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TIMES CITYTHE TIMES OF INDIA, PUNE | TUESDAY, MAY 12, 2015

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Pune: Mite-borne rickettsialinfection, seen primarily in therural populace in the past, isnow being increasingly detect-ed in people residing in expand-ing cities across the country.

The resurgence of this dis-ease can be attributed to risingurbanization — the vectors,ticks and mites, have nowfound their residence in urbanbushes, with the increase intransport, influx of people andcity limits merging into nearbyrural areas.

The disease epidemiology,experts say, has been changingwith increasing urbanization.In view of this, Indian Councilof Medical Research (ICMR)has developed guidelines on di-agnosis and management ofrickettsial diseases in Indiathis year. Of all rickettsiosescases, scrub typhus is the mostcommon and accounts for upto50% of undifferentiated feverpresenting to hospital.

“Rickettsial infections aregenerally incapacitating anddifficult to diagnose, untreatedcases have case fatality rates ashigh as 30-45% with multipleorgan dysfunction, if notpromptly diagnosed and treat-ed. The ICMR’s guidelines de-fine a framework for recogniz-ing manifestations, identifyingappropriate diagnostic testsand initiating prompt and ef-fective treatment,” M D Gupte,chair (epidemiology), ICMR,told TOI on Monday.

The vast variability andnon-specific presentation ofthis infection have often madeit difficult to diagnose clinical-ly. Acute fever is the most com-mon presenting symptom asso-ciated with breathlessness,cough, nausea, vomiting, myal-gia and headache. Besides, aneschar (a dead tissue that shedsor falls off from healthy skin) atthe site of chigger bite can beseen in early disease and is auseful diagnostic clue in scrubtyphus, though its frequencyvaries from 7-97%.

While a rash is consideredas hallmark of rickettsial dis-ease, it is neither seen at pre-sentation nor in all patients.Presence of rash is common inspotted fever and extremelyrare in scrub typhus.

“However, none of theseclinical symptoms and signs,including eschar, is diagnosticof rickettsial disease. There-fore, epidemiological factorspertaining to geographical ar-ea, habitat, occupation, move-ment of the subject (vocationalor recreational) could assist in

reaching a diagnosis of rickett-sial disease with certainty andinitiating treatment on time,”Gupte said.

Complications of scrub ty-phus usually develop after thefirst week of illness. Jaundice,renal failure, pneumonitis,acute respiratory distress syn-drome (ARDS), septic shock,myocarditis and meningoence-phalitis are various complica-tions known with this disease

Pneumonia is one of themost frequent complications ofscrub typhus which manifestsas a non-productive cough andbreathlessness and leads toARDS which could be life-threatening. Severe complica-tions include hepatitis (inflam-

mation of the liver), renal orkidney failure, meningo-en-cephalitis (inflammation of thebrain and meninges) and myo-carditits (inflammation anddamage to the heart muscle)with shock may occur in var-ying proportions of patients.

“Prompt antibiotic therapy,even based on suspicion, short-ens the course of the disease,lowers the risk of complica-tions and reduces morbidityand mortality due to rickettsialdiseases. Currently, doxycy-cline is regarded as the drug ofchoice,” infectious diseases ex-pert Bharat Purandare said.

There is an urgent need forphysicians and health-careworkers at all levels in India to

been reported from severalstates in India, including Jam-mu and Kashmir, HimachalPradesh,Uttarakhand, Bihar,West Bengal, Meghalaya, Ra-jasthan, Maharashtra, Karna-taka, Tamil Nadu and Kerala.

In Maharashtra, cases oftyphus fever are usually report-ed from the Shreerampur beltin Ahmednagar district andSatara district. “The history in-dicates contact with cattle. Thecases of tick typhus in Punehave a contact history of dogs.Besides, body louse-borne ty-phus infection is also seenamong people from lower socio-economic strata,” a senior phy-sician from Deenanath Man-geshkar hospital said.

be aware of the clinical fea-tures, available diagnostic testsand their interpretation, andthe therapy of these infections.

“The guidelines have beendeveloped to help treating phy-sicians towards correct diag-nosis and treatment. For wantof awareness in physicians andthe community, diagnostic de-lays result in patients present-ing to tertiary care centres withacute respiratory distress syn-drome (ARDS) and other se-vere complications. The guide-lines will definitely help indiagnosing and treating thesecases and bring in uniformityin line of treatment,” said aninfectious diseases expert.

Cases of rickettsioses have

ICMR gears up to tackle risingcases of mite-borne infections

Pune: The newly-formed PuneMetropolitanRegion Devel-opment Au-thority(PMRDA) plansto prepare a de-velopmental

plan for the Pune metropolitanregion in the next one year, Gir-ish Bapat, PMRDA head anddistrict guardian minister, saidhere on Monday.

Over 400 villages spreadacross an area of 3535sq kmaround Pune and PimpriChinchwad are part ofPMRDA. The authority, whichofficially started functioningon May 1, is expected to look in-to control development of theentire region spread in fringesof both cities.

Bapat, who held PMRDA’smaiden meeting on Monday,said that the authority will en-sure planned construction ac-tivity in the entire area.

“For this, work of prepar-ing the development plan willbe taken up with top priority.We are not planning to out-source the work to a privateagency. The PMRDA will con-stitute a separate committee ofabout 25 experts from variousdepartments, including townplanning and revenue depart-ments, to formulate the devel-opment plan. We will ensurethat the committee is formed atthe earliest,” Bapat added.

The minister further saidthat there are plans to send aproposal to the state govern-ment to increase PMRDA’s ju-risdiction. He said that revi-sion of limit was necessarybecause the existing area ofPMRDA was marked about 15years ago in 1998. “Lot of devel-

opment and changes have tak-en place in last few years in andaround the area. It is necessaryto include some more parts un-der PMRDA,” Bapat said.

He said the authority willimmediately take up a study onthe extension of PMRDA limitsand submit a report to the gov-ernment in next one month forapproval.

PMRDA to readydevelopment

plan in one yearTIMES NEWS NETWORK

Hamburg: Eighteen years af-ter a busy junction in Aundhwas named Bremen Chowk,symbolising Pune’s associ-ation with the industrial townof Bremen in Germany, the fo-rum catalysing this collabora-tion of ideas and experts fromthe two cities has closed.

Curtains came down on thePune-Bremen Solidarity Fo-rum, which had started in 1980,in January this year, with theforum struggling to attractyoung blood. “This is a volun-tary group supported by theBremen parliament and theBremen government. The av-erage age of (forum members)was 60 to 70 in both Pune andBremen. The partners werefinding it difficult (to get youngpeople),” said Gunther Hillig-es, founder of Pune-BremenSolidarity Forum. Hilliges wasalso its president until it closedin January.

In its 30 years, the forumforged alliances between edu-cational institutions and in-dustrialists, successfully ex-ported India’s ‘gobar gas plant’idea to farmhouses in Bremen,but could not get a key project –of getting the Mula-Mutha riv-er cleaned – to yield the desiredresult.

Speaking to TOI from Bre-men, Hilliges (75) said collabo-rations between the two citiesmay continue if the partnersso will, but the forum was nolonger needed to broker alli-ances as communication ismuch easier now. “There was atime when letters from Punewere routed via the foreignministry. It took two monthsfor the letters to reach us,” hesaid, adding that now all inter-actions are on email.

The forum had come upfour years after Terre DesHommes started its activitiesin Pune, working with hand-icapped children or those with

special needs. “Pune was se-lected as the former CEO ofTerre Des Hommes lived there.

The first project partner wasKEM hospital,” recalled Hillig-es, who was on the board of

Terre Des Hommes and hadstarted receiving letters fromthe Indian partners to broaden

their scope of work.What followed was the for-

mation of the forum and a se-

ries of exchanges and partner-ships. Key among them wasstudents from the Bremen andPune universities coming to-gether to devise a plan to cleanthe Mula-Mutha in Pune andthe Wesar River in Bremen.

“The universities ex-changed students and variousfaculties from both universi-ties came together. We werelucky in Bremen. Administra-tors were able to contain influxof dirty water into Wesar andnow we are talking aboutsourcing drinking water fromit. Thirty different species offish are found in this waternow and people are allowed toswim. But Mula Mutha has on-ly worsened,” Hilliges said, at-tributing the state of the riversin Pune to weak political will.

Another tie-up was be-tween Deenanath Mangesh-kar Hospital and Bremen Hos-pital with a clutch of doctorsand nurses from Pune visitingBremen for a month-long

training programme. The twocities also collaborated to getyoung people interested in thehistory and culture of their re-spective countries – with theÜbersee Museum Bremenpartnering with Raja DinkarKelkar museum in Pune andthe two exchanging experts.

The forum’s oldest part-ners in Pune, Arbutus, whichworks on environmental pro-tection and sustainable devel-opment, is hopeful that the col-laboration goes on. “You don’tget people to carry it forward.Young people are too busy anddon’t get time. But the contactsare there and strong links havebeen formed,” said Dr MeeraBondre, who, with her hus-band Arwind, founded Arbu-tus. She added there is hope.Arbutus is bringing out a Ger-man booklet in which youngpeople from Pune and Bremenhave exchanged their views onthe good life today and tomor-row.

35-yr-old transnational solidarity forum downs shutters, but bonds remainRoli Srivastava@timesgroup.com p

n 1976 | Terre Des Hommes starts activities in Pune for children in need

n 1980 | The Pune-Bremen Solidarity Forum is formed with a view to engage in areas of sustainable development

n November 19, 1997 | The Pune-Bremen Maitri Chowk is inaugurated

The main reason to set up the forum was to overcome tradi-

tional prejudices. In 1982, we held a painting competition in Bremen on impressions on India. Children drew tigers and the holy cow. But today people are aware that India is a lead-ing country in computer technologyGunther Hilliges | FOUNDER, PUNE-BREMEN

SOLIDARITY FORUM

THE PUNE-BREMEN COLLABORATION

Partnershipsn Student exchange between Pune and Bremen universities for cleaning of the Mula-Mutha in Pune and Wesar in Bremen

n Around 40 companies from Bremen have links to Pune and have regular meetings at the Mahratta Chamber of Commerce Industries & Agriculture

n Deenanath Mangeshkar Hospital and Bremen Hospital collaborate on a training programme

n 15 NGOs from Bremen are still working with children in need

n Since 10 years, 20 students from Symbiosis, Pune, come to the Hochschule Bremen for an academic programme. Twentystudents from Bremen visit Pune

n School children have written a book together: Three wi shes for the futureBremen Chowk

Artistes from Bremen at the Raja Dinkar Kelkar museum

Pune: Three Afghan stu-dents were arrested on Mon-day for allegedly thrashingand sodomising a 21-year-old man, who also hails fromAfghanistan. The incidenttook place in Kondhwa onSunday night.

The Kondhwa police saidone of the three suspects andthe complainant, who is pur-suing his B A, study in thesame private college in thecity.

The other two are fromdifferent colleges, whereone is pursuing his B Comand the other is an engineer-ing student. Police said thefourth suspect , who is also aforeign national studying ina city college, is absconding.

Police said on May 10, thecomplainant’s classmatehad invited the former to aparty at his rented flat inKondhwa. “The other threesuspects joined them laterthat night. All of them haddinner and consumed li-

quor. Later, one of themplayed music and asked thecomplainant to dance. Whenthe latter refused, the sus-pects started beating him,”said Rajendra Mokashi, se-nior inspector of the Kondh-wa police station.

Mokashi said when thecomplainant shouted forhelp, one of the suspectsgagged him with a piece ofcloth.

“The suspect who is pur-suing his B Com allegedlysodomised the complainant.The other two attempted tosodomise him,” Mokashisaid.

Mokashi said the com-plainant somehow managedto escape and approachedthe police station.

“We have arrestedthe suspects under sections377 (unnatural offence) and323 (voluntarily causinghurt) of the Indian PenalCode. We have launched asearch to trace the fourthsuspect. He has also beenbooked under the samecharges” he added.

Assistant inspector ofthe Kondhwa police stationSatish Pawar is investigat-ing the case.

Three Afghanstudentsarrested

for sodomy TIMES NEWS NETWORK

Police said theyhave launched asearch for thefourth suspect, whois also a foreignnational studying ina city college

Pune: The city-based KagadKach Patra Kashtakari Pan-chayat (KKPKP) in associ-ation with the SNDT Collegehas drafted a list of recom-mendations for effective im-plementation of the Right toEducation (RTE) Act.

These recommendationsinclude better management ofhelp centres, effective griev-ance redressal system and enddiscrimination in schoolsamong others. The draft wasprepared during a programmejointly organized by the SNDT

Women’s University’s Depart-ment of Continuing & AdultEducation & Extension andthe KKPKP. As many as 100parents came together to dis-cuss their experiences andthat of their childrens’ whileinteracting with schools andthe state administration.

“The Act is in its fourthyear of implementation, so itis a good time to take stock ofthe issues in city and PimpriChinchwad from the parents’perspective. Parents, mostlyfrom the working class,shared both positive and neg-ative experiences in the first

session. The common threadwas the parents their desire toensure what they considered

will provide their childrenwith the best education– anEnglish-medium private

school,” said Poornima Chi-karmane of the SNDT Univer-sity during a press conferenceon Monday.

During the meet, parentsdiscussed about uncoopera-tive officials who delayed in-come certificates, hostileschools and also how theywere made to run from pillarto post for documents. “I havestudied till class II, but I wantmy daughter to be a collector,”said Jyoti Shinde, who tookpart in the discussion.

The report of the pro-gramme prepared by SNDTUniversity and the KKPKP al-

so highlighted that the RTEAct has made it difficult forthe parents and children.However, what remains is toensure that the provisions areimplemented in the spirit, thereport said.

“The gathering resolvedto send a petition to the stateeducation minister and thechief minister,” said Mai-trayee Shankar of theKKPKP. The Akhil BhartiyaSamajwadi Adhyapak Sabha,the Action for the Rights ofthe Child (ARC), Swadhar andMaher also participated inthe event.

Wastepickers’ association drafts plan to implement RTE Act TIMES NEWS NETWORK

n Better management of help centres

n Effective grievance redressal system

n Ending discrimination in schools

n Define neighbourhood schools

n Defining entitlements and other provisions under the RTE Act

n Create awareness and publicity

n Enlist documents required for admission

n Improve interaction between parents and teachers

THEIR RECOMMENDATIONS

Pune: The newly-formedPune Metropolitan RegionDevelopment Authority(PMRDA) has decided to crackdown on illegal constructionin the metropolitan region. Itplans to establish separatevigilance squads to keepcheck on illegal constructionsbesides implementation ofheavy fines and cutting ofpower and water supply.

Girish Bapat, chairman ofPMRDA, on Monday said theauthority plans to come outwith various measures to re-strict illegal con-structions in thePMRDA area.

He said besides strict ac-tion against developers, thereis also a plan to create aware-ness among Sarpanch, policepatil and tehsildars of all thevillages notified underPMRDA to ensure that no ille-gal constructions are enter-tained in their respective juris-dictions. Bapat also said thatthe authority will not hesitateto initiate action against a Sar-panch and revenue officials ifillegal constructions are spot-ted in their jurisdictions.

Bapat said the authoritywill further start a police sta-tion to help the administra-tion keep check on illegal con-structions.

The Pune Municipal Cor-poration (PMC) will extend ahelping hand to the PMRDA todeal with illegal construc-tions. “The PMC will provideinfrastructure as well as hu-man resources support to thenew authority. The expertiseon processes to carry outdrives against the unautho-rized and illegal construc-tions will be shared with theofficials of PMRDA,” MayorDattatraya Dhankawade toldreporters on Monday.

He said the PMC will helpPMRDA in setting up the ten-dering systems, manpower

management sys-tem and machin-ery management

to raze the illegal construc-tion. The training about legal-ities regarding the illegal con-structions will be imparted tonew staff of the authority,most of which will be recruit-ed on temporary basis.

Illegal constructions is amajor issues in PMC areas. Asper PMC’s data, in last coupleyears, the civic body has actedagainst over 4,200 illegal con-structions. As part of the drive,illegal sheds and houses built inconcrete on an area of around25.5 lakh sq ft in slum pockets ofShivajinagar, Kasba Peth, Wad-gaonsheri, Ambegaon, Koth-rud, Katraj, NIBM Road andPashan were demolished.

Squads to check illegal buildingsTIMES NEWS NETWORK

HEAVY FINES

ä If patients come with complications to primary health facility and treating physician considers it as rickettsial infection, treatment with doxycycline should be initiated

ä Patients should be referred to secondary or tertiary centre in case of complications like ARDS or multi organ dysfunction. In addition to recommended

management of community acquired pneumonia, doxycycline is to be initiated when scrub typhus is considered likely

ä In fever cases of duration of five days or more where malaria, dengue and typhoid have been ruled out; doxycycline and azithromycine should be administered once scrub typhus is considered likely

(SOURCE: GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF RICKETTSIAL

DISEASES IN INDIA 2015: INDIAN COUNCIL OF MEDICAL RESEARCH AND

DEPARTMENT OF HEALTH RESEARCH, UNION MINISTRY OF HEALTH AND FAMILY

WELFARE, NEW DELHI)

THE NEED FOR GUIDELINESä The care and management of people with rickettsial diseases is done primarily by the general practitioners and physicians. However, there are no clear directions or guidelines for its management

ä A need for availability of a set of guidelines which can be used by doctors, scientists and public health workers all over the country was strongly felt

ä With this in view, Department of Health Research (DHR) and Indian Council of Medical Research (ICMR) took the initiative to formulate the guidelines for the diagnosis and management of Rickettsial diseases in India

ä The guidelines define a framework for recognizing manifestations, identifying appropriate diagnostic tests and initiating prompt and effective treatment

ä These guidelines have been developed for scientific purpose with the aim to provide physicians and health care workers with practical information to assist with the diagnosis and care of patients with rickettsial infections

ä These guidelines also aim to stimulate thinking among scientists interested in developing this area in the country at the various levels of health care and thus help the people to lead a normal and healthy life

DEFINITION OF SUSPECTED/CLINICAL CASEä Acute undifferentiated febrile illness of 5 days or more with or without eschar should be suspected as a case of Rickettsial infection. (If eschar is present, fever of less than 5 days duration should be considered as scrub typhus)

äOther presenting features

may be headache and rash (rash more often seen in fair persons),lymphadenopathy (lymphnodes which are abnormal in size) multi-organ involvement like liver, lung and kidney involvement

ä The differential diagnosis of dengue, malaria, pneumonia, leptospirosis and typhoid should be kept in mind

DEFINITION OFCONFIRMED CASE

A CONFIRMED CASE IS THE ONE IN WHICH:ä Rickettsial DNA is detected in eschar samples or whole blood by polymerase chain reaction (PCR) test

ä Rising antibody titers on acute and convalescent sera detected by Indirect Immune Fluorescence Assay (IFA) or Indirect Immunoperoxidase Assay (IPA)

ä Indirect Immunoperoxidase Assay (IPA) and Immunofluorescence Assay (IFA) are considered serological gold standards but are available at laboratories with higher level of facilities and expertise

ä Molecular diagnosis by polymerase chain reaction (PCR) is available only at few centres in India

ä However, ELISA based tests, particularly

immunoglobulin M (IgM) capture assays can be made available at secondary level and tertiary levels of health care like District hospitals and medical colleges

ä Weil-Felix test which is helpful in establishing presumptive diagnosis canbe considered at primary level of health care as they can be easily set up with moderate level of infrastructure and expertise at least in areas affected by scrub typhus

THERE ARE VARIOUS LABORATORY TESTS AVAILABLE FOR DIAGNOSIS OF RICKETTSIAL DISEASES

LABORATORY TESTS

THE HEALTHCARE PROVIDER NEEDS TO DO THE FOLLOWING

Head of PMRDA Girish Bapatsaid that the authority has

decided to adopt the latestsoftware to monitor daily work.The software will help trackevery file and also generateupdate on progress report andsend an update through SMS tothe applicant’s mobile number.This will ensure transparencyand speedy disposal ofapplications withoutunnecessary delays, Bapatsaid.

There are about 324 caseswith PMRDA. The authorityplans to process all the files inthe next 10 days. The authoritywill have a team of about 275staff members. There is also aplan to establish ninedepartments to streamlinework. Amongst these will beplanning, illegal construction,accounts, establishments,general administration, trafficand transportation.

Nine departments,latest technology

Urbanisation Brings With It A Disease That Was Once Restricted To Rural Areas

Umesh.Isalkar@timesgroup.com

Pics: Shyam Sonar