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In this retrospective study from 2012 to 2015, 333 clinical isolates of yeasts were identified using Vitek 2 Compact System YST ID card (Biomerieux, France) and internal transcribed spacer (ITS) sequencing. Eighteen species were identified by ITS sequencing. Candida albicans was the most common species (46.5%), followed by Candida tropicalis (27%). The total species supported by Vitek System was 11 (61.11%). The sensitivity of the system in identifying these 11 species was 66.66%-100%; specificity 98.37%-100%; positive predictive value 70%-100%, negative predictive value 96.05%-100%, and diagnostic accuracy 96.99%-100%. Diagnostic accuracy of ITS1 and ITS2 sequences individually was 98.49% and 100% using NCBI Genbank database.

Background & Objectives: The interactions between HIV and malaria co-infection have been shown to influence each other in their clinical outcomes in Sub-Saharan Africa. This study was carried out in the two States of north east India endemic for both HIV and malaria infections, to study the interactions between the two diseases in the HIV-infected population., Methods: In this prospective study, a total of 333 HIV-infected individuals were followed up for a period of 6-18 months in Mizoram and Manipur during 2010-2011. The study assessed the changes in viral load and also the therapeutic efficacy of artesunate plus sulphadoxine-pyrimethamine (AS+SP) combination therapy in HIV-infected and HIV-uninfected individuals with Plasmodium falciparum malaria., Results: Viral load in HIV-infected malaria patients on day zero (D0) ranged from 1110 to 147,000 copies/ml. The log transformation of the geometric means of HIV viral loads revealed no significant difference on different days of follow up. There was 100 per cent adequate clinical and parasitological response (ACPR) after treating with artemisinin based combination therapy (ACT) both in HIV-infected and HIV-uninfected P. falciparum-positive individuals. Similarly, chloroquine showed 100 per cent ACPR in P. vivax HIV-infected individuals., Interpretation & Conclusion: The study showed no significant increase in HIV viral load in malaria cases. All HIV-infected and HIV-uninfected P. falciparum malaria-positive cases responded to the treatment with 100 per cent ACPR.

During August 2013, an outbreak of influenza-like illnesses (ILI) was investigated in Monigong area, near Indo-China border of Arunachal Pradesh, Northeast India. Influenza type A/H3N2 was detected by RT-PCR in 33.3% (8/24) of ILI cases. Sequence analysis of HA and NA genes revealed eight and five amino acid substitutions, respectively in Monigong H3N2 (Mo/H3N2) strains as compared to vaccine strain A/Victoria/361/2011. Four non-synonymous substitutions, three localizing at antigenic sites T144A, A; R158G, B; L173S, D, and one H9Y in close proximity to a potential glycosylation site aa8 in HA1 domain along with the substitution T329N in NA are likely to influence the antigenicity/virulence of Mo/H3N2 viruses. J. Med. Virol. 88:1999-2003, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Introduction: Scrub typhus is a major reason for febrile illness, caused by a bacterium Orientia tsutsugamushi, a rickettsial pathogen. Few outbreaks of scrub typhus have been reported from Arunachal Pradesh in recent past. However, there is lack of seroprevalence data from the region. In this regard, this study was undertaken using archival serum sample available from seven districts of Arunachal Pradesh., Methodology: This serological study was conducted in Regional Medical Research Center for NE Region, Dibrugarh. Reactivity to IgG class of antibodies against scrub typhus was done using Scrub typhus detect IgG ELISA kit as per manufacturer's protocol., Result: Seroprevalence of scrub typhus in seven districts of Arunachal Pradesh was found to be 40% (120/300). The age-specific scrub typhus seroprevalence rose steadily from 5.6% in children <10 years of age to 61.8% in persons aged ≥40 years (p = 0.0001). Prevalence is lowest in Papumpare (25.9%) and highest in East Siang (72.5%) (p = 0.0001). The seroprevalence in males and females was very similar, however, the female prevalence increases from age group ≥30 years (p = 0.053). Moreover, among the farmers, the seroprevalence is higher (58.3%) (p = 0.0001)., Conclusions: As clinical symptoms overlap with other viral/bacterial infections, scrub typhus infection should be considered in differential diagnosis of any acute febrile illness in this part of the country. In view of the high prevalence, empirical therapy of doxycycline/azithromycin may be done in cases of undiagnosed fever. Active surveillance has to be done to understand exact magnitude, epidemiological aspects, and distribution of vector and disease of this reemerging neglected tropical disease.

Objective: Toxoplasma gondii infection is primarily asymptomatic and one third of world's population is estimated to be infected by this protozoan parasite. This study was carried out to determine the seroprevalence of T. gondii infection among pregnant women from north east India, where data on this important parasitic infection is scanty., Methods: A total of 1141 serum archival samples collected from antenatal clinic attendees in 2007-09, were screened for T. gondii IgG by ELISA and analyzed with their socio demographic information., Results: The median age of the subjects were 25 years with an overall IgG seroprevalence of 48% (95% CI=45% to 51%). Seroprevalence was significantly associated with geographical location (p=0.000), among Mongoloids compared to Caucasoid (p=0.005), regular employees (p=0.003) or unskilled labors (p=0.04) compared to housewives, high or middle income group (p=0.003) compared to low income group and with increasing gravida (p=0.04). However on logistic regression analysis, only significant association was with geographical location (p=0.000) and occupation (unskilled labor) (p=0.04). Highest prevalence of 66.7% was noted among subjects with history of blood transfusion and lowest among Rh negative blood group (14.3%)., Conclusions: T. gondii infection prevalence is high among pregnant women living in hilly states of northeast India, which warrants a detail investigation on congenital toxoplasmosis as well as its economic impact.

Background: SPARC-like protein 1 (SPARCL1/Hevin), a member of the SPARC family is defined by the presence of a highly acidic domain-I, a follistatin-like domain, and an extracellular calcium (EC) binding domain. SPARCL1 has been shown to be down-regulated in many types of cancer and may serve as a negative regulator of cell growth and proliferation., Methods: Both tumor and adjacent normal tissue were collected from patients with gastric adenocarcinoma. Monoclonal antibody developed against recombinant SPARCL1 was used to analyze the expression of SPARCL1 by immunohisto chemical and western blotting (WB) analysis., Results: The expression of SPARCL1 was found to be significantly lower or negligible in gastric adenocarcinoma tissues in nearly all of the cases in comparison with adjacent normal tissue. This comparison was found to be independent of the patient's age, sex, and stage of cancer., Conclusions: We postulate that down regulation of SPARCL1 may be related to inactivation of its tumor suppressor functions and might play an important role in the development of gastric adenocarcinoma.

Background: Scrub typhus and leptospirosis are bacterial zoonotic disease causing high morbidity and mortality. The seasonal outbreak of pyrexia is common in Arunachal Pradesh (AP); many times the disease remains undiagnosed., Objective: An outbreak of pyrexia of unknown origin (PUO) occurred in Longding district of Arunachal Pradesh in 2013, with 108 deaths, which was investigated to elucidate the cause of illness., Methodology: Blood samples from the affected region with acute pyrexia were collected, and screened for the malaria parasite, scrub typhus IgM and leptospira IgM., Results: Scrub typhus IgM was reactive in 97% (30/31), and 25% (8/31) cases were co-infected with leptospira. Incidentally, scrub typhus reactive (67%) and leptospira co-infection (62.7%) were higher in females. Record of previous 3 years (2011-2013) from Longding, Community Health Centre showed an increase in indoor pyrexia cases by 2-fold or more during October and November., Conclusion: The present study is the first report of co-infection of scrub typhus with leptospirosis from Northeast India. Medical officers in this region should take scrub typhus and leptospirosis in their differential diagnosis of patients with PUO for early diagnosis and effective treatment.

In hepatitis B virus (HBV) infection, the immune reaction is responsible for viral clearance and preventing their spread within the host. However, the immune system is dysfunctional in patients with chronic HBV infection, leading to an inadequate immune response against the virus. A major factor contributing to inefficient immune function is the phenomenon of immune exhaustion. Hence, understanding immune activation and exhaustion during HBV infection is important, as it would provide insight in developing immunotherapy to control chronic HBV infection. The aim of this review is to highlight the existing information on immune effector functions and immune exhaustion in response to HBV infection.

Unlabelled: Infection of the uterine cervix by human papilloma viruses (HPV) may be associated with cervical pre-cancer and invasive cervical carcinoma if left untreated. With advance in molecular techniques, it has become easier to detect the resence of HPV DNA long before the appearance of any lesion. This study concerned cervical scrape samples of 310 married non-pregnant women attending a gynecology outpatient department for both Pap and PCR testing to detect HPV DNA. Nested PCR using primers for L1 consensus gene with My9/My11 and GP6+/ GP5+followed by multiplex PCR were carried out to detect HPV 16 and HPV18., Result: HPV prevalence was 11.9% out of which 3.67% cases of negative for intra-epithelial lesion or malignancy (NILM) and in 71.1% (27/38) of atypical cervical smears were HPV positive. There was increasing trend of high-risk-HPV positivity (HR HPV 16 and 18), from 20% in benign cytology (NILM) to 42.9 % in LSIL, 71.41% in HSIL and 100% in SCC. There was highly significant association of HPV infection with cervical lesion (x2=144.0, p<0.01) and also with type specific HPV prevalence (x2=7.761*(p<0.05).

We describe the prevalence of human metapneumovirus infection in children visiting outpatient department with symptoms of respiratory illness in rural areas of Dibrugarh District of Assam. Human metapneumovirus was observed in 7.2% (20/276) of children aged =5 years with detection of genotypes A2b and B2.

Context: Japanese encephalitis (JE), an acute mosquito-borne viral disease, is one of the leading causes of viral encephalitis in the South-East Asian region. JE is endemic in Assam. The morbidity and mortality due to JE is significant with outbreaks every year during the monsoons., Aims: The aim was to study the clinicopathological profile of JE; to examine their role in predicting disease outcome; and to document the increase in the incidence of JE among the adult population in this region., Materials and Methods: Clinically suspected acute encephalitis syndrome (AES) cases admitted in Assam Medical College and Hospital during the period of May 2011 to April 2012 were tested by JE virus specific Immunoglobulin M capture ELISA., Statistical Analysis Used: Data analysis was performed using SPSS version 16.0., Results: Out of 424 AES cases, 194 were JE positive. The occurrence of JE in adults was higher (P < 0.001) than the pediatric age group. The study recorded a high rate of renal dysfunction in JE cases. A single case of JE induced abortion and two cases of JE-neurocysticercosis co-infections were documented. Regression analysis revealed that adult population, unconsciousness, paresis and elevated cerebrospinal fluid protein level were associated with a worse prognosis in JE cases. Mortality in JE positive cases was higher than the JE negative cases (P = 0.001)., Conclusion: The study attempts to highlight the role played by a combination of clinical and laboratory parameters in assessing the severity and outcome in JE and may help in directing the limited medical resources toward those that need it the most.

Plasmodium falciparum is the most lethal form of the genus Plasmodium which causes malaria, a 'disease of antiquity'. Globally it affects the health and socio-economic development of a large population especially in Sub-Saharan Africa and Southeast Asia. The Plasmodium falciparum dihydrofolate reductase-thymidylate synthase (PfDHFR-TS) is an important target of antimalarial drugs. Mutations at the active site of PfDHFR have resulted in decrease drug binding affinity of DHFR-inhibitors. In the present study we selected ten compounds of Brucea mollis Wall. Ex kurz and checked for their drug likeness using various computational tools and potential interactions with PfDHFR by molecular docking study. Soulameanone, a quassinoid of Brucea mollis Wall. Ex kurz showed better binding affinity when compared to pyrimethamine for both wild and quadruple mutant drug resistant PfDHFR. In addition, similar isomers of soulameanone were screened for their drug likeness and to study their interactions with PfDHFR. Twenty three compounds showed better binding affinity compared to soulameanone.

A significant number of children die each year from acute respiratory tract infections especially in developing countries. Human respiratory syncytial virus (RSV) is the most common virus identified in such cases. Genetic characterization and the circulation pattern of RSV is important for future selection of appropriate vaccine strains. Limited information is available on the circulation of RSV in developing countries including India. The present study aimed to provide baseline information on the genetic variability of RSV in the Dibrugarh district of Assam, northeast India. Clinical specimens collected from children aged ≤6 years for routine influenza surveillance in the Dibrugarh district of Assam during the period 2009-2012, were screened for RSV by real-time reverse transcription-polymerase chain reaction. Genotyping was based on partial sequencing of the RSV attachment glycoprotein gene. RSV was detected in 7.9% (39/493) of cases. Only RSV group A viruses were detected during the study period with predominance of NA1 genotypes (89%). Two RSV GA5 genotypes were found to be co-circulating during 2012. The specific amino acid substitutions characteristics of the NA1 genotypes were distinct from RSV strains reported from the rest of India. It is concluded that the circulating genotypes of RSV in Assam, northeast India are NA1 and GA5. To our knowledge this is the first report of circulation of the NA1 genotype in India., (Copyright © 2013 Wiley Periodicals, Inc.)

Cholera epidemics with moderately high case fatality rates in Assam, northeast India were investigated in 2007, 2008 and 2010. Based on mismatch amplification mutation assay PCR for detection of ctxB allele, 40 isolates of Vibrio cholerae O1 El Tor collected from the epidemics were found to harbour the classical ctxB gene allele of cholera toxin (CT). DNA sequencing of ctxB gene confirmed the isolates to be genotype 1 of ctxB. Antimicrobial susceptibility tests reveal that 100% of the isolates were resistant to trimethoprim and 40% were resistant to tetracycline. The recent V. cholerae O1 strains circulating in Assam, India are due to the El Tor variant carrying classical type CT. Emergence of tetracycline and trimethoprim resistant strains necessitates the review of antibiotic use for severe cholera., (Copyright © 2012 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.)

Simultaneous occurrence of measles and chickenpox in a single individual is a rare event despite the fact that each of these infections alone is very common. The clinical presentation and molecular characterization of a dual infection caused by measles and Varicella-Zoster virus (VZV) in a 3-year female child is reported for the first time from India. The child presented with high fever, cough, cervical lymphadenopathy, and maculopapular rash followed by vesicular skin rash. The child was not immunized against measles and chickenpox. The viral nucleic acids extracted from the clinical specimen were subjected to PCR-Sequencing for confirmation of a dual infection with measles and VZV. The PCR and sequence analysis from the throat swab samples confirmed the coinfection of wild-type measles (genotype D4) and Varicella-Zoster virus (PstI(+) BglI(+)). The measles virus RNA and VZV DNA could be detected successfully from a single specimen of a throat swab. The case recovered uneventfully. Dual infection with measles and VZV does occur but may be underreported in the literature., (Copyright © 2011 Wiley-Liss, Inc.)

Background: Strongyloidiasis is endemic in many tropical and subtropical countries and reports from northeast India are very few., Aim: A community-based study was carried out in Assam, India, to find out the occurrence of Strongyloides stercoralis., Materials and Methods: Stool samples were obtained from 198 randomly selected individuals from the community. Samples were processed using direct microscopy with formal-ether concentration methods., Results and Conclusion: Seventeen numbers of samples showed the presence of Strongyloides stercoralis (8.5%). A total of 105 (53%) individuals were positive for at least one intestinal parasite. The other intestinal parasites detected were Ascaris lumbricoides (33.3%), Trichuris trichiura (9.1%), hookworm (7.1%), Enterobius vermicularis (1.5%), and Giardia cyst (1.5%). Five out of 17 individuals positive for S.stercoralis had associated gastrointestinal, respiratory, and/or cutaneous symptoms.The present study although not exhaustive for true prevalence calls for attention in the backdrop of high malnutrition and pulmonary tuberculosis.

Injection drug users (IDUs) and their associated risk behavior are responsible for driving the human immunodeficiency virus (HIV) epidemic in northeast India. So a group of IDUs from two northeastern states (Mizoram and Nagaland) of India were studied to find the prevalence of HIV, co-infection with hepatitis C virus (HCV), hepatitis B virus (HBV), and associated risk behaviors. Out of the 400 IDUs enrolled, 398 consented for HIV, HCV, and hepatitis B surface antigen (HbsAg) test. Of them, 10.8% were HIV-1 antibody positive, 47.8% had HCV antibody, and 3.8% had detectable HBsAg. Among the HIV infected subjects, 79.1% were co-infected with HCV and 6.9% had triple infection. Heroin users showed a higher association with HIV (OR = 7.3, 95% CI: 2.5-21.5, p=0.0003) and HCV infection (OR = 7.6, 95% CI: 3.5-16.6, p<0.0001) than Spasmo-proxyvon (dextropropoxyphene, a synthetic opiod analgesic). In summary, apart from the known risk variables among IDUs, type of injecting drugs also influences the HIV/HCV transmission pattern among the IDUs.

Background & Objective: There is a paucity of information on distribution of hepatitis B genotypes from northeastern part of India. Arunachal Pradesh, one of the northeastern State of India bordering Bhutan, China and Myanmar, reported abnormally high numbers of hepatitis B surface antigen (HBsAg) positive cases in one of its districts during January-June 2005. We conducted this study in the subsequent months (August-December 2005) to know the prevalent genotypes by a rapid and specific method based on type-specific primers in Upper Dibang valley of Arunachal Pradesh., Methods: A total of 438 randomly selected individual were screened for HBsAg positivity. Of the 93 HBsAg positive individuals, 36 HBsAg and HBV DNA positive samples were processed for HBV genotyping using type-specific primer based nested PCR (TSP-PCR). Representative samples were retested with RFLP-PCR based genotyping and nucleotide sequencing., Results: Of the 36 samples, 29 (80.1%) could be genotyped by the TSP-PCR based method used. The predominant genotype was genotype A (41.6%) followed by genotypes C (27.8%) and D (11.1%). Seven isolates (19.9%) could not be genotyped by this method., Interpretation & Conclusion: The presence of genotype C in this part of the country needs attention as genotype C takes a more aggressive disease course. Also, detection of genotype C in this isolated community bordering Tibet suggests viral gene flow from Tibet or other South-east Asian countries where genotype C of HBV is predominant.

Aim: To study the prevalence of hepatitis B virus (HBV) infection among an isolated tribe of Northeast India that migrated long back from Tibet., Methods and Materials: Randomly selected 438 subjects from Idu Mishmi tribe of Arunachal Pradesh were screened for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), envelope antigen (HBeAg) using ELISA kits., Results: The point prevalence of HBsAg was found to be 21.2% (93/438). Anti-HBc prevalence was 92.3% (193/209). Anti-HBs above 10 IU/ml were detected in 48% (96/200). Prevalence of HBeAg was higher (42.1%, 16/38) in children (less than 15 years) compared to adolescent and adults (32.7%, 18/55). History of hepatitis was significantly associated with positive HBsAg status (p < 0.000)., Conclusion: Hepatitis B virus infection is hyperendemic among Idu Mishmi tribe of Arunachal Pradesh, India. Though, the route of transmission could not be ascertained, but the high HBV infection (78.6%) among less than 5 yrs and the finding of 58.4% of HBsAg positive mothers bearing HBsAg positive child indicates possibility of vertical transmission in this setting.