Pharmacological benefits of Acacia against metabolic diseases: intestinal-level bioactivities and favorable modulation of gut microbiota

CONTEXT

Obesity-associated chronic metabolic disease is a leading contributor to mortality globally. Plants belonging to the genera Acacia are routinely used for the treatment of diverse metabolic diseases under different ethnomedicinal practices around the globe.

OBJECTIVE

The current review centres around the pharmacological evidence of intestinal-level mechanisms for metabolic health benefits by Acacia spp.

RESULTS

Acacia spp. increase the proportions of gut commensals (Bifidobacterium and Lactobacillus) and reduces the population of opportunistic pathobionts (Escherichia coli and Clostridium). Acacia gum that is rich in fibre, can also be a source of prebiotics to improve gut health. The intestinal-level anti-inflammatory activities of Acacia are likely to contribute to improvements in gut barrier function that would prevent gut-to-systemic endotoxin translocation and limit "low-grade" inflammation associated with metabolic diseases.

CONCLUSION

This comprehensive review for the first time has emphasised the intestinal-level benefits of Acacia spp. which could be instrumental in limiting the burden of metabolic disease.

Improved antioxidant activities of spice require enrichment of distinct yet closely-related metabolic pathways

Improved biosynthesis of commercially and pharmacologically relevant phytometabolites through genetic and metabolic engineering is a lucrative strategy for crop improvement. However, identifying appropriate biosynthetic pathways pertaining to specific bioactivities has been challenging since the major metabolic pathways remain closely interconnected. Here we propose a reverse association strategy in which, based on the phytochemical profile, putative target metabolic pathways could be identified for increased production of phytochemicals. Dried seed fruits of Coriandrum sativum, Trachyspermum ammi, Cuminum cyminum, and Foeniculum vulgare (family Apiaceae) were subjected to untargeted gas chromatography-mass spectrometry-based phytochemical profiling followed by evaluation of the overall antioxidant profile using multiple antioxidant assays. Using bioinformatics approaches, specific phytochemical classes and the enrichment of their respective biosynthetic pathways were identified. Collectively, the data suggest enrichment of isoprenoids and fatty acids biosynthetic pathways. The close association of metabolic pathways with antioxidant capacities indicated a need for enrichment of specific yet closely-related metabolic pathways to achieve an improved quality of spices for better antioxidant effects.

Correlative metabolomic fingerprinting and molecular docking studies of dermatological phytotherapeutics of South-Eastern Himalaya

Viburnum erubescens Wall., Rhododendron arboretum Sm., Eurya japonica Thumb., Symplocos lucida (Thunb.) Siebold & Zucc, and Symplocos pyrifolia Wall. ex G. Don are extensively used by the native and ethnic populations of the South-Eastern Himalayan region for several dermatological conditions, yet their phytochemical composition remained largely unknown. Therefore, the aim of the study was to explore the therapeutically relevant volatile phytochemical compositions and study the molecular interactions against intracellular cytoregulatory transcription factors. Leaves of the five plants were subjected to Gas chromatography-Mass spectrometry (GCMS) post silylation derivation. The results were further analyzed using multivariate statistical methods such as Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA). A total of 115 compounds were identified in the five plants. Multivariate analysis revealed optimum metabolomic correlation between S. pyrifolia and S. lucida (0.876), whereas lowest correlation was found between E. japonica and V. erubescens (−0.242). Arbutin, β-amyrin, betulin, β-sitosterol and stigmasterol demonstrated highest interaction with the molecular targets. Collectively, the present study revealed the bioactive volatile phytochemicals responsible the therapeutic uses against diverse skin conditions.

Acacia nilotica leaf improves insulin resistance and hyperglycemia associated acute hepatic injury and nephrotoxicity by improving systemic antioxidant status in diabetic mice

ETHNOPHARMACOLOGICAL RELEVANCE

Acacia nilotica (L.) Delile is used as a traditional anti-diabetic remedy in Bangladesh, Pakistan, Egypt, Nigeria and is mentioned in Ayurveda as well.

AIM

The objective of the study was to evaluate the ethnomedicinal claim of A. nilotica leaf (ANL) extract for its efficiency in ameliorating diabetic complications.

MATERIALS AND METHODS

ANL was orally administrated (50 and 200mg/kg) to alloxanized mice (blood glucose > 200mg/dL) for 20d. Parameters of glucose metabolism, hepatotoxicity, hyperlipidemia and nephrotoxicity were measured with emphasis on elevated oxidative stress. ANL was chemically characterized using GC-MS. Further, docking studies were employed to predict molecular interactions.

RESULTS

ANL lowered (65%, P< 0.001) systemic glucose load in diabetic mice, which was otherwise 398% higher than control. ANL lowered (35%) insulin resistance, without any significant effect on insulin sensitivity (P> 0.05). Anti-hyperglycemic properties of ANL was further supported by lowering of HbA1c (34%; P< 0.001) and improved glucose utilization (OGTT). Overall diabetic complications were mitigated as reflected by lowered hepatic (ALT, AST) and renal (creatinine, BUN) injury markers and normalization of dyslipidemia. Elevated systemic oxidative stress was lowered by increased catalase and peroxidase activities in liver, kidney and skeletal muscle, resulting in 32% decrease of serum MDA levels. Apart from high phenolic and flavonoid content, tocopherol, catechol and β-sitosterol, identified in ANL, demonstrated substantial binding affinity with Nrf2 protein (5FNQ) reflecting possible crosstalk with intracellular antioxidant defense pathways.

CONCLUSION

The present study revealed the potentials of A. nilotica to alleviate diabetes-related systemic complications by limiting oxidative stress which justified the ethnopharmacological antidiabetic claim.

Effect of Acacia catechu (L.f.) Willd. on Oxidative Stress with Possible Implications in Alleviating Selected Cognitive Disorders

In human body, several categories of degenerative processes are largely determined by free radicals originating in cell. Free radicals are also known to have correlated with a variety of cognitive disorders (CDs) resulting in neuronal injury and eventually to death. Alzheimer's disease (AD) and Parkinson's disease (PD) are such kind of killer CDs that occur due to dysfunction of cholinergic and dopaminergic neurons. Plant parts of Ginkgo biloba, Bacopa monnieri etc. are being used for the treatment of cognitive disorders in several countries. The present study was aimed to explore the detailed antioxidant and anti-cholinesterase activity of Acaciacatechu leaf (ACL) over CDs. Gas chromatography-Mass spectroscopy (GC-MS) analysis and Nuclear Magnetic Resonance (NMR) were employed to identify the bioactive components present in ACL. Furthermore, the extract was evaluated to check the cytotoxic effects of ACL on normal cells. Amongst several antioxidant assays, DPPH assay, hydroxyl radical, nitric oxide radical and hypochlorous acid inhibitory activities were found to be greater in ACL than that of the respective standards while other assays exhibited a moderate or at per inhibitory activity with standards. Total phenolic and flavonoid content were also found to be present in decent amount. In addition, we found, a greater acetylcholinesterase (AChE) inhibitory activity of ACL when compared to other medicinally important plants, indicating its positive effect over CDs. Forty one bioactive components were explored through GC-MS. Of these, gallic acid, epicatechin, catechin, isoquercitrin etc. were found, which are potent antioxidant and a few of them have anti-neurodegenerative properties. Eventually, ACL was found to be nontoxic and safer to consume. Further studies with animal or human model however, would determine its efficacy as a potential anti-schizophrenic drug.

Assessment of haemolytic, cytotoxic and free radical scavenging activities of an underutilized fruit, Baccaurea ramiflora Lour. (Roxb.) Muell. Arg

Baccaurea ramiflora Lour. (Roxb.) Muell. Arg. is an underutilized juicy fruit bearing plant found in sub-Himalayan area, South China, Indo-Burma region, etc. The fruit is considered to be nutritive, and in this study, we evaluated its antioxidant, haemolytic and cytotoxic properties. The juice was examined for the quenching activity of hydroxyl radical, nitric oxide, singlet oxygen, peroxynitrite, total antioxidant activity (TAA), erythrocyte membrane stabilizing activity (EMSA) along with quantification of phenolic and flavonoid contents and also tested for its potential activity as iron chelator, inhibitor of lipid peroxidation and total reducing power. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) were also performed to correlate antioxidant capacities with the phenolic and flavonoid content. Haemolytic activity on murine erythrocyte and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cytotoxic test was performed on murine splenocytes, thymocytes, hepatocytes and peritoneal exudates macrophage to examine the cytotoxic effect of its juice. The result exhibited its potent free radical scavenging activity. In case of TAA, DPPH (2, 2-diphenyl-1-picrylhydrazyl), EMSA and lipid peroxidation, the fruit juice was found to have significant (P < 0.001) antioxidant capacity, which is evident from low IC50 (half maximal inhibitory concentration) value. Results obtained from haemolytic inhibition assay and MTT cytotoxic test confirms that the juice does not contain any cytotoxic effect and the fruit is safe for consumption. Fourier transform infrared (FTIR) spectra analysis exhibited high possibility of presence of flavonoid compounds in the juice.

Assessment of anti-diabetic activity of an ethnopharmacological plant Nerium oleander through alloxan induced diabetes in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Nerium oleander L. (syn. Nerium indicum Mill. and Nerium odorum Aiton.) is used for its anti-diabetic properties in Pakistan, Algeria, Morocco and is also recognized in Ayurveda. The present study was undertaken to investigate the anti-diabetic capacity of a standardized hydromethanolic extract of Nerium oleander in alloxan induced diabetes in mice.

MATERIALS AND METHODS

Nerium oleander leaf extract (NOLE) was orally administered at 50 and 200mg/kg body weight (BW) dose to alloxanized mice (blood glucose >200mg/dl). After 20 consecutive days of treatment, various diabetic parameters were studied and compared with untreated mice. Furthermore, gas chromatography-mass spectrometry (GC-MS) and high performance liquid chromatography (HPLC) analysis was employed to reveal the phytochemical composition of the plant extract.

RESULTS

NOLE demonstrated antihyperglycaemic activity by reducing 73.79% blood glucose level after 20 days of treatment. Oral glucose tolerance test (OGTT) revealed increase in glucose tolerance as evident by 65.72% decrease in blood glucose in 3h post treatment. Percentage decrease in different liver marker enzymes were significant along with decrease in triglyceride and cholesterol levels, displaying potent antihyperlipidemic activity. Peroxidase and catalase activity in liver, kidney and skeletal muscle were significantly restored besides marked reduction in lipid peroxidation and normalization of hepatic glycogen level in the NOLE treated alloxanized mice. Different bioactive phytocompounds with potent anti-diabetic activity were identified by GC-MS and HPLC analysis.

CONCLUSION

The present investigation revealed that Nerium oleander possess potent anti-diabetic activity as claimed in different ethnopharmacological practices.

Ethnobotany, traditional knowledge and socioeconomic importance of native drink among the Oraon tribe of Malda district in India

AIM

Preparation of daily traditional drink by the indigenous tribes is a common phenomenon in India. Oraon tribes in Malda district of West Bengal, India are very much practiced in making of their own native brew, known as Chullu. Therefore, the aim of this study was to explore the whole Chullu procedure technology of the region and its socioeconomic effect on Oraon. Ethnomedicinal investigation of local plants involved in Chullu preparation was another aspect of this study.

MATERIALS AND METHODS

The present study was conducted from April 2012 to June 2013. Consecutive field surveys were performed to collect information from Chullu producers to focus the procedure technology of local brew by means of semi-structured individual interviews, informal interviews and group discussion. A semi-structured questionnaire process was also performed to obtain the information regarding the ethnic use of plant species involved in Chullu preparation.

RESULTS

The present study revealed that four medicinal plant species along with rice having strong local ethnomedicinal value were used to prepare this indigenous drink. Oraon prepare the brew using their unique home-made distillation process. Commercialization of this local brew represents an alternative income to develop their economic condition, especially for poor households. The index of importance value was considered to evaluate the importance, usage, and knowledge of the five studied species.

CONCLUSION

It could be concluded that practices of Chullu preparation represent a bonding between ethnic knowledge and Oraon people of the province. Commercialization of Chullu may be considered as a source of alternative way of income for poor households in the region.

Indigenous knowledge of plants in local healthcare management practices by tribal people of Malda district, India

Aim:

The present study was aimed at exploring the indigenous knowledge of native tribes on the utilization of wild plant species for local healthcare management in Malda district of West Bengal.

Materials and Methods:

Successive field surveys were carried out from July 2012 to August 2013 in search of traditional healers or practitioners who ceaselessly use their worthy knowledge to treat several ailments for human purposes. The information was collected by means of open-ended conversations, semi-structured questionnaire, group discussion, etc. Information obtained from the informants was also cross verified to check the authenticity.

Results:

The present study revealed that a total of 53 medicinal plants belonging to the 37 families are frequently used to treat 44 types of ailments with 88 herbal preparations. Of 53 plants, herbs possess the highest growth forms (32%) that were used in making traditional preparation, followed by shrubs (24%), trees (23%), climbers (17%), and parasites (4%). Roots comprised the major plant parts used (25%), followed by leaves (21%), seeds (17%), bark (13%), whole plant (8%) and fruits (6%) to prepare the medicinal formulations. The chief ailments treated in this province were azoospermia, diabetes, menstrual disorder, dysentery, rheumatism, etc.

Conclusion:

It can be concluded that the documentation of the ethnobotanical knowledge in management of local healthcare is the first step, which will open new door for the researchers in the field of modern drug development.

A prospective study of phage types & biotypes of Salmonella enterica serotype Typhi isolated from hospitalized children in Kolkata, India

BACKGROUND & OBJECTIVES

Kolkata and its suburbs in eastern India faced an epidemic of typhoid fever in 1990. A prospective, hospital and laboratory based study over a period of 12 yr (1990-2001), on the phage typing and biotyping pattern of Salmonella enterica serotype Typhi was carried out, to see if there has been a change.

METHODS

A total of 338 S. enterica serotype Typhi isolates from 1491 blood samples were phage typed and biotyped. The mean age of isolation was calculated.

RESULTS

The age distribution of subjects (neonates to 12 yr) has been analysed. Of the 338 (22.7%) isolates obtained, eight different S. enterica serotype Typhi phage types were detected. Biotype I (95.8%) was more prevalent as compared to biotype II (4.1%). Phage type E1 was the commonest phage type in Kolkata and its suburbs.

INTERPRETATION & CONCLUSION

The mean age at isolation was found to be 6.7 +/- 3.3 yr. Biotype I was predominant and it was of interest that all strains of phage type E1 belonged to biotype I.

Decreasing trend in the occurrence of Salmonella enterica serotype Typhi amongst hospitalised children in Kolkata, India during 1990-2000

In a prospective hospital based surveillance, 1454 children clinically diagnosed as typhoid fever were enrolled during the period between 1990 to 2000. Of them 336 (23.1%) children were positive for Salmonella enterica serotype Typhi by blood culture. A declining trend of hospitalization and identification of the pathogen was observed from 1992 to 2000 as compared to 1990-1991. A declining trend of resistance to the commonly used anti-typhoid drugs was seen in the S. enterica serotype Typhi isolates. Recently in 2000, nine strains were detected as ciprofloxacin resistant. Misuse and overuse of ciprofloxacin for the treatment of typhoid fever influenced the development of ciprofloxacin resistant strains of S. enterica serotype Typhi in and around Kolkata.

Isolation of Salmonella enterica serotypes from children with diarrhoea in Calcutta, India

The prevalence of Salmonella enterica serotypes, antimicrobial susceptibility, and phage typing of serovers were studied. Clinical presentations of the infected cases were also examined. The study was carried out during August 1993-September 1996 in and around Calcutta, India. In total, 1,025 faecal samples from hospitalized diarrhoeal children were screened for enteropathogens. Four S. enterica serotypes were identified in 157 (15.3%) cases as a single pathogen. S. enterica serotype Typhimurium was detected in 110 (70%) cases. S. Seftenberg, S. Infantis, and S. Virchow were detected in 28 (17.8%), 14 (8.9%), and 5 (3.2%) cases respectively. S. Typhimurium was isolated from 11 (3.2%) non-diarrhoeal control children. All of these children had acute watery diarrhoea, and 5% of them had severe dehydration, 40% had some dehydration, and 55% had no dehydration. Vomiting, fever, and diffused pain in abdomen were the associated presentations of these children. Most (95%) of them recovered with oral rehydration therapy only and without any antibiotics. In-vitro susceptibility testing showed that 120 of the 121 S. Typhimurium strains isolated from cases and controls were resistant to the commonly-used drugs. Thirteen of the 121 strains were phage-typeable and belonged to the phage type 193. However, no clinical or epidemiological significance could be established with these typeable strains. The findings of the study indicate that diarrhoeagenic Salmonella is one of the major pathogens causing diarrhoeal diseases in eastern India.

Comparison between the multiplex PCR, sensitivity to biotype specific phages & polymyxin B for biotyping of Vibrio cholerae O1

A total of 196 Vibrio cholerae O1 strains isolated between 1970 and 1996 were biotyped by multiplex PCR, susceptibility to polymyxin B and sensitivity to biotype specific phages. We modified the multiplex PCR by increasing the primer concentration of tcpA to improve the results. Comparison of the results of modified multiplex PCR and sensitivity to biotype specific phages and to polymyxin B showed that multiplex PCR was as efficient as phage typing for biotyping of V. cholerae O1. All the strains of V. cholerae O1 could be accurately distinguished based on polymyxin B sensitivity. Thus our results show that susceptibility of strains of V. cholerae O1 to polymyxin B is the easiest method to biotype V. cholerae O1 and is feasible in most laboratories when compared with multiplex PCR and sensitivity to biotype specific phages.

Value of faecal leucocyte count as an indicator of invasiveness in mucoid diarrhoea

Importance of faecal leucocyte count as an indicator of invasiveness in mucoid diarrhoea was studied. A total of 290 faecal specimen, 170 from mucoid diarrhoea and 120 from watery diarrhoea were examined for faecal leucocyte count under high power field (hpf) from rural children below four years of age during the period from November 1992 to October 1995. Faecal leucocyte count > 10/hpf was noted in 45.9% of mucoid diarrhoea as against 19.2% of watery diarrhoea (p < 0.0001) samples. From faecal samples with > 10 faecal leucocyte count, invasive pathogens could be recovered in 19 (24.5%) to none of 23 patients with watery diarrhoea (p < 0.006 Fisher exact test). This sample test appears to be of value as an indicator of invasiveness in mucoid diarrhoea in the absence of culture facility.

Multi-drug resistant typhoid fever with diarrhea

OBJECTIVE

To provide information about the characteristics of diarrheal stool in multi-drug resistant typhoid fever and observe the clinical course after treatment with furazolidone or ciprofloxacin.

SETTING

Hospital based.

SUBJECTS AND METHODS

Twenty one male children who were positive for multi-drug resistant S. typhi by blood and stool cultures, having diarrhea at the time of hospitalization comprised the subjects. Serum and stool electrolytes were estimated. Stool samples were also processed to detect established enteropathogens, leukocytes and red blood cells. Children were treated either with furazolidone or ciprofloxacin and evaluated till recovery.

RESULTS

Mean (+/- SD) pre-admission duration of fever and diarrhea of these cases were 19.1 (+/- 5.6) and 15.8 (+/- 4.6) days, respectively. Stool character in 81% of the patients was watery with mean (+/- SD) volume of stool 51.4 (+/- 25.1) ml per kg body weight in the first 24 hours of observation. Leukocyte count varied between 20-49 per high power field in 66.7% stool samples. Occult blood was present in only 19% cases. Fecal red blood cells in high power field were detected in 52.4% cases. Mean fecal electrolytes (mmol/liter) were as follows: sodium-53.8, potassium-51.4, chloride-41.6 and total CO2-24.3. Most of the children (71.4%) had no dehydration and had normal serum electrolytes. The isolated strains of S. typhi were multi-drug resistant. These children were treated successfully either with furazolidone or ciprofloxacin.

CONCLUSION

The stools of multi-drug resistant typhoid fever patients were watery with little blood. Their electrolyte contents were more similar to the diarrheal stool seen in shigellosis rather than cholera. Uncontrolled observations revealed that children recovered with furazolidone or ciprofloxacin therapy.

Isolation of Escherichia coli to detect faecal contamination of infants and their mothers in West Bengal

The present study was undertaken to gain insight into the sources of faecal contamination of infants in rural Bengal. It was carried out in three villages near Calcutta, India, from June 1993 to August 1995 among 148 infants and their mothers. Escherichia coli was used as an indicator of faecal pollution. A total of 725 samples, including hand rinsings of children and mothers, feeding utensils and leftover food were examined. The total isolation rate of faecal E. coli was 30%. The isolation rates from hands of children and mothers were 17% and 40% respectively. The germs from 30% of utensils and 59% of leftover food and drinks were recovered further. The study highlights the precarious hygiene in rural Bengal.

Occurrence of diarrhoeal diseases in relation to infant feeding practices in a rural community in West Bengal, India

In a rural community-based prospective study, diarrhoea in relation to the feeding patterns of a cohort of infants was studied. A total of 148 infants between the ages of 0 and 2 months were enrolled and followed until the completion of 1 year of age. Survival analysis showed that by the fourth month of age exclusive breastfeeding dropped by 75%. The proportion of complementary breastfeeding increased from 18.6 to 52.9% during the same period and to 83.7% by the eighth month. This study clearly highlights the tendency for early switch over from exclusive breastfeeding to complementary breastfeeding. Early weaning was associated with an incidence rate ratio (IRR) of 3.02 (95% CI 1.043-8.802). The IRR of 3.02 and its confidence limits (1.043-8.02) suggest a significant protective effect of exclusive breastfeeding against diarrhoea in infants. The results of this study indicate that promotion of exclusive breastfeeding has a potential role to reduce the incidence of diarrhoea amongst infants. The findings of this study will be useful for Diarrhoeal Disease Control Programme in reducing diarrhoeal morbidity.

Distribution of age-specific rotavirus antibody in human: a hospital-based study in Calcutta

Sera obtained from 332 non-diarrhoeic individuals belonging to different age groups were tested by enzyme-linked immunosorbent assay method for detection of rotavirus antibody. All the sera were found to contain rotavirus antibody in varying titres, the highest being recorded in neonates which declined to the lowest by the age of 6 months with a rapid rise during the next 5 years. This study indicates the acquisition of rotavirus antibody in different age groups.

Validity of new phage typing scheme against Vibrio cholerae 01 biotype ElTor strains

A total of 538 strains of V. cholerae 01 biotype ElTor were phage typed by the conventional Basu and Mukerjee and also the new typing scheme developed at the National Institute of Cholera and Enteric Diseases, Calcutta. The strains could be clustered into seven types by the new scheme as against only two by the conventional method. The results provide conclusive evidence on the validity of the new scheme for phage typing of V. cholerae strains.

Multi-drug resistant typhoid fever in hospitalised children. Clinical, bacteriological and epidemiological profiles

A total of 592 children with clinical diagnosis of typhoid fever admitted to the Dr B. C. Roy Memorial Hospital for Children, Calcutta, India during the period between February 1990 and January 1992, were screened for Salmonella typhi by blood culture. S. typhi was isolated from 221 (37.3%) cases. The majority of the strains (92.3%) showed multi-drug resistant (MDR). They were resistant to chloramphenicol, ampicillin, tetracycline and trimethoprim-sulphamethoxazole. However, all the strains were uniformly (100%) susceptible to gentamicin, amikacin, furazolidone, norfloxacin and ciprofloxacin. Minimum inhibitory concentration of the antimicrobial agents against the resistant strains of S. typhi ranged between 200 and > 1600 micrograms/ml. Phage type 0 was most frequently encountered. The rate of isolation of S. typhi was more or less the same in all the pediatric age groups. The majority of the cases came from lower socio-economic classes with poor personal hygiene. Fever was the main presenting feature in all the cases. Other associated features of the MDR typhoid fever cases, who were uncomplicated during admission, were headache (36.0%), chill and rigor (23.2%), diarrhea (37.2%), anorexia (26.2%), vomiting (23.8%), cough (18.0%) and abdominal pain (19.8%). Hepatosplenomegaly was present in 42.4% cases. However, complications were less frequently encountered among the MDR typhoid fever cases who were uncomplicated during admission and treated as in-patients. Fourteen bacteriologically-confirmed MDR typhoid fever cases had jaundice and another 18 cases had an abnormal state of consciousness during admission. Four (2.0%) bacteriologically-confirmed MDR typhoid fever patients died during the period of observation.

Value of a single Widal test in the diagnosis of typhoid fever

Results of a single Widal test in patients with bacteriologically confirmed typhoid fever (116), clinically suggestive but culture negative fever (170) and non-typhoidal febrile illness (98) and in normal control children (54) were analysed. Positive Widal test (antibody titre against S. typhi O antigen of 1:160) was recorded in 61.2 per cent of patients with bacteriologically confirmed typhoid fever and in 58.8 per cent with culture negative but clinically suggestive typhoid fever. In contrast, the same titre was observed in 10.2 per cent patients with other febrile illnesses of known etiology and in 1.8 per cent of normal children. Differences in the positivity of Widal test in patients with bacteriologically confirmed typhoid fever and clinically suggestive but culture negative fever were highly significant (P < 0.000001) when compared to that of patients with non-typhoidal febrile illnesses and normal controls. High specificity and positive predictive value in 1:160 dilution makes the Widal test acceptable as a diagnostic tool.

Ciprofloxacin for treatment of severe typhoid fever in children

Eighteen children with bacteriologically confirmed severe typhoid fever were initially treated intravenously with ciprofloxacin (10 mg/kg of body weight per day). Clinical cure with eradication of multiresistant Salmonella typhi infection was observed in 17 patients (94.4%; 95% confidence interval [CI], 84 to 100%). Children regained normal consciousness within an average of 2 days (95% CI, 1.8 to 2.2 days). The temperatures of the children returned to normal within 3.3 days (95% CI, 3.1 to 3.5 days). Complications were not observed during the hospital stay or a 3-month follow-up period. Relapse and carrier state were also not encountered during the follow-up period.

Prospective study of nosocomial enteric infections in a pediatric hospital, Calcutta

Hospital acquired enteric infections were investigated by studying 3138 children under 5 years of age who were admitted without diarrhea in nine medical words of a pediatric hospital, Calcutta during the period between March and September 1987. Three hundred and twenty (10.2%) children developed nosocomial diarrhea during their hospital stay. Fecal samples from 178 nosocomial diarrhea, 345 hospitalized diarrhea cases, 178 hospital controls and 200 outpatient controls were collected for detection of established enteropathogens. There were no statistically significant differences in the detection of most of the enteropathogens from fecal samples of nosocomial diarrhea, hospitalized diarrhea and hospital controls. Enteric pathogens were detected at a higher frequency (statistically significant) from fecal samples of nosocomial diarrhea cases as compared to outpatient controls. This study highlights the importance of most of the enteropathogens like Shigella, Salmonella, rotavirus, enteropathogenic E. coli as the cause of hospital cross infection. This study reinforces the importance of developing preventive measures in order to reduce the frequency of illness.

Randomized clinical trial of furazolidone for typhoid fever in children

The efficacy of furazolidone and chloramphenicol was compared in a randomized trial involving 133 children with bacteriologically confirmed typhoid fever. Sixty-five children were randomized to receive furazolidone, 7.5 mg/kg/day, and 68 children to receive chloramphenicol, 75 mg/kg/day. Both drugs were administered orally. The clinical characteristics of the two treatment groups were comparable on admission. All the strains of Salmonella typhi isolated from the furazolidone group were susceptible to furazolidone. However, of the 68 strains of S. typhi isolated from the chloramphenicol group, 10 were susceptible and 58 were resistant to chloramphenicol. Clinical and bacteriologic cure was observed in 56 (86.2%) children treated with furazolidone and in 35 (51.5%) children given chloramphenicol who were infected with S. typhi strains, irrespective of susceptibility pattern (P = 0.00003). Cure was achieved in 86.2% of furazolidone recipients and 90.0% of chloramphenicol recipients who were infected with strains of S. typhi susceptible to both drugs (P = 0.6). The difference in cure rate was statistically significant (P = 0.000003) when the two treatment groups infected with furazolidone-susceptible but chloramphenicol-resistant strains of S. typhi were compared. There was no relapse or carriers in either of the groups. Furazolidone appears to be a satisfactory alternative to chloramphenicol in the treatment of typhoid fever caused by chloramphenicol-resistant strains of S. typhi.

Occurrence of multi-drug resistant Salmonella typhi in Calcutta

Blood and faecal samples were collected from 122 hospitalised patients of Calcútta clinically suspected to have enteric fever, for isolation of S. typhi. It was isolated from 34.4, 4.9 and 4.1 per cent patients by blood culture, stool culture and by both respectively. The in vitro drug susceptibility testing showed that all the isolates were resistant to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole, but were uniformly susceptible to ciprofloxacin, norfloxacin and furazolidone. In view of the appearance of multi-drug resistant S. typhi in Calcutta, great care should be exercised in the use of newer quinolone derivatives.

Nosocomial rotavirus diarrhea in two medical wards of a pediatric hospital in Calcutta

One hundred eighty nine children suffering from different medical problems were admitted in two wards of a pediatric hospital in Calcutta during the period between November 18, 1985 and February 10, 1986. Amongst them, 36 children developed nosocomial diarrhea and rotavirus was detected from 80.5% of the cases. The nosocomial rotavirus diarrhea cases had lesser frequency of stools and only mild dehydration but the course of illness was longer in comparison to that of the hospitalized rotavirus diarrhea cases. There is a possibility of spread of infection via fomites, environmental surfaces and most likely mothers.

Occurrence of multi-resistant Salmonella typhimurium infection in a pediatric hospital at Calcutta

Salmonella typhimurium was isolated from 55 (15.9%) of the 347 hospitalized diarrheal children and 14 (11.1%) of the 126 non-diarrheal controls. All the 98 asymptomatic children attending hospital outpatients were negative. Six (3.7%) of the 162 samples of different categories examined from the hospital were positive for S. typhimurium. Finger washing of one female food handler, feces of two cats of the wards, surface of wash basin, lavatory seat and shelf yielded positive isolations. In vitro antibiotic sensitivity testing showed majority of the strains were resistant against commonly used antimicrobial agents while they were uniformly sensitive to norfloxacin and ciprofloxacin. The present study points to cross-infection by multi-resistant S. typhimurium strains in the hospital wards.

Oral rehydration solution containing 90 millimol sodium is safe and useful in treating diarrhoea in severely malnourished children

The safety and efficacy of standard oral glucose-electrolyte solution, containing 90 mmol of sodium per litre, was evaluated in the treatment of dehydrating diarrhoea among severely malnourished (marasmic) children. A total of 81 male children aged between 6 and 48 months were studied; 41 were in the malnourished group (study group: less than 60% of Harvard Standard weight-for-age) and 40 were in the well-nourished group (control group: 80% or more Harvard Standard weight-for-age). Children of both groups could be rehydrated with standard oral rehydration solution (ORS) without encountering any clinical or biochemical complications. The results of this study lend support to the World Health Organization's concept of a unified formula of ORS for the treatment of all cases of acute diarrhoea, including severely malnourished children.

Prevalence of Clostridium difficile in hospitalised patients with acute diarrhoea in Calcutta

During a 12-month period, Clostridium difficile was isolated from 38 (11.1%) of 341 hospitalised patients suffering from acute diarrhoea and from five (3%) of 172 patients as control who were admitted with illnesses other than diarrhoea. It was the sole bacterial pathogen in 31 cases. 87% of the isolates obtained from patients with diarrhoea produced neutralisable cytotoxin. None of these patients had any history of previous treatment using antibiotics. No age or gender-specific high incidence was observed. Clinical presentation in these patients revealed no distinctive pattern. Both dysenteric and diarrhoeal presentations were found, the latter being more frequent. The results suggest that Clostridium difficile by itself may be a causal agent of acute diarrhoea.

Report of an outbreak of diarrhoeal disease caused by cholera followed by rotavirus in Manipur

An outbreak of acute diarrhoeal disease between August and October 1985 in 3 districts of Manipur state was investigated amongst 9,29,077 population at risk. The overall attack rate and case fatality rate were 0.2% and 0.9% respectively. Hospital records revealed that 58.8% of cases occurred amongst older children above 5 years of age. V.cholera was isolated from 25.3% of cases sampled. Interestingly, increased frequency in weekly admission of cases amongst children during first two years of life increased in the beginning of October when the original peak of diarrhoeal outbreak was about to decline. The October peak was caused by rotavirus which could be detected from 50.0% of diarrhoeal children in this age group. This possibly reflected beginning of the usual rotavirus diarrhoea season in the locality.

Effectiveness of oral rehydration salt solution (ORS) in reduction of death during cholera epidemic

An extensive outbreak of acute gastroenteritis involving all age group of patients occurred during July-September, 1978 in the Central district of Manipur state. A total of 4469 cases occurred during the period. 45.7% of diarrhoea cases sampled and 47.6% of water samples collected from rivers were found to be positive for V.cholerae biotype EITor. Case fatality rate in this epidemic was exceptionally low (0.8%) which was attributed to the early domiciliary use of oral rehydration salt solution (ORS) in the affected villages. Utility of ORS in drastic reduction of case fatality rate during any epidemic situation was first of its kind in the Indian scene.

Occurrence and significance of Cryptosporidium infection in Calcutta

During a 2-year study, Cryptosporidium oocysts were detected in 32 (5.6%) of 566 hospitalized paediatric diarrhoea cases and 2 (1.2%) of 167 non-diarrhoeic individuals. Cryptosporidium was the sole pathogen detected in 17 (3.0%) of the 32 positive cases; in the other 15 it occurred in combination with one or more other established enteropathogen(s). The frequency of detection of the parasite was highest in the 0-6 months age group; no sex-specific difference was discernible. The detection rate of the parasite was highest during the monsoon and post-monsoon months. Most of the patients had watery stools with a mild to moderate degree of dehydration, with the diarrhoea lasting for less than 7 d.

Comparison of the modified Elek test and Wagatsuma agar for determination of the Kanagawa phenomenon of Vibrio parahaemolyticus

The modified Elek test and Wagatsuma agar were compared for their ability to detect the Kanagawa activity of 142 strains of Vibrio parahaemolyticus. The performance of the modified Elek test was on a par with that of the Wagatsuma agar as far as positivity was concerned, and the test was far superior to Wagatsuma agar in eliminating doubtful results. The results of the modified Elek test were not unduly influenced by the different types of agar used.