- Email: [email protected]
Distribution of Plasmodium falciparum in West Bengal
420
TRANSACTIONS OF THE ROYAL Socm’w
OF
TROPKALMEDICINE
Yersinia enterocolitica : incidence in Madrid order to investigate the role of Yersinia enterocohtica in diarrhoea we cultured 2,166 stool specimens from people living in Madrid, from January 1978 until May 1979. Y. enterocolitica was sought by inoculating the stools on MacConkey Agar (Oxoid), S.S. Agar (Oxoid) and Selenite Broth (Difco). The inoculated plates were incubated at 37°C overnight. The stools were also inoculated on Yersinia-Selektivagar nach Wauters (Merck) and incubated at 30°C overnight and on Selenite Broth (Difco) and kept at 4°C for one month. Both children and adults, all in-patients or outpatients at the Centro Ramon y Cajal, were investigated. Y. enterocolitica was cultured in 13 of 1,300 diarrhoea specimens (1.00 “/) corresponding to 13 patients with diarrhoea. Nine of the thirteen were children aged less than 13 years. The incidence of other intestinal pathogens in the population studied was as follows : Salmonella typhimurium 120 (5 *54 y’) S. enteritidis 40 (1 .84:/,), S. typhi 20 (0*92%), other Salmonella 33 (1.52%). Shigella sonnei 24 (1.10 %), S. f?exneri 12 (1 a00 %), enteropathogenic E. coli 0119 13 (1*08%), enteropathogenic E. coli 0111 3 (0*13%), other enteropathogenic E. coli 37 (1.70%). We have also cultured Y. enterocohtica in 14 blood cultures corresponding to three patients with raised temperature. Cases of human infection with Y. enterocolitica have been reported throughout the world (AHVONEN, 1972; MOLLARET, 1971, 1972; NILE~> 1969; DELORME et al., 1974; TOMA & LAFLEUR. 1974; BISSET. 19761. All the strains identified as Y.* enterocohtica were Gram-negative bacteria, sucrose, saccharose, P-galactosidase and ornitindecarboxylase positive, motility and VogesProskauer reaction positive at 22°C. All the cultured strains belonged to biotype 4, serotype 0:3 and phagotype VIII. Y. enterocolitica serotype 0:3 is the most frequently occurring serotype in Europe (MOLLARET, 1971; NILEHN, 1969). There appears to be no doubt that Y. enterocolitica is a causative agent of diarrhoea and septicaemia. Erithema nodosum, arthritis and miscellaneous forms have all been ascribed to Y. enterocolitica infection (AHVONEN, 1972; LARSEN, 1972; WINBLAD, 1969). In these clinical pictures the use of serology could be of value. We studied ten patients serologically. The serological diagnosis of yersiniosis was made by tube agglutination (WINBLAD, 1975), microagnlutination-TTC (RICCIARDI et al.. 1979) and ymmunofluorescent‘antibody test (IFAT) using the isolated strain as antigen. Three patients were diagnosed as septicaemic with blood culture positive for Y. enterocolitica, Reiter’s Syndrome was diagnosed in one patient and terminal ileitis in another. In all the patients the serological titre was positive (2 1:160) using tube agglutination, microagglutination-TTC and IFAT. In two cases of rheumatoid svndrome the serological titre was positive (2 l-160) in the microagglutination-TTC and IFAT technique but the tube agglutination was negative. In three SIR-In
AND
HYGIENE, VOL. 74, No. 3, 1980. CORRESPONDENCE
patients with appendicular syndrome the serological titre was only positive (a 1:160) using microagglutination-TTC test but the tube agglutination and IFAT were negative. Y. enterocolitica must be sought in diarrhoea, septicaemia and other clinical pictures, but serology could be used in diagnosis when the micro-organism is not recovered. We are, etc., M. LOPEZ-BREA M. MESEGUER M. BAQUERO L. DE RAFAEL D. MOLINA Department of Microbiology, Centro Especial Ram&t y Cajal, Madrid-34, Spain References Ahvonen, P. (1972). Human yersiniosis in Finland. Annals of Clinical Research, 4, 30-48. Bissett, M. L. (1976). Yersinia enterocolitica. Isolates from humans in California, 19681975. Journal of Clinical Microbiology, 4, 137-144. Delorme, J., Laversiere, M., Martineau, B. & Lafleur, L. (1974). Yersiniosis in children. Canadian Medical Association Journal, 110, 281284. Larsen, J. H. (1972). Human yersiniosis, the result of a serological investigation with Yersinia enterocolitica. Ugeskrift for Laeger, 134, 141. Mollaret, H. H. (1971). L’infection humaine a Yersinia enterocolitica en 1970, a la lumiere de 642 cas recents. Pathologie et biologic, 19, 189-205. Mollaret, H. H. (1972). Un domaine pathologique nouveau: l’infection li Yersinia enterocolitica. Annales de biologie clinique, 30, 1-6. Nilehn. B. (1969). Studies of Yersinia enterocolitica. with’special reference to bacterial diagnosis and occurrence in human acute enteric disease. Acta Pathologica et Microbioloeica Scandinavica (Suppl.j, 206, 5. Ricciardi, I. D., Pearson, A. D., Suckling, W. G. & Klein, G. (1978). A microagglutination test for Yersinia enterocolitica infection: recognition of multiple serotypes in experiments with stained suspensions df serotypes 05,27. Journal of Medical Microbiologv. 2. 359. Toma, S. & Lafleur, L. (1974). Survey on the incidence of Yersinia enterocolitica. Applied Microbiology, 28, 469-473. Winblad, S. (1969). Erytheme nodosum associated with Yersinia enterocolitica. Scandinavian Journal of Infectious Diseases, 1, 11. Winblad, S. (1975). Arthritis associated with Yersinia enterocolitica. Scandinavian Journal of Infectious Diseases, 7, 191. VII
Accepted
for
Distribution
publication
I
10th October, 1979.
of Plasmodium falciaarum in West Bengal ” * SIR-It is interesting to note that with the resurgence of malaria, the distribution of the different species of Plasmodium has changed in West Bengal.
TRANSACTIONS
OF THE ROYAL
SOCIETY
OF TROPICAL
MEDICINE
Earlier records (KNOWLES et al., 1930) reveal that all three species, namely, P. vz’vax, P. falciparum and P. mdlariae were well represented -in Bengal (Table). and the distribution of P. fulciparum varied from 8:5:/, (Central Bengal) to 56.5:[ (Hooghly). Table : Distribution of three species of malaria parasites in Bengal Plasmodium vivax
Bengal Presidency Calcutta
41.4”” 370;,
Plasmodium falciparum
46.3:;,
56U<,
Plasmodium malariae
12.5:; 7’:;
The data collected through NMEP of India during 1971-78 show a completely different picture. P. malariae has become virtually extinct, though it is known to be present in a sizeable number in one area of India (ROY et al., 1976). P. fulciparum constitutes 11.321: of the total cases detected: in Calcutta only 10 (O.l”/$) imported cases of P. alciparum have been reported. The distribution varies from nil (Howrah) to 29.87% (Coochbihar). P. falciparum accounts for 50Uh and‘ more of the total cases of malaria in Bihar, Meghalaya, Nagaland, Orissa and Trioura states in India (Chakrabortv. \ <, cited by HATI, i979). The reasons for this change are, however, not quite clear. Has the host-parasite relationship altered? Has there been any replacement of known vectors? Although it has been claimed that Anopheles philippinensis has disappeared from West Bengal (Report of the evaluation in depth of the NMEP of India, 1970), in a recent small scale survey conducted by our department A. phihppinensis has been found to amount to 6.85 “Cl of the total anopheline mosquitoes in one endemic area. Has the phenomenon got any relation to vectorial cauacitv? ROY (1943) in Calcutta was unable to iniect the salivary glands of A. stephensi with P. malariae, whereas 45.41; of these mosquitoes were infected with P. vivax and 37.3Ob with P. falciparum. In the peak transmission season, experimentally, we have also been unable to infect the salivary glands of A. stephensi with P. malariae and the 28.00,;, infection in this snecies of mosauito achieved with P. vivax produced only scanty sporozoites in the salivary glands. It has not been possible for us to collect data on the susceptibility of local mosquitoes to P. faZciparun2 in recent years as clinical cases are rare. We are, etc., A. K. HATI Calcutta Calcutta
School of Tropical 700073, India
N. C. MUKHOPADHYAY Medicine,
References K. (1979). In: Medical Entomology. Calcutta: Allied Book Aaencv, 18A Shvamacharan Dey Street, Calcutta 7C!J073,Fp. 37. e Knowles, R., Senior White, R. & Das Gupta, B. M. (1930). Studies in the parasitology of malaria. Indian Medical Research Memoirs, No. 18, pp. 80-86.
HATI,
A.
AND HYGIENE,
VOL.
74, No.
3, 1980.
CORRESPONDENCE
421
Report of the evaluation in depth of the National Malaria Eradication Programme of India (1970). Part III, 6-6. Roy, D. N. (1943). The role of A. subpictus Grassi as a carrier of malaria. Journal of the Malaria Institute of India, 5, 117-121. Roy, R. G., Madesayya, N. M., Sitaraman, N. L. & Ghosh, R. B. (1976). Plasmodium malariae infection in Karnatka State (1968-73). Journal of Communicable Diseases, 8, 81-82.
Accepted
for
publication
17th October,
1979.
Leishmaniasis in Tuscany (Italy). (III) The prevalence of canine leishmaniasis in two foci of Grosset0 Province SIR-The area of Baccinello (Scansano) and of Monte Argentario represent two foci of human leishmaniasis in the province of Grosseto. The hamlet of Baccinello and its surrounding farms, located in a hilly inland territory, is a hypoendemic focus of both visceral and cutaneous leishmaniasis (VL and CL) (BETTINI et al.. 1977). Phlebotomus perfiliewi is the dominant species of sandfly (99.0 ‘yU) (MAROLI & BETTINI, 1977). Leishmania has been isolated from wild mammals (Rattus rattus and Vulpes vulpes) in that area (BETTINI et al., 1980; GRADONI et al., 1978) and two isolates from R. rattus and the one from V. vulpes have been identified as belonging to the donovani complex (Chance, M. L., personal communication). The focus of M. Argentario, on the other hand, consists of a fossil island (actually a promontory) of about 50 km2 which, in the post-war period, presented a relatively high number of cases of infantile VL (SEGANTI & PALOMBELLI. 1955) but recently only a‘ few cases (BETTINI et al.; 1977) have occurred. CL has never been reported from that area. P. perniciosus is the most abundant sandfly species and considered as the probable vector (CORRADETTI & NERI, 1955). Leishmania has also been isolated from R. rattus in this focus (Pozio et aZ., in preparation). Canine leishmaniasis has not yet been described from these two foci, nor from Tuscany in general. In the present note we report the results of a survey on canine leishmaniasis carried out in the foci mentioned above. An accurate clinical examination was carried out on all doas studied. The following sinns were considered as pathognomonic of the disease: cutaneous alterations (alopecia, desquamation, ulcers), keratoconjunctivitis, hypertrophy of claws, ganglia1 swelling. A blood sample was taken from each dog. Sera from dogs from Baccinello were tested by the complement fixation technique (BCG antigen) (DE ALENCAR et al., 1966), and the sera of dogs from M. Argentario were tested by the indirect fluorescence technique*. In clinically * Sera from dogs of Baccinello could not be tested with the indirect fluorescence technique because the samples were lost when the laboratory was moved.
TRANSACTIONS OF THE ROYAL Socm’w
OF
TROPKALMEDICINE
Yersinia enterocolitica : incidence in Madrid order to investigate the role of Yersinia enterocohtica in diarrhoea we cultured 2,166 stool specimens from people living in Madrid, from January 1978 until May 1979. Y. enterocolitica was sought by inoculating the stools on MacConkey Agar (Oxoid), S.S. Agar (Oxoid) and Selenite Broth (Difco). The inoculated plates were incubated at 37°C overnight. The stools were also inoculated on Yersinia-Selektivagar nach Wauters (Merck) and incubated at 30°C overnight and on Selenite Broth (Difco) and kept at 4°C for one month. Both children and adults, all in-patients or outpatients at the Centro Ramon y Cajal, were investigated. Y. enterocolitica was cultured in 13 of 1,300 diarrhoea specimens (1.00 “/) corresponding to 13 patients with diarrhoea. Nine of the thirteen were children aged less than 13 years. The incidence of other intestinal pathogens in the population studied was as follows : Salmonella typhimurium 120 (5 *54 y’) S. enteritidis 40 (1 .84:/,), S. typhi 20 (0*92%), other Salmonella 33 (1.52%). Shigella sonnei 24 (1.10 %), S. f?exneri 12 (1 a00 %), enteropathogenic E. coli 0119 13 (1*08%), enteropathogenic E. coli 0111 3 (0*13%), other enteropathogenic E. coli 37 (1.70%). We have also cultured Y. enterocohtica in 14 blood cultures corresponding to three patients with raised temperature. Cases of human infection with Y. enterocolitica have been reported throughout the world (AHVONEN, 1972; MOLLARET, 1971, 1972; NILE~> 1969; DELORME et al., 1974; TOMA & LAFLEUR. 1974; BISSET. 19761. All the strains identified as Y.* enterocohtica were Gram-negative bacteria, sucrose, saccharose, P-galactosidase and ornitindecarboxylase positive, motility and VogesProskauer reaction positive at 22°C. All the cultured strains belonged to biotype 4, serotype 0:3 and phagotype VIII. Y. enterocolitica serotype 0:3 is the most frequently occurring serotype in Europe (MOLLARET, 1971; NILEHN, 1969). There appears to be no doubt that Y. enterocolitica is a causative agent of diarrhoea and septicaemia. Erithema nodosum, arthritis and miscellaneous forms have all been ascribed to Y. enterocolitica infection (AHVONEN, 1972; LARSEN, 1972; WINBLAD, 1969). In these clinical pictures the use of serology could be of value. We studied ten patients serologically. The serological diagnosis of yersiniosis was made by tube agglutination (WINBLAD, 1975), microagnlutination-TTC (RICCIARDI et al.. 1979) and ymmunofluorescent‘antibody test (IFAT) using the isolated strain as antigen. Three patients were diagnosed as septicaemic with blood culture positive for Y. enterocolitica, Reiter’s Syndrome was diagnosed in one patient and terminal ileitis in another. In all the patients the serological titre was positive (2 1:160) using tube agglutination, microagglutination-TTC and IFAT. In two cases of rheumatoid svndrome the serological titre was positive (2 l-160) in the microagglutination-TTC and IFAT technique but the tube agglutination was negative. In three SIR-In
AND
HYGIENE, VOL. 74, No. 3, 1980. CORRESPONDENCE
patients with appendicular syndrome the serological titre was only positive (a 1:160) using microagglutination-TTC test but the tube agglutination and IFAT were negative. Y. enterocolitica must be sought in diarrhoea, septicaemia and other clinical pictures, but serology could be used in diagnosis when the micro-organism is not recovered. We are, etc., M. LOPEZ-BREA M. MESEGUER M. BAQUERO L. DE RAFAEL D. MOLINA Department of Microbiology, Centro Especial Ram&t y Cajal, Madrid-34, Spain References Ahvonen, P. (1972). Human yersiniosis in Finland. Annals of Clinical Research, 4, 30-48. Bissett, M. L. (1976). Yersinia enterocolitica. Isolates from humans in California, 19681975. Journal of Clinical Microbiology, 4, 137-144. Delorme, J., Laversiere, M., Martineau, B. & Lafleur, L. (1974). Yersiniosis in children. Canadian Medical Association Journal, 110, 281284. Larsen, J. H. (1972). Human yersiniosis, the result of a serological investigation with Yersinia enterocolitica. Ugeskrift for Laeger, 134, 141. Mollaret, H. H. (1971). L’infection humaine a Yersinia enterocolitica en 1970, a la lumiere de 642 cas recents. Pathologie et biologic, 19, 189-205. Mollaret, H. H. (1972). Un domaine pathologique nouveau: l’infection li Yersinia enterocolitica. Annales de biologie clinique, 30, 1-6. Nilehn. B. (1969). Studies of Yersinia enterocolitica. with’special reference to bacterial diagnosis and occurrence in human acute enteric disease. Acta Pathologica et Microbioloeica Scandinavica (Suppl.j, 206, 5. Ricciardi, I. D., Pearson, A. D., Suckling, W. G. & Klein, G. (1978). A microagglutination test for Yersinia enterocolitica infection: recognition of multiple serotypes in experiments with stained suspensions df serotypes 05,27. Journal of Medical Microbiologv. 2. 359. Toma, S. & Lafleur, L. (1974). Survey on the incidence of Yersinia enterocolitica. Applied Microbiology, 28, 469-473. Winblad, S. (1969). Erytheme nodosum associated with Yersinia enterocolitica. Scandinavian Journal of Infectious Diseases, 1, 11. Winblad, S. (1975). Arthritis associated with Yersinia enterocolitica. Scandinavian Journal of Infectious Diseases, 7, 191. VII
Accepted
for
Distribution
publication
I
10th October, 1979.
of Plasmodium falciaarum in West Bengal ” * SIR-It is interesting to note that with the resurgence of malaria, the distribution of the different species of Plasmodium has changed in West Bengal.
TRANSACTIONS
OF THE ROYAL
SOCIETY
OF TROPICAL
MEDICINE
Earlier records (KNOWLES et al., 1930) reveal that all three species, namely, P. vz’vax, P. falciparum and P. mdlariae were well represented -in Bengal (Table). and the distribution of P. fulciparum varied from 8:5:/, (Central Bengal) to 56.5:[ (Hooghly). Table : Distribution of three species of malaria parasites in Bengal Plasmodium vivax
Bengal Presidency Calcutta
41.4”” 370;,
Plasmodium falciparum
46.3:;,
56U<,
Plasmodium malariae
12.5:; 7’:;
The data collected through NMEP of India during 1971-78 show a completely different picture. P. malariae has become virtually extinct, though it is known to be present in a sizeable number in one area of India (ROY et al., 1976). P. fulciparum constitutes 11.321: of the total cases detected: in Calcutta only 10 (O.l”/$) imported cases of P. alciparum have been reported. The distribution varies from nil (Howrah) to 29.87% (Coochbihar). P. falciparum accounts for 50Uh and‘ more of the total cases of malaria in Bihar, Meghalaya, Nagaland, Orissa and Trioura states in India (Chakrabortv. \ <, cited by HATI, i979). The reasons for this change are, however, not quite clear. Has the host-parasite relationship altered? Has there been any replacement of known vectors? Although it has been claimed that Anopheles philippinensis has disappeared from West Bengal (Report of the evaluation in depth of the NMEP of India, 1970), in a recent small scale survey conducted by our department A. phihppinensis has been found to amount to 6.85 “Cl of the total anopheline mosquitoes in one endemic area. Has the phenomenon got any relation to vectorial cauacitv? ROY (1943) in Calcutta was unable to iniect the salivary glands of A. stephensi with P. malariae, whereas 45.41; of these mosquitoes were infected with P. vivax and 37.3Ob with P. falciparum. In the peak transmission season, experimentally, we have also been unable to infect the salivary glands of A. stephensi with P. malariae and the 28.00,;, infection in this snecies of mosauito achieved with P. vivax produced only scanty sporozoites in the salivary glands. It has not been possible for us to collect data on the susceptibility of local mosquitoes to P. faZciparun2 in recent years as clinical cases are rare. We are, etc., A. K. HATI Calcutta Calcutta
School of Tropical 700073, India
N. C. MUKHOPADHYAY Medicine,
References K. (1979). In: Medical Entomology. Calcutta: Allied Book Aaencv, 18A Shvamacharan Dey Street, Calcutta 7C!J073,Fp. 37. e Knowles, R., Senior White, R. & Das Gupta, B. M. (1930). Studies in the parasitology of malaria. Indian Medical Research Memoirs, No. 18, pp. 80-86.
HATI,
A.
AND HYGIENE,
VOL.
74, No.
3, 1980.
CORRESPONDENCE
421
Report of the evaluation in depth of the National Malaria Eradication Programme of India (1970). Part III, 6-6. Roy, D. N. (1943). The role of A. subpictus Grassi as a carrier of malaria. Journal of the Malaria Institute of India, 5, 117-121. Roy, R. G., Madesayya, N. M., Sitaraman, N. L. & Ghosh, R. B. (1976). Plasmodium malariae infection in Karnatka State (1968-73). Journal of Communicable Diseases, 8, 81-82.
Accepted
for
publication
17th October,
1979.
Leishmaniasis in Tuscany (Italy). (III) The prevalence of canine leishmaniasis in two foci of Grosset0 Province SIR-The area of Baccinello (Scansano) and of Monte Argentario represent two foci of human leishmaniasis in the province of Grosseto. The hamlet of Baccinello and its surrounding farms, located in a hilly inland territory, is a hypoendemic focus of both visceral and cutaneous leishmaniasis (VL and CL) (BETTINI et al.. 1977). Phlebotomus perfiliewi is the dominant species of sandfly (99.0 ‘yU) (MAROLI & BETTINI, 1977). Leishmania has been isolated from wild mammals (Rattus rattus and Vulpes vulpes) in that area (BETTINI et al., 1980; GRADONI et al., 1978) and two isolates from R. rattus and the one from V. vulpes have been identified as belonging to the donovani complex (Chance, M. L., personal communication). The focus of M. Argentario, on the other hand, consists of a fossil island (actually a promontory) of about 50 km2 which, in the post-war period, presented a relatively high number of cases of infantile VL (SEGANTI & PALOMBELLI. 1955) but recently only a‘ few cases (BETTINI et al.; 1977) have occurred. CL has never been reported from that area. P. perniciosus is the most abundant sandfly species and considered as the probable vector (CORRADETTI & NERI, 1955). Leishmania has also been isolated from R. rattus in this focus (Pozio et aZ., in preparation). Canine leishmaniasis has not yet been described from these two foci, nor from Tuscany in general. In the present note we report the results of a survey on canine leishmaniasis carried out in the foci mentioned above. An accurate clinical examination was carried out on all doas studied. The following sinns were considered as pathognomonic of the disease: cutaneous alterations (alopecia, desquamation, ulcers), keratoconjunctivitis, hypertrophy of claws, ganglia1 swelling. A blood sample was taken from each dog. Sera from dogs from Baccinello were tested by the complement fixation technique (BCG antigen) (DE ALENCAR et al., 1966), and the sera of dogs from M. Argentario were tested by the indirect fluorescence technique*. In clinically * Sera from dogs of Baccinello could not be tested with the indirect fluorescence technique because the samples were lost when the laboratory was moved.