BackgroundAmong healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.Methodology/Principal FindingsAmong 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4–55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.ConclusionsOur study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.

BackgroundApproximately one million malaria cases were reported in India in 2015, based on microscopy. This study aims to assess the malaria prevalence among hospitalised fever patients in India identified by PCR, and to evaluate the performance of routine diagnostic methods.MethodsDuring June 2011-December 2012, patients admitted with acute undifferentiated fever to seven secondary level community hospitals in Assam (Tezpur), Bihar (Raxaul), Chhattisgarh (Mungeli), Maharashtra (Ratnagiri), Andhra Pradesh (Anantapur) and Tamil Nadu (Oddanchatram and Ambur) were included. The malaria prevalence was assessed by polymerase chain reaction (PCR), routine microscopy, and a rapid diagnostic test (RDT) with PCR as a reference method.ResultsThe malaria prevalence by PCR was 19% (268/1412) ranging from 6% (Oddanchatram, South India) to 35% (Ratnagiri, West India). Among malaria positive patients P. falciparum single infection was detected in 46%, while 38% had P. vivax, 11% mixed infections with P. falciparum and P. vivax, and 5% P. malariae. Compared to PCR, microscopy had sensitivity of 29% and specificity of 98%, while the RDT had sensitivity of 24% and specificity of 99%.ConclusionsHigh malaria prevalence was identified by PCR in this cohort. Routine diagnostic methods had low sensitivity compared to PCR. The results suggest that malaria is underdiagnosed in rural India. However, low parasitaemia controlled by immunity may constitute a proportion of PCR positive cases, which calls for awareness of the fact that other pathogens could be responsible for the febrile disease in submicroscopic malaria.

BackgroundNurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort.Methodology/Principal Findings436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3–12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort.ConclusionsOur study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.

Glucocorticoid misuse will contribute to the burden of hypertension, diabetes, osteoporotic fracture, tuberculosis, cataracts and deaths due to hypoadrenal crisis. One in 15 people in Raxaul Block are likely to have a suppressed hypothalamo-pituitary-adrenal axis.

Background: The state of Bihar has the third largest number of snakebite deaths in India. The purpose of this study is to explore the factors related to human-snake conflicts in northwest Bihar and southern Nepal. Using these findings, various strategies were proposed to reduce the incidence of snakebites. Method: Data were collected from 609 patients at Duncan Hospital in Raxaul, Bihar, India between 1 July 2012 and 30 June 2013. Patients were included if they had a history of snakebite or unknown bites. Patients with symptoms of envenomation but no known bites were also included, as were patients who were dead on arrival due to a snakebite. Results: The 10-19 year old age group is the peak age group (28.4%) for snakebite. There is a slight preponderance of males (52.7%). 51.4% of bites occurred on the foot/ankle. The envenomation rate was 12.6%. The mortality rate of those envenomed that arrived at the hospital alive was 6.3%. Fourteen people were dead on arrival at the hospital. 75% of people were unable to identify what, or what type of snake, bit them. Common Wolf Snakes (Lycodon aulicus) were the most common snakes brought to the hospital, followed by Spectacled Cobra (Naja naja). Patients who brought snakes to the hospital and attempted identification were all successful at identifying cobras, but all those who brought in Common Wolf Snakes incorrectly identified them as Kraits. The highest monthly frequency of snakebites occurred between June and September; while on a daily basis, the highest frequency occurred between 1700hrs-2200hrs, the time in which 39.1% of all bites occurred. 59.2% of the bites occurred in and around the house. Farming, housework, sleeping, playing, and toileting in fields were the activities most commonly occurring when bitten. Sleeping on the floor increased the risk of envenomation [OR= 5.8, 95%CI 1.8-18.6], while sleeping under a mosquito net decreased the risk of envenomation [OR= 0.17, 95%CI 0.04-0.6]. Conclusion: Snakebite is a rural hazard in Northern Bihar, not just an occupational hazard. Use of toilets and sleeping on beds with well tucked in mosquito nets may help prevent snakebites. Education to reduce the risk of snakebites should begin in childhood and be regularly reinforced prior to the rainy season. Prevention measures should include environmental management such as keeping eating areas clean and keeping food storage and sleeping areas a distance apart.