Hepatitis implies injury to liver characterized

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1 RESEARCH PAPER International Journal of Medical Sciences (October, 2009 to March, 2010) Vol. 2 Issue 2 : A Study on the Prevalence of Dengue, Hepatitis B and HIV in Tiruchirappalli Region G. AKILA, M. POORANI, T. MANJULA DEVI, V. SIVAKUMARI AND N.V. BASKAR See end of the article for authors affiliation V. SIVAKUMARI Department of Environmental and Herbal Sciences, Tamil University, Thanjavur (T.N.) INDIA ABSTRACT Viral diseases such as rabies, yellow fever and smallpox have affected humans for centuries. Examples of common human diseases caused by viruses include the common cold, influenza, chickenpox, diarrhea and cold sores. Serious diseases such as Ebola, AIDS, Avian influenza and SARS are caused by viruses. The ability of viruses to cause devastating epidemics in human societies has led to the concern about viruses. Hence the prevalence of Hepatitis, Dengue and AIDS virus has been undertaken in the present study by using ELISA in Trichy area. Different diagnosis tests were carried out for these virud diseases, which are more prevalent in India with the aim of their diagnosis, cure and effective management Key words : Hepatitis, Dengue, AIDS and ELISA Accepted : September, 2009 Hepatitis implies injury to liver characterized by presence of inflammatory cells in the liver tissue. Hepatitis can also be due to toxins (notably alcohol), other s or from autoimmune process. It may run a sub clinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs liver functions that include, among other things, screening of harmful substances, regulation of blood composition and production of bile to help digestion (Arankalle et al., 1994). Dengue ever is an infectious disease which is characterized by severe pain in eyes and head extremities. It is transmitted by the bite of a mosquito break bone fever was first described by Benjamin Rush in 1780 in Philadelphia, the vector (Aedes aegypti) was implicated in 1905 and Albert Sabin isolated the virus in 1945 (Alcon et al., 2002). Transmission of HIV among injection drug users occurs primarily through HIV infected blood contamination of injection paraphernalia, which is re-used by uninfected injection drugs users. Behaviors that increase the likelihood frequency and magnitude of exposure to infected blood increase the risk of. Among injection drug users, several demographic and behavioral characteristics are associated with greater risk of acquiring HIV. Foremost among risk factors is the sharing of needles, syringes and other injection equipment. Sharing is a common practice among injection drug users world wide (Burack Jeffrey and Bangsberg, 1998). Diagnosis is done by knowing the level of Alkaline Aminotransferase (ALT), Alkaline Phosphatase (ALP), Aspartate Aminotransferase (AST), Bilirubin levels, urea, creatinine, albumin, globulin and detecting viral antibodies, viral proteins and genetic material. Detection is done by ELISA procedure which uses direct sandwich assay. As dengue, hepatitis, HIV are more prevalent in India so this study focuses on diagnosis of these viral diseases as the proper diagnosis is crucial in not only curing but diseases management also. MATERIALS AND METHODS The blood was obtained by venipuncture and was allowed to form clot at room temperature ( C) and then centrifuged. The serum was separated as soon as possible and refrigerated (2-8 0 C) or colder if not tested within two days. Self-defrosting freezers were avoided as it was not recommended for storage. Lipaemia or microbial growth is not recommended. The NCCLS provides recommendation for storing blood specimens (Approved standard procedure for the handling and processing of blood specimens, HI8-A3, 2004). Detection of dengue virus: Serum dengue NSI antigen, when present,

2 binds to anti-nsi antibodies attached to the polystyrene surface of the microwell test strips (assay plate). Residual serum was removed from the assay plate by washing. HRP conjugated anti-ns1 MAb was added to the assay plate. After incubation, the microwells were washed and a colorless substrate system, tetramethylbenzidine / hydrogenperoxide TMB / H2O2 were added. The substrate was hydrolyzed enzyme and the chromogen changed to a blue colour. After stopping the reaction with acid, the TMB turned yellow. Colour development was indicative of the presence of dengue NS1 antigen in the test sample. Interpretation of results: The cut-off was determined using endemic and nonendemic negative population. The cut-off was determined using a population from Australia, Honduras and Thailand. The population consisted of 43 characterized NS1 positive samples, 144 negative samples from non-endemic blood donors and 69 negative samples from individuals residing in dengue endemic regions. RESULTS AND DISCUSSION About 57 individuals were tested for dengue with ELISA among which 5(8.7%) were primary dengue, 8(14%) were secondary dengue, 3(5.2%) were previous dengue were found to be positive and 41(72%) cases were found to be negative, which shows reactive cases (positive) and non reactive cases (negative) for dengue. The range for reactive and non reactive cases for dengue antigen was found to be 0.41 mg/dl to 51.2 mg/dl. The range for reactive and non reactive cases for dengue IGM antibody was found to be mg/dl and dengue IgG antibody was found to be mg/dl (Table 1). 35 individuals were tested for hepatitis B with ELISA, among which 5(14%) cases were found to be positive and 30 (86%) cases were found to be negative. The range for reactive and non reactive cases for hepatitis was found to be mg/dl to mg/dl (Table 2). 30 individuals were tested for HIV with ELISA, among which 3(10%) cases were found to be positive and 27 (90%) cases were found to be negative. The range for reactive and nonreactive cases for hepatitis was found to be mg/dl to mg/dl (Table 3). Biochemical study was conducted in the patients who were screened for patients who tested positive for Hepatitis B. The SGOT, Urea, globulin, creatinine, total bilirubin level was increased than the normal levels. The normal value of SGOT level is > 38µl. The SGPT, total protein, albumin, alkaline, phosphatase level was found G. AKILA, M. POORANI, T. MANJULA DEVI, V. SIVAKUMARI AND N.V. BASKAR Table 1 : Number of patients who have tested positive for Dengue Antibody to Dengue Sr. No. Antigen IgG IgM Impression Previous Dengue Secondary Dengue Secondary Dengue Secondary Dengue Primary Dengue Primary Dengue Primary Dengue Secondary Dengue Secondary Dengue Secondary Dengue Contd Table 1 186

3 187 A STUDY ON THE PREVALENCE OF DENGUE, HEPATITIS B & HIV IN TIRUCHIRAPPALLI REGION Table 1 contd Primary Dengue Primary Dengue Primary Dengue Secondary Dengue Primary Dengue Previous Dengue Secondary Dengue (i) Total number of cases: 57 (ii) Total number of positive cases: 16 (a) No. of (+) ve Dengue with percentage: 28% (iii) Total no. of primary cases: 5 (a) No. of primary Dengue with percentage: 8.7% (iv) Total no. of secondary cases: 8 (a) No. of secondary Dengue with percentage: 14% (v) Total no. of previous cases: 3 (a) No. of previous Dengue with percentage: 5.2% (vi) Total no. of negative cases: 41 (a) No. of negative Dengue with percentage: 72% to be decreased than the normal levels (Table 4). Biochemical study was conducted in the patients who were tested for HIV. There was a universal changes in the overall serum, biochemical values of patients who tested positive for HIV. The SGOT, SGPT, urea, albumin, globulin, creatinine, total bilirubin, total protein level was found increased when compared to the normal levels. The normal value of SGOT level is > 38µl. The SGOT was found to be 38 µl to 135 µl alkaline phosphatase level was found to be decreased when compared to normal levels (Table 5). The biochemical study was conducted in the patients who were screened for HIV. There was a universal Table 2 : Patients with positive Hepatitis B test Sr. No. Hepatitis B Impression NR NR NR NR NR R NR NR R NR NR NR NR NR NR R NR NR NR NR NR NR NR NR NR R NR NR NR NR NR NR NR NR R NR = Non-reactive; R= Reactive (i) Total number of cases: 35 (ii) Total number of positive cases: 5 (a) No. of (+) ve cases for Hepatitis B with percentage: 14% (iii) Total no. of Negative cases: 30 No. of (-) ve cases for Hepatitis B with percentage: 86% change in the overall serum, biochemical values of patients who tested positive for HIV. The SGOT and SGPT, urea, albumin, globulin, creatinine, total bilirubin, total protein level was increased than the normal levels. The normal value of SGOT level is >38µl. SGOT was found to be 38µl to 135µ l. The alkaline phosphatase level was decreased to the normal level. Alkaline phosphatase level was found to be >240 µl to µl. In an earlier study

4 G. AKILA, M. POORANI, T. MANJULA DEVI, V. SIVAKUMARI AND N.V. BASKAR 188 Table 3 : Patients with positive HIV test Sr. No. HIV Impression NR NR NR NR NR R NR NR NR NR NR NR NR NR NR NR NR NR NR NR R NR NR NR NR R NR NR NR NR NR = Non-reactive; R= Reactive (i) Total number of cases: 30 (ii) Total number of positive cases: 3 (a) No. of (+) ve cases for Hepatitis B with percentage: 10% (iii) Total no. of Negative cases: 27 No. of (-) ve cases for Hepatitis B with percentage: 90% by Onuchic et al. (2006), it was found that the blood urea level in a patient infected with HIV disease was above normal. There was an increase in the level of serum creatinine in the HIV infected subjects compared with the apparently healthy controls. Though there was an increase, it was not statistically significant in this study. The biochemical parameters showed that the levels of blood urea, creatinine serum enzymes and total protein were elevated in the HIV infected groups compared to the apparently healthy controls. It is recommended that the biochemical data obtained in this study be used as baseline in the pre-intervention and subsequent management of HIV disease patients. Table 4 : Enumeration of biochemical parameters in blood of patients tests for Hepatitis B Negative Positive Normal range for range for Sr. No. value Hepatitis Hepatitis B patients B patients Urea Creatinine Tot. bilirubin > Tot. protein (gm/dl) SGOT(µ/l) > SGPT(µ/l) > Alubumin (gm/dl) Globulin (gm/dl) Alkaline phosphatase (µ/l) > Table 5 : Enumeration of biochemical parameters in blood of patients tests for HIV Negative Positive Normal range for range for Sr. No. value HIV HIV patients patients Sugar Urea Creatinine Tot. bilirubin > Tot. protein (gm/dl) SGOT(µ/l) > SGPT(µ/l) > Alubumin (gm/dl) Globulin (gm/dl) Alkaline phosphatase (µ/l) > Alubumin / Globulin 1: : : Authors affiliations: G. AKILA AND M. POORANI, Department of Microbiology, Ponnaiyah Ramajayam College, THANJAVUR (T.N.) INDIA T. MANJULA DEVI, Shrimati Indira Gandhi College, TIRUCHIRAPALLI (T.N.) INDIA N.V. BASKAR, Department of Microbilogy, Marudhu Pandiyar College, THANJAVUR (T.N.) INDIA REFERENCES Alcon, S., Talarmin, A., Debruyne, M., Falconar, A., Deubel, V. and Flamand, M. (2002). Enzyme-linked immunosorbent assay specific to dengue virus type 1 nonstructural protein NS1 reveals circulation of the antigen in the blood during the acute phase of disease in patients experiencing primary or secondary. J. Clin. Microbiol., 40:

5 189 A STUDY ON THE PREVALENCE OF DENGUE, HEPATITIS B & HIV IN TIRUCHIRAPPALLI REGION Arankalle, V.A., Chadha, M.S., Tsarev, S.A., Emerson, S.U., Risbud, A.R., Banerjee, K. and Purcell, R.H. (1994). Seroepidemiology of water-borne hepatitis in India and evidence for a third enterically-transmitted hepatitis agent. Proc. Natl. Acad. Sci. USA, 91: Burack Jeffrey, H. and Bangsberg, D. (1998). Epidemiology and transmission of HIV among injection drug users. J. Virol., 81(11): Onuchic, T., Tsurimoto, T., Ueda, K., Okubo, K. and Matsubara, K. (2006). Sexual transmission of HIV. Proc. Natl. Acad. Sci. USA, 86: ***