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Papers by Monil Singhai

Infectious Disease Reports, Dec 14, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Infectious Disease Reports, Nov 29, 2022

Journal of Communicable Diseases, 2018

In the present study phylogenetic analysis of 30 rabies virus (RV) isolates collected from North ... more In the present study phylogenetic analysis of 30 rabies virus (RV) isolates collected from North and North East India between 2013 and 2016 was carried out. Analysis of two sets of sequence of non-coding G-L intergenic region, based upon a 132-nucleotide region of the cytoplasmic domain (CD) of the G gene (G-CD) and a 549-nucleotide (Psi-L) was done. The phylogenetic tree constructed using 549 nucleotide sequence of hyper variable region (Psi-L) showed the same topology as that obtained on the basis of 132 nucleotide sequence of G-CD region. Four different genetic clusters (GCs) distributed among three geographical regions were identified. Comparison of deduced amino acid (aa) sequences showed four amino acid changes-aa462G, aa465H/R and aa468K in G-CD region. The change observed at position aa465R indicated the spillover of Indian wild strain (mongoose) to domestic animals in Delhi region. The homology among the Indian RV isolates shared >97% nucleotide similarity irrespective of their geographical regions and hosts. The study revealed that the RV isolates are region specific, not host specific and all belonged to genotype 1.

Journal of Case Reports, 2012

Histoid leprosy is a rare form of multibacillary leprosy with unique clinical and histopathologic... more Histoid leprosy is a rare form of multibacillary leprosy with unique clinical and histopathological features. Lesions of histoid leprosy can mimic neurofibroma, xanthoma, dermatofibromas, reticulohistioc ytosis and cutaneous metastasis. W e report a

Journal of Family Medicine and Primary Care

Journal of Communicable Diseases, 2020

Introduction: Japanese Encephalitis (JE), a leading cause of AES is a vector-borne disease is cau... more Introduction: Japanese Encephalitis (JE), a leading cause of AES is a vector-borne disease is caused by the JE virus belonging to the genus Flavivirus (Flaviviridae family), and transmitted by bite of Culex vishnui subgroup tritaeniorhynchus, the most important reported vector species for JE transmission in India. Methodology: A study was conducted on 1131 AES suspected cases in JE laboratory of Centre for Arboviral and Zoonotic diseases, National Centre for Disease Control (NCDC), Delhi from tertiary care referral hospitals of Delhi for laboratory confirmation of JE during the period from January 2017- December 2019. CSF and/ or Serum Samples from 1131 hospitalized AES suspected cases mostly from Delhi, UP, Haryana addresses. They were tested and interpreted for IgM antibodies by the JE IgM Capture ELISA kit (National Institute of Virology, Pune). The demographic profile (age/ sex/ seasonality/ place) of JE confirmed cases were analyzed. Result: 77 (6.8%) out of 1131 AES suspected ...

Ethiopian Journal of Health Sciences, 2017

The association between physical activity and the metabolic syndrome among type 2 diabetes patien... more The association between physical activity and the metabolic syndrome among type 2 diabetes patients in Gaza Strip,

Indian Journal of Medical Biochemistry, 2022

Breakthrough Infections and Omicron Variant: Dealing with the Dilemma About two years have elapse... more Breakthrough Infections and Omicron Variant: Dealing with the Dilemma About two years have elapsed since the first official SARS-CoV-2 infection was reported in Wuhan. The introduction of vaccines, along with efforts around masking and social distancing has raised the hopes that the SARS-Coronavirus-2 pandemic can be contained. However, the continuous emergence of new variants of the virus, breakthrough infections, and sustained vaccine hesitancy pose considerable challenges to our efforts towards ending the current pandemic. Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, the emergence and circulation of a large number of variants that may harbor one or more mutations have been reported. Some of these variants are designated as a 'Variant of Concern' or a 'Variant of Interest' due to shared attributes and characteristics that warrant public health attention. These variants may have possible effects on virulence, transmissibility, viral replication, reinfection etc. The Omicron variant of SARS COV-2 was first identified in Botswana and South Africa and was reported to the World Health Organization (WHO) on 24th November 2021 and was convened by WHO as SARS-CoV-2 variant of concern (B.1.1.529) on 26 November 2021. SARS-CoV-2 has undergone over 50 genetic mutations including 15 mutations in the receptor-binding domain (RBD) of the viral spike protein which has led to the increased potential for transmissibility, immune escape, and infectivity of the omicron variant. 1,2 It is presently the most common variant rapidly replacing the Delta variant of the virus and is prevalent in nearly all countries. The screening test by real-time PCR for detection of omicron variant for SARS-CoV-2 shows S gene dropout /target failure and detection of other targets such as ORF 1ab and N gene etc. as a marker indicating SARS-COV2 positive infection by Omicron variant which may be further confirmed by genetic sequencing. Omicron has surprised the world by rapidly spreading and infecting the double-dose vaccinated individuals even when 60% of the world population has received at least one dose of COVID-19 vaccine and many countries are at the level of achieving a fair percentage of their population being fully vaccinated against COVID-19. Omicron has a definite growth advantage over the Delta variant, sustained transmissibility potential, and causes reinfections owing to its property of immune evasion. 3,4 These reinfections could also be due to antibody escape by the variant coupled with the waning of neutralizing antibodies over the three to six months that intervened between vaccination and omicron infection. Data released by Pfizer demonstrated that three doses of the Pfizer-BioNTech COVID-19 vaccine neutralize the Omicron variant while two doses show significantly reduced neutralization titers. But, as 80% of epitopes in the spike protein recognized by CD8+ T cells are not affected by the mutations in the Omicron variant, two doses may still induce protection against severe disease. In an in vitro study of live virus neutralization assay, omicron was able to escape neutralization by Pfizer mRNA vaccine (Pfizer-BioNTech) raising concern over the possible risk of reinfections with this variant. 5 Other studies have also reported low vaccine effectiveness against omicron infection, with only 57% effectiveness at preventing hospitalization following more than six months duration since completion of two-dose primary immunization. Another study showed reduced vaccine effectiveness of 70 % against hospital admission with Omicron. 6 The Lancet has reported the first documented report of symptomatic breakthrough infections with omicron variant in a group of 7 German visitors to South Africa in November 2021. All of them had received three doses of SARS-CoV-2 vaccines, including at least two doses of an mRNA vaccine. Infections were mild to moderate in all the individuals suggesting protection offered by the booster dose against severe disease and hospitalization by omicron variant. The individuals demonstrated high serum levels of neutralizing IgG levels as well as strong T cell responses. 7 Even though breakthrough infections with Omicron variant may pose a low risk to millions of vaccinated individuals in terms of the severity of the disease, natural infection with the variant could be dangerous for the unvaccinated population. Millions of immunocompromised, elderly, and medically vulnerable people are still at higher-than-average risk. Surety of lifelong immunity with any of the current COVID vaccines was never promised. Instead, the crucial objective of vaccination is to prevent COVID-19 deaths. Due to the waning of immunity observed 6-9 months post-vaccination with primary series, there is definite usefulness of providing booster vaccines to the high-risk group individuals such as elderly, healthcare workers, and immunocompromised individuals for protection against severe disease and deaths with breakthrough infections. However, there is currently no evidence of the immediate need to provide booster doses to the entire population of the countries. High-income countries are way ahead of low-income countries in COVID-19 vaccination coverage and globally, 3 billion people have still not received their first dose of the vaccine. These unvaccinated populations provide a good opportunity for the SARS-COV-2 virus to multiply, evolve and mutate further, which may even lead to the emergence of deadly variants and so it is these groups who will majorly shape and drive the course of the pandemic. Therefore, the focus of the countries should be on accelerating the vaccination coverage of its unvaccinated or additional booster doses to high-risk populations and not on offering additional doses to all the primary vaccinated individuals who are not at high risk. The future of the pandemic will decide the need for the development and rollout of variant-specific SARS-COV-2 vaccines, depending upon the lethality of future variants, herd immunity of the population, and cost-effectiveness of the approach.

Indian Journal of Medical Microbiology, 2021

BACKGROUND This perspective documents the historical aspects of outbreaks of plague of last six d... more BACKGROUND This perspective documents the historical aspects of outbreaks of plague of last six decades, establishment of plague surveillance network in India with detailed insights about its activities and recent developments requiring focus on plague surveillance. Human plague was reported in Mulbagal area of Karnataka in 1966-67 only to re-emerge in the country in 1994 in Beed district (Maharashtra) and subsequently in Surat (Gujarat). Later Plague outbreak has been reported in the year 2002 with index case from Village Hatkoti, Shimla District in Himachal Pradesh. The last outbreak reported from India was in 2004 from Village Dangaud, Uttarkashi District in Uttarakhand followed by a period of quiescent since last 17 years. OBJECTIVES During the last few decades, at least three geographical areas experienced outbreaks of plague after silent period of 28 years. We recapitulate the response mechanism for containing outbreaks during the last three outbreaks of plague held in Maharashtra & Gujarat (1994), Himachal Pradesh (2002) and Uttarakhand (2004). We also document the Plague surveillance network of India and its activities which is a comprehensive surveillance system comprising of rodent, flea, canine and human surveillance whose foundation was started in 1964. The recent developments of last decade in terms of revised Human plague surveillance case definitions, Plague surveillance sites, vector control, novel diagnostics and vaccines in our country are also mentioned. CONCLUSION The thrust areas in control of plague outbreak are early detection and isolation of cases, timely effective antibiotic treatment, chemoprophylaxis to contacts, strengthening of surveillance system and massive IEC campaign in infected areas. Yersinia pestis (causative agent of Plague) also being an important bioterrorism agent, clinicians need to pay special attention to diagnose and microbiologists must be provided skilled training for laboratory confirmation to this pestilential disease for effective and timely management.

Cornea, 2021

To the Editor: Rabies virus transmission through solid organs or tissues allotransplantation (ROT... more To the Editor: Rabies virus transmission through solid organs or tissues allotransplantation (ROTA), including corneal tissue, leading to fatalities, has been previously described.1 A routine screening for rabies before corneal transplantation is not performed because of the rarity of its occurrence and variable symptomatology. We present a case of corneal donation where ROTA was averted due to high index of suspicion of rabies in the donor. The corneas were subjected to fluorescent antibody test (FAT), and rabies virus antigen was detected. A pair of optical grade corneas was received from a voluntary home donation from a 50-year-old man on March 9, 2020. The reported cause of death was acute psychosis. The cause of death, however, was not convincing, and the treatment sheets of the deceased were reviewed by the eye bank director. The records revealed occurrence of sudden onset agitated behavior followed by jump from the roof of the house 3 days before his death, for which he was taken to the psychiatric emergency. The patient had been bitten by a stray dog on the leg 5 months before with no details of postexposure prophylactic treatment. He was advised oral antipsychotics but succumbed to the illness within the ensuing 6 hours. Because the cause of death was uncertain, the corneas received in Cornisol (Aurolab, India) were not released for transplantation. The brain tissue being unavailable, the donor corneal tissues and serum sample were transported to National Rabies Reference laboratory, World Health Organization Collaborating Center for Rabies Epidemiology, Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, Delhi, India. Smears were prepared from both corneas as per standard procedure for FAT. They were stained with fluorescein isothiocyanate conjugate antirabies antibody (Bio-Rad) and examined under fluorescent microscope at 400 nm.2 Apple green fluorescence was observed in both smears. Reverse transcriptase polymerase chain reaction for rabies nucleocapsid gene (N gene, 430 bp) performed as per standard protocol was found to be negative.3 The donor serum was negative for IgG antirabies antibody using Platellia Rabies II kit (Bio-Rad, France).4 ROTA has been reported in 16 transplant recipients from cornea (8 cases), solid organs (7 cases), and vascular tissue (1 case). These cases have been from 6 countries: United States (5 Cases), Germany (4 cases), Thailand (2 cases), India (2 cases), Iran (2 cases), and France (1 case).5 In humans, rabies manifests as encephalitic or paralytic form.1 The incubation period for rabies is typically 31 to 90 days, and in 1% of cases, it may extend further. In our case, the possibility of rabies was suspected in the donor because of the sudden onset of psychotic behavior in conjunction with a history of dog bite and no documentation of postexposure prophylactic treatment. However, the long post-bite asymptomatic period of 5 months made it a less likely possibility. FAT is the gold standard for the diagnosis of rabies on specimens such as brain tissue, corneal smears, and nuchal skin biopsy.6 In our case, corneal tissue was the only available specimen, and rabies virus antigen could be demonstrated by FAT in the corneal smears. The negative result of reverse transcriptase polymerase chain reaction for rabies nucleic acid could have resulted from the inhibitory effect of storage media contents, also observed by Vetter et al.5 The inability to detect the antirabies antibodies in the serum sample further corroborated the absence of host immune response. Corneal transplantation, similar to other organs, opens a potential route for human exposure to the deadly rabies virus to healthy recipients. A preexposure prophylaxis before transplantation is not justified due to the rarity of infection, high cost, and serious side effects of the vaccine.4 To the best of our knowledge, this is the first published report of rabies antigen demonstration in donor corneal tissue. It highlights the importance of detailed evaluation of the cause of death before utilization of donor corneal tissue to avert the transmission of rabies virus from an infected donor to 2 recipients.

Annals of Global Health, 2021

Background: Nipah virus (NiV) first emerged in 1998 in Malaysia, causing an outbreak of respirato... more Background: Nipah virus (NiV) first emerged in 1998 in Malaysia, causing an outbreak of respiratory illness and encephalitis in pigs. Pig-to-human transmission of NiV associated with severe febrile encephalitis was described, and it was thought to occur through close contact with infected animals. The first outbreak was reported in India in Siliguri, West Bengal in 2001 followed by Nadia, West Bengal and adjoining areas of Bangladesh in 2007, where an intermediate animal host was not identified, suggesting bat-to-human and human-to-human transmissions. Although it is extremely difficult to document the spillover event and ascertain crossing of trans-natural boundaries by bats and bringing new viruses in an unexposed population, efforts for source identification are important to understand the epidemiology of disease. As the disease transcends beyond one species and has shown to infect humans, it therefore requires the 'One Health approach' in which multiple sectors coordinate and work together to achieve better public health outcomes.

Textbook of Pharmacology, Pathology and Genetics for Nurses (2 Volumes), 2016

Annals of Tropical Medicine and Public Health, 2016

We report a case of fatal fulminant hepatitis E and Salmonella paratyphi A coinfection in a patie... more We report a case of fatal fulminant hepatitis E and Salmonella paratyphi A coinfection in a patient of the sub-Himalayan region. The patient presented with acute febrile illness accompanied with sudden unconsciousness. Concomitant infection can result an illness having overlapping symptom, resulting in a situation where the diagnosis and treatment of patient may be difficult.

National Academy Science Letters, 2015

From July 2012 to August 2013 a total of 124 serum samples were received in the Department of Mic... more From July 2012 to August 2013 a total of 124 serum samples were received in the Department of Microbiology Govt Medical College, Haldwani from suspected water borne viral hepatitis outbreaks from different area of Kumaon region, Uttarakhand. All sera were screened for IgM Hepatitis A Virus and Hepatitis E virus (HAV & HEV) by enzyme immune assay. Water samples from two outbreaks were analysed by multiple tube method. Of the total of 124 samples 82 (66.1 %) were reactive to at least one seromarker of hepatitis A or E. Hepatitis A was the major cause of outbreak in 41.5 % (34/82). However, in Haldwani town HEV was detected in higher number. Co infection of HAV and HEV was detected in 28 % and it was significantly higher in female. Serology results showed that over all adults outnumbered children (79 vs. 21 %), which was statistically significant. Point source contamination of water supply with sewerage was identified. In Kumaon region HAV is predominant except in Haldwani town where hepatitis E is the major cause of waterborne hepatitis. HAV–HEV co-infection was higher in female. Significantly higher rates of infection in adults suggest an epidemiological shift in this region.

A fluconazole-resistant (MIC>32 µg ml̄ ) Candida albicans strain obtained from oral thrush les... more A fluconazole-resistant (MIC>32 µg ml̄ ) Candida albicans strain obtained from oral thrush lesion 1 of an HIV-1 infected patient was studied for protein profile by Sodium dodecyl Sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Membrane, cytosolic and total proteins were analysed by respective conventional buffers. An in-house, simple, buffer was designed for effective extraction of the proteins and compared with conventional buffers. Clinical and standard strains of Candida spp including fluconazole-resistant and susceptible C. albicans isolates obtained from other clinical specimens were included to evaluate the reproducibility and discriminatory power of SDS-PAGE by using our in-house prepared buffer. Analysis of the whole cell protein extract of fluconazole-resistant Candida albicans strain, from HIV patient, revealed at least 23 proteins of molecular weights ranging between 13 kDa-104 kDa. Proteins between 13 kDa-64 kDa were identified as abundant proteins. Reproducib...

Indian Journal of Medical Microbiology, 2015

BACKGROUND Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis and hepato... more BACKGROUND Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis and hepatocellular carcinoma. Thus this study was undertaken for detection and to observe genotypic distribution of the virus in this geographical region. The aim of the study is to quantitatively detect HCV-RNA in Hepatitis C patients and to determine the distribution pattern of its genotypes by real time polymerase chain reaction. MATERIALS AND METHODS This study was conducted in a tertiary care hospital in north India from January 1, 2013 to June 30, 2015. Quantification of HCV-RNA was done by real time PCR and in HCV-RNA positive samples, genotyping for HCV was conducted. RESULTS A total of 465 patients were recruited in the study, of which 217 were anti-HCV positive and 420 were HCV-RNA positive. These positive samples were further subjected to genotype determination using real time PCR. 163 samples were subjected to genotyping, where genotype 3 was the commonest as seen in 102 patients, followed by genotype 1 seen in 25 patients and genotype 4 in 8 patients, and in 27 patients genotype was undetected. CONCLUSION Without reliable assays for antigenemia and the inability of antibody tests to define viraemia in all cases, the detection of viral nucleic acid is necessary for diagnosis of active HCV infection. Genotype is clinically important in determining potential response and duration to interferon-based therapy. Genotype 1 and 4 are less responsive to interferon based treatment than are the other genotypes (2, 3, 5 and 6). Duration of standard interferon based therapy for genotypes 1 and 4 is 48 weeks, whereas treatment for genotypes 2 and 3 is completed in 24 weeks.

North American Journal of Medical Sciences, 2012

Type 2 diabetes (T2DM) mellitus is a serious implication of obesity. The effect of insulin therap... more Type 2 diabetes (T2DM) mellitus is a serious implication of obesity. The effect of insulin therapy on levels of inflammatory markers among obese and non-obese diabetics has been inadequately studied. The study aimed to analyze the preinsulin and postinsulin levels of tumor necrosis factor α (TNF-α) and IL-6 in nonobese and obese T2DM patients. We assessed TNF-α and IL-6 levels in healthy controls (n=10) and diabetic patients (obese and nonobese; n=20 each) and analyzed the postinsulin effect on TNF-α and IL-6 levels after 24 and 48 weeks. TNF-α and IL-6 levels were also correlated with fasting plasma glucose of obese and nonobese diabetic patients after insulin therapy. There is augmentation of TNF-α and IL-6 levels in diabetic patients and augmentation is more in obese than in nonobese diabetics. The obese group showed a significant decrease (P value&amp;amp;amp;lt;0.05) after 24 weeks of insulin therapy and an extremely significant decrease (P&amp;amp;amp;lt;0.001) in TNF-α and IL-6 levels after 48 weeks of therapy. The nonobese group showed an extremely significant decrease (P&amp;amp;amp;lt;0.001) in TNF-α and IL-6levels after 24 and 48 weeks both. There is augmented inflammation in diabetes and it is more in obese diabetics. Insulin therapy tends to counter this inflammation, but the response is delayed in obese diabetics.

Indian journal of clinical biochemistry : IJCB, 2014

Metabolic syndrome is a complex of metabolic factors which includes central obesity, insulin-resi... more Metabolic syndrome is a complex of metabolic factors which includes central obesity, insulin-resistance, dyslipidemia and hypertension. Metabolic syndrome is associated with increased risk of cardiovascular disease. This study aimed to know the rate of metabolic syndrome in outpatients presenting to medicine department of our hospital and their profile. The metabolic syndrome was diagnosed using International Diabetes Federation criteria. The parameters analyzed included age, sex, blood pressure, BMI, fasting plasma glucose, HDL and triglycerides. The rate of metabolic syndrome was 21.1 % in our study. The younger population was most susceptible to metabolic derangements. Further, females were found to be affected more than males. The extremely significant parameters were deranged fasting plasma glucose, HDL, triglycerides while hypertension was found to be insignificant. Being overweight maybe a strong predictor for presence of metabolic syndrome in our region of study, and all ove...