Malaria is the third leading cause of death due to infectious diseases affecting around 243 million people, causing 863,000 deaths each year, and is a major public health problem. Most of the malarial deaths occur in children below 5 years and is a major contributor of under-five mortality. As a result of environmental and climatic changes, there is a change in vector population and distribution, leading to resurgence of malaria at numerous foci. Resistance to antimalarials is a major challenge to malaria control and there are new drug developments, new approaches to treatment strategies, combination therapy to overcome resistance and progress in vaccine development. Now, artemisinin-based combination therapy is the first-line therapy as the malarial parasite has developed resistance to other antimalarials. Reports of artemisinin resistance are appearing and identification of new drug targets gains utmost importance. As there is a shift from malaria control to malaria eradication, more research is focused on malaria vaccine development. A malaria vaccine, RTS,S, is in phase III of development and may become the first successful one. Due to resistance to insecticides and lack of environmental sanitation, the conventional methods of vector control are turning out to be futile. To overcome this, novel strategies like sterile insect technique and transgenic mosquitoes are pursued for effective vector control. As a result of the global organizations stepping up their efforts with continued research, eradication of malaria can turn out to be a reality.

Neurocysticercosis (NCC) is difficult to diagnose clinically because of its varied clinical presentation. However, an accurate diagnosis is possible only after suspicion on epidemiological grounds, proper interpretation of the clinical data, analysis of the findings on imaging studies, and specific immunological tests on the serum and cerebrospinal fluid (CSF). The diagnosis of NCC by any single parameter thus continues to remain difficult. In the past, detection of NCC was based on autopsy studies and histological confirmation. In recent times, the advent of imaging methods such as computed tomography and magnetic resonance imaging have provided excellent non-invasive tools for easy detection of NCC. Nevertheless, an imaging technique of the brain, although useful, is not considered as a gold standard for the diagnosis of NCC. Serological tests are being increasingly used in adjunct with imaging techniques, to aid the diagnosis of NCC. Immunodiagnostic techniques include detection methods for specific antibodies and for circulating parasite antigens in the serum and CSF. Currently, many of the immunodiagnostic tests, including the enzyme-linked immunosorbent assay and enzyme immunotransfer blot, use purified native antigens for the immunodiagnosis of NCC. Nevertheless, the main problem with the use of native cysticercal antigens is that the native proteins often show cross reactions with sera from humans infected with other parasites. The preparation of native antigens also demand a constant supply of parasitic material from the intermediate host pig. In order to overcome the problems in using native antigens, the recombinant antigens or synthetic peptides, which can be produced under stable conditions, are being evaluated for the serodiagnosis of NCC.

Trichomoniasis is one of the most common sexually transmitted infections (STIs) with a prevalence of 5-75%. In India, trichomoniasis accounts for 2-7% of all STIs. Infection with Trichomonas vaginalis is known to cause vaginitis. Significant association has also been noted between trichomoniasis and cervical cancer, atypical pelvic inflammatory disease, infertility, low birth weight, and respiratory-tract infection in neonates. Of interest are the recent documentations of association of this parasite with human immunodeficiency virus. Use of fluorescent dyes such as acridine orange has increased the sensitivity of the direct microscopy. Culture has been found to be more sensitive than the direct microscopy but has its own limitations. Antigen detection systems have hastened the proce ss of diagnosis tremendously. Molecular methods have been found to be very sensitive and specific. Once the presence of T. vaginalis has been documented, other STIs should also be actively looked for in that particular individual. Therapy should involve both the partners for proper control and eradication of the disease.

Background: Periplasmic serine proteases of HtrA type of Wolbachia have been shown to play a role in the pathogenesis of filarial disease. Aims: This study was aimed to sequence Wb-HtrA serine protease and analyze its phylogenetic position by comparing with other filarial and non-filarial nematode homologs. Materials and Methods: Partial HtrA gene fragment was amplified from DNA isolated from periodic and sub-periodic Wuchereria bancrofti parasites collected from Pondicherry and Nicobar islands, respectively. The amplicons were sequenced, and sequence homology and phylogenetic relationship with other filarial and non-filarial nematodes were analyzed. Results: Partial orthologue of HtrA-type serine protease from Wolbachia of W. bancrofti was amplified, cloned and sequenced. The deduced amino acid sequence exhibited 87%, 81% and 74% identity with the homologous Wolbachia proteases identified from Brugia malayi, Onchocerca volvulus and Drosophila melanogaster, respectively. The Wb-HtrA has arthologues in several proteobacteria with very high homology and hence is highly conserved not only among Wolbachia of filarial parasites but also across proteobacteria. The phylogenetic tree constructed using Neighbor-Joining method showed two main clusters: cluster-I containing bacteria that dwell in diverse habitats such as soil, fresh and marine waters and plants and cluster-II comprising Anaplasma sp. and Erlichia, and Wolbachia endosymbionts of insects and nematodes, in distinct groups. Conclusions: HtrA-type serine protease from Wolbachia of W. bancrofti is highly conserved among filarial parasites. It will be of interest to know whether filarial Wolbachia HtrA type of serine protease might influence apoptosis and lymphatic epithelium, thereby playing a role in the filarial pathogenesis. Such information will be useful for identifying targets for the development of newer drugs for filariasis treatment, especially for preventing lymphatic pathology.

Objective: The short-term objective of our endeavour was to understand the perception of Grama panchayat presidents and secretaries on the issues related to malaria and its control, being the key leaders of the Panchayat Raj Institutions (PRIs) at a Grama panchayat level. This was necessary to achieve the long-term objective of the role of PRIs in malaria control and their enhanced participation/partnership with the public health sector. Materials and Methods: Grama panchayat presidents and secretaries representing all the 28 Grama panchayats of Chikkanayakanahalli taluk Tumkur district in Karnataka were invited for a 1-day workshop. Deliberations with the participants (n = 32) shed light on their perceptions with respect to knowledge, attitude and practice vis-a-vis malaria and its control strategies. Results: Their knowledge of malaria as a disease was fairly good as they were well aware of it being a communicable disease and its transmission by mosquitoes. However, knowledge about the breeding sources of malaria mosquitoes (Anophelines) was very poor. Many practices in vogue to control mosquitoes at the community level were unscientific. There was a general negative attitude toward the government's handling of the malaria problem and the credibility of the health care system. Conclusion: Existence of health committees in every Grama panchayat coupled with their jurisdiction and responsibilities toward sanitation, water supply and health care resources makes PRIs a natural partner to the health sector. While health education and public health intervention strategies should be based on generic principles of science, the implementation and operational specifics should definitely be based on a sociological perspective of the stakeholders.

Background: Intestinal parasitic infections (IPIs) are endemic worldwide and have been the cause of illness and disease worldwide. Objectives: The study is aimed to estimate prevalence, intensity, and factors associated with IPIs among school children aged 6-12 years. Materials and Methods: This cross-sectional survey was carried out from February to July 2010, in the diagnostic laboratory of Microbiology department. The study group was divided into four groups, namely, Group A; Group B; Group C; and Group D. A total of 1769 eligible children were enrolled for sampling from these schools. For each enrolled child in the study, a standard stool ova and parasite test with formol-ether concentration technique was done for the assessment of the outcome. Results: Among 1224 participants, 714 (58.3%) were boys and 508 (41.5%) were girls. The overall prevalence of IPIs was estimated as 51.5%. Group A 84%, Group B 64.7%, Group C 62.4%, and Group D 39.3%. Single IPIs were 65.7%, among which 48% were helminthic and 19.3% were protozoan. Multiple IPIs were 34.2%, among which protozoan along with helminthic were 25.9%, polyhelminthic were 8.5% and polyprotozoan were 4.2%. Among the IPIs detected, overall prevalence of helminth was 75.9%, protozoan was 24.1%. Among the helminthes hookworm was highest (28%). Among the protozoan Entamoeba histolytica/dispar was highest (14.8%). Conclusions: The study confirmed that prevalence of IPIs is high as 51.5%. Overall prevalence shows an endemic situation. Therefore, it is recommended that local health sectors should make provision for regular examination of parasitosis and deworming.

Background: Simple and rapid latex-based diagnostic tests have been used for detecting specific antigens or antibodies in several diseases. Aims: The aim of the present study was to standardize and evaluate the latex agglutination test (LAT) for the detection of Taenia solium metacestode antigen in the cerebrospinal fluid (CSF) and serum for the diagnosis of neurocysticercosis (NCC). Settings and Design: The study was conducted at Department of Microbiology, Jawaharlal Institute of Post graduate medical education and research after obtaining informed consent from the study subjects. Materials and Methods: In the present study, CSF and serum samples were collected from clinically suspected NCC, CT/MRI proven cases of NCC, non-cysticercal central nervous system infection control and from healthy control subjects. CSF was not collected from healthy controls. Polyclonal antisera raised in rabbits against porcine T. solium metacestode complete homogenate antigen, was used in the LAT to detect the antigen in the specimens. Statistical Analysis Used: The statistical analysis was carried out using Epi Info. The sensitivity, specificity, positive predictive value, and negative predictive value of the LAT were calculated. Results: The LAT exhibited sensitivity of 64.7% and specificity of 85.7% with CSF samples and sensitivity of 52.08% and specificity of 96% with serum samples. Conclusions: Results of the present study shows that the LAT can be employed as a moderately sensitive and specific test for the detection of T. solium metacestode antigen in the CSF and serum specimens for the diagnosis of NCC in poorly equipped laboratories.

Background: A survey of Schistosoma haematobium infection in Epe, an urban community in Lagos State, Southwest Nigeria, was carried out to ascertain the possibility that schistosomiasis, otherwise considered a rural disease, could reach urban populations. Materials and Methods: About 100 ml of voided urine samples from 200 pupils aged 6-13 years [109 (54.5%) males and 91 (45.5%) females], attending an Anglican primary school, Ebute Afuye, and a community primary school, Erepoto, were examined parasitologically for hematuria and S. haematobium ova following informed consent obtained from their parents/guardians. All samples were screened using polymerase chain reaction (PCR) amplification of the schistosome Dra1 gene. Fourteen Bulinus snails collected from the two sites, Ebute Afuye (6) and Erepoto (8), were screened for schistosome infection by the PCR amplification of the schistosome Dra1 gene. PCR-RFLP of the snails' its region was analyzed for species identification and a subregion of the cox1 gene from four infected snails (two from each site) was amplified and sequenced. Results: In the Anglican primary school, Ebute Afuye, and community primary school, Erepoto, 16% and 29% were positive for hematuria, and 16% and 17% had schistosome ova, respectively. PCR analysis showed that 57% and 40% were positive for the infection in Anglican primary school, Ebute Afuye, and community primary school, Erepoto, respectively. PCR screening of the snails confirmed that four from Ebute Afuye and three from Erepoto were infected with schistosomes. PCR-RFLP showed that all the 14 snails were Bulinus truncatus while phylogenetic analysis of the sequenced partial cox1 gene corroborated the PCR-RFLP results. Conclusions: There was a high prevalence of S. haematobium infection among the participants detected by PCR, which was able to detect infection in cases otherwise shown to be negative by hematuria. We also observed that B. truncatus is one of the snail species responsible for the transmission of urinary schistosomiasis in the Epe community. For national control programs, it is very important that trends in the prevalence and intensity of schistosomiasis in urban cities be monitored.

Background: Survey on the prevalence of various intestinal parasitic infestations in different geographic regions is a prerequisite to obtain an accurate understanding of the burden and cause of intestinal parasitic infestations in a particular area. The aim of the present study was to determine the intestinal parasitic infestation among children in a semi-urban area. Materials and Methods: A total of 335 stool samples were collected, processed, and microscopically examined for intestinal parasites. Results: One hundred twenty-eight (38%) stool samples showed presence of ova/cysts. Multiple parasites were seen in 42 (32.8%) samples. Among the protozoans, Entamoeba histolytica (55.3%) was the most common followed by Giardia lamblia (40.4%). Ascaris lumbricoides and Hymenolepis nana (24.2%) were the most common helminths detected. Conclusions: In most of the cases, intestinal parasitic infestation spreads due to low standards of personal hygiene, poor sanitation, non-usage of toilets and an illiterate population, thus suggesting regular surveys to help in devising optimum methods of control.

Background: Several governmental efforts have been exerted toward controlling schistosomiasis during the last decades in Egypt. This work was designed to study the prevalence of colorectal schistosomiasis in patients with different gastrointestinal symptoms. Materials and Methods: Patients presented to the gastroenterology unit with different gastrointestinal symptoms were endoscopically examined, where three to six tiny biopsies were taken from those with visible, suspected schistosomal lesions for histopathological examination and two additional rectal biopsies were taken from the apparently normal colonic mucosa. Form each patient, at least three stool samples were examined by the formal-ether concentration method for schistosoma ova. Results: Colonic abnormalities were detected in 510 out of 984 patients presented with different gut symptoms. Schistosoma mansoni was detected in 205 patients (180 males, 25 females) with an age range (18-65years). Six patients only had schistosomal polyps and excised successfully by snare polypectomy. The squash technique established the diagnosis of schistosomiasis in all endoscopically normal 118 (50.75%) cases by demonstrating the schistosomiasis ova and their associated histopathological findings showed no or minimal reaction in 96 (46.82%) cases and variable degrees of submucosal granulomata in the remaining cases. Stool examination detected the schistosomiasis ova in 25 (9.83%) patients only of the biopsy-positive cases. Conclusions: Our data revealed that despite governmental efforts, the prevalence of colorectal schistosomiasis (20.83%) is significant among patients with gut symptoms. Gaps in health care services should be detected and filled appropriately.

Cysticercosis is endemic in India. Neurocysticercosis most commonly affects the brain parenchyma, which presents as focal lesions with the surrounding edema which later calcify. Rarely, it may affect the ventricular system and subarachnoid spaces and this form is known as racemose cysticercosis. We present magnetic resonance findings in a case of racemose cysticercosis.

Entrapped temporal horn is due to obstruction of one lateral ventricle in the region of trigone causing dilatation of the temporal horn. The isolated temporal horn presents itself as mass lesion. Intraventricular hydatid cyst presenting as an entrapped temporal horn has not been reported in literature till now. We report two cases of intraventricular hydatid cyst causing entrapped temporal horn.

Human ocular infestation by a live filarial adult worm is a rare occurrence. We report a case of ocular infestation of a female adult Brugia malayi. A 35-year-old female presented with chief complaint of severe headache, blurring of vision, redness, and lacrimation since one year. On examination, there was conjunctival chemosis, congestion, and white-colored worm with wriggling movement in the anterior chamber of eye. The worm removed by paracentesis of anterior chamber. Identification basing on typical morphology showed to be adult female B.malayi, and was confirmed by immunochromatographic test. The patient responded completely to diethylcarbamazine treatment. Live adult worm in the anterior chamber of eye is uncommon in India; nevertheless, ophthalmologists should be aware of this clinical manifestation and go for a proper identification of the worm.

In tropical and subtropical countries, parasitic infections are very rampant causing peripheral blood and or tissue eosinophilia. Here, a case of microfilaria in lymph node that produced intense eosinophil infiltrate is being reported. The dense eosinophil collection in the lymph node raised a possibility of Kimura's disease because no worms were seen in the initial sectioning of the tissue. Extensive sampling and diligent search revealed sections of microfilaria embedded in the eosinophil abscess along with foreign body giant cell reaction to its sheath material, leading to the correct diagnosis of this case.

Hydatid disease caused by Echinococcus granulosus is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur following a rupture of the hydatid cyst into the peritoneal cavity producing secondary echinococcosis. Rarely, the cyst may develop de novo in the peritoneal cavity without the involvement of any other intra-abdominal organ. We present a unique case of a 57-year-old man with a primary intra-abdominal hydatid cyst.

The larval form of the parasite Echinococcus granulosus causes a hydatid cyst. The most common sites are liver and lungs. We present an unusual case of an isolated primary hydatid cyst of the spleen. In our case, ultrasonography images of the spleen were not suggestive of hydatid disease except a large cystic lesion. We proceeded to conservative splenectomy that detected hydatid cyst incidentally during operation. This issue is considered common in our geographical area. A high suspicion of this disease is justified in endemic regions. Moreover, medical treatment should precede and follow the surgical intervention.

Filariasis is major public health hazard particularly in tropical countries like India. The presence of microfilaria using fine needle aspiration cytology has been reported from various sites. However, the presence of the adult gravid filarial worm with a surrounding host response has rarely been reported on breast aspirates. Here, we report a unique case in which aspiration cytology from a breast lump clinically suspicious of fibroadenosis of the breast, showed adult filarial worms with numerous microfilariae and a granulomatous inflammatory host response. The filarial worm appears to be ubiquitous in endemic areas, and the presence of an unexplained granulomatous lesion in breast should prompt a careful consideration of the filarial etiology in our country. Therapy with diethylcarbamazine, albendazole, and antibiotics are sufficient for treatment of this type of lesion.

Hepatic hydatidosis is common in many parts of our country. Largest cyst reported measured 37 × 14.88 × 15.4 cm. We encountered a case of giant hepatic hydatid cyst arising from the left lobe of liver, measuring 45 × 35 × 25 cm. It was completely occupying the peritoneal cavity and had a narrow pedunculated attachment to the liver. This hydatid cyst is larger than the largest reported cyst. Also, a pedunculated hydatid cyst has never been reported. Hence, the report.

Hydatid cysts usually involve the liver; extrahepatic localization is reported in 11% of all cases of abdominal hydatid disease. Cyst at unusual localization includes kidney, heart, spleen, pancreas and brain. Isolated involvement of muscle is also rare in children. Here is a case of hydatid cyst in a female child involving the rectus abdominis muscle, which is a very rare presentation. There were no cysts in any other location. Serological tests were negative for cystic echinococcosis. The patient was operated on and the cyst was completely excised. The pathologic examination confirmed the diagnosis of hydatid cyst.

We report a rare case of ascariasis of gall bladder. The unusual features in this case were the presence of eggs of Ascaris lumbricoides in the lumen. Some of the eggs had evoked a foreign body reaction indicating chronicity. The bladder wall was unevenly thickened with yellowish white nodules and showed maximum thickness around the neck region. Microscopy showed predominantly xanthogranulomatous inflammation in the thickened parts of the wall.

A 25-year-old transgender patient came with complaints of watery discharge, red eye and photophobia in the left eye since 2 days. The patient had a history of wearing colored contact lenses since 4 years and cleaning the lens with tap water. Culture of lenses on Mac Conkey and blood agar yielded Klebsiella pneumoniae and Pseudomonas aeruginosa. Sabouroud's agar showed yeast cells and double-walled cysts of Acanthamoeba species. On further incubation of Sabouroud's agar, the cysts transformed to trophozoites. Parallel results were obtained on tap water agar. The previous therapy of moxifloxacin was changed to local Neosporin application.