Open Access Review Article

The Pathogenesis and Immune-Response in Dengue Haemorrhagic Fever

A. M. Meer Ahmad, S. Arumugam, Chee Loon Leong

Asian Journal of Research in Infectious Diseases, Page 1-12
DOI: 10.9734/ajrid/2019/v2i230100

Introduction: Dengue fever has spread to be endemic in addition of 100 countries to a total estimate incidence of 50 – 100 million cases annually globally. About 0.7% of these cases become the complication that is dengue hemorrhagic fever which is severe and leads to about 22,000 deaths annually.

The pathogenesis of benign dengue fever becoming dengue hemorrhagic fever, and aspects of the immune-response behind it, have remained relatively unknown.

Methods: Existing literature on the Topic was retrieved through Google Scholar and PubMed searches, and the literature reviewed.

Results: Dengue hemorrhagic fever appears commoner in females and those with co-morbids such as diabetes-mellitus and obesity. Also, the case-fatality rate in severe dengue appears much bigger in females. The reasons for this are largely unknown but the additionally robust immune response in females, resulting in females to be additionally prone to develop bigger inflammatory response or enhanced susceptibility to capillary permeability could be the reason.

It has been shown that viremic-load, including the initial viremic-load at the bite of the Aedes-mosquito may be a factor leading to dengue hemorrhagic fever.

Yet different factors felt to be causative in the pathogenesis of dengue hemorrhagic fever include the role of the viral-protein, and then that which is termed the original antigenic-sin, the antibody-directed enhancement, autoimmunity, inhibition of interferon-alpha and cytokine-storm within the memory-cells.

Regionally, certain different strains of the DENV also seem to be associated with dengue hemorrhagic fever.

Newer-vaccines, based on the immunology of the disease, offer much hope in the near future.

Conclusion: Much knowledge has been forthcoming in realizing the pathogenesis of dengue hemorrhagic fever. But, additional studies need to be done.

Open Access Original Research Article

Central Nervous System (CNS) Manifestations in Probable Case of Rickettsial Infections in Children in Central Karnataka

K. R. Sachin, S. Madhu Pujar, C. Divya, K. M. Vinay

Asian Journal of Research in Infectious Diseases, Page 1-5
DOI: 10.9734/ajrid/2019/v2i230098

Introduction: Central nervous system (CNS) manifestations in children with rickettsial diseases are increasingly being reported from various parts of India but still rickettsial disease, as a cause of central nervous system (CNS) infections are underdiagnosed because of lack of freely available rapid and cheap diagnostic tests and varied clinical spectrum of rickettsial fever.

Objective: To report CNS manifestations in probable cases of rickettsial diseases so as to increase awareness amongst pediatricians.

Materials and Methods: A retrospective analysis of children (birth to 18 years) hospitalized in Bapuji Child Health Institute, which is secondary referral centre catering to children from five districts of Karnataka, with diagnosis of rickettsial disease from January 2016 to December 2018. The diagnosis of rickettsial infections was made by scoring system proposed by Rathi Goodman Aghai (RGA), weil felix test, prompt response to doxycycline within 48 hours and exclusion of differential diagnoses.

Results: Out of 278 patients, who were diagnosed as probable case of rickettsia, 172 patients had neurological involvement. Out of 172 patients with diagnosis of rickettsial disease having symptomatic neurological involvement, 148 (86%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of rickettsial diseases too, along with neurological manifestations. The youngest patient was 3 month old infant. The various neurological manifestations seen were altered mental status (76%), irritability (61%), headache (48%), meningeal signs (32%), seizures (31%), papilloedema (26%), focal neurological deficits (18%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (28%).

Conclusions: The myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in rickettsial infections and should have high index of suspicion for rickettsial diseases in febrile patients having neurological features specially in endemic areas.

Open Access Original Research Article

Prevalence Rate of Vulvovaginal Candidiasis among Women Attending Abia State Teaching Hospital Aba, Nigeria

C. A. Azike, V. N. Agi, D. Uwalaka

Asian Journal of Research in Infectious Diseases, Page 1-6
DOI: 10.9734/ajrid/2019/v2i230099

Background: Most women regard any secretion from the vagina as abnormal discharge and the first task for primary health care giver is to confirm whether it is physiological or pathological.

Aim: The aim of this study is to determine the prevalence rate of Candida infection among women, attending Abia State teaching hospital, Abayi Aba. A structured questionnaire was administered to obtain demographic data.

Methodology: One hundred high vaginal swab samples were collected from both symptomatic and asymptomatic non-pregnant women between ages 15-45 years old. These specimens were analyzed with standard microbiological techniques. The swabs were inoculated on sabouraud dextrose agar and incubated at 37 degrees centigrade for 48hrs. Wet preparation was examined microscopically for presence of yeast cells. Gram staining was also done. Germ tube test was carried out to confirm Candida albicans species.

Results: Of the 100 specimens analyzed, the overall prevalence of Candida species was 57% (n=57). There were 47 symptomatic participants and 53 asymptomatic participants in the study. Of the 47 symptomatic women, 36 had Candida species while 21 out of 53 asymptomatic women had Candida species. The participants were also grouped according to their socio-economic status and the result revealed that traders were most affected with prevalence rate of 35.1% while the housewives were least affected with prevalence rate of 14.0%.

Conclusion: This study recorded higher prevalence of vulvovaginal candidiasis among both symptomatic and asymptomatic non-pregnant women in Abia State teaching hospital. Regular checkup and good hygiene practice are critical in order to forestall avoidable complications.

Open Access Original Research Article

Improving Detection of Trichomonas vaginalis Infection among Adult Females in a Resource-poor Setting in Ogoniland, Niger Delta, Nigeria

Easter Godwin Nwokah, Ziganubari Monica Monday, Chidimma Anthonia Azike

Asian Journal of Research in Infectious Diseases, Page 1-5
DOI: 10.9734/ajrid/2019/v2i230101

Aim: Trichomonas vaginalis infection is a neglected tropical parasitic infection affecting mostly women of child bearing age, especially those of low socio-economic status and those that have poor hygiene lifestyle. Unfortunately, the traditional wet mount microscopy routinely used in the rural health care settings, for the detection of this parasite from clinical specimen, hardly detect this parasite (false negative), thus making the diagnosis of trichomoniasis a huge challenge in the rural settings. The aim of this study was to determine the prevalence rate of Trichomonas vaginalis among adult females in Bori, a rural resource-poor setting in Ogoniland, Niger Delta, Nigeria using modified Parasite Concentration-Giemsa staining technique.

Study Design: This was a randomized study of adult females attending Government Health Centers in the Ogoni areas of Rivers State, Nigeria between April and August, 2018.

Methodology: A total of five hundred (500) women, grouped into married (128) and unmarried (372), were enrolled in this study. A structured questionnaire was also administered to the participants for demographic data. Using sterile specula, high vaginal swab samples were collected and analyzed using the wet mount preparation and 10% Giemsa staining of centrifuged specimens.

Results: Results obtained showed that the prevalence rate was 1.8% (9 out of 500 subjects). The sensitivity of wet mount and Giemsa stain methods were 56.2% and 100% respectively while their specificity were 100% and 98.2% respectively. While wet mount detected 0.4%, Giemsa staining method detected 1.8%. Two (1.6%) out of 128 married women examined had T. vaginalis while 7 (1.9%) out of 372 unmarried women examined had T. vaginalis.

Conclusion: Although study recorded a low prevalence, Trichomonas vaginalis infections, exists in rural areas of Rivers State and therefore a source of concern because of its attendant morbidities. Early detection using improved diagnostic methods and in this case, the relatively inexpensive Parasite Concentration-Giemsa staining method, will improve management within the rural setting. A meta screening of more rural communities is advocated.

Open Access Commentary

Socio-cultural Determinants of Spread of Ebola Outbeak in West Africa 2014- 2016: Lessons Learnt

Anthonia Okeke

Asian Journal of Research in Infectious Diseases, Page 1-6
DOI: 10.9734/ajrid/2019/v2i230097

Ebola is one of the most deadly infectious diseases known to man. It is a viral disease which is transmitted from animal to man (zoonotic) . Ebola as a zoonotic disease for which no cure has been found, requires intensive efforts at prevention and control. Health inequalities due to socio-cultural factors coupled with geographical factors have perpetuated the disease among humans. This needs to be addressed to stem the re-emergence and spread of Ebola in West Africa and indeed in the world at large.