BACKGROUND:Gastrointestinal (GI) infections, common in tropical countries, are likely to precipitate acute exacerbations in patients with ulcerative colitis (UC). However, data are scant. Accordingly, we evaluated GI infections in patients with UC and determined their predictors. METHODS:Consecutive patients with acute severe ulcerative colitis (ASUC) and those in remission were evaluated for GI infections by stool microscopy, modified acid-fast stain, culture, and Clostridioides difficile toxin A/B/GDH, and cytomegalovirus (CMV) was studied using rectal biopsy by real-time polymerase chain reaction (RT-PCR), histology, and serum immunoglobulin M anti-CMV antibody. Demographic, clinical, and laboratory parameters, along with the frequency and predictors of GI infections, were assessed and compared between the two groups. RESULTS:Among 158 patients with UC (mean age 35.2 ± 13.0 years; male-to-female ratio 1.3:1; 108 with ASUC and 50 in remission), 79 (50%) had CMV infection (53 detected by RT-PCR alone, one by inclusion bodies, and 25 by both methods). Overall, 92/158 (58.2%) patients had GI infections, of whom 20/158 (12.6%) had multiple infections. CMV infection (70/108 (64.8%) vs. 9/50 (18%); p < 0.001) and overall GI infections (76/108 (70.3%) vs. 16/50 (32%); p < 0.001) were more common in patients with ASUC than in those in remission. C. difficile infection was observed in 3.7% of patients with ASUC. CMV coinfection was significantly associated with greater than two courses of systemic corticosteroids, extensive colitis, severe endoscopic inflammation, and deep ulcerations. Patients with concomitant parasitic infections were more likely to have prior azathioprine exposure. CONCLUSIONS:GI infections were more common in patients with ASUC than in those in remission, with CMV being the predominant pathogen; C. difficile and parasitic infections were identified in a smaller but clinically relevant proportion of patients. CMV infection was independently associated with prior systemic corticosteroid exposure, severe disease activity, extensive colitis, and deep ulcerations. These findings support routine screening for GI infections, particularly CMV, while considering C. difficile and parasitic infections in the diagnostic evaluation of patients with ASUC.

Background Acinetobacter baumannii has emerged as a predominant cause of hospital-acquired infections worldwide, posing a significant challenge due to its extraordinary ability to acquire resistance to multiple antibiotics. According to recent data, infections caused by multidrug-resistant A. baumannii lead to increased morbidity, longer hospital stays, and higher healthcare costs. Carbapenems and tigecycline have historically provided reliable treatment for A. baumannii infections; however, recent global trends indicate a significant increase in carbapenem and tigecycline resistance among circulating isolates. Objectives The study aimed to determine the prevalence and genetic characterization of tigecycline resistance in A. baumannii (TRAB) among carbapenem-resistant isolates and to assess the transferability of carbapenem and tetracycline resistance genes between isolates. Methods All 160 clinical isolates were obtained from admitted patients in SGPGIMS, Lucknow (India). Identification of the isolates was performed using MALDI-TOF MS, followed by antimicrobial susceptibility testing (AST), determination of minimum inhibitory concentrations (MICs), and PCR-based detection of carbapenem and tetracycline resistance genes. The transferability of resistance genes was further assessed through conjugation assays, and the AST of transconjugant isolates was evaluated accordingly. Results A total of 32 out of 160 isolates (20%) were resistant to both carbapenem and tigecycline. All these isolates were multidrug-resistant (MDR), exhibiting resistance to more than three classes of antibiotics. Genetic screening showed the blaNDM and blaOXA-48 carbapenemase genes in 25% and 18.75% of the respective isolates; blaKPC was not detected. Among tetracycline resistance genes, only tet(B) was present in 15.63% (5/32) of the isolates; other genes such as tet(A), tet(K), tet(M), and tet(S) were absent. Both carbapenemase and tetracycline resistance genes were plasmid-mediated, and often co-existed in the same isolates. However, only the carbapenemase genes were transferable by conjugation; the tetracycline resistance genes were not transferable. Conclusions The increasing prevalence of carbapenem and tigecycline-resistant A. baumannii is primarily linked to plasmid-mediated carbapenemase genes, which facilitate their spread. In contrast, tigecycline resistance, although present, appears to be non-transferable under the conditions studied.

Background Whether cytomegalovirus (CMV) infection is a cause or consequence of relapse or therapeutic refractoriness in patients with ulcerative colitis (UC) remains debatable. This study aimed to evaluate the frequency of CMV infection and the association between mucosal CMV DNA load and medical management failure in patients with acute severe ulcerative colitis (ASUC). Methods Consecutive patients with ASUC admitted between May 2023 and November 2024 were included. All patients received intravenous (IV) hydrocortisone and ganciclovir when quantitative CMV DNA real-time polymerase chain reaction (RT-PCR) levels were >250 copies/mg and/or histopathology demonstrated CMV infection. The primary outcome was to determine the frequency of CMV infection and to evaluate the association between quantitative CMV PCR levels from biopsy samples obtained during sigmoidoscopy and the risk of medical management failure (IV steroids ± ganciclovir). The secondary outcome was medical management failure, defined as the need for rescue therapy. Results CMV infection was detected in 70 (64.8%) patients with ASUC (44 by RT-PCR alone, one by inclusion bodies alone, and 25 by both methods). Patients with medical management failure had a significantly higher CMV DNA load than responders (44,990,045.76 copies/mg (0-754,359,454.0) vs. 249,720.95 copies/mg (0-9,729,500.00); p < 0.05) and a higher proportion of CMV DNA titres >250 and >1000 copies/mg (p < 0.05). Eight patients developed toxic megacolon, among whom seven (87.5%) had CMV infection. Overall, 17 (15.7%) of the 108 patients with ASUC experienced medical management failure. Conclusion Higher mucosal CMV DNA load was associated with medical management failure in patients with ASUC. Patients with higher CMV DNA loads also had higher frequencies of rescue therapy, toxic megacolon, and mortality.

Background Therapeutic options for critical infections by carbapenem-resistant Enterobacterales (CRE) are largely limited to polymyxins in India. They have significant toxicity, unpredictable kinetics and prohibitive cost. The objective of the current study was to find the mechanisms of resistance in CRE and to evaluate the in vitro efficacy of potential treatment options.Methods In a prospective study performed during October 2023-March 2024, all Enterobacterales clinical isolates of our laboratory were screened for carbapenem resistance. All CRE isolates were phenotypically and genotypically tested for mechanisms of resistance and underwent extended antimicrobial susceptibility testing.Results During the study period, 12.90% (100/775) of Enterobacterales were CRE, among which 99% (99/100) were multidrug resistant. Phenotypic metallo-beta-lactamase screening was positive in 87/100 (87%) of isolates. Aztreonam-avibactam was found to effectively inhibit 96% of isolates, while cefiderocol effectively inhibited 87%. Two isolates resistant to aztreonam-avibactam were susceptible to cefiderocol, both of which harboured blaNDM. The blaNDM gene was detected in 87% of the isolates, one of which also co-harboured blaKPC.Conclusions Our study showed an exceptionally high prevalence of the blaNDM gene among CRE clinical isolates. Either aztreonam-avibactam or cefiderocol was found to be effective against 98% of CRE isolates highlighting the immediate need of making these two drugs accessible to patients in India.

Background/Aims:Patients with ulcerative colitis in remission (UC-R) may experience symptoms consistent with irritable bowel syndrome (IBS). This prospective study aims to examine the relative influence of peripheral factors, such as gut mucosal inflammation, and central factors, like psychological conditions, on the severity of IBS symptoms to evaluates (1) the IBS Symptom Severity Score (IBS-SSS), (2) levels of inflammatory markers, and (3) the presence of psychological comorbidities across 3 groups: UC patients with IBS symptoms (UC-IBS), UC-R patients without IBS, and individuals with usual IBS. Methods:Rome III and IV IBS criteria were used in UC-R patients (Mayo score 0), with symptom severity measured by IBS-SSS. Serum and fecal inflammation markers were compared across UC-R without IBS, UC-IBS, and IBS groups. Results:Among UC-R patients, 31.3% (26/83) met Rome III and 9.6% (8/83) met Rome IV IBS criteria. IBS-SSS scores were significantly lower in UC-IBS compared to IBS (n = 50; 167.5 [150-200] vs 255 [225-325]; P < 0.001). Fecal calprotectin levels were higher in UC-IBS than in UC-R or IBS (62.6 μg/g [34.1-85.6] vs 50.6 μg/g [27.3-96.6] vs 37.6 μg/g [12.1-62.3], P = 0.057), while other fecal markers (lactoferrin and MMP-9) showed no significant differences between UC-IBS and UC-R. Serum inflammatory marker including tumor necrosis factor-alpha, interleukin-6, interleukin-10, and granulocyte-macrophage colony-stimulating factor, C-reactive protein were similar across groups. Patients with IBS reported significantly higher anxiety, pain, functional impairment, and coping difficulties (all P < 0.001) compared to UC-IBS, with the lowest levels observed in UC-R without IBS. Conclusions:One-third and one-tenth of UC-R patients met Rome III and IV IBS criteria, respectively. UC-IBS had lower IBS-SSS and higher fecal calprotectin than IBS. Psychological comorbidities were worse in IBS, least in UC-R without IBS, suggesting more peripheral inflammation and less central involvement in UC-IBS.

Objective: To determine the prevalence of intestinal parasitic infections and to identify temporal trends over a two-year period among patients attending a tertiary care hospital.Methods: A retrospective study was conducted in the Microbiology Department, AIIMS Kalyani, West Bengal. Stool samples sent for diagnostic screening from August 2022 to May 2024 were included in the analysis. Complete patient details and blood parameters were retrieved from hospital records.Results: Out of the 532 subjects, 64.7% were males and 35.3% were females, with 39.8% of the children aged between 0-18 years. The prevalence of intestinal parasitosis was 6.8%. The highest prevalence of parasitosis was observed in the age group over 60 years, followed by 46-60 age year group, at 14.1% and 9.5% respectively. The lowest prevalence was found in the age group of 31-45 years at 2.2%. Entamoeba histolytica/dispar showed the highest prevalence at 61.1%, followed by Giardia spp. at 16.7%. Multi-parasitism was observed in only 2.8 % of the subjects.Conclusions: There was an annual increase in the trend of intestinal parasitic infections over the 2 year period from 2022 to 2024. Therefore, important interventions are warranted, such as enhancing sanitary conditions, implementing periodic deworming programs, and educating the public about the risks of faecal contamination of water, the importance of drinking boiled water, and promoting environmental hygienic practices.

Increasing prevalence of multidrug-resistant infections has rendered the healthcare systems ineffective in managing infectious diseases. Drugs of "last resort" like carbapenems and polymyxins are becoming less effective in the management of antibiotic-resistant Gram-negative bacterial infections, leaving the clinicians with limited choices. Evaluation of the efficacy of other available broad-spectrum antibiotics (belonging to a different class) is warranted as a treatment alternative. The current study was undertaken to evaluate the in vitro antibacterial activity of minocycline and a new drug, omadacycline among carbapenem-resistant Gram-negative bacteria (GNB), isolated from clinical samples (pus and sputum) and to genotypically analyze them. A prospective cross-sectional study was conducted in a 3,200-bedded tertiary care medical center, located in Lucknow in the northern part of India. All the clinical isolates recovered from pus and sputum samples of patients admitted in intensive care units were processed according to the standard protocols. Identification and antibiotic susceptibility testing were performed, and carbapenem-resistant Gram-negative bacteria (CRGNB) showing resistance to minocycline were included in the study. Molecular screening of β-lactamase and tetracycline resistance genes was done by the conventional polymerase chain reaction method. Minimum inhibitory concentration analysis was performed using the broth microdilution technique. Among 700 CRGNB, 15.29% (n = 107/700) were minocycline resistant by disk diffusion method. Genetic analysis demonstrated the presence of tetracycline-resistant genes in about one-third isolates, among which the tet(B) gene was present in 41.12% (n = 44/107). Upon broth microdilution analysis, the overall minimum inhibitory concentration for minocycline was raised, wherein 4.76% (n = 5/107) of our clinical Gram-negative isolates were inhibited at ≤8 mg/L and 15.23% (n = 28/107) were inhibited at ≤16 mg/L. Omadacycline was able to inhibit 13.08% (n = 14/107) of the minocycline-resistant isolates at ≤4 mg/L (susceptible breakpoint for Enterobacterales). Based on the cut-off value proposed, 15.09% (n = 16/107) isolates resistant to minocycline were inhibited by omadacycline. High prevalence of multidrug-resistant bugs entails judicious use of minocycline and omadacycline. The presence of tet genes coexisting with blaNDM and blaOXA in our bacterial isolates shows that the resistance pattern in Gram-negative bacilli is regularly evolving, and a fully functional surveillance program across the health care system is needed to prevent the emergence and spread of antimicrobial resistance.

BACKGROUND:As dysregulated gut microbiota is known in irritable bowel syndrome (IBS) and probiotics may improve it, we investigated the efficacy and safety of a combination probiotic, Lactobacillus acidophilus LA-5 and Bifidobacterium animalis ssp. lactis BB-12 in non-constipated IBS. METHODS:Two hundred non-constipated IBS patients were randomized to the above-mentioned probiotic and placebo for 84 days. The outcome measures included IBS-Global Improvement Scale (IBS-GIS), IBS-Quality of Life (IBS-QoL), EAR3Q, IBS-Severity Scoring System (IBS-SSS), and patient-reported improvement. Fecal microbiota was evaluated in a subset. RESULTS:Response in IBS-GIS was higher with probiotics than with placebo at days 28 (19.3% vs. 8.9%; p = 0.048), 56, and 84. Total and abdominal pain, distension, and QoL scores of IBS-SSS decreased at day 28 with probiotics that persisted till days 56 and 84. The percentage of patients with "severe" symptoms reduced from 20.8% at baseline to 3.9% at day 84, and the median IBS-QoL score decreased significantly at day 28; the beneficial effect on QoL was sustained till days 56 and 84 (p < 0.001). Improvement in abdominal pain, distension, urgency of defecation, bowel habit satisfaction, and stool frequency was noted earlier with probiotics than with placebo; 4.0% in the probiotic group and 0.9% in the placebo group had mild/moderate adverse events (p = 0.167). Symptom recurrence occurred in 3.0% in the probiotic group and 3.9% in the placebo group during follow-up of 180 days (p = 0.718). No difference was observed in the fecal microbiota between the two groups, but healthy genera were enriched with probiotics. CONCLUSIONS:The probiotic blend studied was more effective than placebo in non-constipated IBS in adults.

Aim:Less than half of all patients with Crohn's disease remain in remission with long-term use of azathioprine. Our aim was to assess the efficacy of Artesunate and Curcumin in maintaining remission in patients with Crohn's disease, who had ongoing evidence of disease activity despite taking azathioprine. Methods:Patients with Crohn's disease being treated with azathioprine for at least 3 months but still had mild to moderate Crohn's disease (CDAI 150-450) were included. Patients were randomized into four blocks of 10 patients each in a 2 × 2 factorial design to receive artesunate 200 mg PO daily for 2 weeks and/or curcumin 200 mg PO daily for 3 months or placebo. Harvey-Bradshaw Index, CDAI, and fecal calprotectin were measured at baseline, 1 week, 1 month, 3 months, and 6 months. Results:Forty patients were recruited and randomized into the study. Both Artesunate and Curcumin were well tolerated with no adverse effects. The Harvey-Bradshaw Index statistically differed across the treatment groups at 6 months (p = 0.047), there were no significant group differences in the post hoc pairwise analysis. The differences in CDAI from baseline to 6 months were statistically significant in Artesunate + Curcumin (p = 0.0098) and Curcumin + Placebo (p = 0.0431) groups. Similarly, statistically significant differences were observed between Baseline and 6 months for the Harvey-Bradshaw Index in the Artesunate + Curcumin (p = 0.0070) and Curcumin + Placebo (p = 0.0138) groups. Conclusion:A combination of artesunate and curcumin in patients with ongoing inflammatory activity appears to be effective as measured by CDAI and Harvey-Bradshaw Index.

: The rise of cases of the infectious COVID -19 pandemic has led to significant burden on healthcare settings. : The current study tried to evaluate the knowledge, perceptions and experiences of Health care workers (HCW) towards a well-executed PPE and Hand Hygiene (HH) training before and after attending the sessions : Study was planned for a period of twelve months for various HCWs of different departments of the Institute. Every participant was evaluated for pre-test as well as post-test knowledge (cognitive domain) assessment using a pre-structured format along with demonstration (psychomotor domain). : A total of 535 HCWs were included for the study. Statistically significant (P < 0.001) increase in post test score was noted in different domains of learning of Faculty, residents and Nurses group. The mean pre-test and post test score was significantly higher for Critical care units (CCU) as compared to other units. The difference in overall scores for various parameters in pre and post training was as follows: 5.2 for MCQs,2.5 for PPE OSPE,5.1 for HH OSPE and13.1 for total scores. : HH and PPE training sessions will impart knowledge and confidence to HCWs working in hospitals for better patient care as well as infection control practices.

Introduction Leptospirosis is a zoonotic infection caused by Leptospira bacteria, which is reemerging in various regions and often poses a diagnostic challenge due to its nonspecific symptoms. While most infections are mild, severe cases occur in 5-10% of patients and are associated with high mortality, especially in areas with poor sanitation and urbanization. This study aims to investigate the association of specific parameters with leptospirosis diagnosis using a machine learning model and geographic mapping tools to identify spatial patterns and high-risk areas for the disease. Methods An observational retrospective study conducted at a tertiary care center analyzed patients clinically suspected of leptospirosis over the course of one year. The study utilized laboratory investigations, geographic mapping, and machine learning models to explore the association between various laboratory parameters and the predictive diagnosis of leptospirosis. Results The study, conducted over one year at All India Institute of Medical Sciences, Kalyani, India, included 325 patients, of whom 43 (13.2%) tested positive for leptospirosis by IgM ELISA. Geographic mapping revealed case clusters around nearby districts of West Bengal, with a few cases from Tripura and Bangladesh. The study found no significant association between individual laboratory parameters and leptospirosis diagnosis. However, machine learning models, particularly k-nearest neighbors (KNN), demonstrated moderate predictive accuracy (accuracy: 74%, area under the curve: 0.6). Conclusion Geographic mapping identified clusters of leptospirosis cases; however, no significant association was found between individual laboratory parameters and the disease diagnosis. Machine learning models, particularly KNN, demonstrated moderate predictive accuracy. The study also highlighted the overlapping clinical features of leptospirosis, dengue, and scrub typhus in West Bengal, although it noted the absence of detailed clinical data as a limitation.

Objectives: The prevalence of Clostridioides difficile infection (CDI) is on rise among patients with inflammatory bowel disease (IBD). This study sought to describe the prevalence and risk factors of CDI in patients with IBD as compared to non-IBD controls. Materials and Methods: This was a prospective study conducted at a Department of Microbiology in collaboration with a Department of Gastroenterology. The patients with IBD and controls without IBD presenting with diarrhea were included in the study. The screening test for C. difficile infection was done by glutamate dehydrogenase (GDH) assay and toxin detection by enzyme-linked immunoassay (ELISA). Anaerobic culture for C. difficile was done on a selective cycloserine cefoxitin fructose agar and polymerase chain reaction (PCR) was done for Toxin A (TcdA) and Toxin B (TcdB) gene detection. C. difficile infection was confirmed if GDH and toxin ELISA or PCR were positive. Statistical Analysis: Data were analyzed with the Statistical Package for the Social Sciences version 20.0.The numerical variables were presented by means and standard deviations. Comparison of continuous variables was done using Student’s t-test. Categorical variables were analyzed by Chi square test. P<0.05 was considered to be statistically significant. Results: A total of 160 cases and 112 age- and gender-matched control were included in IBD group and nonIBD group, respectively. Only one culture was positive, 12 and six were positive for GDH ELISA and TcdA and TcdB ELISA, respectively, and 7 were positive by PCR for toxin genes. The factors found significantly associated with CDI were proton-pump inhibitors use (P = 0.001), levofloxacin (P =0.001), and azathioprine (P =0.042). Using PCR as a reference method for C. difficile toxin detection, the sensitivity, and specificity of GDH ELISA and ELISA for toxins were 100%, 96.8% and 85.7%, and 100%, respectively. Conclusions: The prevalence of CDI among patients with IBD has been found to be low, that is (only 4.4%) in this study population.

A BSTRACT Introduction: Intestinal parasitic infections pose a substantial threat to public health and are a huge burden to the economic development of a developing country. We aimed to identify the spectrum of intestinal parasitic infections with an emphasis on demographic and clinical characteristics observed among immunocompromised and immunocompetent patients. Materials and Methods: This observational study was performed in the Parasitology section of the Department of Microbiology from January 2022 to July 2022. A total of 2628 stool samples were obtained from patients presenting with chief complaints of abdominal pain, distension, vomiting, and foul-smelling feces. All the clinical and diagnostic data of the patients enrolled in the above-mentioned period were extracted from the ward files, hospital electronic records, and laboratory registers. Result: A total of 2628 stool samples were sent to the Parasitology section of the Department of Microbiology. Out of the above-mentioned samples, 70 (70/2628, 2.66%) samples yielded gastrointestinal parasites on microscopic examination. The mean age of the patients included in our cohort study was 32.53 ± 16.21 years with a male predominance of 72.86% (51/70, 72.86%). The most common gastrointestinal parasite identified from stool samples was Giardia lamblia (61/70, 87.14%). All cases of opportunistic gastrointestinal infection caused by Cryptosporidium spp . (4/70, 5.71%) in our study cohort were found to infest the immunocompromised patients. Conclusion: This study determines the spectrum of intestinal parasitic infections among the immunocompromised and immunocompetent individuals and guides physicians in starting appropriate anti-parasitic treatment along with the instillation of strict hand hygiene techniques.

Background: While mapping Escherichia coli susceptibility in community acquired simple UTIs across 38 centres, DASH to Protect Antibiotics, (https://dashuti.com/), a multiregional study also assessed impact of socio-economic conditions and climate on antimicrobial susceptibility. Methods: The centres were located in the Indian subcontinent, Middle East, North and West Africa, Eurasia, Europe, and North America. Harmonic means were used for comparative analysis of the antimicrobial susceptibility of E. coli in simple cystitis. Kruskal-Wallis test was utilized to compare susceptibility means between the antimicrobials and the GDP. A two-way ANOVA to simultaneously analyzed the impact of the antimicrobials and GDP on the proportion of susceptible E. coli while adjusting for variables (low and high temperature, humidity and population density per sqkm). Findings: Antimicrobial susceptibility varied between regions and within large countries like India and Pakistan. Nitrofurantoin (89%) and fosfomycin (96%) emerged as the most effective antimicrobials. In majority of the centres, susceptibility to other oral antimicrobials was low: cotrimoxazole.

Persistent gastrointestinal (GI) symptoms and functional gastrointestinal disorders (FGIDs) are increasingly being recognized after Coronavirus disease-19 (COVID-19). Though quite a few studies addressed irritable bowel syndrome (IBS) following COVID-19, the disorders' prevalence varies greatly. We evaluated, (i) overall frequency of post-COVID-19 IBS, (ii) relative risk of development of IBS among COVID-19 patients compared to healthy controls using systematic review and meta-analysis techniques. Literature search was performed for studies on GI symptoms and FGIDs after COVID-19 using electronic databases (Medline, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar and Web of Science) till April 28, 2023. We included studies reporting IBS after COVID-19 with any duration of follow-up and any number of subjects. Studies on pediatric population and those not providing relevant information were excluded. Relative risk of development of IBS using Rome criteria among COVID-19 patients compared to healthy controls was calculated. Analysis was done using MedCalc (Applied Math, Mariakerke, Belgium, version 7.2) and Comprehensive Meta-Analysis version 3.3.070 (Biostat Inc. Englewood, NJ 07631, USA). Of the available studies, 13 (four case-control) reporting on IBS after COVID-19 met inclusion criteria. Among 3950 COVID-19 patients and 991 controls, 7.2

PURPOSE:Genetically diverse parasites enhances resistance against antimalarials, vaccines and host immune responses. The present study was designed to evaluate the role played by Plasmodium falciparum genetic diversity in predicting the real world malarial population.METHODS:Initially, the incidence pattern of all four northern Indian malarial species was examined using 18S rRNA gene and performed principal component analysis (PCA) based on frequencies of Plasmodium species. Consequently, genetic variance of Plasmodium falciparum histidine-rich protein-2 (Pfhrp2) gene among different malarial populations were compared using phylogenetic analysis. Multi-dimensional scaling was performed to assess genetic similarities and distances among studied populations.RESULTS:Of total 2168 patients screened, 561 patients with fever of unknown origin were included. 18S rRNA and Pfhrp2 genes were amplified in 78 and 45 samples, respectively. Among them 13.9%(78/561) patients had Plasmodium infection. Infections by P. falciparum, P. vivax and mixed infections were diagnosed among 47(60.2%) and 28(35.9%) and 3(3.8%) patients, respectively. We found eight types of Pfhrp2 amino acid sequence repeats among northern Indian population. The PCA findings were in line with genetic diversity and phylogenetic data. Temporal analysis showed the proportion of total diversity present in total subpopulation (ΔS/ΔT) was maximum for P. falciparum.CONCLUSIONS:Higher incidence of Pfhrp2 sequence variation through genetic recombination among multiple strains during sexual reproduction is potentially correlated with high transmission activity. This sequence variation might alter RDT detection sensitivities for different parasites by modulating the structure and frequency of antigenic epitopes.