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   2017| January-June  | Volume 7 | Issue 1  
    Online since March 16, 2017

 
 
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SYMPOSIUM
Revisiting the global problem of cryptosporidiosis and recommendations
Arpit Kumar Shrivastava, Subrat Kumar, Woutrina A Smith, Priyadarshi Soumyaranjan Sahu
January-June 2017, 7(1):8-17
DOI:10.4103/2229-5070.202290  PMID:28459010
Cryptosporidiosis is a gastrointestinal illness caused by the protozoan parasite Cryptosporidium species, which is a leading cause of diarrhea in a variety of vertebrate hosts. The primary mode of transmission is through oral routes; infections spread with the ingestion of oocysts by susceptible animals or humans. In humans, Cryptosporidium infections are commonly found in children and immunocompromised individuals. The small intestine is the most common primary site of infection in humans while extraintestinal cryptosporidiosis occurs in immunocompromised individuals affecting the biliary tract, lungs, or pancreas. Both innate and adaptive immune responses play a critical role in parasite clearance as evident from studies with experimental infection in mice. However, the cellular immune responses induced during human infections are poorly understood. In this article, we review the currently available information with regard to epidemiology, diagnosis, therapeutic interventions, and strategies being used to control cryptosporidiosis infection. Since cryptosporidiosis may spread through zoonotic mode, we emphasis on more epidemiological surveillance-based studies in developing countries with poor sanitation and hygiene. These epidemiological surveys must incorporate fecal source tracking measures to identify animal and human populations contributing significantly to the fecal burden in the community, as mitigation measures differ by host type.
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ETHICS IN SERIES
Bioethics: A brief review
Jharna Mandal, Dinoop Korol Ponnambath, Subhash Chandra Parija
January-June 2017, 7(1):5-7
DOI:10.4103/tp.TP_4_17  PMID:28459009
Medical and life sciences research is a key driver in development, which leads to better quality of life. These pursuits can lead to discrimination, human rights violation, and injustice. The field of bioethics explores the ethical issues arising due to these advances in research and encompasses social, judicial, and environmental aspects affecting human beings. This brief review discusses the origin of bioethics, its principles, various international organizations, and their network involved in the development and propagation of guidelines on conducting biomedical research.
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SYMPOSIUM
Cryptosporidiosis in children in the Indian subcontinent
Malathi Murugesan, Santhosh Kumar Ganesan, Sitara SR Ajjampur
January-June 2017, 7(1):18-28
DOI:10.4103/tp.TP_2_17  PMID:28459011
Cryptosporidiosis is a leading cause of diarrheal disease among children under two in developing countries. Previous estimates have shown a high burden of cryptosporidial diarrhea in children from Sub-Saharan Africa and South Asia. Asymptomatic cryptosporidial infections which go undetected and untreated have been shown to result in significant malnutrition. In this review, we carried out a literature search of studies published on cryptosporidiosis in children in the Indian subcontinent from 1983 to 2016. Of the 154 publications identified, 54 were included for final analysis with both hospital-based and community-based studies. There were wide variations in reported prevalence rates from hospital studies and highlight the need to be carry out these studies with uniform sampling and molecular tools for detection, especially in countries with a dearth of information. Community-based studies, however, showed similarities in spite of differences in when (the late 1990s up until recently) and where (South India or Bangladesh) they were conducted. When more sensitive detection methods were used, cryptosporidial diarrhea accounted for 7%–9% of all diarrhea episodes and 20%–30% of children in these cohorts experienced at least one cryptosporidial diarrheal episode. High rates of asymptomatic infections with increased detection by serology and multiple infections (symptomatic and asymptomatic) were also documented in all cohorts. This overview brings to light the high burden of disease associated with cryptosporidiosis in children in the subcontinent and the gaps in knowledge to be addressed.
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ORIGINAL ARTICLES
Detection of Cryptosporidium in stool samples of immunocompromised patients
K Vanathy, Subhash Chandra Parija, Jharna Mandal, Abdoul Hamide, Sriram Krishnamurthy
January-June 2017, 7(1):41-46
DOI:10.4103/tp.TP_66_16  PMID:28459014
Introduction: Cryptosporidium species is the most common opportunistic enteric parasite encountered in the immunocompromised patients. Considering the need to diagnose them early relies mostly on rapid tests such as antigen detection by immunochromatographic test (ICT), ELISA, and microscopy. However, the sensitivity and specificity varies with different methods and different kits used. This study was conducted to determine the intestinal parasitic profile in immunocompromised patients and to assess the diagnostic accuracy of the ICT using ImmunoCard STAT kit in detecting Cryptosporidium spp. Materials and Methods: The patients in this study were divided into two groups: one group was immunocompromised patients (n = 73) and the other was nonimmunocompromised individuals (n = 73). Stool microscopy, ICT, and polymerase chain reaction (PCR) were carried out for all stool samples. Results: Totally, 4 (5.4%) of 73 patients of the study group were positive for Cryptosporidium. The species detected were Cryptosporidium parvum and Cryptosporidium hominis. PCR was taken as gold standard in the current study. PCR detected Cryptosporidium in four samples while ICT in two samples and microscopy in one sample. Conclusion: Cryptosporidium was found to be the most common enteric parasite in the immunocompromised patients studied, followed by Cystoisospora, Entamoeba histolytica, and Strongyloides stercoralis. Although the ICT is a rapid test, it was less sensitive and more expensive in comparison to the PCR; hence, its utility appears to be limited in our setting.
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GUEST COMMENTARY
Guest commentary: Plasmodium knowlesi-need to diagnose in India
Abhishek Mewara, Rakesh Sehgal
January-June 2017, 7(1):2-4
DOI:10.4103/2229-5070.202287  PMID:28459008
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DISPATCHES
Cystic echinococcosis: A neglected disease at usual and unusual locations
Soma Sarkar, Himansu Roy, Puranjay Saha, Mallika Sengupta, Krisnendu Sarder, Manideepa Sengupta
January-June 2017, 7(1):51-55
DOI:10.4103/tp.TP_55_16  PMID:28459017
Echinococcus granulosus causes a zoonotic infection called cystic echinococcosis (CE) or more commonly known as hydatid disease. Although the two most common locations of hydatid cyst are liver and lung, it may also appear in other parts of the body. Clinical presentation of the hydatid disease depends on the site and size of the lesion. A retrospective study was done in Medical College and Hospital, Kolkata, from January 2012 to June 2014, to find the site of involvement, distribution, clinical features, history of contact, mode of presentation, laboratory diagnosis, and treatment modalities of the cases of hydatid cyst. The cases were identified by radiological and laboratory methods, the data were entered in Excel spreadsheet, and analysis was done. Among the 21 cases of hydatid cyst included in the study, solitary hepatic involvement was seen in 11 (52.38%), pulmonary involvement in 4 (19%), and 6 (28.71%) were in unusual locations such as liver cyst extending as retroperitoneal, omental cyst, choledochal cyst, splenic cyst, and in hepatorenal pouch. History of contact with dog was seen in 15 (71.43%). All the patients were treated with surgery and albendazole and were discharged in healthy condition. CE may be present in usual and unusual locations with a lot of variations in the clinical features. Hence, proper radiological and laboratory diagnosis is required for accurate diagnosis and appropriate management of these cases.
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ORIGINAL ARTICLES
Coccidian intestinal parasites among immunocompetent children presenting with diarrhea: Are we missing them?
Praveen Kumar, Omvati Vats, Dinesh Kumar, Sarman Singh
January-June 2017, 7(1):37-40
DOI:10.4103/2229-5070.202291  PMID:28459013
Background: Diarrhoea is an important cause of both morbidity and mortality among children in India. Coccidian parasitic infections are an important cause of diarrhea in immunocompromised patients, but their investigations are rarely sought by the treating physicians in seemingly immunocompetent children. This study was aimed to find the incidence rate of coccidian parasites in all children presented with diarrhoea, irrespective of their immune status. Materials and Methods: Between December 2015 and May 2016, all fecal samples from children aged between 0 and 15 years presenting with diarrhoea, irrespective of their immune status, were examined using conventional wet mount and modified acid-fast staining. At the end of the study, records of their clinical history and immune status including HIV positivity were evaluated. Findings of wet-mount and modified acid-fast stained smear microscopy were analyzed in relation with clinical details. Results: During the study, samples from 200 children (single sample) with diarrhea were processed. Their mean age was 5.7 ± 3.3 years (range 4–168 months). Seventeen out of 200 (8.5%) samples were positive for acid-fast coccidian parasites. Eight (4%) samples were found to be positive for Cryptosporidium hominis, while 5 (2.5%) were positive for Cyclospora cayetonensis and 4 (2%) samples for Isospora belli oocysts. Half (50%) of the children who were tested positive for Cryptosporidium and Cyclospora were found to be otherwise immunocompetent. However, all four cases of Isosporiasis were immunocompromised patients. Conclusion: We highlight the high incidence of coccidian parasites among immunocompetent children with diarrhea. The clinicians need to be aware that coccidian parasites are a potential cause of childhood diarrhea even in immunocompetent children.
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Stage-specific antibody response against two larval stages of Brugia malayi in different clinical spectra of brugian filariasis
Praveen Kumar Tripathi, Ramesh Chander Mahajan, Nancy Malla, Naveen Kumar, Shailja Misra Bhattacharya, Ranganatha Krishna Shinoy, Abhishek Mewara, Rakesh Sehgal
January-June 2017, 7(1):29-36
DOI:10.4103/2229-5070.202298  PMID:28459012
Context: T-cell hypo-responsiveness in microfilaria (Mf) carriers against the microfilarial stage antigen of Brugia malayi has been described, but no study has been carried out to assess antibody dynamics against stage-specific antigens. Aim: The work was carried out with the aim to assess stage-specific antibody responses against L3 and microfilarial stage antigens in brugian filariasis in an endemic area. Setting and Design: Patients with different clinical spectra of brugian filariasis were recruited to evaluate antibody responses to brugian antigens. Subjects and Methods: Serum samples were collected from patients with different clinical spectra and antibody response was evaluated for total immunoglobulin G (IgG), IgG isotypes (IgG1, IgG2, IgG3, IgG4) and immunoglobulin E (IgE) response to L3 and microfilarial stage by enzyme-linked immunosorbent assay. Statistical Analysis: Paired t-test and one-way analysis of variance were carried out to analyze the data. Results: L3 and microfilarial stage antigens showed almost similar antibody responses in adenolymphangitis (ADL) and chronic pathology (CP) patients, however, diminished antibody response was observed with Mf stage antigen, especially with microfilaraemia. ADL patients had minimum antibody levels of all isotypes except IgG2 on day 0 which showed an increase subsequently, indicating suppression of antibody response during filarial fever. CP patients showed increase in IgE and decrease in IgG4 antibodies on day 365 indicating that these differences may be due to recent conversion into CP. Conclusion: A prominent hyporesponsiveness in microfilaraemic individuals against microfilarial stage, but not against the L3 stage of the same parasite was observed, concluding stage-specificity in humoral immune response in brugian filariasis.
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DISPATCHES
Visceral leishmaniasis-associated hemophagocytosis: A tale of two unexpected diagnoses from a nonendemic region
Rashmi Kaul Raina, Sujeet Raina, Manupriya Sharma
January-June 2017, 7(1):56-58
DOI:10.4103/2229-5070.202288  PMID:28459018
A case of visceral leishmaniasis (VL)-associated hemophagocytic lymphohistiocytosis (HLH) in an immunocompetent native from a nonendemic area was reported. The patient belonged to Ravi river valley area (altitude 996 meters above the mean sea level) of Chamba, Himachal Pradesh, India. VL and HLH were not a differential diagnosis. Identification of the Leishman-Donovan bodies and hemophagocytosis in bone marrow aspirate and biopsy provided the diagnosis. The patient recovered to the treatment with amphotericin B.
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EDITORIAL
A hearty new year wishes to all readers
Subhash Chandra Parija
January-June 2017, 7(1):1-1
DOI:10.4103/tp.TP_7_17  PMID:28459007
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LETTERS TO EDITOR
Falciparum malaria and parvovirus B19 coinfection: A rare entity
Rakesh Agarwal, Rashmi Baid, Rajarshi Datta, Manjari Saha, Nirmalendu Sarkar
January-June 2017, 7(1):47-48
DOI:10.4103/2229-5070.202299  PMID:28459015
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CALENDAR OF UPCOMING EVENTS IN PARASITOLOGY FOR THE YEAR 2015
Calendar of Upcoming Events in Parasitology: 2017

January-June 2017, 7(1):59-60
DOI:10.4103/2229-5070.202293  PMID:28459019
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LETTERS TO EDITOR
Utility of aptamers for antileishmanial drug targets: A potential hypothesis
Masoud Keighobadi, Abbas Khonakdar Tarsi, Mahdi Fakhar, Saeed Emami
January-June 2017, 7(1):49-50
DOI:10.4103/tp.TP_55_15  PMID:28459016
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