Papers by Niyamat Siddiqui
Journal of Tropical Diseases & Public Health, 2016
There have been relatively few large-scale studies of spread of Post Kala-azar Dermal Leishmanias... more There have been relatively few large-scale studies of spread of Post Kala-azar Dermal Leishmaniasis (PKDL) and factors that affects its prevalence. Consequently, little is known about the dynamics of PKDL, or the confounding factors that may give rise to its spread. A large-scale survey-based study of PKDL prevalence was conducted in the endemic region of Araria in Bihar, India. The results of the study indicate a sample prevalence of as high as 7.9 cases per 10,000 individuals. Socio-economic and demographical factors were recorded for each study participant, and the influence of these factors on PKDL and non-PKDL incidence in the sample populations was analysed. Our results suggest that factors of caste, cattle shed proximity, and gender all contribute to the characterization of the PKDL-afflicted population. The mean household size for PKDL households was found to be 4.9, almost doubled the number observed for non-PKDL households. Individuals in the age-group 10-19 years old, Hindus, or those belonging to Schedule Caste are more likely to get PKDL than others in the population. Consideration of these factors can provide a clear starting point for further in-depth examination of their contribution to PKDL patterns.
SSRN Electronic Journal, 2020
Background: Visceral leishmaniasis (VL) is declining in India, but still persists in disadvantage... more Background: Visceral leishmaniasis (VL) is declining in India, but still persists in disadvantaged communities despite WHO's 2020 'elimination as a public health problem' target. Combined interventions might achieve elimination if we knew their impact. Furthermore WHO's forthcoming NTD road map has opened a policy window for strategy change for 2021-2030. We estimated the combined effect from a district-wide pilot of intensified interventions in the highly endemic Vaishali district, where cases fell from 3,598 in 2012-2014 to 708 in 2015-2017. Methods: The intensified control approach comprised indoor residual spraying with improved supervision; VL-specific training for Accredited Social Health Activists to reduce onset-to-diagnosis time; and increased Information Education and Communication activities in the community. We compared the rate of incidence decrease in Vaishali to other districts in Bihar via an interrupted time series analysis with a spatiotemporal model, and estimated the number of cases averted by the pilot. Findings: Changes in Vaishali's rank among Bihar's endemic districts in terms of monthly case numbers showed a change pre-pilot (3rd highest out of 33 reporting districts) versus during the pilot (9th) (p<0·0001). The rate of decline in Vaishali's cases was 26th highest pre-pilot and 19th during the pilot (p<0·0001). Model simulations suggest a median 1,071 cases (IQR 849-1,333) were averted in Vaishali between March 2015-December 2017. Interpretation: Strengthening control strategies may have precipitated a faster decline in VL case numbers in Vaishali and suggests this approach should be piloted in other highly endemic districts. Funding: Government of India, Bill & Melinda Gates Foundation, Newton Fund. Declaration of Interest: VK, NAS, SK, VNRD, KP& PD were the permanent employees of RMRIMS, Patnaand RM was a PhD337student under Department of Vector Biology, RMRIMS, Patna. Government of India entrusted RMRIMS with thispilotwork. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest Ethical Approval: The Institutional Ethical Committee of RMRIMS(03/RMRI/EC/2018)approved the intensified control programme.University of Warwick’s Biomedical & Scientific Research Ethics Committee (REGO-662018-2231) approved this analysis
Background Visceral leishmaniasis (VL), also known as kala-azar (KA), is a neglected vector-borne... more Background Visceral leishmaniasis (VL), also known as kala-azar (KA), is a neglected vector-borne disease, targeted for elimination, but several affected blocks of Bihar are posing challenges with the high incidence of cases, and moreover, the disease is spreading in newer areas. High-quality kala-azar surveillance in India, always pose great concern. The complete and accurate patient level data is critical for the current kala-azar management information system (KMIS). On the other side, no accurate data on the burden of post kala-azar dermal leishmaniasis (PKDL) and co-infections are available under the current surveillance system, which might emerge as a serious concern. Additionally, in low case scenario, sentinel surveillance may be useful in addressing post-elimination activities and sustaining kala-azar (KA) elimination. Health facility-based sentinel site surveillance system has been proposed, first time to do a proper accounting of KA, PKDL and co-infection morbidity, morta...
American Journal of Tropical Medicine and Hygiene, 2009
We report two cases of post-kala-azar dermal leishmaniasis (PKDL), which had subsequently develop... more We report two cases of post-kala-azar dermal leishmaniasis (PKDL), which had subsequently developed after successful treatment of visceral leishmaniasis with miltefosine. Both patients had maculo-nodular lesions all over the body, and they were diagnosed as PKDL by parasitologic examination for Leishmania donovani bodies in a skin snip of lesions. Patients were put on amphotericin B and responded very well for nodular lesions with one course of treatment. However, longer duration of the treatment is needed for total clearance of macular lesions from body surface in PKDL cases. This is the first case report of PKDL in India, which developed after successful treatment of visceral leishmaniasis with miltefosine.
This study was undertaken to assess the extent of community awareness and related practices about... more This study was undertaken to assess the extent of community awareness and related practices about kala-azar undertaken by them to control the disease, in an highly endemic focus of Bihar, India. A household-based cross-sectional knowledge, attitude, and practices (KAP) survey consisting of quantitative components on knowledge, attitude, and practices concerning kala-azar was administered to heads-of-household through a semi-structured questionnaire. Data indicated that 61% respondents were illiterate, 4% had correct knowledge that sandfly bites caused kala-azar, 26% do not know any specific transmission agents for kala-azar. A majority (72%) of respondents were not able to recognize sandfly, 33% had no specific knowledge about the symptoms. All of them (100%) believed that this disease could affect his or her family income. Nearly all (95%) were positive that the kala-azar cases could be reduced with implementation of proper health measures. A few (11%) suggested isolation of patien...
The American Journal of Tropical Medicine and Hygiene, 2020
A rapid and noninvasive rK39 rapid diagnostic test (RDT) is the best and most reliable tool for v... more A rapid and noninvasive rK39 rapid diagnostic test (RDT) is the best and most reliable tool for visceral leishmaniasis (VL) screening in the field. However, splenic and bone marrow aspiration remain two gold standard methods for microscopic identification of Leishmania donovani (LD) and confirmatory diagnosis of VL. Five patients with signs and symptoms of fever, loss of appetite, loss of weight, hepatomegaly, and massive splenomegaly were found to be false positive with the rK39 RDT. These patients were suspected to have chronic myeloid leukemia (CML) because their blood pictures showed a total white blood cell count of > 100,000/mm3 and abnormal cells such as stab, segmented promyelocytes, myelocytes, metamyelocytes, and blast cells. Splenic aspirate and bone marrow were negative for Leishman-Donovan (LD) bodies. The bone marrow showed myeloid series of cells, that is, myelocytes, metamyelocytes, stab and segmented cells, blast cells, and markedly increased myeloid:erythroid. Later, the CML diagnosis was confirmed in all cases by BCR-ABL gene positive test results. In this study, the rK39 RDT's false positivity was observed in CML cases. It could have important implications for the differential diagnosis of VL with CML. The rK39 positive test result in CML cases was a serendipitous occurrence; this should be validated further to determine the utility of the rK39 test in the differential diagnosis of VL with CML.
Infection, Jan 10, 2015
Visceral leishmaniasis (VL), a protozoan disease, is 100 % fatal if left untreated. Anemia is com... more Visceral leishmaniasis (VL), a protozoan disease, is 100 % fatal if left untreated. Anemia is common in VL which plays a role in expression of clinically overt VL disease. Laboratory clues are scarce for strengthening clinical suspicion for severity in VL. Hypertriglyceridemia has emerged as a new concept for the diagnosis and prognosis in VL. The present study is aimed at correlating the magnitude of hypertriglyceridemia with the severity in VL. A retrospective case-control study was conducted between January 2012 to December 2013 among 124 patients coming for treatment from VL endemic areas, who had fever of more than 15 days and did not respond to antimalarials and antibiotics. The parasitologically confirmed VL cases (n = 87) were categorized as mild/moderate (n = 60) and severe (n = 27) groups according to WHO classification for anemia and parasite burden. Serum triglycerides were assayed in VL groups along with controls (n = 37). Serum triglyceride level was significantly high...
Journal of Tropical Medicine, 2012
Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as ho... more Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced.Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention.Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care.Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or sp...
Journal of Medical Case Reports, 2009
Introduction: Visceral leishmaniasis, a tropical infectious disease, is a major public health pro... more Introduction: Visceral leishmaniasis, a tropical infectious disease, is a major public health problem in India. Tuberous sclerosis, a congenital neuro-ectodermosis, is an uncommon disease which requires life long treatment. Case presentation: A 15-year-old Indian patient, presented to the outpatient department of our institute with a high-grade fever for two months, splenomegaly and a history of generalized tonicclonic convulsions since childhood. The clinical and laboratory findings suggested visceral leishmaniasis with tuberous sclerosis. The patient was treated with miltefosine and antiepileptics. Conclusion: The patient responded well and in a follow up six months after presentation, she was found free of visceral leishmaniasis and seizures. Diagnosis and treatment of this rare combination of diseases is difficult.
BMC Public Health, 2012
Background: Active case detection (ACD) significantly contributes to early detection and treatmen... more Background: Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal. Methods: The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method. Results: Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing. Conclusion: National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.
PLOS Neglected Tropical Diseases
PLOS Neglected Tropical Diseases
Post-kala-azar dermal leishmaniasis (PKDL) is clinical outcome of visceral leishmaniasis (VL) and... more Post-kala-azar dermal leishmaniasis (PKDL) is clinical outcome of visceral leishmaniasis (VL) and is thought to be the potential reservoir of parasite. Miltefosine (MF) is the only oral drug existing for treatment of post-kala-azar dermal leishmaniasis (PKDL). Increased miltefosine tolerance in clinical isolates of Leishmania donovani has been reported and is one of the major concerns in the treatment of PKDL. Here, we report a highly ulcerated PKDL case that was successfully cured after miltefosine treatment.
Hospital Practices and Research
Background: From Gaya and adjoining regions, the trend in patients admitted with acute neurologic... more Background: From Gaya and adjoining regions, the trend in patients admitted with acute neurological illness was investigated. Illnesses were identified as sudden outbreaks of Japanese virus encephalitis (JE), Herpes simplex virus encephalitis (HSV1&2), and other acute encephalitis syndrome (AES). Objective: In the current study, an investigation was carried out to assess potential infectious pathogens in patients aged 16 years or younger who were admitted to Anugrah Narayan Magadh Memorial Medical College Hospital, Gaya, with encephalitis-like symptoms. Methods: Cross-epidemiological, serological, and molecular biological studies were performed on samples collected from 71 patients below 16 years of age. Patients’ clinical histories, i.e. fever, socio-demographic characteristics, and other clinical data, were extracted from patient files. Results: The results showed confirmed AES cases, including 49.30% JE and 7.04% HSV positive patients. A higher casefatality rate of 40% in JE and ...
Journal of Medical and Allied Sciences
PLOS ONE
Background Lesishmaniasis is a neglected tropical disease endemic in Bihar, India. Inappropriate ... more Background Lesishmaniasis is a neglected tropical disease endemic in Bihar, India. Inappropriate health seeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients may increase the disease duration, severity and transmissibility. Simultaneously, lack of knowledge and perceived stigma may also increase the length of delay in receiving treatment. This ultimately effects the kala-azar elimination program. Methods A cross sectional study was conducted in 120 confirmed PKDL patients, aged 18 years and older. Data related to knowledge and health seeking behaviour was collected by a pretested questionnaire. EMIC stigma scale was used for assessing the perceived stigma. Patients were personally interviewed after taking informed consent. Data analysis was done by using SPSS 16 software. Results The time between appearance of symptoms and first medical consultation (patient delay) ranged from 15 days to 5475 days (15 years) with a median of 285 days. The time between first medical consultations to onset of specific treatment (system delay) ranged from 2 to 5475 days with a median of 365 days. Many patients approached first to quacks (8.4%), homeopathic and ayurvedic practitioners (25.8%) upon recognition of symptoms. Majority of the patients (68.3%) had poor knowledge about PKDL and its vector. Type of skin lesions PLOS ONE |
Health and Quality of Life Outcomes
Background: This study was aimed to assess the impact of quality of life using WHOQOL-BREF in pat... more Background: This study was aimed to assess the impact of quality of life using WHOQOL-BREF in patients with Visceral leishmaniasis (VL). Methods: A total of 95 VL cases and 95 healthy participants filled out the questionnaires. Data on sociodemographic aspects along with disease duration were collected. Data were compared using a t-test, analysis of variance and chi-square test. Results: VL patients experienced very high impact on their quality of life. Study cohort had male preponderance (72.63%). Majority (64.21%) were aged < 40 years. Longer disease duration was found to have significantly poor quality of life (p < 0.05). The physical domain was found to be most affected domains of quality of life (QOL). QOL was affected most in illiterate, married, housewife, rural population and patients with longer disease duration (p < 0. 05). The psychological and environmental domains were significantly affected in > 40 years of age group married patients (p < 0.05). Conclusions: VL significantly impaired the patients' (QOL) in all four domains (physical, psychological, social relationship and environmental). Physical domain was significantly the most affected domain.
Background: Underreporting of Visceral Leishmaniasis (VL) in India remains a problem to public he... more Background: Underreporting of Visceral Leishmaniasis (VL) in India remains a problem to public health controls. Effective and reliable surveillance systems are critical for monitoring disease outbreaks and public health control programs. However, in India, government surveillance systems are affected by levels of scarcity in resources and therefore, uncertainty surrounds the true incidence of asymptomatic and clinical cases, affecting morbidity and mortality rates. The State of Bihar alone contributes up to the 40\% of the worldwide VL cases. The inefficiency of surveillance systems occurs because of multiple reasons including delay in seeking health care, accessing non-authentic health care clinics, and existence of significant asymptomatic self healing infectious cases. This results in a failure of the system to adequately report true transmission rates and number of symptomatic cases that have sought medical advice (thus, high underreporting of cases). Objectives and Methods: The...
The American journal of tropical medicine and hygiene, Jan 10, 2018
The diagnosis of visceral leishmaniasis (VL) is one of the foremost barriers in the control of th... more The diagnosis of visceral leishmaniasis (VL) is one of the foremost barriers in the control of this disease, as demonstration of the parasite by splenic/bone marrow aspiration is relatively difficult and requires expertise and laboratory support. The aim of the present study was to find a noninvasive diagnostic approach using the existing recombinant kinesine-39 (rK-39) immunochromatographic nitrocellulose strips test (ICT) with a human sweat specimen for the diagnosis of VL. The investigation was carried out on specimens (blood, sweat, and urine) collected from 58 confirmed VL, 50 confirmed post kala-azar dermal leishmaniasis (PKDL), 36 healthy control, and 35 patients from other diseases. The data obtained from this study reveal that 96.55% clinically confirmed active VL participants were found to be positive when tested against a sweat specimen. Interestingly, the scenario was similar when tested against a blood specimen (96.55% positive by rK-39). Moreover, a test of both sweats...
International Journal of TROPICAL DISEASE & Health
Background: Indoor Residual Spraying (IRS) and Insecticide Treated Nets (ITNs) are important tool... more Background: Indoor Residual Spraying (IRS) and Insecticide Treated Nets (ITNs) are important tools in the fight against insect vectors of important diseases. In spite of having operational and logistic limitation(s), IRS and ITN are still in practice as conventional tools with mixed results for controlling Phlebotomus argentipes, the vector of Visceral Leishmaniasis (VL) in the Indian subcontinent. A combination of both tools might results better for reducing VL vector densities during the attack phase of the VL elimination initiative. Methods: A comparison-based study was designed for analyzing the field efficacy of a combination strategy of IRS+ITN (PermaNet 3.0 ®) versus single interventions with IRS and ITNs alone comparing with control respectively. The study was conducted at the villages of Samastipur district of Bihar (India) using aspiration and light traps techniques (i.e., AT and LTT respectively) for collecting sand fly. The numbers of all types of sand flies (male, unfed, fed and gravid female) were recorded during a period of 12 months after the intervention in the three study arms. The bioavailability of insecticide for IRS as well as ITN was also observed at the interval of 3 months with the help of cone bioassay technique established by World Health Organization (WHO). Results: The observed highest percent-reduction of sand flies (93.59%-100%) at the sites with combined intervention of IRS+ITN, as compared to the sites without any intervention at control (with 0% reduction) or with single control intervention either with IRS (4.29%-86.77%) or with ITN (60.18%-97.07%) followed by the reduction in bioavailability of insecticide in IRS (i.e., 52.38%, 58.33%, 45.45% & 50.00%) and ITN (84.44%, 82.50%, 77.78% & 83.33%) over the period of 12 months since intervention, establishes the success of IRS plus ITN as a combined approach for contaminating vector population. Also, through the house-to-house survey at the end of study period, the acceptance of combined approach for IRS plus ITN by the community was accessed to be highest i.e., 100% as compared to the single-intervention approaches for IRS (87%) and ITN (100%). Conclusions: Study results advocate the use of the combined strategy during the attack phase of the VL elimination initiative in order to reduce or interrupt disease transmission. It may also be a valid approach during the maintenance phase in hot-spots of VL transmission.
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Papers by Niyamat Siddiqui