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   Table of Contents - Current issue
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July-December 2020
Volume 10 | Issue 2
Page Nos. 69-171

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EDITORIAL  

Parasitology in the times of COVID-19 p. 69
Subhash Chandra Parija
DOI:10.4103/tp.TP_126_20  
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SYMPOSIUM Top

Pondicherry declaration on the identification and detection of Entamoeba histolytica Highly accessed article p. 71
Subhash Chandra Parija, Rakesh Sehgal, Ujjala Ghoshal, Sumeeta Khurana, Vinay Khanna, Debadatta Dhar Chanda, Tapashi Ghoshal, Namrata K Bhosale
DOI:10.4103/tp.TP_111_20  
Stake holders meet on “Identification and Detection of Entamoeba histolytica” was conducted on July 21, 2019 at Sri Balaji Vidyapeeth Deemed-to-be-University, Pondicherry. This programme was of national importance, since the amoebiasis is being increasingly reported from different parts of India because of poor socioeconomic conditions and sanitation levels. Experts in amoebiasis research across India attended this meeting. This meeting was conducted with an objective to frame the guidelines on the identification and detection of E. histolytica with reference to conventional diagnostic methods and molecular diagnosis targeting appropriate genes of E. histolytica. The recommendations of the panel were released as declaration on the diagnosis of amoebiasis and were circulated to various administrative and scientific bodies in India as reference policy document on the diagnosis of amoebiasis.
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ORIGINAL ARTICLES Top

Prevalence and the factors influencing soil-transmitted helminths among school age children (5–14 years age) in a rural area of Coimbatore district p. 74
V Xavier Christu Rajan, M Sivamani, B Appalaraju
DOI:10.4103/tp.TP_33_19  
Context: Highest intensity of soil-transmitted helminthiasis (STH) is seen among school age children. Aims: The aim of this study is to find out the prevalence and factors associated with soil-transmitted helminthic infection among school age children (5–14 years) in a rural area of Coimbatore district. Settings and Design: The study was conducted in the field practice area of the Rural Health Training Centre (RHTC) Vedapatti, Coimbatore. RHTC caters to a total population of 23,841 distributed in 14 villages. After getting ethical clearance, five of the 14 villages of Vedapatti were selected by the cluster sampling method. Totally, 819 participated in the survey conducted between November 2015 and July 2016 in the field practice area. Subjects and Methods: Structured questionnaire was used to collect the information. Consent from parents and assent from child were obtained. Totally, 610 gave one adequate stool sample. Early morning samples were collected and transported to the laboratory within four hours. Formal ether concentration method was performed, and examination was done. Statistical Analysis Used: Data analysis was performed with the SPSS version 19 software. The prevalence is expressed in percentage with 95% confidence interval (CI). Univariate and multivariate analyses were performed. Strength of association was expressed in terms of odds ratio (OR) and adjusted OR with 95% CI. P < 0.05 was considered as statistically significant. Results: The prevalence of STH was 7.70% (95% CI: 5.58–9.82). Ascaris lumbricoides was highly prevalent 6.9% (4.89%–8.91%) followed by Hook worm 0.7% (0.04%–1.36%), and Trichuris trichura 0.2% (0.15%–0.55%). Mulitivariate logistic regression analysis showed that pucca houses offered protection against STH. Conclusions: The prevalence of STH in a rural area of Coimbatore is 7.7% (95% CI: 5.58–9.82), and is continuing as a public health problem.
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A study on intestinal parasitic infections among school children in Karaikal Highly accessed article p. 79
S Sai Teja, SR Swarna, D Jeyakumari, Vignesh Kanna
DOI:10.4103/tp.TP_42_19  
Introduction: Intestinal parasitic infections (IPIs) play a major role in global disease burden with significant morbidity. The most vulnerable age group was school going children and is transmitted through soil. About 90% of infected individuals remain asymptomatic. The present study was designed to screen for IPI among school children in Karaikal, to identify the asymptomatic infections and to assess the type and occurrence of IPIs. Methodology: A cross-sectional study was carried out from July to September 2018 among school children in the age group of 6–14 years after getting ethical clearance. A total of 335 single stool samples were collected. The samples were subjected to macroscopic examination, microscopic examination and subjected to concentration techniques such as salt floatation and formal ether sedimentation technique. Two separate fresh stool smears were made on the microscopic slides for trichrome and modified acid-fast staining. The results were calculated as percentage, frequency/proportion, and Chi-square test using IBM SPSS software version 19. Results: Only 90 (28%) out of 324 stool samples were positive for the presence of intestinal parasites. The sensitivity of formal ether sedimentation technique (58%) was higher than other techniques. None of the ova of helminths detected. Modified acid-fast staining was negative for coccidian parasites. Conclusions: The low prevalence of protozoan parasites and total absence of helminths in the study revealed the effective role of nationwide deworming program and Swachh Bharat Abhiyan program. However, anthelminthic does not cover the protozoan parasites and it exists among asymptomatic healthy population.
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A study on multi-organ dysfunction syndrome in malaria using sequential organ failure assessment score p. 86
Amish Bhutani, Rajeev Mohan Kaushik, Reshma Kaushik
DOI:10.4103/tp.TP_12_19  
Purpose: The purpose of this study is to examine the prevalence, clinical spectrum, prognostic factors, and outcome of multi-organ dysfunction syndrome (MODS) in patients with malaria. Materials and Methods: One hundred and twenty-four patients with malaria, diagnosed by a positive peripheral blood film and rapid malaria test, were studied for MODS using the sequential organ failure assessment (SOFA) score. The severity of malaria was assessed by the WHO criteria. Results: Severe malaria was present in 54 (43.54%) patients. MODS was detected in 108 (87.09%) patients with malaria (Plasmodium falciparum - 57 [85.07%], Plasmodium vivax - 46 [88.46%] and mixed P. falciparum and P. vivax malaria - 5 [100%] cases). SOFA scores of MODS-and non-MODS-patients differed significantly (P < 0.001). No significant association was seen between MODS and type of malaria (P = 0.894). Mortality among malaria patients with MODS was 5.55% (6/108) (P. falciparum 8.77% [5/57] and P. vivax 2.17% [1/46]). The outcome of MODS was associated significantly with the severity of the SOFA score at admission (P = 0.011) but not with the type of malaria, malaria parasite index, and the number of organs involved (P > 0.05 each). The SOFA score at admission correlated significantly with the duration of hospitalization (P < 0.0001). Conclusions: MODS occurs with high frequency in malaria and is not dependent on the type of malaria. The outcome of MODS and recovery time depends on the severity of MODS. The SOFA score is useful in detecting MODS and ascertaining its severity and prognosis in malaria.
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Thrombocytopenia in malaria patients from an arid region of Western Rajasthan (India) p. 95
Yashik Bansal, Vinod Maurya, Nidhima Aggarwal, Vibhor Tak, Vijaya Lakshmi Nag, Abhishek Purohit, Akhil Dhanesh Goel, Gopal Krishna Bohra, Kuldeep Singh
DOI:10.4103/tp.TP_68_19  
Context: The arid climate of Western Rajasthan is challenging for malaria transmission, with the number of cases correlating directly with the annual rainfall pattern. Moreover, >90% of the cases in this region are caused by Plasmodium vivax, which has recently been shown to cause a similar degree of thrombocytopenia as Plasmodium falciparum. Aims and Objectives: The aim of the study was to determine the degree of thrombocytopenia in malaria patients and its association with different species of malaria in this region with an unstable malaria epidemiology. Materials and Methods: This retrospective study was conducted on all microbiologically confirmed malaria patients with documented platelet counts from August 2017 to October 2018. Microbiological diagnosis was established by rapid diagnostic tests and peripheral blood film examination. Platelet counts were used to assess the degree of thrombocytopenia. Results: A total of 130 cases were included in the study, of which 118 (91%) were caused by P. vivax, while the rest 12 (9%) were caused by P. falciparum. Thrombocytopenia was present in 108 (83%) cases, and the mean values of platelets in thrombocytopenic patients with P. vivax and P. falciparum infection were 72600/μL and 48500/μL, respectively. Although P. falciparum infection was significantly associated with severe thrombocytopenia (odds ratio: 4.7, [95% confidence interval 1.3–16.1]), extremely low platelet counts (n = 5) warranting platelet transfusions (n = 1) were seen only in P. vivax cases. Only one patient required platelet transfusions in these patients suggesting good tolerance to thrombocytopenia. Conclusions: Avoiding unnecessary transfusions in febrile thrombocytopenic patients with an established malaria diagnosis can help in reducing transfusion-transmitted infections.
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Risk factors for placental malaria and associated low birth weight in a rural high malaria transmission setting of Cote d'Ivoire p. 102
Offianan Andre Toure, Carole B C. Konan, Valery N Kouame, Eric A Gbessi, Adama Soumahoro, Issiaka Bassinka, Ronan Jambou
DOI:10.4103/tp.TP_58_19  
Background: Placental malaria (PM) is associated with increased risk of both maternal and neonatal adverse outcomes. The objective of this study was to assess risks factors associated with PM including intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). Methods: A cross-sectional study was conducted at Ayame hospital in the southern region of Cote d'Ivoire between August 2016 and March 2017. Sociodemographic baseline characteristic and antenatal data were obtained from the mother's antenatal card and included timing and number of IPTp-SP doses. Newborn characteristics were recorded. Peripheral blood as well as placental and cord blood were used to prepare thick and thin blood films. In addition, pieces of placental tissues were used to prepare impression smears. Regression logistics were used to study factors associated with PM and low birth weight (LBW) (<2.500 g). Results: Three hundred delivered women were enrolled in the study. The mean age of the participants was 25 ± 6.5 years and most participants were multigravida (52.8%). The coverage rate of IPTp-SP with the full three doses recommended was 27.8%. Overall, 7.3% (22/300) of women examined had PM detected by microscopy using impression smear (22/300). Multivariate analysis showed that significant risks factors of PM were maternal peripheral parasitemia at delivery (P < 0.0001), residence (P = 0.03), and not sleeping under long-lasting insecticide treated nets (LLINs) (P = 0.006). LBW infants were born to 22.7% (5/22) of women with PM and 13.3% (37/278) of women without PM (P = 0.47). Only primiparous was associated with LBW in the multivariable analysis (P = 0.04). Conclusion: The prevalence of PM was 7.3%. Low parity, residence and not using LLINs and maternal peripheral parasitemia were identified as risks factors. PM was associated with LBW. Implementation of IPTp-SP should be improved by the National Malaria Control Program in rural settings.
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Coexistent malaria and filaria among the febrile patients attending for malaria diagnosis: A clinic-based study p. 109
Alisha Acharya, Anindita Rakshit, Supriya Halder, Moytrey Chatterjee, Sourankur Chakrabarti, Pabitra Saha, Dilip Kumar Bera, Banya Chakraborty, Pratip K Kundu, Tapashi Ghosh, Ardhendu K Maji
DOI:10.4103/tp.TP_93_20  
Context: Both malaria and lymphatic filariasis (LF) are mosquito-borne diseases caused by protozoal and nematode parasites, respectively, and are serious public health problem in India. Although the vectors of the diseases are different, they can coexist in favorable conditions. Fever is the common symptom for both the diseases, but the emphasis is given for diagnosis and treatment of malaria due to its life-threatening severity, LF remained neglected. Detection and management of microfilaria are equally important. During the diagnosis of malaria, a few microfilaria were detected, which prompted us to undertake this study with following objectives. Objectives: The objective of the study was to determine the incidence of microfilaremia among the febrile patients attending for malaria diagnosis. Subjects and Methods: Thick and thin peripheral blood smears from all patients attended were examined following Giemsa staining. Different malarial indexes were analyzed. Results: Out of 8681 patients examined, 1778 were positive for Plasmodium vivax and 328 for Plasmodium falciparum with a slide positivity rate 20.48%. Twenty-six patients were positive for microfilaria of Wuchereria bancroftii among which five were coinfected with P. vivax and one with P. falciparum. Most of the microfilaria-positive patients were adult and originally from northern districts of Bihar. Conclusions: High incidence of microfilaria among febrile patients attending for malaria is alarming for urban Kolkata. Although the patients were originally from Bihar, they are staying in Kolkata for a long time, might be a source for transmission. Epidemiological study by collecting night blood samples and entomological survey is highly suggestive to explore local transmission if any.
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Canine intestinal parasitic infections and soil contamination by Toxocara spp. in selected areas of Sri Lanka p. 114
Hashini Wickramasinghe, Lahiru Sandaruwan Galgamuwa, Devika Iddawela
DOI:10.4103/tp.TP_62_19  
Introduction: Contaminated environment with canine parasitic eggs is the main source for toxocariasis and other geohelminth infections of humans. This study aimed to determine the prevalence and associated risk factors for intestinal parasitic infections in dogs and the degree of soil contamination with Toxocara eggs in Kandy and Gampaha districts in Sri Lanka. Methods: A total of 188 fecal samples from both stray and domestic owned dogs from Gampaha district and Kandy district were collected. In addition, soil samples were collected from home gardens and public places. Hypochlorite recovery technique and zinc sulfate floatation method were used to concentrate eggs in soil samples. Results: The prevalence of intestinal parasitic infections of domestic and stray dogs in Gampaha district was 38.2% and 42.9%, respectively, while in Kandy district, it was 41.1% and 50%, respectively. Hookworms were the most common parasitic infection among domestic dogs (18.5%), while Toxocara spp. were the most common among stray dogs (17.2%). Intestinal parasitic infections were significantly more prevalent among female dogs than males. Age, deworming, immunization, immunization time, and living in rural areas were not significantly associated with intestinal parasitic infections in domestic dogs. A total of 4% and 4.5% soil samples were contaminated with Toxocara spp. eggs in Gampaha and Kandy districts, respectively. Conclusions: The higher prevalence of intestinal parasitic infections in dogs could be a major public health issue. Implementations of programs to improve the awareness of parasitic infections among pet owners and control strategies need to decrease the risk of infections to both animal and human health.
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Rhinosporidiosis in Central India: A cross-sectional study from a tertiary care hospital in Chhattisgarh p. 120
Rakesh Kumar Gupta, Bhanu Pratap Singh, BR Singh
DOI:10.4103/tp.TP_63_19  
Background and Aims: Chhattisgarh is an endemic region for rhinosporidiosis infection in Central India. This high prevalence can be explained by suitable hot tropical environment as well as social practice of common bathing of public with animals outdoor, mainly in ponds and river. There are more than 200 ponds in and around Bilaspur district, mainly in Ratanpur region. However, due to limited literature describing rhinosporidiosis from this part of India, it remains neglected and still not recognized as a serious health-care issue and any definite government or private measures/initiatives are not taken to counter this problem. Materials and Methods: It is a retrospective demographic study analyzing 113 consecutive biopsies received from different clinical departments in a tertiary care center with a histological diagnosis of rhinosporidiosis over a period of 7 years from January 2011 to December 2017. Results: Most of the patients presented in the otorhinolaryngology (86.7%) department, followed by ophthalmology (10.6%). The mean age of the patients was 23.4 years, with a range of 3–70 years. A male-to-female ratio of about 3:2 was noted. Nasal cavity was the most common site of involvement (90/113), followed by conjunctiva (7/113), nasal cavity with oropharynx (6/113), and eyelid (3/113). Patients' complaints showed a varying range from nasal block, nasal mass, bleeding, bleed on touch, difficulty in breathing, and conjunctival mass. Two of the cases presented as recurrent rhinosporidiosis. Conclusion: Rhinosporidiosis is endemic and possesses a great health-care burden in Chhattisgarh. The socioeconomic status, outdoor bathing, and cultural practice in rural areas are the major factors contributing to newer cases. An urgent government initiative to decontaminate public water bodies and public health education through health-care workers and nongovernment organizations is the need of the hour to curtail the incidence of rhinosporidiosis.
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A hospital-based study on the prevalence of trichomoniasis and evaluation of accuracy of various diagnostic techniques p. 124
Sweety Singh, Rumpa Saha, Amita Suneja, Shukla Das
DOI:10.4103/tp.TP_45_19  
Background: The sexually transmitted infections (STIs) caused by Trichomonas vaginalis have been associated with adverse pregnancy outcomes and increased risk of HIV transmission. Trichomoniasis remains underreported despite being easy to diagnose and treat. Moreover, availability of battery of diagnostic tools causes dilemma on the most appropriate techniques to be used. Aims and Objectives: The purpose of this study was to determine the prevalence of T. vaginalis and its diagnostic accuracy employing various diagnostic techniques in women presenting with vaginal discharge in gynecological outpatient department (GOPD) of our tertiary care hospital. Materials and Methods: Five vaginal swabs were collected from 204 patients with symptomatic vaginal discharge attending GOPD. Wet mount microscopy, Giemsa and acridine orange staining, culture in Kupferberg media and InPouch™ TV culture system, and polymerase chain reaction (PCR) were performed and compared. Results: The prevalence of T. vaginalis was 1.96% in the present study. Wet mount microscopy, staining method, and culture detected 1.96% of cases, whereas PCR detected 2.45% of cases. Conclusion: The prevalence of T. vaginalis was <3% among symptomatic vaginal discharge patients from GOPD. Although PCR had a higher detection rate, there was no significant difference in sensitivity and specificity between other diagnostic methods (direct wet mount, Giemsa/acridine orange staining, and InPouch™ TV culture system). Hence, the availability in a particular setting would determine the methods of choice to be used for the diagnosis of T. vaginalis.
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First record of the mosquito control potentiality of Stigmatogobius sadanundio (F. Hamilton, 1822) Gobiidae, Perciformes in laboratory condition p. 130
Priti Ranjan Pahari, Niladri Prasad Mishra, Abhijit Sahoo, Rama Prasad Bhattacharya, Tanmay Bhattacharya
DOI:10.4103/tp.TP_55_19  
Background and Objectives: In recent years, resurgence of mosquito-borne diseases has become a serious health problem in India. In the present study, Stigmatogobius sadanundio, a common indigenous fish, has been tested for its biocontrol potentiality for controlling Culex quinquefasciatus larvae. This small larvivorous fish can consume large number of Culex larvae even in the presence of alternate prey. This is the first report on the mosquito control ability of this fish. Materials and Methods: Experimental fishes were captured from tidal canals of Rupnarayan River in Purba Medinipur district, West Bengal. Mosquito larvae, pupae, and chironomid larvae were collected from Tamralipta municipality drainage system. Predation efficacy of the fish was evaluated on C. quinquefasciatus larvae and pupae as well as on Chironomus ramosus larvae which were collected from the drainage system of Tamralipta municipality and reared in the laboratory maintaining similar water parameters. Prey were offered to the fish separately and in paired combination to study its dietary preference. Results: S. sadanundio is a diurnal predator consuming significantly large number of prey during daytime. It prefers mosquito and chironomid larvae over mosquito pupae. The rate of predation was very high during 1st h of predation. It consumed more chironomid larvae in the presence of mosquito larvae during daytime but consumed large number of mosquito larvae as compared to other larvivorous fish. Conclusion: S. sadanundio, an indigenous fish, is an effective biocontrol agent for the larvae of C. quinquefasciatus in laboratory condition. Even though the presence of alternate prey chironomid larvae influences the predation rate, it consumed large number of mosquito larvae. However, careful controlled field trials must be conducted before this fish is used as a biocontrol agent.
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Molecular identification and phylogenetic relationship of Demodex mites based on mitochondrial 16S rDNA p. 136
Pawan Prasher, Dolly Baghra, Drishtant Singh, Sharad Thakur, Navpreet Kaur Gill, Anup Kumar Kesavan
DOI:10.4103/tp.TP_76_19  
Background and Objective: Demodex mites are tiny parasites that live around hair follicles of mammals. The two main species of Demodex i.e. Demodex folliculorum and Demodex brevis present in humans are found near the hair follicles of eyes. The present study was to understand the presence of Demodex mites in people suffering from blepharitis in Amritsar, Punjab. Material and Methods: Demodex mites samples present in blepharitis patients were isolated from the eyelashes. DNA was isolated from three mites and used for PCR amplification of mitochondrial (mt) 16S rDNA. The amplified PCR product were purified and used for molecular identification. Results: The amplified mt16s rDNA product was sequenced and subjected to BLAST search in the NCBI database for molecular identification. The identified mite belongs to Demodex folliculorum species. The phylogenetic tree constructed by using mt16s rDNA sequence suggests that D. folliculorum is closer to D. canis than to D. brevis. Conclusion: All the three isolates belong to D. folliculorum and the mitochondrial DNA 16S rDNA partial sequence is applicable for phylogenetic relationship analysis.
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DISPATCHES Top

Postpartum genital myiasis – Dermatobia hominis infestation with giant uterine fibroid: A rare case with review of literature p. 142
Vishakha Ashopa, Usha Verma, Pooja Nareda, Eshank Gupta, Prabhu Prakash
DOI:10.4103/tp.TP_65_19  
A 32-year-old multiparous rural woman having 26 weeks of pregnancy with giant uterine fibroid extending up to the cervix had stillbirth 2 weeks back and left hospital against medical advice. She was readmitted in emergency with necrotic prolapsed uterine fibroid with offensive vaginal bleeding. On examination, the patient had necrotic prolapsed fibroid with very offensive bloody discharge and a large number of larvae of Dermatobia hominis (human botfly) were crawling in necrotic tissue. The location of this infestation at genital region is an extremely rare occurrence in postdelivery patients.
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Ophthalmomyiasis externa: A case report p. 147
Manoj Vedpathak, Nirjhar Chatterjee, Vasant Baradkar, Jayanthi Shastri
DOI:10.4103/tp.TP_2_20  
Ophthalmomyiasis is the infestation of ocular structures by fly larvae (maggots). Oestrus ovis is common among them. This is usually observed in rural areas, but a case presented here is from the urban areas. Depending on the species of larvae and ocular structure involved, manifestations vary from self-limiting condition to optic nerve involvement which may lead to blindness, and hence, identification and prompt management is necessary. This case report alerts the ophthalmologists from the urban areas to consider time management and also microbiologists for rapid identification.
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Survival of primary amebic meningoencephalitis by Naegleria fowleri: First reported case from Tamil Nadu, South India p. 150
Venkatesh Perumalsamy, Raja Sundaramoorthy, Vithiya Ganesan, VG Geni
DOI:10.4103/tp.TP_34_19  
A case of primary amebic meningoencephalitis (PAM) in a 47-year-old male is described. The disease may have been contracted during bathing. The source of water was from a pond. The clinical presentation, the isolation of the ameba from the cerebrospinal fluid, and the response to amphotericin B are all consistent with the diagnosis of PAM. To our knowledge, this is the first case of PAM to be reported in Tamil Nadu, India.
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Dipylidium caninum: First case in an adult female from uttarakhand and review of literature p. 153
Suneeta Meena, Arpana Singh, V Pradeep Kumar, Rohit Gupta, Pratima Gupta
DOI:10.4103/tp.TP_22_19  
Dipylidium caninum is a rare cestode infection in India, only previously reported in children. We herein report the case of a 50-year-old female from India who presented with a 1-year history of abdominal pain associated with vomiting, cough, and passing worm segments in stool. She had been treated with albendazole without benefit. A stool examination revealed proglottids and egg clusters of D. caninum. She was treated with praziquental 600 mg once daily for 5 days. At follow-up a month later, she had recovered completely, and repeat stool examination was negative for proglottids and eggs. Dipylidiasis can rarely occur among adults in India and present with abdominal pain and cough.
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Nightmares with a starry sky – Treating neurocysticercal encephalitis, how far to go p. 158
Anirban Ghosal, Kajari Bhattacharya, A Shobhana, Rashmi Saraff
DOI:10.4103/tp.TP_65_20  
Cysticercosis, an infection caused by the larval stage of tapeworm Taenia solium, is the most common parasitic disease of the human nervous system and the single most common cause of acquired epileptic seizures in the developing world. Here, we describe the stormy course of a 67-year-old female with neurocysticercosis (NCC) having a recurrent encephalitic presentation. She went through the most severe spectrum of this disease, namely NCC encephalitis and disseminated cysticercosis and had a classical starry sky brain in neuroimaging. In contrary to the popular practice of avoiding antihelminthic drugs in such extreme presentation, as a desperate measure, we had to use albendazole in this case, which showed clinical and radiological improvement.
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Pulmonary cystic echinococcosis: A case report from tertiary care hospital p. 163
Sheetal Bankar, Phudang Rebon Tokbipi, Isha Ranwadkar, Jayanthi Shastri
DOI:10.4103/tp.TP_3_20  
Human echinococcosis is a zoonotic infection transmitted by dogs in livestock-raising areas. We present a case of a 30-year-old female with respiratory symptoms.
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LETTERS TO EDITOR Top

Pediculicidal activity assessment of four essential oil terpenoids using filter contact and immersion bioassays p. 165
Kerdalidec Candy, Mohammad Akhoundi, Arezki Izri
DOI:10.4103/tp.TP_41_19  
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FACE TO FACE Top

Changing face of paragonimiasis p. 168
David Blair
DOI:10.4103/tp.TP_120_20  
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