Bangladesh Journal of Infectious Diseases

3-5

Authors: Md Shafiul Alam, Md Abdus Salam, Tayseer Farzana, ASM Raushan Newaz, Md Saiful Islam

Background: Spinal tuberculosis is more frequently reported in developing countries. Objective: The purpose of the present study was to see the socio-demographic characteristics of spinal tuberculosis patients. Methodology: This study was carried out in the Department of Neurosurgery, Dhaka Medical College Hospital during the period of January 2002 to December 2004 to elucidate the effectiveness of surgical and conservative treatment of the tuberculosis of the spine. For this purpose, a total number of 50 consecutive cases admitted during the study period with tuberculosis of the spine supported by investigations were included in this study. Result: The mean age of the patients was 25.4 years and ranged from 7 years to 68 years. The highest incidence of tuberculosis of the spine was found in age group between 11 to 20 years and 70% of the patients were under 30 years of age. Incidence of tuberculosis of this spine was more in male (62%) in comparison to female (3 8%) with a male female ratio of 1.63:1. In this study most of the patients came from low class society (66%) followed by middle class (28%) and high class (6%) respectively. Conclusion: Spinal TB more frequently occurs among the young age group with a male predominance.

17-23

Authors: Rezina Parveen, Shaheen Ara Begum, Ishrat Sharmin, Rashida Akhter Khanam, Md Sabbir Quadir, Md Abdullah Yusuf

The relation between ZIKV infection during pregnancy and microcephaly in neonate has been established by the Brazillian Ministry of Health. Therefore, more attention regarding control of Aedes mosquito is required. Since it transmits this disease, which has more disastrous consequences than dengue viral infection. Potentially effective methods of prevention that are focused on reducing infections among pregnant women include avoiding unnecessary travel to areas of ongoing Zika virus transmission, avoiding unprotected sexual contact with partners who are at risk for Zika virus infection. According to Institute of Epidemiology Disease Control and Reseaech (IEDCR) there is nothing to panic at this moment for Bangladesh, but they stressed on mosquito control, which is the only tool to prevent and fight off Zika virus. They however, could not mention how the virus came to Bangladesh. May be somebody brought it while travelling. There is good survillence and testing system to detect the disease in Bangladesh.

28-32

Authors: Shahin Ara Begum, Shabeen Afreen, Aliya Rashid, Nasreen Farhana

Background: Surgical site infection is one of the commonest complications after surgical intervention. Source of wound infections may be exogenous or endogenous. Wound swabs culture is the most frequently used method for confirming the diagnosis of surgical site infection. A regular bacteriological review is necessary to identify the causative agents and their antibiotic susceptibility pattern. Objective: The purpose of the present study was to find out the aerobic bacteria from wound swabs culture and their antibiotic susceptibility pattern. Methodology: A total of 175 wound swabs sample were collected aseptically from surgical site infection during the study period. Standard bacteriological methods were used for isolation and identification of organisms and their susceptibility pattern. Results: A total of 175 wound swab samples were collected from surgery departments. Out of 175 samples 102 (58.28%) were positive by culture. Among the isolated organisms the gram negative bacilli were predominant 67 (65.68%) than the gram positive cocci 35 (34.32%).The most common isolated bacteria were Escherichia.coli 30(29.41%) followed by Staphylococcus aureus 28 (27.45%) Pseudomonous areuginosa 20(29.85%), Acinetobacter spp 08(11.94%), Coaggulase negative Staphylococcus (CONS) 07(6.86%) Klebsiella pneumoniae 05(4.90%), Proteus spp 03(4.45%), and Citobacter spp 01(1.49%). Among the total 175 samples 114(65.14%) were collected from male patients and 61(34.86%) were from female patients. All the isolated gram negative bacilli showed resistant to all antibiotics and all isolated gram positive cocci were resistant to all antibiotics except Linezolid. Among the isolated Staphylococcus aureus 8 (24.85%) were MRSA and one (3.57%) were VRSA. The most effective antibiotics were Amikacin, Meropenem, Imipenem and Tazobactam in this study. Conclusion: Surgical site infections remain the commonest post operative complications after surgery and one of the commonest encountered hospital acquired infections. Therefore, periodic review needs be done to find out the causative agents and their antibiotic susceptibility pattern for better treatment and management

37-41

Authors: SK Shahinur Hossain, Md. Safiul Islam, Md. Mustafizur Rahman, Shubhashish De

Background: Diagnosis of cough variant asthma is very important. Objectives: The purpose of the present study was to measure the diagnostic value of eosinophil counts in sputum for the diagnosis of cough variant asthma patients. Methodology: This descriptive type of cross-sectional study was carried out in the Department of Respiratory Medicine at National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh from September 2014 to August 2015 for a period of one year. Patients presented with cough variant asthma attending in NIDCH were selected as study population. Methacholine challenge test was performed to diagnosis of cough variant asthma. After Methacholine test, patient was encouraged to produced sputum. Sputum was collected in a plastic container and labeled accordingly and was sent to microbiology department of NIDCH for sputum eosinophil counts. Result: A total number of 50 patients were recruited for this study. The mean age±SD was found 19.1±7.6 years. 20 patients had leucocytosis. 96% patients had sputum eosinophil, 90% patients had >3% sputum eosinophil and 10% patients had ≤3% sputum eosinophil count. All patients had trigger factor with negative CFT for Filaria and increased serum IgE. Conclusion: In conclusion increased eosinophil count in sputum is diagnostic tool in cough variant asthma.

3-8

Authors: Rezwana Sultana, Akkur Chandra Das

Background: Human immunodeficiency virus (HIV) is one of the very much concerning issues and nearly 30 million people have died because of HIV related causes, which are found mostly low and lower income countries of the world. Objective: The objective of this study was to evaluate knowledge and practice to reduce risk factors of getting HIV among urban and rural men in Bangladesh with the comparative analysis among them. Methodology: This is a cross sectional study among 3997 men (urban=1437 and rural=2560). Frequency and percentage on knowledge and practice to reduce risk factors of getting HIV were counted to describe and also urban-rural significance levels of knowledge and practice issues regarding HIV were tested. Result: Knowledge and practice regarding HIV among urban-rural men were comparatively different where 93.7% urban and 81.9% rural men heard about HIV; 88.3% urban and 74.8% rural men thought that HIV can get by using unsterilized needle or syringe; 90.3% urban and 75.6% rural men thought that unsafe blood transfusions resulted HIV; 78.3% urban and 62.2% rural men use condom always during sex; and these urban-rural knowledge and practice related differences are statistically significant at P<.000. Conclusion: In Bangladesh, there weren’t massive differences between urban and rural men’s knowledge and practice reducing risk factors of getting HIV; but urban men have comparatively more knowledge and practice levels than those of rural men have because of having urban men’s higher level of socio-demographic and economic status.

13-18

Authors: Rezina Parveen, Md. Abdullah Yusuf, Ishrat Sharmin, Md. Saiful Islam, Ina Rahim

Background: Urinary tract infection is very common in both male and female. Objectives: The purpose of the present study was to see the antibiotic sensitivity pattern of isolated from urinary tract infected patients. Methodology: This cross sectional study was carried out in Dhaka Medical College Hospital, Dhaka for a period of 12 months. Clinically diagnosed cases of urinary tract infection irrespective of age and sex having pus cells ≥5/HPF in the deposits of centrifuged urine were selected as study population. Data regarding organisms causing UTI and their antibiotic sensitivity patterns were collected. For urine culture the urine samples were inoculated on HiCrome UTI agar, CLED agar, 5% sheep blood agar and MacConkey’s agar media with a calibrated loop having diameter of 1.45 mm which contains 0.001 ml of urine. The inoculation at 37o C for 24 hours and CFU count of 105/ml of urine were considered positive for UTI. Identification of bacteria was done by standard biochemical techniques and their distinct colony characteristics. All the isolated organisms were tested for antimicrobial sensitivity against different antimicrobial agents by disc diffusion method on Mueller-Hinton agar plates. Result: Diagnosis of bacteria causing UTI with their sensitivity to different antibiotics was performed with a total of 300 samples from both male (38.66%) and female (61.33%) of different age groups. Among 300 samples 107 strains were isolated. Out of 107 identified strains, 95(31.67%) samples showed single growth and 6(2%) samples showed mixed growth. Escherichia coli (64.49%) was found to be the predominant organism. Regarding antimicrobial sensitivity pattern Esch. coli showed 98.55 to 63.77% sensitivity to imipenem, amikacin, ceftazidime and nitrofurantoin. Other isolated organisms showed 50 to 100% sensitivity to ceftazidime, amikacin, imipenem except Klebsiella, Pseudomonas and enterococci spp. which showed 40% and less sensitivity. Conclusion: In conclusion Escherichia coli is the most commonly isolated bacteria which is highly sensitive to imipenem.

23-26

Authors: Prabhasish Adhikary, Shahjada Selim, Nazim Uddin, Sajalendu Biswas, Ariful Basher, Hassan Mahmoud, Md. Abdullah Yusuf, Hafez Mohammad Nazmul Ahsan, Syed Ghulam Mogni Mowla, Md. Ridwanur Rahman

Melioidosis is not widely recognized in Bangladesh which is evident from the paucity of published reports on melioidosis from this region. Here, we summarize the clinical presentation, laboratory results, prevention and control policies and make important recommendations for patient management. A 35- years-old diabetic male forest officer from Gazipur Sadar located north-west of Dhaka city got admitted to Shaheed Suhrawardy Medical College Hospital, Dhaka with history of recurrent fever for last 1 year. Initially the fever was high grade (upto 105°F), intermittent nature and lasted for a few days to week. About five months back, the patient developed a parietal abscess over the left lumber region and was treated surgically accordingly. The patient then gradually recovered and remained afebrile for about one month. Fever again recurred, high grade, quotidian in nature and has been persistent for the last 3 months. The patient had also developed marked loss of appetite, altered bowel habit with occasional vomiting and lost about 15kg of his body weight. The patient noticed profuse watery diarrhea for last 2 days and got himself admitted. On examination, the patient was found wasted, conscious but slow mentation, dehydrated and moderately anaemic. His pulse was 116/min, blood pressure 80/60 mm Hg, respiration 24/min and oral temperature was 103°F but no palpable lymph nodes. The patient had moderate hepato-splenomegaly with left sided pleural effusion and bilateral depressed ankle jerks. Burkholderia pseudomallei was isolated and identified by blood and urine culture as well as with serological test. We should be more alert among the diabetic patients who are presented with fever with high ESR and neutrophilic leucocytosis, even if radiography or cytopathology is indicative of tuberculosis.

3-7

Authors: Fatema Nusrat, K.M. Shahidul Islam, S.M. Shamsuzzaman, Md. Abdullah Yusuf, Aleya Farzana, Samia Afrin

Background: Antibiotic sensitivity pattern of Neisseria gonorrhoae is changing frequently. Objective: The purpose of the present study was to see the antibiotic sensitivity pattern of Neisseria gonorrhoae isolated from women presented with cervicitis. Methodology: This cross sectional study.carried out in the Department of Microbiology at Dhaka Medical College, Dhaka from July 2011 to December 2012 for a period of one and half year. All the women presented with or without the clinical features of cervicitis at child bearing age (15 to 49 yrs) with or without pregnancy were enrolled as study population. Endocervical swabs were collected for Gram staining, culture, biochemical test from clinically diagnosed patients of cervicitis for presumptive identification of Neisseria gonorrhoeae. The isolates with presumptive identification were confirmed by rapid carbohydrate utilization test (RCUT), which differentiates N.gonorrhoeae from other Neisseria. Antimicrobial susceptibility test was done according CLSI guideline. Result: A total 245 females were recruited of which N. gonorrhoeae were detected from 39(15.9%) cases. Among 39 positive cases of gonococcal cervicitis, 19 (48.71%) were detected in the age group of 21-30 years. 56.41% were sensitive and 30.76% were resistant to ceftriaxone. Similarly 51.28% were sensitive and 23.07% were resistant to cefuroxime; 23.07% sensitive, 30.76% moderately sensitive and 46.15% resistant to ciprofloxacin. Conclusion: Gonococcal cervicitis is found in a high frequency rate with a reduced sensitivity to antibiotics especially ciprofloxacin, second and third generation cephalosporins.

12-17

Authors: Mostaqimur Rahman, M. Mujibur Rahman, Waseka Akhter Jahan

Extended Spectrum β-lactamases (ESBLs) can confer resistance to all extended spectrum cephalosporins, all penicillins and monobactam. Being plasmid and transposon mediated has facilitated the spread of these enzymes to other species of bacteria. This is a challenge for the laboratory to detect ESBL-containing Gramnegative bacilli because they can appear susceptible in vitro to certain beta-lactam antimicrobial agents yet result in clinical treatment failure. Till now there is no gold standard test for detection of ESBLs. CLSI recommended the phenotypic method as confirmatory test. However, the traditional methods need much labor and time for cultivation and require at least overnight incubation after isolated colonies are available from primary culture. Therefore, about 48 hours is required for ESBLs reporting by traditional methods. Molecular characterization of the isolated ESBL was also not possible in maximum laboratories due to lack of facilities. But rapid detection of ESBLs from the patient with severe infection is urgently required; otherwise it may be fatal. In this present review this diagnostic dilemma of ESBL has been discussed.