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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 11 | Issue 1
Page Nos. 1-67

Online since Friday, May 14, 2021

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EDITORIAL  

The persistent challenges of malaria Highly accessed article p. 1
Subhash Chandra Parija
DOI:10.4103/tp.tp_29_21  
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PRESIDENTIAL ORATION Top

Molecular diagnosis of infectious parasites in the post-COVID-19 era Highly accessed article p. 3
Subhash Chandra Parija, Abhijit Poddar
DOI:10.4103/tp.tp_12_21  
The endemicity of several parasitic diseases across the globe and recent evidence of distress among COVID-19 patients with preexisting parasitic infections requires strengthening One Health framework and advanced strategies for parasitic detection. Owing to the greater sensitivity and accuracy, molecular technologies such as conventional polymerase chain reaction (PCR), reverse transcription (RT)-PCR, nested PCR, loop-mediated isothermal amplification (LAMP), and xMAP technology have been extensively studied for parasitic diagnosis. Varieties of genes have been targeted for primer development where 18S rRNA, internal transcribed spacer regions, and mitochondrial DNAs coding for cytochrome, and other enzymes have been widely used. More recent, low-cost sequencing and advances in big data management have resulted in a slow but steady rise of next-generation sequencing-based approaches for parasite diagnosis. However, except for few parasites of global concerns such as Plasmodium and Entamoeba, most of the molecular tools and technologies are yet to witness bench to bedside and field translations. This review looks into some of the advancements in the molecular diagnosis of parasites that have potential relevance to clinical purposes and may pave the way toward disease management in an efficient and timely manner.
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REVIEW ARTICLE Top

Cryptosporidium and waterborne outbreaks – A mini review Highly accessed article p. 11
Anusha Gururajan, Nonika Rajkumari, Utpala Devi, Parismita Borah
DOI:10.4103/tp.TP_68_20  
Cryptosporidium spp. is one of the prime agents of infectious diarrhea. Cryptosporidium spp. has been gaining awareness as a pathogen of public health importance in India and other developing countries. Owing to the nature of multiple transmission routes such as person-to-person, animal-to-person, waterborne and foodborne, the epidemiology of cryptosporidiosis in humans is not well known. A deeper understanding of the pathogenesis may lead to better diagnosis and better treatment of the condition. Asymptomatic human and animal transmission illustrates that the spread of infection through the environment is a more plausible explanation, waterborne transmission in particular. The disease burden is underestimated and its global impact is yet to be quantified due to the lack of country-specific estimates. Assessment of the disease itself has been crucial since the morphological indistinguishability, differences in distribution and transmission, and variations in the genotypes.
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BRIEF BIOGRAPHY Top

The forgotten malariologist: Giovanni Battista Grassi (1854–1925) Highly accessed article p. 16
Abhijit Chaudhury
DOI:10.4103/tp.tp_21_21  
The discovery of the mosquito as a vector for malaria parasite was an important discovery at the turn of the 19th century for which Sir Ronald Ross received the Nobel Prize in 1902. Battista Grassi, an Italian physician and a zoologist is also credited with this discovery and he described the species of the mosquito and proved the transmission in healthy human volunteer. Although we remember his name only in this context, he also made numerous other discoveries spanning the fields of protozoology, helminthology, entomology, and zoology.
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ORIGINAL ARTICLES Top

L-cysteine whether a nutritional booster or a radical scavenger for Plasmodium p. 19
Shweta Sinha, CS Gautam, Rakesh Sehgal
DOI:10.4103/tp.TP_20_18  
Introduction: Plasmodium falciparum is the most noxious species among other Plasmodium species that cause malaria. Attention is required to understand more about the pathophysiology and parasite biology to obscure this disease. The fact is, very little is known about the nutritional requirement in sense of carbohydrate, lipid, nucleic acid, and amino acid metabolism that regulate the growth of parasite and out of this, studies related to the metabolism of amino acid are exceptionally limited. Out of several amino acids, L-cysteine is essential for the continuous erythrocytic growth of Plasmodium. However, the exact role of L-cysteine in regulating the growth of Plasmodium is unknown. Here, we tried to investigate how does L-cysteine affects the growth of Plasmodium in in vitro culture, and also the study was aimed to find whether there is a synergism with chloroquine on the Plasmodium growth in vitro. Materials and Methods: Parasite inhibition assay based on schizont maturation inhibition following WHO protocol on P. falciparum chloroquine-sensitive strain (MRC-2) was employed to determine IC50 value and drug interaction pattern was shown through fractional inhibitory concentration index. Results: Inhibitory effect of L-cysteine hydrochloride on Plasmodium growth was depicted with IC50 1.152 ± 0.287 μg/mL and the most synergistic pattern of interaction was shown with chloroquine. Conclusions: The present study anticipates two important findings, firstly inconsistent results from previous findings and secondly, synergistic effect with chloroquine suggests its potency that may be used as an add-on therapy along with chloroquine. However, further study is needed to validate the above findings in vivo models.
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Clinical profile of malaria at a tertiary care teaching hospital in North India p. 25
Ritu Karoli, Shobhit Shakya, Nikhil Gupta, Vineeta Mittal, Anil Kumar Upadhyay
DOI:10.4103/tp.TP_76_20  
Introduction: Despite recent reductions in the overall malaria case incidence, malaria remains an important public health issue. There has been a change in clinical and epidemiological profile of malaria in our country and vivax malaria known to be benign has been reported to cause severe complications. Therefore, the present study was conducted to delineate the clinical profile of malaria, proportion of severity, spectrum of complications, and presence of comorbidities among adult patients admitted at a tertiary health-care center in North India. Materials and Methods: This was an observational prospective study conducted in all adult patients (>15 years of age) diagnosed to have Plasmodium vivax malaria, Plasmodium falciparum, and mixed malarial infection at a tertiary care teaching hospital on the basis of peripheral smear or rapid diagnostic tests. Results: The study included 295 patients, the most common species was vivax (62%) followed by falciparum (29%) and mixed plasmodium spp. (9%). The mean age of the patients was 34.23 ± 15.7 years, with 64% male and 36% female. Out of all patients, 23% patients had at least one component of severe malaria. Severe anemia (hemoglobin <5 mg/dl), thrombocytopenia (platelet count <1 lac/cmm), and acute kidney injury were significantly greater in patients with P. vivax. Presence of comorbid conditions was observed in a significant proportion (32%) of patients. Conclusion: P. vivax is the plasmodium species which is responsible for most of the cases. Its potential to cause life-threatening illness is the cause of concern. The role of comorbid conditions in influencing the clinicaloutcome of malaria should be further explored.
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In vitro antiplasmodial activity of Phyllanthus amarus against Plasmodium falciparum and evaluation of its acute toxicity effect in mouse model p. 31
Karimatu Aliyu, Yusuf Mohammed, Idris Nasir Abdullahi, Amina Abdullahi Umar, Fatima Bashir, Mujahid Nura Sani, Auwal Idris Kabuga, Al-Mukhtar Yahuza Adamu, Azeez Oyebanji Akande
DOI:10.4103/tp.TP_78_20  
Background: The emergence of widespread resistance of Plasmodium species to most antimalarial drugs has led to a more vigorous and concerted research on traditional medicinal plants for the treatment of malaria. Objective of Study: The study was aimed to investigate the in vitro antiplasmodial activity of crude ethanolic and aqueous extracts of Phyllanthus amarus against clinical isolates of Plasmodium falciparum in Northwestern Nigeria. Materials and Methods: The plant was extracted using two solvents, water and ethanol, where a high yield was obtained from the aqueous extracts (11.9%) as compared to the ethanolic extract (9.64%). The extracts were evaluated in vitro at concentrations of 6.25, 12.5, 25, 50, and 100 μg/ml, and the level of potency in each case was expressed as the concentration of the extract that exhibited a 50% reduction of the parasites relative to control (100%) parasitemia. Artemether-lumefantrine was used as a positive standard in the assay. Results: All extracts showed a significant reduction in parasite growth relative to control (P ≤ 0.05). Ethanolic extract exhibited a higher antiplasmodial activity of 76.8%, half-maximal inhibitory concentration (IC50) of 5.80 μg/ml, and aqueous extract had an activity of 75.3%, IC50 of 7.94 μg/ml. Both extracts exhibited very active antiplasmodial activity. Oral acute toxicity test in the doses of 500, 1000, and 1500 mg/kg showed no sign of toxicity on albino mice after 48 h. Conclusion: Although there was an increase in appetite after 24 and 48 h, the findings from this study show that P. amarus possesses a promising antimalarial activity which can be exploited for malaria therapy and justifies the traditional use of the plant in malaria treatment.
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A report on incidence of COVID-19 among febrile patients attending a malaria clinic p. 38
Subhasish Kamal Guha, Malabika Biswas, Bishal Gupta, Alisha Acharya, Supriya Halder, Bibhuti Saha, Moytrey Chatterjee, Pratip Kumar Kundu, Ardhendu Kumar Maji
DOI:10.4103/tp.TP_105_20  
Context: Screening for malaria and coronavirus disease (COVID-19) in all patients with acute febrile illness is necessary in malaria-endemic areas to reduce malaria-related mortality and to prevent the transmission of COVID-19 by isolation. Aims: A pilot study was undertaken to determine the incidence of SARS-CoV-2 infection among febrile patients attending a malaria clinic. Subjects and Methods: All patients were tested for malaria parasite by examining thick and thin blood smears as well as by rapid malaria antigen tests. COVID-19 was detected by rapid antigen test and reverse transcriptase–polymerase chain reaction in patients agreeing to undergo the test. Results: Out of 262 patients examined, 66 (25.19%) were positive for Plasmodium vivax, 45 (17.17%) for Plasmodium falciparum (Pf) with a slide positivity rate of 42.40%, and Pf% of 40.50%. Only 29 patients consented for COVID-19 testing along with malaria; of them, 3 (10.34%) were positive for COVID-19 alone and 2 (6.89%) were positive for both COVID-19 and P. vivax with an incidence of 17.24%. A maximum number of patients (196) did not examine for COVID-19 as they did not agree to do the test. Conclusion: Diagnosis of COVID-19 among three patients (10.34%) is significant both in terms of identification of cases and to isolate them for preventing transmission in the community. Detection of COVID-19 along with malaria is equally important for their proper management.
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DISPATCHES Top

Fasciola hepatica association with gallbladder malignancy: A rare case report p. 42
Bichitrananda Swain, Sarita Otta, Manoj Kumar Sahu, Kanishka Uthansingh
DOI:10.4103/tp.TP_25_20  
Fasciolopsis is one of the rarest parasitic infestations in our locality. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of a liver fluke – Fasciola. In the chronic phage of Fasciolopsis, the patient presents with cholestasis and cholangitis. Yet, there is no proof of association of this parasite with carcinoma of the gallbladder. We here present such a case of Fasciolopsis in association with Stage IV gallbladder malignancy. Fasciola worms were extracted on endoscopic retrograde cholangiopancreatography done as a palliative measure for associated obstructive jaundice. The chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice if not properly investigated. The importance of repeated stool examination for parasitic ova and cysts should never be understated as it may help in early diagnosis of such treatable conditions as well as preventing the complications.
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Pancytopenia with hemophagocytic lymphohistiocytosis in Plasmodium falciparum: A unusual presentation p. 46
Shewta Chaudhry, Aditi Arya, Monika Matlani, Vineeta Singh, Shyam Sundar Meena
DOI:10.4103/tp.TP_34_20  
Hematological manifestations such as anemia and thrombocytopenia are known complications in malaria. Here, we report two cases presented as pancytopenia with hepatosplenomegaly and initial diagnosis kept as hematological malignancy like leukemia but later on its diagnosed as malaria-associated hemophagocytic lymphohistiocytosis which is a rare entity. The aim of this report is to draw the attention of physicians, especially in tropical countries such as India and Sub-Saharan nations to keep in mind this uncommon presentation of malaria, though the exact pathophysiological mechanism still remains obscure.
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Sparganosis mimicking a soft-tissue tumor: A diagnostic challenge p. 49
Shiwangi Sharma, Rakesh Kumar Mahajan, Hira Ram, M Karikalan, Arvind Achra
DOI:10.4103/tp.TP_40_20  
Human sparganosis is a rare but important food borne zoonosis and could be attributed to increased consumption of raw meat of fish, frogs, snakes etc. Sparganosis may involve varied organ systems but subcutaneous sparganosis remains the one of the commonly reported clinical condition. Rarity of this problem reinforces the necessity of sensitising the treating physicians of the differential possibility of this infection in patients with history of practice of consuming raw meat. Expansion of health communication and provision of safe food and water by the civic agencies can be a part of powerful preventive strategies.
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Pulmonary cryptosporidiosis in a case of adenocarcinoma of stomach: A rare case report p. 53
Kavita Chaudhari, B Gurushankari, Nonika Rajkumari, Noyal Mariya Joseph, Anandhi Amaranathan, Sureshkumar Sathasivam, Deepak Barathi, Vikram Kate
DOI:10.4103/tp.TP_41_20  
Cryptosporidium species are commonly known to cause chronic intractable diarrhea in patients suffering from human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome, however extra-intestinal presentations have been rarely reported. Hereby, we report a rare case of isolated pulmonary cryptosporidiosis in a 75-year-old HIV-negative patient with metastatic carcinoma of the stomach who was managed conservatively with hemostatic radiotherapy for palliative care. The patient had presented with cough with expectoration for 2 months. Sputum microscopic examination was suggestive of pulmonary cryptosporidiosis. There was no evidence of intestinal cryptosporidiosis. Therapy for pulmonary cryptosporidiosis was started with tablet nitazoxanide. The patient succumbed to the disease few days later following discharge. Although rare, patients with disseminated gastrointestinal malignancy can potentially have isolated pulmonary cryptosporidiosis.
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Primary pelvic echinococcosis though uncommon but not rare p. 56
Kumar S Abhishek, Twishi Shrimali, Vibhor Tak, Vijaya Lakshmi Nag, Sumit Banerjee, Sudeep Khera
DOI:10.4103/tp.TP_64_19  
Echinococcosis is caused by larva of Echinococcus granulosus. Liver being most commonly involved, other organs/body parts such as bone involvement is not so uncommon, especially in cattle-raising countries such as India. Primary osseous echinococcosis remains undiagnosed until complications have developed. We report a case of complicated pelvic echinococcosis presented with left gluteal mass, acetabulum and femoral head destruction, and reduced hip mobility. Pre- and postoperative chemotherapy with albendazole and en bloc surgical removal of the cyst were advocated as the preferred option of treatment. Primary osseous echinococcosis must be kept in mind when encountering a case of chronic bony mass not responding to antitubercular therapy, and hydatid serology should be performed along with other imaging and histopathological examinations to support or confirm the diagnosis to prevent long-term complications.
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“Strongyloides stercoralis infestation in a severely malnourished (SAM) celiac disease child:” A rare case report from Western Rajasthan p. 60
Usha Verma, Vishakha Ashopa, Pooja Nareda, Eshank Gupta, Ekta Gupta, Prabhu Prakash
DOI:10.4103/tp.TP_86_19  
A case of Strongyloides stercoralis infection in severe protein energy malnutrition child with associated celiac disease (CD) is herein reported. The case was a 4-year-old, severely malnourished female admitted to the tertiary level hospital of Western Rajasthan, due to watery diarrhea, pain abdomen, and vomiting, not responding to treatment. The patient was HIV negative, nondiabetic, had no evidence of tuberculosis, Liver Function Test, Renal Function Test were normal was within normal limits. She had microcytic hypochromic anemia, hypoalbuminemia, and serum Antitissue transglutaminase (anti tTG IgA)was 301.35 U/ML which confirmed the diagnosis of CD. Stool parasitological examination revealed numerous rhabditiform larvae of threadworm “S. stercoralis.” After treatment with gluten free diet and Albendazole and Ivermectin, the patient recovered without evidence of S. stercoralis in follow-up stool samples.
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FACE TO FACE Top

Face to face: Balantioides coli: A forgotten parasite p. 64
Alynne Da Silva Barbosa
DOI:10.4103/tp.tp_5_21  
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