Letters to the Editor

Indian Pediatrics 2002; 39:1071-1073

Reporting Trend of Infectious Diseases Through Case Reports and Brief Reports Published in Indian Pediatrics

Case reports and brief reports are two common formats in scientific reporting. However, these reports are often criticized for their lack of original research, isolated observations, and superficial approach(1). We conducted a study to determine whether a comprehensive study of case reports and brief reports published in the journal, Indian Pediatrics give potentially useful information. The search strategy was based on the inclusion of infectious diseases related reports from the journal website (http:/www. indianpediatrics.net). Reports related to non-infectious diseases, non-infectious diseases complicated by an infection, and articles whose full text was not accessible through internet were excluded from the study. These search criteria yielded 43 infectious disease related articles (out of a total of 307 articles; 157 case reports, and 150 brief reports), consisting of 22 case reports, and 21 brief reports. These articles were published in the journal "Indian Pediatrics" between August 1999 to March 2002. One-way ANOVA was used to compare the distribution of infectious disease related reports during the study period, and Spearman rank order correlation test was done to quantify association between microbial etiology, recovery rate, and type of diagnostic test.

There was no significant difference in the reporting of infectious disease related reports during the study period ( P = 0.657481; one-way ANOVA). Tertiary care centers and apex hospitals in New Delhi, Vellore, Chandigarh, and Mumbai topped the list in infectious disease reporting (Table I). Most of the reported cases were sporadic (76.8%), and bacterial and viral pathogens comprised 76.7% of the reports. ELISA along with culture (27.9% each) was found to be the commonest diagnostic method used. Case reports were predominantly descriptive epidemiologic studies (95.5 %), whereas brief reports were either, analytical cross sectional studies (52.4%), analytical cohort studies (23.8%), or interventional studies (23.8%). Single case reporting (modal value of statistical average = 1) was commonest in case reports; in brief reports larger sample sizes (mean = 343; SD = 907; range: 1417-2157) were studied. The geographical origin of the case(s) or the population group was rarely mentioned in the reports. Viral diseases were more frequently associated with rapid tests like ELISA (rs = 0.5745; one-tailed P = 0.000029, two-tailed P = 0.0000057; Spearman test). In case reports bacterial diseases showed a significantly higher recovery rate than other infectious diseases ( rs = 0.4303; one-tailed P = 0.022889, two-tailed P = 0.045778; Spearman test).

Table I- Results of the Study Parameters Regarding Case Reports (n=22) and Brief Reports (n=21)

Study Parameters

No. of 
Case Repors

No. of 
Brief reports

Total

Year of reporting

1999*

3/24 (12.5)

5/21 (23.8)

8/45 (17.8)

2000

5/62 (8.1)

7/56 (12.5)

12/118 (10.2)

2001

11/53 (20.8)

7/55 (12.8)

18/108 (16.7)

2002+

3/18 (16.7)

2/18 (11.1)

5/36 (13.9)

Place of reporting

New Delhi

9 (40.9)

8 (38.1)

17 (39.5)

Vellore

2 (9.1)

4 (19)

6 (14)

Chandigarh

4 (18.2)

0 (0)

4 (9.3)

Mumbai

0 (0)

3 (14.3)

3 (7)

Others

7 (31.8)

6 (28.6)

13 (30.2)

Reporting
institution

Christian Medical College,
Vellore

2 (9.1)

4 (19)

6 (14)

All India Institute of Medical
Sciences, New Delhi

2 (9.1)

3 (14.3)

5 (11.6)

University College of
Medical Sciences, New Delhi

2 (9.1)

3 (14.3)

5 (11.6)

Postgraduate Institute of 
Medical Education &
Research, Chandigarh

4 (18.2)

0 (0)

4 (9.3)

Maulana Azad Medical
College, New Delhi

1 (4.5)

2 (9.5)

3 (7)

Others

11 (50)

9 (42.9)

20 (46.5)

Type of study

Descriptive epidemiology

21 (95.5)

0 (0)

21 (48.8)

Analytical cohort study

0 (0)

5 (23.8)

5 (11.6)

Analytical cross sectional
Study

1 (4.5)

11 (52.4)

12 (27.9)

Interventional study

0 (0)

5 (23.8)

5 (11.6)

Type of pathogen

Bacteria

9 (40.9)

5 (23.8)

14 (32.6)

Mycobacteria

1 (4.5)

2 (9.5)

3 (7)

Virus

4 (18.2)

12 (57.1)

16 (37.2)

Parasite

5 (22.7)

0 (0)

5 (11.6)

Fungus

3 (13.6)

 0 (0)

3 (7)

Bacteria+Fungus

0(0)

2 (9.5)

2 (4.7)

Diagnostic 

Culture+/-microscopy

9 (40.9)

3 (14.3)

12 (27.9)

technique

ELISA

5 (22.7)

7 (33.3)

12 (27.9)

PCR+/-ELISA

1 (4.5)

3 (14.3)

4 (9.3)

Others

7 (31.8)

8 (38.1)

15 (34.9)

Age

Range

1.5 months to
12 years 

0-18 years

0-18 years

Average

4.8 years

NA

NA

Sex

Total no. of males

18

701

719

Total no. of females

8

611

619

Nature of the

Sporadic

22 (100)

11 (52.4)

33 (76.7)

disease

Epidemic

0 (0)

4 (19)

4 (9.3)

Endemic

0 (0)

6 (28.6)

6 (14)

Sample size of

Total

165

7208

7373

the study

Average*

1

343

171

Clinical

Recovery

18

2

20 (46.5)

Outcome

Death

2

0

2 (4.7)

Recovery + Death

1

5

6 (14)

Not applicable/NA

1

14

15 (34.9)

Figures within parentheses indicate percentage; * from August, 1999; + till March, 2002

Childhood morbidity and mortality data is an important socio-economic development index, and infectious disease of childhood is a public health problem in India. An assessment of the reporting trend of infectious disease is important, hence an indexed journal "Indian Pediatrics", which is also internet accessible, was chosen. The journal reports Indian data predominantly, and reports both infectious and non-infectious diseases. The study reveals the emergence of rapid diagnostic techniques like ELISA, and PCR in the diagnostic arsenal. This trend was more obvious with respect to diseases where the causative microorganism is difficult or time consuming to culture, such as in viral diseases, and extrapulmonary tuberculosis. However, traditional methods like culture and microscopy continued to the methods of choice for many diseases.

The place of reporting does not necessarily reflect the geographic origin of the case. It was unfortunate to note that this important demographic data was lacking in most reports. This information is important not only for the creation of case distribution maps, and epidemiologic studies, but also for institution of prophylactic measures at the right place at the right time to prevent spread and future recurrence.

It is suggested that comprehensive study employing the database of the indexed journals may be helpful in understanding the actual trend of infectious diseases in India.

References

1. Adler RH. Hard and soft data: a semiotic point of view. Schweiz Med Wochenschr 2000; 130: 1249-1251.