Mosquito-borne diseases in Assam, north-east India: current status and key challenges

Mosquito-borne diseases, including malaria, Japanese encephalitis (JE), lymphatic filariasis and dengue, are major public health concerns in the north-eastern state of Assam, deterring equitable socioeconomic and industrial development. Among these, malaria and JE are the predominant infections and are spread across the state. The incidence of malaria is, however, gradually receding, with a consistent decline in cases over the past few years, although entry and spread of artemisinin-resistant Plasmodium falciparum remains a real threat in the country. JE, formerly endemic in upper Assam, is currently spreading fast across the state, with confirmed cases and a high case-fatality rate affecting all ages. Lymphatic filariasisis is prevalent but its distribution is confined to a few districts and disease transmission is steadily declining. Dengue has recently invaded the state, with a large concentration of cases in Guwahati city that are spreading to suburban areas. Control of these diseases requires robust disease surveillance and integrated vector management on a sustained basis, ensuring universal coverage of evidence-based key interventions based on sound epidemiological data. This paper aims to present a comprehensive review of the status of vector-borne diseases in Assam and to address the key challenges.

Quality and shelf life evaluation of pork nuggets incorporated with fermented bamboo shoot (Bambusa polymorpha) mince

Pork nuggets were processed by incorporating fermented bamboo shoot mince and their physico-chemical, microbiological and sensory characteristics were evaluated during 35 day storage at refrigeration temperature (4±1 °C). Addition of fermented bamboo shoot significantly affects the pH, moisture, protein, fat, fiber, instrumental color values and texture profiles of nuggets, especially at 6% and 8% addition levels. Nuggets with 6% and 8% FBSM had significantly lower TBARS values at the end of the storage period (i.e. 0.39 and 0.33 mg malonaldehyde/kg respectively) compared to the control (0.84 mg malonaldehyde/kg). Bamboo shoot addition significantly improved the microbial and sensory qualities of the pork nuggets. Incorporation of fermented bamboo shoot at 8% level increased the shelf life of pork nuggets by at least two weeks i.e. from 21 days to 35 days at 4±1 °C compared to the control.

Therapeutic efficacies of antimalarial drugs in the treatment of uncomplicated,Plasmodium falciparummalaria in Assam, north-eastern India

In the Indian state of Assam, the current therapeutic efficacies of the drugs commonly used in the area for the treatment of uncomplicated, Plasmodium falciparum malaria were investigated. As is routine in this area, subjects found positive for P. falciparum malaria were initially treated with chloroquine (CQ). They were given sulfadoxine-pyrimethamine (SP) if this treatment failed, and subsequently quinine if the SP failed. The protocol of the World Health Organization's extended in-vivo test was used to follow parasite clearance and clinical cure. Therapeutic response was assessed by comparing the baseline (day-0) level of parasitaemia with that observed on day 3. Many (75.7%) of the 144 evaluable subjects were treatment successes after CQ, but six early (4.2%) and 29 (20.1%) late CQ-treatment failures were observed. Of the 34 CQ-treatment failures followed, 31 (91.2%) responded adequately to SP but the other three were early (one) or late (two) SP-treatment failures. Two (66.7%) of the SP-treatment failures responded adequately to parenteral quinine but the other (a late quinine-treatment failure) had to be given an artemisinin derivative to achieve a clinical cure. The foci in which multidrug-resistant cases of malaria are developing in India need to be identified quickly, so that such cases can be cured before the mutant strains of P. falciparum that are resistant to several drugs have a chance to become more widespread.

Temporal lobe involvement in Japanese encephalitis: problems in differential diagnosis

BACKGROUND AND PURPOSE

On MR imaging and CT, Japanese encephalitis (JE) shows lesions in the thalami, substantia nigra, basal ganglia, cerebral cortex, cerebellum, brain stem, and white matter, whereas temporal lobe involvement is characteristically seen in Herpes simplex encephalitis (HSE). Temporal lobe involvement in JE may cause problems in differentiating it from HSE. We undertook this study to show the temporal lobe involvement pattern in JE and highlight differentiating features from temporal lobe involvement in HSE.

METHODS

Sixty-two patients with JE underwent CT or MR imaging or both. MR imaging was done in 53 and CT in 53. The diagnosis of JE was confirmed by cerebrospinal fluid (CSF) IgM enzyme-linked immunosorbent assay.

RESULTS

Eleven (17.7%) patients showed temporal lobe involvement with abnormal MR imaging in all. All the patients showed hippocampal involvement. Two patients showed extension of lesions into the amygdala and uncus with insular involvement in 1. The rest of the temporal lobe was spared. All patients had thalamic and substantia nigra involvement with basal ganglia involvement in 7. Six of 9 CT scans were abnormal and the temporal lesions were seen in 2.

CONCLUSIONS

The temporal lobe involvement pattern is fairly characteristic and mostly involves the hippocampus, usually sparing the rest of the temporal lobe. This and the concurrent involvement of the thalami, substantia nigra (SN), and basal ganglia allow differentiation from HSE. However, if the temporal lobe involvement is more severe, laboratory tests may be the only way to differentiate it from HSE, and it may be prudent to start antiviral therapy in the interim period.

An outbreak of Plasmodium falciparum malaria due to Anopheles minimus in central Assam, India

Epidemiological investigations were conducted in Nellie subcentre, PHC Jhargaon, under Morigaon district (Assam). The results of fever cases revealed 68 per cent slide positivity rate (SPR) and 40 per cent slide falciparum rate (SfR). The Pf proportion was > 87 per cent and remaining cases were P. vivax infections. An. minimus was incriminated as a malaria vector during the study period. The sporozoite rate was 3.08 per cent. The indoor man mosquito contact was 35 per bait/night as against 23 in outdoors. Results of susceptibility test revealed that the vector was still susceptible to both DDT and malathion at discriminating dosages. The study revealed that inadequate surveillance and vector control measures were contributing factors for malaria outbreak. In view of this, insecticide treated nets may be introduced to provide cost-effective control of malaria.