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R L Ichhpujani

Publications and source records attributed to R L Ichhpujani.

At least 19 recordsLinked to original sources
PubMed2006

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001.

BACKGROUND & OBJECTIVE: The viral encephalitides caused by animal or human viruses are characterized by sudden outbreaks of neurological disease in both tropical and temperate regions. An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001. This outbreak was investigated by a team of scientists from four major institutions, and the findings are presented here. METHODS: Detailed information about the outbreak was collected with the help of local health authorities. Limited entomological investigations were also done. Samples collected from cases and contacts were sent for analysis. RESULTS: A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus. INTERPRETATION & CONCLUSION: This outbreak highlights the importance and urgency of establishing a strong surveillance system supported by a network of state-of-the-art laboratories equipped to handle and diagnose new pathogens and including patient isolation techniques, use of personal protective equipment, barrier nursing and safe disposal of potentially infected material in the prevention and control measures for Nipah/Hendra virus infection.

Adolescent↗
PubMed2005

Safety and immunogenicity of the intradermal Thai red cross (2-2-2-0-1-1) post exposure vaccination regimen in the Indian population using purified chick embryo cell rabies vaccine.

PURPOSE: To test the immunogenicity of the WHO recommended "2-2-2-0-1-1" post-exposure rabies vaccination regimen in Indian subjects to determine the feasibility of replacing crude sheep brain nerve tissue rabies vaccine with modern tissue culture rabies vaccine at major anti-rabies treatment centers throughout India. METHODS: Purified chick embryo cell vaccine (PCECV) was administered in the dosage of 0.1 mL per site to 53 Indian subjects. RESULTS: All subjects produced rabies antibodies above 0.5 IU/mL by day 14 post-vaccination. Only minor adverse reactions including swelling (6.6%), erythema (5.4%) and pain (1.4%) were observed for which no treatment was required. CONCLUSIONS: This study demonstrated that PCECV is safe and highly immunogenic in Indian subjects when administered intradermally as 0.1 mL/site using the "2-2-2-0-1-1" post-exposure regimen.

Animals↗
PubMed2005

Comparative evaluation of commonly used laboratory tests for post-mortem diagnosis of rabies.

Animal brain samples received at WHO Collaborating Centre laboratory at National Institute of Communicable Diseases (NICD) during the years 1991-2002 were tested by Seller's stain, Fluorescent Antibody Test (FAT) and Mouse Innoculation Test (MIT) as methods of rabies diagnosis. Negri bodies on Seller's staining could be detected in 52.5% of MIT positive brains, the concordance of this test with MIT was found to be 77.8%. FAT was positive in 91.5% of MIT positive brains, though it showed concordance of 95.7% with MIT results in the total samples. 12.2% of the samples were found positive by FAT of which 1/3rd also showed the presence of Negri bodies when MIT was negative i.e. showing that the virus is present in inactivated form. Thus emphasizing the need for timely and proper collection and transportation of specimens for testing. Seller's stain and FAT give reliable diagnosis of rabies in the brain samples in majority of the cases. MIT being time-intensive test, is of academic value only in decision making as regards initiation of Post Exposure Treatment (PET), it is recommended that in cases where Seller's stain and FAT have yielded negative results the decision to initiate PET should give due consideration to the nature and circumstances of the animal bite and other epidemiological features.

Animals↗
PubMed2004

Human rabies in Delhi.

OBJECTIVE: Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course of one year was undertaken to understand the epidemiology of rabies. METHODS: The data was collected using standardized proforma and was analyzed on EPI Info 6.02 software version. A total of 49.8% of the human rabies came from Delhi and rest belonged to adjoining states of UP (30.3%), Haryana (18.3%), Bihar (0.8%), Punjab (0.4%) and MP (0.4%). Children in the age group 5-14 years fell victim to the disease in significantly higher numbers (36.7%) as compared to other age groups. Male Female ratio was 4:1. Biting animals involved were dog (96.7%), jackal (1.7%), cat (0.8%), monkey (0.4%) and mongoose (0.4%). Majority (78.8%) had Category III exposure. Hydrophobia, which is the pathogonomic feature of human rabies, was present in 95% of cases. Remaining (5%) gave history of animal bite and presented with features of aerophobia, photophobia along with fever, weakness in limbs, parasthesia, and/or paralysis. Significantly higher number (93.4%) did not receive any local wound treatment. Most (91.7%) cases never received any vaccination and remaining were inadequately vaccinated; only five had received 10-14 injections of Neural Tissue Vaccine (NTV) and one child who had multiple bites on face, received 5 doses of NTV, local wound treatment and intramuscular ARS on 3rd day. RESULT: The data strongly reveals that people who died due to rabies either did not receive any treatment or were inappropriately and inadequately treated. Hence, there is need to educate the community and the health care professionals about the importance of immediate and adequate post exposure treatment. The data also indicates that the epidemiology of the disease has not changed much over the decades. CONCLUSION: The disease can be prevented with the available tools and all we need to do is to implement them effectively.

Adolescent↗
PubMed2004

Quick control of bubonic plague outbreak in Uttar Kashi, India.

A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the disease can be diagnosed early and mounting of supervised comprehensive response can prevent the disease to proceed to pneumonic stage where man to man transmission gets established and outbreak assumes larger dimensions.

Adult↗
PubMed2004

An outbreak of human anthrax in Mysore (India).

Anthrax is a zoonotic disease caused by Bacillus anthracis. Intestinal anthrax though a rare entity mostly ends with fatal outcome. Very few cases of intestinal anthrax are reported. Present outbreak of intestinal anthrax is unique in itself that four cases succumbed to the illness within a span of 48-72 hours in a small hamlet of Mysore district of Karnataka, after consuming diseased deer meat. Confirmation of the diagnosis was carried out at NICD, Delhi by bacteriological culture isolation, biochemical tests, animal pathogenicity and polymerase chain reaction (PCR). This outbreak clearly indicates surveillance of anthrax in animals in endemic areas is an essential part in the control of the disease with intersectoral coordination between the departments of health, animal husbandary, agriculture and forest.

Adult↗
PubMed2003

Immune response in HIV-1-infected children with thalassaemia given a primary course of DPT vaccine before acquiring HIV-1 infection.

The effect of HIV infection on immune response to diphtheria and tetanus primary immunisation was investigated in 24 HIV-1-positive multi-transfused (MT) children with thalassaemia and compared with 48 HIV-1-negative MT thalassaemic children and 36 HIV-1-negative non-transfused (NT) children in the community. Diphtheria and tetanus antibody levels in the HIV-1-positive MT group were comparable with the two HIV-negative groups. The proportions of children with antibody titres below the protective level (i.e. <0.01 IU/ml) for antidiphtheria antibodies were 20.8, 16.6 and 16.6%, and 12.5, 12.5 and 13.9% for anti-tetanus antibodies in the three groups, respectively. On the other hand, delayed-type hypersensitivity (DTH) response to diphtheria and tetanus antigens was significantly depressed in the HIV-1-positive group compared with the HIV-negative controls. The mean percentages of both mature (CD20+) and immature (CD10+) B-cell counts were significantly higher in the HIV-1-positive group than in the HIV-negative MT and NT groups (p<0.05). Levels of serum immunoglobulins and spontaneously secreted immunoglobulins were significantly higher in the HIV-1-positive group compared with both HIV-negative groups. The HIV-1-positive group showed a mean (SD) IL-6 of 52.9 (28.8) pg/ml compared with 23.7 (12.1) pg/ml and a detection rate of 54.2% in the HIV-negative MT group, and 23.6 (8.2) pg/ml and a 50% detection rate in the HIV-negative NT group. The IL-2 level was significantly lower (p<0.05) in the HIV-1-positive group [41.7% detection rate and mean (SD) 28.8 (17.1) pg/ml] than in the HIV-negative MT and NT groups [75% and 83.3% detection rates and mean (SD) 57.2 (42.3) pg/ml and 99.3 (51.1) pg/ml, respectively]. During follow-up for 3 years, the frequency of major infections was significantly higher in the HIV-1-positive group than in the other two groups. Acute pneumonia and acute sinusitis were the predominant infections regardless of HIV status while primary bacteraemia, osteomyelitis, pyogenic meningitis and septic arthritis were common in the HIV-1-positive group. We conclude that, in HIV-1-infected children pre-immunised with DPT, DTH response to diphtheria and tetanus antigens might be more reliable than anti-diphtheria and anti-tetanus antibody levels in predicting susceptibility to major bacterial infections.

Adolescent↗
PubMed2003

Animal bites: the current management guidelines.

Rabies is a major public health problem in India. It is mainly transmitted by stray dogs, which form an overwhelming population in the country. Dogs are responsible for upto 95% of animal bites requiring antirabies treatment. In view of the exceptionally high fatality rate of human rabies, the prevention of infection after exposure is of utmost importance. With the availability of safe and effective tissue culture vaccines prevention of this dreaded disease is virtually assured by immediate and appropriate post exposure treatment. This is a three pronged approach including proper wound management, judicious use of antirabies serum and modern tissue culture vaccines. In India, Neural Tissue Vaccine is still used for post exposure treatment in public sector, though effective, this vaccine has serious side effects. The production and use of tissue culture vaccine should be encouraged with the aim to phase out neural tissue vaccine. WHO recommends use of intradermal route of inoculation of Tissue Culture Vaccine which makes the treatment very economical. However, this route as yet, is not approved by Drug Controller, Government of India (DCGI). There are no uniform guidelines for management of animal bite cases in India. In this article an attempt is made to discuss various aspects of animal bite management.

Animals↗
PubMed2002

Immunogenicity of purified chick embryo cell anti-rabies vaccine in post-exposure treatment of animal bite cases.

The observations on immunogenicity of Purified Chick Embryo Cell (PCEC) anti rabies vaccination in post-exposure prophylaxis is reported. In total 207 serum samples collected from patients receiving 3 to 6 doses of PCEC were analysed for the presence of anti-rabies antibodies. The samples were collected from 10 days to 11 months after the last dose of vaccine. All the vaccinees (n=33) tested after 3 doses of PCEC showed protective titres (> or = 0.5 IU/ml) and those receiving 5-6 doses (n=161) showed 4-5 times higher than protective titres. The analysis pertains to specimens collected at one point of time only after the vaccination. However, in all 17 vaccinees where samples were collected 7-11 months after 3-6 doses of vaccine, the protective titres were sustained, these being 3-4 times higher than the protective titres in those receiving 5-6 vaccine doses. The results indicated that there was no need of routine anti-rabies antibody monitoring in healthy individuals receiving post-exposure prophylaxis in recommended doses of vaccine.

Animals↗
PubMed2002

Kala-azar in Uttar Pradesh--a study of 66 patients.

Sixty-six laboratory confirmed cases of Kala-azar from Uttar Pradesh attending various hospitals of Delhi over a period of 10 years (1989-1999) have been analysed. The geographical distribution showed that the disease involved widespread areas varying from a height of 10,000 ft. extending up-to the plains. Male, female ratio was 2:1 and maximum patients were in the age group of 5-15 years. L.D. bodies could be demonstrated in 59 patients in bone marrow aspirate smears while in 7 in splenic aspirate smears. One patient was co-infected with HIV. Indirect immuno fluorescent test was positive in 65 patients in titres ranging from 1:100 to 1:25,600 except in one HIV co-infected patient where no antibodies could be detected. Sixty-two (93.9%) patients responded completely to sodium stibogluoconate.

AIDS-Related Opportunistic Infections↗
PubMed2001

Epidemiological characteristics of rabies in Delhi and surrounding areas, 1998.

OBJECTIVE: To describe the epidemiological characteristics of rabies in Delhi in 1998. METHODS: Analysis of the records of hydrophobia cases admitted to the Infectious Diseases Hospital, Delhi (IDH) in 1998. RESULTS: About 46 percent (99/215) of the hydrophobia cases admitted to the IDH in 1998 belonged to Delhi. The remaining came from the adjoining states, both urban and rural areas. In Delhi residents, overall hospitalization rate was 0.81 per 100,000 population. It was significantly higher in 5-14 year old than in other age groups and in males than in females (p <0.0009). Cases occurred round the year. Almost 96 percent cases (206/215) gave history of animal exposure, 13 days to 10 years (median 60 days) before hospitalization. Majority (195/206) had class III exposure. Animals involved were stray dog (193/206 = 90 percent), pet dog, cat, jackal, mongoose, monkey and fox. Most of cases were never vaccinated (78 percent) or inadequately vaccinated (22 percent); only 1 percent each received appropriate wound treatment, or rabies immunoglobulin. CONCLUSIONS: Rabies is a major public health problem in Delhi. Its incidence is significantly higher in 5-14 year old children than in other age groups. The results indicate the need to educate the community and health care workers about the importance of immediate and adequate post-exposure treatment and to start an effective control program for dogs, the principal vector of rabies.

Adolescent↗
PubMed2001

Detection of antibodies to Taenia solium in sera of patient with epilepsy using ELISA.

Enzyme linked immunosorbent assay (ELISA) was used for detection of antibodies to cysticerci of Taenia solium in patients suffering from suspected neurocysticercosis. Serum antibodies to cysticercosis were detected in 10.4% of the patients. Antibodies were absent in healthy controls. No cross-reactivity was observed in sera from patients with other parasitic diseases viz. toxoplasmosis, filariasis and kala-azar. However sera from patients with hydatid disease showed cross reactions in 20%. Age group distribution showed gradual non-significant increase in seropositivity rates with advancing age. No significant gender difference, was observed. Analysis of dietary habits of patients showed statistically significant difference in seropositivity rates in non-vegetarians (15.4%) as compared to vegetarians (6.9%) (P value < .001).

Adolescent↗
PubMed2000

Silent spread of dengue and dengue haemorrhagic fever to Coimbatore and Erode districts in Tamil Nadu, India, 1998: need for effective surveillance to monitor and control the disease.

Dengue fever (DF) or dengue haemorrhagic fever (DHF) has not previously been reported in Coimbatore and Erode districts in Tamil Nadu in India. In 1998, 20 hospitalized cases of fever tested positive for dengue virus IgM and/or IgG antibodies. All of them had dengue-compatible illness, and at least four had DHF. Two of them died. Sixteen cases were below 10 years of age. The cases were scattered in 15 distantly located villages and 5 urban localities that had a high Aedes aegypti population. Although the incidence of dengue-like illness has not increased recently, almost 89% (95/107) of samples from healthy persons in the community tested positive for dengue IgG antibodies. The study showed that dengue has been endemic in the area, but was not suspected earlier. A strong laboratory-based surveillance system is essential to monitor and control DF/DHF.

Adolescent↗
PubMed1997

Transplacental dilution of tetanus antitoxins in Delhi.

Maternal blood-cord samples from 171 women of middle socio-economic status who had been administered at least two doses of tetanus toxoid (TT), were assayed for tetanus antitoxins by passive haemagglutination (PHA) test. All the mother as well as cord samples had antitoxin titres > or = 0.015IU/ml, the generally accepted minimal protective level; 98 per cent of the mothers and 97 per cent of the newborns had levels > or = 0.125IU/ml. Transplacental dilution was observed in 45 per cent of the samples; the cord/maternal antitoxin ratio (C/M) of geometric mean titre (GMT) was found to be 0.72. The C/M ratio was not affected by the maternal age, parity, birth weight, and number of TT doses administered to mother. The study showed that tetanus antitoxins were diluted on the fetal side of circulation, but the protective levels of antitoxins were achieved in all the newborns as the mothers had received at least two doses of TT before delivery.

Adolescent↗
PubMed1997

Investigation of the outbreak of cholera in Alleppey & Palghat districts, south India.

In May 1996, a massive outbreak of cholera occurred in Alleppey district of Kerala which spread to Palghat district by July 1996. Of the 575 patients hospitalized at the Alleppey Medical College hospital between May 1 and August 2, 1996, 30 deaths occurred with a case fatality rate of 5.2 per cent while of the 638 diarrhoea patients admitted at Agali PHC of Attapadi area in Palghat district, 30 (4.7%) deaths were recorded. Clinically, the patients had profuse watery diarrhoea with vomiting. The epidemic of cholera in Alleppey and Palghat districts was caused by V. cholerae O1 of the EITor biotype, Ogawa serotype which possessed both the ctxA and tcpA genes when examined by multiplex PCR. Gross contamination of water sources was incriminated as the cause of the epidemic.

Adolescent↗
PubMed1996

Immunity to diphtheria in women of childbearing age in Delhi in 1994: evidence of continued Corynebacterium diphtheriae circulation.

Blood samples from 171 full-term pregnant women (aged 18-38 years) of middle socioeconomic status from Delhi were tested for diphtheria antitoxins by indirect hemagglutination (IHA) test. History of primary immunization/clinical diphtheria during childhood was not ascertainable, but none had been revaccinated against diphtheria at any time. About 94% women had very high antitoxin titers (> or = 0.125 IU/ ml); none had antitoxin titer less than 0.015 IU/ml, the minimum protective level. The titers were uniformly high in all age groups. However, women having 2 or more children had significantly higher antitoxin titers than those having no or one child (p < 0.01). The results from this study and historical data on diphtheria in Delhi are compatible with continued transmission of C. diphtheriae in recent times in Delhi which is of sufficient magnitude to boost the antitoxin levels in adults, especially mothers having two or more children. The study highlights the need of increasing the immunization coverage with DPT among children to reduce the transmission of Corynebacterium diphtheriae.

Adolescent↗