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Kottarathil M, Reju S, Barani R, Krishna V, M RK, M M, Srikanth P. Are we dealing with melioidosis under the mask of tuberculosis? - A case series. Indian J Tuberc 2024; 71:99-104. [PMID: 38296398 DOI: 10.1016/j.ijtb.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 02/08/2024]
Abstract
Melioidosis is prevalent in South-East Asia. India is now become endemic to melioidosis. Melioidosis mimicks Tuberculosis (TB) and is often overlooked clinically. The spectrum of disease ranges from acute pulmonary infection to focal infection and septicemia. We report three cases of melioidosis, which was primarily suspected to be tuberculosis due to similarities in the clinical features. All patients were male and had risk factors such as type 2 diabetes mellitus as well as other risk factors such as chronic obstructive pulmonary disease (COPD), systemic hypertension, glucocorticoid therapy etc. All three patient samples were culture negative as well as negative for tests performed for the detection of tuberculosis. Conventional nested PCR targeting 251bp of 16S-23S spacer region of B. pseudomallei. was performed among individuals suspected to have extrapulmonary Tuberculosis. The presence of 251 bp was considered positive for B. pseudomallei. All three patients were treated with third generation cephalosporin and recovered due to timely diagnosis. Patients suspected for tuberculosis should be screened for B. pseudomallei, especially when AFB smear and MTB GeneXpert are negative. Often clinical samples may be culture negative for B. pseudomallei as patients are treated with antibiotics, therefore it is worthwhile performing PCR for B. pseudomallei to rule in a diagnosis of melioidosis and initiate appropriate antibiotics.
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Affiliation(s)
- Malavika Kottarathil
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, India
| | - Ramya Barani
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, India
| | - Vidya Krishna
- Department of Paediatric Medicine, Sri Ramachandra Institute of Higher Education and Research, India
| | - Raj Kumar M
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, India
| | - Mohankumar M
- Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, India
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, India.
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Giri S, Chhabra P, Kulkarni R, Reju S, Sabapathy SK, Selvarajan S, Varghese T, Kalaivanan M, Dorairaj P, Kalrao V, Mankar S, Sangamnerkar M, Purushothaman GKC, Srikanth P, Kang G, Vinjé J. Hospital-based norovirus surveillance in children <5 years of age from 2017 to 2019 in India. J Med Virol 2024; 96:e29384. [PMID: 38235830 PMCID: PMC10875411 DOI: 10.1002/jmv.29384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
After the introduction of the rotavirus vaccine into the Universal Immunization Program in India in 2016, relatively few studies have assessed the prevalence and epidemiological patterns of acute gastroenteritis (AGE) among hospitalized children ≤5 years of age. We used a uniform protocol to recruit children with AGE as well as standardized testing and typing protocols. Stool specimens from children with AGE younger than 5 years of age admitted to six hospitals in three cities in India were collected from January 2017 through December 2019. Norovirus was detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) followed by typing positive specimens by conventional RT-PCR and Sanger sequencing. Norovirus was detected in 322 (14.8%) of 2182 specimens with the highest rate in 2018 (17.6%, 146/829), followed by 2019 (14.4%, 122/849) and 2017 (10.7%, 54/504). Rotavirus vaccine status was known for 91.6% of the children of which 70.4% were vaccinated and 29.6% not. Norovirus positivity in rotavirus-vaccinated children was 16.3% and 12% in unvaccinated children. GII.4 Sydney[P16] (39.3%), GII.4 Sydney[P31] (18.7%), GII.2[P16] (10%), GI.3[P13] (6.8%), GII.3[P16] (5.9%), and GII.13[P16] (5%) accounted for 85.8% (188/219) of the typed strains. Our data highlight the importance of norovirus in Indian children hospitalized with AGE.
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Affiliation(s)
- Sidhartha Giri
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Preeti Chhabra
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruta Kulkarni
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth, Pune, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Satheesh Kumar Sabapathy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE), Chennai, India
| | - Sribal Selvarajan
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Tintu Varghese
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | | | - Vijay Kalrao
- Bharati Hospital, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | | | | | | | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Selvarajan S, Reju S, Gopalakrishnan K, Padmanabhan R, Srikanth P. Evolutionary analysis of rotavirus G1P[8] strains from Chennai, South India. J Med Virol 2021; 94:2870-2876. [PMID: 34841551 DOI: 10.1002/jmv.27462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022]
Abstract
Rotaviruses by virtue of its segmented genome generate numerous genotypes. G1P[8] is the most common genotype reported globally. We intend to identify the evolutionary differences among G1P[8] strains from the study with vaccine strains. Stool samples collected from children <5 years were screened for rotavirus antigen by enzyme linked immunosorbent assay. The samples that tested positive for rotavirus were subjected to VP7 and VP4 semi-nested RT-PCR. Sanger sequencing was performed in randomly chosen VP7 and VP4 rotavirus strains. Phylogenetic analysis showed less homology between study strains and vaccine strains and they were placed in different lineages. The VP7 and VP4 proteins of rotavirus were analyzed by two different platforms to identify the amino acid substitutions in the epitope regions. Nine amino acid substitutions with respect to Rotarix®, RotaTeq® and Rotasiil®-V66A, A/T68S, Q72R, N94S, D100E, T113I, S123N, M217T, and I281T were observed in VP7. There were five amino acid substitutions-S145G, N/D195G, N113D, N/I78T, E150D in VP4 (VP8 portion) with respect to Rotarix® and RotaTeq® vaccine strains. M217T substitution in VP7 (epitope 7-2) and N113D, D195G substitution in VP4 (epitope 8-3, 8-1) confer changes in polarity/electrical charge with respect to vaccine strains, thus indicating the need for continued surveillance.
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Affiliation(s)
- Sribal Selvarajan
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Krithika Gopalakrishnan
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ramachandran Padmanabhan
- Department of Paediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Babji S, Sindhu KN, Selvarajan S, Ramani S, Venugopal S, Khakha SA, Hemavathy P, Ganesan SK, Giri S, Reju S, Gopalakrishnan K, Ninan B, Iturriza-Gomara M, Srikanth P, Kang G. Persistence of G10P[11] neonatal rotavirus infections in southern India. J Clin Virol 2021; 144:104989. [PMID: 34607240 PMCID: PMC8556361 DOI: 10.1016/j.jcv.2021.104989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
Background: Neonatal rotavirus infections are predominantly caused by distinct genotypes restricted to this age-group and are mostly asymptomatic. Method: Stool samples from neonates admitted for >48 h in neonatal intensive care units (NICUs) in Vellore (2014–2015) and Chennai (2015–2016) in southern India, and from neonates born at hospitals in Vellore but not admitted to NICUs (2015–2016) were tested for rotavirus by ELISA and genotyped by hemi-nested RT-PCR. Results: Of 791 neonates, 150 and 336 were recruited from Vellore and Chennai NICUs, and 305 were born in five hospitals in Vellore. Positivity rates in the three settings were 49.3% (74/150), 29.5% (99/336) and 54% (164/305), respectively. G10P[11] was the commonly identified genotype in 87.8% (65/74), 94.9% (94/99) and 98.2% (161/164) of the neonates in Vellore and Chennai NICUs, and those born at Vellore hospitals, respectively. Neonates delivered by lower segment cesarian section (LSCS) at Vellore hospitals, not admitted to NICUs, had a significantly higher odds of acquiring rotavirus infection compared to those delivered vaginally [p = 0.002, OR = 2.4 (1.4–4.3)]. Conclusions: This report demonstrates the persistence of G10P[11] strain in Vellore and Chennai, indicating widespread neonatal G10P[11] strain in southern India and their persistence over two decades, leading to interesting questions about strain stability.
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Affiliation(s)
- Sudhir Babji
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Sribal Selvarajan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Sasirekha Ramani
- Baylor College of Medicine, Houston, TX, United States of America
| | - Srinivasan Venugopal
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Shainey Alokit Khakha
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Priya Hemavathy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Santhosh Kumar Ganesan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sidhartha Giri
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Krithika Gopalakrishnan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections at University of Liverpool, Liverpool, United Kingdom of Great Britain
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
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Selvarajan S, Reju S, Pushpanathan P, Arumugam R, Padmanabhan R, Kothandaramanujam SM, Srikanth P, Kang G. Molecular characterisation and clinical correlates of rotavirus in children and adults in a tertiary care centre, Chennai, South India. Indian J Med Microbiol 2018; 35:221-227. [PMID: 28681810 DOI: 10.4103/ijmm.ijmm_16_51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS This study was undertaken to determine the rate of detection of rotavirus causing diarrhoea among children and adults, identify the common genotypes circulating and determine clinical correlates. SETTINGS AND DESIGN This is a cross-sectional study in a tertiary care centre. MATERIALS AND METHODS Stool samples were collected from adults and children, transported on ice, aliquoted and stored at - 80°C. Rotavirus antigen detection enzyme-linked immunosorbent assay was performed on all samples. Representative samples were typed by conventional hemi-nested VP7 and VP4 reverse transcription-polymerase chain reaction. STATISTICAL ANALYSIS USED Test of proportion, Student's t-test and Chi-square test were used for statistical analysis. RESULTS A total of 444 stool samples were collected and tested over 14 months. Among these, 116 were paediatric with a rate of positivity of 36.21% and 328 were adults with rate of positivity of 20.73%. Among children under 5 years (n = 90), the rate of positivity was 41.11%. Vesikari scale was used for clinical assessment. The mean ± standard deviation Vesikari score in rotavirus-infected children and rotavirus-uninfected children was 11.2 ± 3.2 and 8.9 ± 3.6, respectively, and the difference was statistically significant. Nineteen samples were genotyped in children < 5 years, 94.7% were of G1P[8] and 5.3% were of G9P[4] genotype. Genotyping of 14 adult samples, G1P[8](85.7%) was found as the predominant genotype, two samples (14.3%) were partially typed (G9PUT and G12PUT). CONCLUSIONS The rate of positivity of rotavirus in children under 5 years was 41.11%. G1P[8] is the most common strain circulating across all age groups.
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Affiliation(s)
- Sribal Selvarajan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Premalatha Pushpanathan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Rajesh Arumugam
- Division of Gastrointestinal Sciences, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramachandran Padmanabhan
- Department of Paediatrics, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Sudhakar Muthiah Kothandaramanujam
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
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Srikanth P, Sarangan G, Mani M, Barani R, Reju S, Annamalai R, Damodharan J. Periodicity in the waxing and waning of Influenza A H1N1: A report from a tertiary care center in Chennai India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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