhoptries and micronemes are responsible for their virulence and pathogenicity. They can be transmitted from animals, human to human, water, food, and tends to cause waterborne outbreaks. The clinical manifestation in immunocompetent patient is self-limiting when compared to immunocompromised individual where it causes chronic diarrhea not responding to treatment. Hence, it is necessary to diagnose them early to prevent any complication in these patients. There are many investigations currently available such as stool microscopy after Sheather's concentration technique, rapid test targeting specific antigen, molecular methods, and imaging techniques.
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SYMPOSIUM Top

Epidemiology and clinical features of soil-transmitted helminths p. 81
Subhash Chandra Parija, Meenachi Chidambaram, Jharna Mandal
DOI:10.4103/tp.TP_27_17  
Soil-transmitted helminths (STH) consist of Ascaris lumbricoides, Trichuris trichiura, and hookworm (Necator americanus and Ancylostoma duodenale). It affects nearly 1.7 billion people globally in which Ascaris contributes nearly 1.2 billion cases. The main mode for transmission of Ascaris and Trichuris is through contaminated food and water, whereas hookworm transmitted by skin penetration. STH were mainly seen in areas with poverty, overcrowding, and poor sanitation. The prevalence is more in rural areas compared to urban areas. It affects mainly children and causes lack of school attendance, anemia, and cognitive deficits. This review emphasizes on the epidemiology and clinical features of all STH and emphasizes on the role on preventive measures in containing STH.
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Laboratory diagnosis of soil transmitted helminthiasis p. 86
Sumeeta Khurana, Shveta Sethi
DOI:10.4103/tp.TP_29_17  
Soil-transmitted helminths (STHs) include, i.e., hookworms (Ancylostoma duodenale, Necator americanus), roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and Strongyloides stercoralis. Globally, around 1.5 billion people are infected with STHs. STHs contribute to significant impairment of mental and physical growth, especially in developing countries. Unfortunately, these infections mostly remain undiagnosed due to lack of trained personnel and appropriate technologies. Intermittent shedding of eggs or larvae further makes the diagnosis difficult. Thus, there is a dire need of rapid and accurate tests for the diagnosis of STHs. The diagnostic methods include conventional and molecular methods. Conventional methods include microscopy, culture, and egg counting. Serology has a role, especially in case of S. stercoralis where conventional methods have very poor sensitivities. The rapid, highly sensitive molecular techniques, particularly quantitative polymerase-chain reaction make it suitable for diagnosing STH over insensitive as well as labor-intensive conventional methods. Until now, molecular detection of STH was mainly restricted to the research setting, but now, there is recommendation of adopting molecular tests in the World Health Organization STH elimination programs. Thus, STH infections are important public health problems and should be appropriately diagnosed and managed to reduce the mortality and morbidity significantly.
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ORIGINAL ARTICLES Top

Morphological and histological analysis of Cotylophoron cotylophorum treated with Acacia concinna p. 92
P Priya, L Veerakumari
DOI:10.4103/tp.TP_65_16  
Objective: Paramphistomosis (stomach fluke disease) is a parasitic infection caused by digenetic trematodes and is considered to be one of the most important parasitic diseases affecting livestock worldwide. This disease is widely prevalent in India, and the highest incidence is reported during monsoon and post-monsoon months. In the present study, in vitro effect of aqueous extract of pods of Acacia concinna (AcP E) on the morphology and the histology of the digenetic trematode Cotylophoron cotylophorum have been investigated. Materials and Methods: The in vitro effect of Ac PE on the morphology and the histology of a digenetic trematode C. cotylophorum have been examined using scanning electron microscopy (SEM), transmission electron microscopy (TEM) and light microscopic techniques. Results: The SEM micrograph of treated flukes showed the appearance of few blebs near the oral region and rupture of the dorsal surface of the tegument. The light and TEM observations revealed significant deleterious changes in the internal organization of the fluke. Severe injury to the tegument due to bleb formation, detachment of tubercles, and vacuolization of the subtegumental region was observed. Nuclear indentation, cytoplasmic autolysis, and mitochondrial abnormalities were the other prominent observations. Conclusion: The results of the present study convincingly showed that Ac PE is an effective anthelmintic causing detrimental effect to C. cotylophorum and appears to be a potent phytotherapeutic agent to control paramphistomosis.
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Prevalence of trypanosome infection in tsetse flies from Oji River and Emene axis of Enugu State, Nigeria: A preliminary report p. 98
Kenechukwu Chibuike Onyekwelu, Fidelis Ebele Ejezie, Anthonius Anayochukwu Eze, Joy Ebele Ikekpeazu, Richard Chukwunonye Ezeh, Godknows Chizurumoke Edeh
DOI:10.4103/tp.TP_14_17  
Introduction: Trypanosomes are protozoan parasites of vertebrates transmitted by blood-sucking tsetse fly. Trypanosomes remain a constant threat to the lives of humans and animals throughout large regions of Africa. Aims and Objectives: This study investigated the presence, prevalence, and species of trypanosome parasite in tsetse flies caught in two areas of no previous documented history of trypanosome infection. Materials and Methods: For this purpose, 63 and 77 nonterenal tsetse flies were collected from Oji River and Emene areas of Enugu State Nigeria, respectively. Genomic DNA was isolated from the whole tsetse fly using genomic DNA extraction kit. Identification and characterization of trypanosome were done using two approaches: the amplification of internal transcribed spacer 1 of ribosomal DNA and the use of primers specific to Trypanozoon. Results: In Oji River, of 63 tsetse flies collected, the identification of trypanosome parasite was done on 57 flies and 6 (10.71%) tsetse flies were infected with trypanosome parasite. Six flies were infected with Trypanosoma Congolense, 2 with Trypanosoma Vivax, and 1 with Trypanosoma brucei. Two mixed infections of T. vivax and T. congolense and 1 mixed infection of T. brucei and T. congolense was also identified. In Emene, of 77 tsetse flies collected, the identification of trypanosome parasite was done on 66 flies and 11 (16.6%) tsetse flies were infected with trypanosome parasite. Nine flies were infected with T. congolense, 2 with T. vivax, and 3 with T. brucei. Mixed infections identified include 2 mixed infections of T. brucei and T. congolense and 1 mixed infections of T. vivax and T. brucei. None of the subspecies of T. brucei were detected using species specific primers. Discussion: This study shows the parasitological evidence on the occurrence of animal African trypanosomiasis and also demonstrated that there is likely no active transmission of human African trypanosomiasis in the study areas. Conclusion: This study shows that there is likely no active transmission of human African trypanosomiasis going on in these localities since no human infective form of the parasite was detected.
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Seroprevalence of human cystic echinococcosis from North India (2004–2015) p. 103
Kamran Zaman, Abhishek Mewara, Sunil Kumar, Kapil Goyal, Sumeeta Khurana, Praveen Tripathi, Rakesh Sehgal
DOI:10.4103/tp.TP_15_17  
Context: Cystic echinococcosis (CE) caused by Echinococcus granulosus is a disease of a significant burden in India. The World Health Organization recommends the use of hospital data for population surveillance to measure the prevalence of CE. Aim: The aim of this study was to estimate the seroprevalence of CE and to compare with previous prevalence rates to estimate the changing pattern in seroprevalence of CE. Materials and Methods: A retrospective analysis of laboratory data of 3929 clinically and/or radiologically suspected cases of CE was carried out for 12 years from 2004 to 2015 and compared to the previous data from 1984 to 2003. The seroprevalence of anti-hydatid immunoglobulin G (IgG) was assessed by enzyme-linked immune sorbent assay. Casoni's intradermal skin test and microscopy on aspirated hydatid cyst fluid were also done. The statistical significance was assessed using Chi-square test and Fisher's t-test. Results: Of the 3929 samples, 1124 (28.6%) were positive for specific anti-hydatid IgG antibody response, while of the 121 tested by Casoni's test, 56 (46.3%) were positive. The seropositivity of CE over the period of 12 years is rising. As compared to our previous data from 1984 to 2003, an overall significant increase in seropositivity was observed during 2004–2015 (28.6% vs. 15.0% in 1984–2003, P < 0.0001). Conclusions: This study emphasizes the necessity of continuous surveillance and integrated control measures to prevent CE in humans and livestock across the country.
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Chitinase-gene-based analysis of the genetic variability among the clinical isolates of Entamoeba dispar from Puducherry, India p. 107
Selvarathinam Ajay Philips, Kumar Manochitra, Subhash Chandra Parija
DOI:10.4103/tp.TP_31_17  
Introduction: Amebiasis is known to be caused by the protozoan parasite Entamoeba histolytica. Entamoeba dispar is considered to be a sibling species of E. histolytica, as the two are phylogenetically closest. There are reports that certain strains of E. dispar isolated were capable of causing hepatic lesions in the experimental animal models. The intra-/inter-species genetic variation has been found to have profound implication in the invasiveness of the disease. Thus, studying polymorphism in E. dispar aids to improve our perspective related to the variability in the genome of the parasite. Materials and Methods: The highly polymorphic region of the gene encoding the enzyme chitinase was targeted for the strain variation analysis in E. dispar. Isolates from the stool and liver abscess aspirate were subjected to the polymerase chain reaction (PCR) for the amplification of the targeted polymorphic loci. The PCR products were sequenced, and genetic variability analysis was carried out. Results: A total of 23 samples in the stool and 1 sample from liver abscess pus were positive for E. dispar by nested multiplex PCR which was confirmed by sequencing. Of these positive samples, 13 amplified for chitinase gene by PCR. We observed seven genotypes in our study isolates, of which four were found to be distinct. Conclusion: This study shows that high degree of genetic variation exists among the clinical isolates of E. dispar in our location. The future studies including the analysis of other genetic makers such as serine-rich E. dispar protein or other loci have to be carried out to get an idea about the distribution of the different strains of E. dispar.
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Evaluation of the utility of conventional polymerase chain reaction for detection and species differentiation in human hookworm infections p. 111
Meenachi Chidambaram, Subhash Chandra Parija, Pampa Ch Toi, Jharna Mandal, Dhanalakshmi Sankaramoorthy, Santosh George, Mailan Natarajan, Shashiraja Padukone
DOI:10.4103/tp.TP_26_17  
Background: Human hookworm infection is caused mainly by Necator americanus and Ancylostoma duodenale. Among the zoonotic hookworm species, only Ancylostoma ceylanicum causes potent human infections where dogs and cats act as reservoir of infection. Hence, species differentiation is imperative because the eradication of both anthroponotic and zoonotic hookworm depends on the concurrent human and animal health programs, hygienic practices, and mass drug administration for humans and dogs. Objective: This study was performed to evaluate the utility of polymerase chain reaction (PCR) for detection of hookworm infections. Materials and Methods: A total of 209 stool samples were collected and subjected to stool microscopy, Kato-Katz method to identify the intensity of the infection, coproculture for L3 larval identification and species differentiation and semi-nested PCR with sequencing. Results: The prevalence of hookworm was estimated as 7.6%. Highest hookworm prevalence was seen in 20–30 years of age group. Majority of the infections were mild intensity infections. Sensitivity of stool microscopy was found to be 81.2% and the specificity was 100%. Sensitivity of Kato-Katz method was 87.5% and specificity was 100%. True positivity by agar plate culture was 83.3% and false positivity rate was 16.6%. Conclusion: Stool microscopy is the major mode of detection, but it has a higher false negative rate. Coproculture is time-consuming and needs the expertise to differentiate the species. On the other hand, PCR is known to be a sensitive, specific, and a reliable investigative tool which can help in diagnosis as well as in species differentiation.
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LETTERS TO EDITOR Top

Reactive arthritis associated with Strongyloides stercoralis: Report of an uncommon relation p. 117
Srujana Mohanty, Madhusudan Samprathi, Sucheta Parija
DOI:10.4103/tp.TP_9_17  
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Enterobius vermicularis infestation of urinary tract leading to recurrent urinary tract infection p. 119
Sunirmal Choudhury, Barun Kumar, Dilip Kumar Pal
DOI:10.4103/tp.TP_22_17  
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DISPATCHES Top

Severe Blastocystis subtype 3 infection in a patient with colorectal cancer p. 122
Shashiraja Padukone, Jharna Mandal, Subhash Chandra Parija
DOI:10.4103/tp.TP_87_15  
Colorectal cancer (CRC), more of lifestyle-related disorder, is one of the deadliest types of cancer across the globe. Nevertheless, infectious agents could be responsible for 20% of cancer. Recent findings have indicated the association of Blastocystis in CRC and recommend routine screening for Blastocystis. Herein, we describe a case of CRC with severe Blastocystis infection.
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Giardiasis mimicking celiac disease in a patient of common variable immunodeficiency p. 125
Kumar Saurabh, Vijaya Lakshmi Nag, Daisy Khera, Poonam Elhence
DOI:10.4103/tp.TP_45_16  
An adolescent boy presented to pediatrics outpatient department with complaints of recurrent diarrhea, nausea, vomiting, and pedal edema since 3–4 months, with no relief even after taking treatment. His investigation revealed decreased serum IgA, IgG, and IgM levels with hypoproteinemia. Duodenal biopsy showed features of celiac disease (CD), but tissue transglutaminase IgA was negative. In stool examination, plenty of Giardia lamblia cysts and eggs of Hymenolepis nana were present. He improved on treatment and remained asymptomatic for 4 months. However, he again developed symptoms and succumbed to his illness. In patients of common variable immunodeficiency (CVID), who present with features of CD, coinfection, especially with G. lamblia and other parasites must always be kept in mind. The aim is to report a case of recurrent giardiasis with CVID mimicking CD from Western Rajasthan, India.
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FACE TO FACE Top

An E-mail Interview with Prof. Gagandeep Kang p. 128

DOI:10.4103/tp.TP_30_17  
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CALENDAR OF UPCOMING EVENTS Top

Calendar of upcoming events in parasitology - 2017 p. 131
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