Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1983"

Protection against Cholera in Breast-Fed Children by Antibodies in Breast Milk

Abstract: We performed a prospective study to examine whether the IgA antibodies against cholera that are present in breast milk protect breast-fed infants and children against colonization with Vibrio cholerae 01 and disease. Among families of patients with cholera, we collected breast milk from mothers who had not had diarrhea in the previous week and monitored them and their breast-fed children for cholera colonization and diarrhea for 10 days. Breast milk was assayed for IgA antibodies to cholera toxin and lipopolysaccharide. Ninety-three mother–child pairs were studied; 30 infants became colonized with V. cholerae 01 and disease developed in 19. There were no differences between the antibody levels in milk fed to children who became colonized and in milk fed to children who did not. However, among the children who became colonized, those who had diarrhea drank breast milk containing significantly lower levels of both kinds of cholera antibodies than were present in the milk consumed by children who ha...

Epidemiologic and Clinical Features of Endemic Campylobacter jejuni Infection in Bangladesh

Abstract: Epidemiologic and clinical features of infection with Campylobacter jejuni in Bangladesh were examined in (1) diarrheal patients infected with C jejuni, (2) healthy control subjects, and (3) village children who were cultured monthly and at each diarrheal episode during a 10-month period. C jejuni was isolated from 437 (14%) of 3,038 outpatients with diarrhea. These patients had no distinct clinical presentation and were more likely to have a mixed infection than were patients infected with other pathogens (59% vs 42%, P less than 0.01). Age-specific infection rates were greatest in infants and did not differ significantly from those in control subjects. C jejuni was isolated less frequently from village children with diarrhea than from those cultured routinely (5% vs 9%, P less than 0.05). Forty percent of 47 patients with C jejuni vs 23% of 48 control subjects (P less than 0.01) had an elevated convalescent-phase antibody titer as determined by complement fixation test. In Bangladesh, enteric infection with C jejuni is common but often asymptomatic, although pathogenicity is suggested by serologic response in some patients.

Serologic Differentiation Between Antitoxin Responses to Infection with Vibrio cholerae and Enterotoxin-Producing Escherichia coli

Abstract: A ganglioside enzyme-linked immunosorbent assay (ELISA) was used to study and attempt to differentiate between antitoxin responses in persons infected with either Vibrio cholerae or Escherichia coli producing heat-labile enterotoxin. In most cases (69%-94%), experimentally infected North Americans and naturally infected Bangladeshis responded to either infection with significant (greater than twofold) increases in serum antibody titer to both heat-labile enterotoxin and cholera toxin. In all but one instance, the response was higher to the homologous than to the heterologous toxin, and for the Americans the homologous antitoxin titers remained significantly higher for at least one year. Determination of levels of antibodies to purified subunits A and B of cholera toxin by an ELISA showed that V. cholerae infection in most instances induced a significant response to subunit B but rarely to subunit A. E. coli infection, on the other hand, induced only slight increases in antibody titer to either subunit.

Plasmid-Borne Multiple Drug Resistance in Vibrio cholerae Serogroup O1, Biotype El Tor: Evidence for a Point-Source Outbreak in Bangladesh

Abstract: In 1979, an outbreak of plasmid-borne, multiply drug-resistant Vibrio cholerae serogroup O1 biotype El Tor (V. cholerae O1) occurred in the Matlab area of Bangladesh. The outbreak could have resulted from the introduction into the area of a single resistant strain or from multiple conjugations of drug-sensitive V. cholerae O1 with C plasmids in other environmental flora. Resistant strains were phage typed to determine their relatedness, and plasmid studies were conducted to determine the frequency of C plasmids in nonvibrio flora of family contacts of cholera patients. Forty-one (85%) of 48 resistant strains of V. cholerae O1 examined belonged to two closely related phage types new to the area, whereas 59 drug-sensitive strains from the same period were primarily of two different phage types. Group C plasmids were in nonvibrio strains from five of 36 family contacts of patients with drug-resistant cholera but none of 82 family contacts of patients with sensitive cholera. This outbreak most likely began from the introduction into the area of a single, multiply drug-resistant strain of V. cholerae O1. C plasmids detected in the nonvibrio flora of family contacts probably came from the resistant strain of V. cholerae O1.

Value of stool examination in patients with diarrhoea.

Abstract: Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.

Whole-Gut Transit Time and Its Relationship to Absorption of Macronutrients during Diarrhoea and after Recovery

Abstract: Whole gut transit time (TT) was measured in 68 children aged up to 5 years (29 cholera, 17 rotavirus, 13 enterotoxigenic Escherichia coli, and 9 Shigella) during acute stages of diarrhoea and 2 weeks after recovery. Absorption of calories, fat, protein, and carbohydrates contained in a normal Bangladeshi diet was studied for 72 h after the first appearance of a charcoal marker in the stool, both during acute diarrhoea and 2 weeks after recovery. Mean TT varied from 5.5 to 7.3 h during the acute stage and from 14.1 to 15.5 h during the recovery period of diarrhoea of all aetiologies; the increase in the TT was significant as expected (P < 0.001). Correlation coefficients were calculated between TT and the coefficients for absorption of fat, nitrogen, calories, and carbohydrates in the acute and recovery stages of cholera, rotavirus, E. coli, and Shigella. No significant relation was found between TT and absorption of nutrients in any stage of diarrhoea of any aetiology. The results of this study suggest th...

Seasonality of classical and El tor cholera in Dhaka, Bangladesh: 17-year trends

Abstract: Data on the cholera patients admitted monthly to the ICDDR,B, hospital in Dhaka (Bangladesh) from 1964 through 1980 have been studied and analysed. Although Vibrio cholerae variant El Tor did not enter Bangladesh until 1963, it has completely displaced classical cholera since 1973. There have also been changes in seasonality, which are discussed.

Amoebiasis and giardiasis in Bangladesh: parasitological and serological studies

Abstract: To determine the prevalence of infections with Entamoeba histolytica and Giardia lamblia in Bangladesh, we screened stool specimens from patients with diarrhoea attending an urban (N = 2,246) and a rural (N = 2,791) hospital and a group of healthy urban residents (N = 440). Sera from 200 healthy villagers were also examined for antibody to E. histolytica using the immunofluorescent antibody test. The prevalence of E. histolytica cysts or trophozoites in all groups assessed by examination of a single stool specimen ranged from 0% among infants (

Clinical Illnesses and Causes of Death in a Burmese Refugee Camp in Bangladesh

Abstract: In 1978 almost 200 000 Burmese refugees entered Bangladesh. Thirteen camps were set up for refugees. Data for the camp at Leda is presented here. There were four medical clinics; including a diarrhoea clinic operated by the International Centre for Diarrhoeal Disease Research, Bangladesh. The four clinics recorded a total of 174 201 visits by the refugees, of which 28% were for watery diarrhoea, 32% for dysentery and 40% for other illnesses. Of 2321 diarrhoea stools cultured, 29.2% yielded pathogens of which 22% were Shigellae alone. Coliform count of water was extremely high. The death rate (89/1000/year) was higher than the birth rate (28/1000/year). Most of the deaths were among infants (640), children (357) and old people (131). Main causes of death were clinical diarrhoea (11.8%), fever (23%) and poor nutrition (52%). Prompt arrangements for food, identifying the vulnerable groups, and proper sanitation perhaps could have reduced the number of deaths considerably.

Changes in serotypes of enterotoxigenic Escherichia coli in Dhaka over time: usefulness of polyvalent antisera.

Abstract: The finding that enterotoxigenic (ET) Escherichia coli strains from many geographic areas belong to a limited number of serogroups led investigators to hope that polyvalent antisera could be used to screen for ET E. coli in areas of the world where more complicated tests of toxigenicity are not available. We compared the serotypes of 207 ET E. coli strains obtained from patients attending the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, in 1980 with results obtained from similar surveys conducted in 1976 and 1978. During that time the distribution of serogroups changed significantly so that only 46% of our strains had O serogroups included in the polyvalent antisera capable of detecting 66% of ET E. coli strains in 1978. O167, a serogroup which was not included previously, was the third most common serogroup in our study. These findings suggest that polyvalent antisera used to screen for ET E. coli need to be reassessed over time as well as in different geographic areas and may not be as useful for field diagnosis as was originally hoped.

Effects of Food Policy on Intrahousehold Food Distribution in Bangladesh

Abstract: Bangladesh, a country of more than 90 million people living in an area of about 55,000 square miles, is a food deficit country. Therefore, achieving self-sufficiency in food has always been a national concern. The need for having a food policy has been recognized for a long time, but it was not until the Second Five Year Plan that a food policy known as the Food Security Plan was developed by the Ministry of Food in August 1980. The main goal of this food security plan is to ensure people the minimum desirable level of consumption. The present paper will discuss the major characteristics of Bangladesh’s food policy and show its effects on household food availability and the food distribution pattern. The approach of both economists and anthropologists and their different perspectives in studying food-related behaviour will be discussed in reference to food policy formulation, and the need for having a broader perspective in food policy formulation will be emphasized.

Enteric fever in patients admitted to a diarrhoeal disease hospital in Bangladesh.

Abstract: The hospital records of 62 patients with blood culture-proven enteric fever admitted to the Dacca Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, over a one-year period were reviewed. Older children and young adults had the highest age-specific rates of disease. The clinical, epidemiological and laboratory features of patients with enteric fever were compared with similar information from patients in hospital for cholera and shigellosis. Patients with enteric fever had a significantly longer prodrome of illness and were more likely to have fever than patients in the other groups. Our hospital cares primarily for patients with diarrhoeal diseases and while 94% of enteric fever patients had diarrhoea, only 5% had the recognized diarrhoeal pathogens Shigella or Vibrio cholerae identified, compared to 25% of the total hospital in-patient group, suggesting that Salmonella typhi itself may be a cause of diarrhoea. Antibiotic resistance patterns of S. typhi isolates were reviewed, and one isolate was found to be multiply antibiotic resistant. The advent of an effective oral typhoid vaccine makes further work on the epidemiology of enteric fever in endemic areas such as Bangladesh a high priority.

Diarrhea and Nutrient Requirements

Abstract: The high prevalence rates, particularly among young children in most developing countries, make the influence of diarrhea on nutritional requirements of major concern. The multiple mechanisms whereby diarrhea of infectious origin can affect dietary requirements for calories and protein are listed in Table I. Estimation of the consequences for nutritional requirements is complicated by large quantitative and qualitative variations in the disease burden among different population and age groups. The effects depend on the type of diarrhea as well as on its frequency, severity, and duration. Moreover, available quantitative data are extremely limited. Those available under each of the categories indicated are examined separately in the text that follows.

Outbreak of enterovirus 70 conjunctivitis in Bangladesh—1981

Abstract: Between April and July 1981, an outbreak of acute haemorrhagic conjunctiyitis (AHC) occurred in Dacca, Bangladesh. The disease, characterized by redness of the eyes, discharge, foreign body sensation and subconjunctival haemorrhage, spread rapidly, affecting 63% of the 135 family members of 28 index patients studied. Enterovirus 70 (EV) 70) was isolated from one of 19 conjunctival swabs tested. This is one of the few reports documenting the isolation of EV 70 during the recent pandemic of AHC.

Rotavirus diarrhoea: An expanding clinical spectrum

Abstract: To explore the clinical spectrum of rotavirus diarrhoea in Bangladeshi children, we reviewed surveillance data from randomly selected diarrhoeal cases who were intensively studied at the International Centre for Diarrhoeal Diseases Research--Bangladesh. Twenty-seven (29%) of children aged less than or equal to 4 years excreted rotavirus; rotavirus was the only pathogen isolated from 13 cases. Seven of these 13 cases displayed the typical features of rotavirus diarrhoea: occurrence in infancy, prominent vomiting, watery diarrhoea, and acid stools rarely exhibiting blood or leucocytes. In contrast, six of the 13 cases presented with non-watery diarrhoea. These cases were distinguished by older ages, infrequent vomiting, less acidic stools, faecal blood and leucocytes, and frequent left shifts on peripheral blood examination. We conclude that the clinical spectrum of rotavirus infections may include an invasive diarrhoeal syndrome that differs in several respects from the more widely appreciated watery diarrhoeal syndrome.

Role of breast feeding in preventing acquisition of roundworm and hookworm in Dhaka slum children

Abstract: Breast feeding was found to give protection against many gastrointestinal infections in infants. A study has been conducted to examine whether breastfeeding protects children from contracting ascaris lumbricoides and hookworm infections. History of breast feeding and supplementation in urban children from low economic strata were obtained and stools were examined for ova of ascaris and hookworm. There was no significant difference in the presence of hookworm ova between the only breastfed group and the breastfed with supplemented group by two years of age. By the age of six and 24 months the presence of ascaris ova was significantly higher in the breastfed with supplemented group than the breastfed only group. It appears that exclusive breast feeding may have some role in preventing acquisition of ascaris infection in urban slums with poor sanitation facilities.

Endoscopy of the Small Intestine in ETEC and NAG Vibrio Diarrhea

Abstract: The authors have already reported the endoscopic1), microscopic2) and electron microscopic findings3) of the small intestine in human cholera. In order to investigate the diarrheal mechanism further, endoscopy and simultaneous biopsy of the small intestine were done in patients with enterotoxicogenic Escherichia coli (ETEC) or Non-O Group 1 Vibrio cholerae or Nonagglutinating (NAG) vibrio diarrhea.