Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1985"
TL;DR: Blood group did not affect an individual's risk of having a culture-proven infection with V. cholerae 01 but was directly related to the severity of disease, and individuals with the most severe diarrhea compared with those with asymptomatic infection were more often of blood group O.
Abstract: At the Matlab Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the authors examined the blood groups of patients hospitalized between January and September 1979 for diarrheal disease due to a variety of bacterial and viral agents. A significant association was identified only for cholera, in which cholera patients were twice as likely to have blood group O and one-ninth as likely to have blood group AB as community controls. A follow-up study of family contacts of cholera patients, carried out between September 1980 and July 1982, indicated that blood group did not affect an individual's risk of having a culture-proven infection with V. cholerae 01 but was directly related to the severity of disease. Individuals with the most severe diarrhea compared with those with asymptomatic infection were more often of blood group O (68% versus 36%, p less than 0.01) and less often of AB (0% versus 7%, p less than 0.01). It was not possible to identify the molecular basis for this genetically related protection using biologic models of cholera that are currently available. The constant selective pressure of cholera against people of O blood group may account in part for the extremely low prevalence of O group genes and the high prevalence of B group genes found among the people living in the Gangetic Delta.
242 citations
Journal Article•
TL;DR: The study shows that, even under epidemic conditions of severe Cholera or in cholera-like diarrhea, the glucose or sucrose solutions can be replaced by rice powder with improved results.
Abstract: A ramdomized trial using oral rehydration solutions (ORS) with rice or glucose was carried out in 342 patients with acute watery diarrhea in the outpatient ward of the International Centre for Diarrheal Disease Research Bangladesh during an epidemic of cholera between December 1982-March 1983. On admission 75% of these patients had severe dehydration and 70% were positive for Vibrio cholerae. There were 185 children aged under 10 years and 157 adults; 169 patients were treated with rice-ORS and 173 with glucose-ORS. Patients in both groups were comparable in age and body weight as well as the duration and severity of illness. Patients with severe dehydration were first rehydrated intravenously and then treated with ORS. Those with moderate dehydration received ORS from the start. The mean stool output in the first 24 hours in children treated with rice-ORS was less than that in those treated with glucose-ORS (155 vs 204 ml/kg 24h; P0.01). The same was the case for the adult patients the corresponding values for stool output being 115 versus 159 ml/kg24h (P0.05); the corresponding intakes in adult patients were respectively 180.5 and 247 ml/kg24 hours. A gain of about 10% of the body weight on admission was observed in all the groups. 6 cases (4 children and 2 adults) who failed to respond to oral rehydration after intravenous therapy all belonged to the glucose-ORS group. The study shows that even under epidemic conditions of severe cholera or in cholera-like diarrhea the glucose or sucrose solutions can be replaced by rice powder with improved results. Glucose and sucrose are manufactured products which are expensive and not always available in countries where diarrheal diseases are a problem. Rice a staple food in many of these countries reduces the fluid requirements when used in ORS and also provides increased nutrition even in the acute stage of illness.
119 citations
TL;DR: The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983.
Abstract: The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
110 citations
TL;DR: In Dhaka, Bangladesh, fresh isolates of Escherichia coli from 197 patients with diarrhea were investigated for production of enterotoxin and possession of colonization factor antigen (CFA) I or II, and mixed infection was seen in 23% of those from whom recognized pathogens were identified.
Abstract: In Dhaka, Bangladesh, fresh isolates of Escherichia coli from 197 patients with diarrhea were investigated for production of enterotoxin and possession of colonization factor antigen (CFA) I or II. Enterotoxigenic E. coli (ETEC) was isolated from 34% of the patients, and of the 67 enterotoxin-positive strains, 75% carried CFAs. Among 68 healthy control persons no strains positive for both enterotoxin and CFA were found. The CFAs in general were restricted to certain serotypes of E. coli. In a subgroup of patients, part of an ongoing surveillance study, mixed infection was seen in 23% of those from whom recognized pathogens were identified. There was a tendency to more severe dehydration when the two virulence factors, enterotoxin and CFA, were simultaneously present.
84 citations
TL;DR: Resistance to ampicillin is increasing rapidly, particularly in S. dysenteriae type 1, which has made a dramatic comeback in Bangladesh after 10 years when Shigella flexneri was the dominant serogroup.
Abstract: Shigella dysenteriae type 1 (Shiga bacillus) has made a dramatic comeback in Bangladesh after 10 years when Shigella flexneri was the dominant serogroup. Whereas S. flexneri showed little increase in resistance to the commonly used antimicrobial agents--namely, trimethoprim-sulfamethoxazole (TMP-SMX) and ampicillin-over the years, S. dysenteriae type 1 underwent rapid changes with regard to sensitivity pattern during the last two years. The first TMP-SMX-resistant strain of S. dysenteriae type 1 was detected in September 1982; however, by mid-1984 most strains were resistant while retaining sensitivity to ampicillin. During this period, the ratio of S. flexneri to S. dysenteriae type 1 narrowed from 0.15 to 1. Such propagation of high resistance to TMP-SMX might have been due to widespread use of the drug imported into the country in large quantities. Resistance to ampicillin is increasing rapidly, particularly in S. dysenteriae type 1.
72 citations
TL;DR: In two villages of Bangladesh, 2471 infants born in 1976 and 1977 were followed up for a year to study the impact of environmental sanitation and crowding on their mortality, and neonatal mortality was completely unrelated to the environmental factors investigated.
62 citations
TL;DR: Consumption of rice and wheat, the major non-breast milk sources of energy and protein, had distinct seasonal patterns, thus limiting the overall seasonal variability in cereal intake.
59 citations
50 citations
TL;DR: Resistance to antibiotics appears to be increasing and the development of new drugs and preventive methods within economic reach of less developed countries are crucial for reduction of the disease and related deaths.
Abstract: We examined whether the proportion of Shigellae patients among diarrhoeal cases, the distribution, species, case-fatality rates and hospital visits changed over time in Dhaka. We isolated 19639 Shigella strains from 822812 diarrhoea cases treated at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), between 1969 and 1982. The number of cases increased from 209 (2.5%) in 1969 to 4833 (7.7%) in 1976. Extrapolating from a 4% vigorous systematic sample of ICDDR,B hospital visits shigellosis cases and their proportion among diarrhoea cases increased to more than 9500 (12.0%) in 1981. The prevalence of various shigellae species altered over time. For example: in 1969 Shigella flexneri predominated in 74% of all Shigella cases; in 1973 Shigella dysenteriae accounted for 56%, and in 1981 Shigella flexneri again predominated (75%). More than 20% of all Shigella isolations were from infants: 60% in males and 40% in females. Over 7% of severe cases of Shigella infection referred from the outpatient department and admitted for treatment died. Nearly 40% of all the Shigella deaths were in infants of less than a year old while 49% were in 1-4 year old children. Increasing prevalence of shigellosis appears to be an important cause of diarrhoea in Dhaka especially among children. Areas with poor sanitation and water supply had higher prevalence. However, hospitalized cases represented a fraction of the actual problem. Resistance to antibiotics appears to be increasing and the development of new drugs and preventive methods within economic reach of less developed countries are crucial for reduction of the disease and related deaths.
40 citations
TL;DR: Using a unique set of birth registration data from the Demographic Surveillance System of the International Center for Diarrheal Disease Research, Bangladesh, and socioeconomic information collected in the 1974 census, fertility was studied in relation to occupation, size of dwelling, number of cows and number of boats owned.
Abstract: Using a unique set of birth registration data from the Demographic Surveillance System of the International Center for Diarrheal Disease Research Bangladesh for the period 1974-77 and socioeconomic information collected in the 1974 census fertility was studied in relation to occupation size of dwelling number of cows and number of boats owned. The total fertility rate was found to vary between 6 and 6.5 except in the famine year of 1975. There was no consistent relationship between fertility and education of women. The age-specific fertility rates by religion show that Muslims had higher fertility at all ages in 1974 and 1977 and at older ages in 1975 and 1976. Overall however fertility of Hindus is consistently lower than that of Muslims but the relative differences are under 10%. Fertility differentials by occupation showed that the household heads who were farm laborers had relatively lower fertility compared to other occupational groups except for the year 1977 where the families of service holders were found to have relatively lower fertility. Women in households whose heads were businessmen or farmers (owning their land) had above average fertility. In 1974 households in the business occupational groups had on average 1 birth more than other households. Women in households with fishermen as heads had below average fertility in 1974 and 1975 but very high fertility in 1976 and 1977. Fertility levels differed according to the type of household in which the family resided. Nuclear families had below average fertility up to the age of 35 and above average fertility at the end of the reproductive age. In the 15-19 age group augmented families had higher fertility each year examined. The association between dwelling place and fertility is positive each year the relative differences in fertility between the groups being largest in 1974. Positive relations were found between economic status and fertility.
40 citations
TL;DR: A feasibility study of rice-salt solution for oral rehydration (OR) was conducted in a village in the Chandpur area of rural Bangladesh in 1983 and showed that mothers in rural areas could prepare rice-Salt OR solution quite easily and use it to treat diarrhoea patients.
TL;DR: Eight strains of Vibrio mimicus isolated from patients with diarrhoea in Bangladesh were all found to produce an extracellular toxin identical to cholera toxin produced by VIBrio cholerae O1 bacteria, with regard to subunit structure and immunological properties.
Abstract: Eight strains of Vibrio mimicus isolated from patients with diarrhoea in Bangladesh were all found to produce an extracellular toxin identical to cholera toxin produced by Vibrio cholerae O1 bacteria, with regard to subunit structure and immunological properties. Like cholera toxin, but in contrast to heat-labile enterotoxin from Escherichia coli most of the toxin from V. mimicus was found extracellularly and was proteolytically ‘nicked’ in its A subunit. This may relate to the finding that V. mimicus also produced an extracellular hemagglutinin which was immunologically indistinguishable from the soluble hemagglutinin/nicking protease of V. cholerae O1.
TL;DR: The oral administration of tetrachloroethylene and hexylresorcinol were associated with severe anaphylactic reactions which were prevented by prior treatment with antihistamines.
Abstract: Four relatively new broad spectrum anthelmintics (thiabendazole, mebendazole, levamisole and pyrantel pamoate) were compared with two older anthelmintics, (tetrachloroethylene and hexylresorcinol) to treat heavy Fasciolopis buski infections in 17 children aged 4-13 years in hospital. Tetrachloroethylene was the most effective drug in these 17 children and another 49. Large numbers of worms were expelled and faecal egg counts were markedly reduced (99%). The mean number of worms per child was 122 with a range of 7 to 818. All the other anthelmintics tested were ineffective; no worms or only a few were expelled after treatment. However, the oral administration of tetrachloroethylene and hexylresorcinol were associated with severe anaphylactic reactions which were prevented by prior treatment with antihistamines.
TL;DR: There was strong evidence that nutritional status is an important factor in the estimated age at sterility, with thinner women experiencing an earlier menopause, with stronger evidence that sterility occurs earlier among the thinner women.
Abstract: In a prospective study of 2324 women in Matlab Bangladesh the occurrence of primary and 2ndary sterility by age groups was examined. The results were related to the nutritional status of the women as assessed by measurements of height weight arm circumference and ponderal index. Approximately 98% of the women who were in the age group 15-19 were found to be fertile. This proportion decreases gradually up to the age group 30-34 years and thereafter declines sharply reaching only 31% in the age group 45-49. The height data suggest no significant difference in the age pattern of sterility among the 3 groups of women although there is a slight tendency that women who were less tall reached menopause earlier than the other 2 groups. Variations in weight are more conspicuous than in height. There is the suggestion that thinner women may experience an earlier menopause. Women having an arm circumference less than 21 cm between 21-22 cm and 23 cm and above and currently aged 17 years have an expected fertile life estimated at 25.0 25.8 and 26.6 years respectively. The median ages at sterility were 42.8 44.0 and 44.3 years respectively with a difference of about 1 year between the 1st 2 groups. This suggests that sterility occurs earlier among the thinner women. Since detailed investigation of nutritional status was not possible it was assessed by anthropometry. There was strong evidence that nutritional status is an important factor in the estimated age at sterility with thinner women experiencing an earlier menopause. Although it is impossible to measure the onset of sterility one can obtain a minimum estimate of it from the age-specific distribution of the proportion of women who have not produced a child for 5 years of being at risk.
TL;DR: A randomized, controlled trial was conducted to investigate the ability of indomethacin and chloroquine to reduce intestinal secretion in 29 adult patients with severe cholera.
TL;DR: The results indicate that patients with diarrhea during typhoid fever have a wide range of rates of purging, and the diarrhea is characterized by liquid stool containing large quantities of leukocytes and protein and is resolved by treatment with chloramphenicol.
Abstract: To study the pathogenesis of diarrhea occurring with typhoid fever, we selected 42 patients with diarrhea and blood cultures positive for Salmonella typhi or Salmonella paratyphi A, but without diarrheal copathogens, for measurement of stool output and examination of fecal composition. The mean duration of fever before hospitalization was 9.5 days, and the mean duration of diarrhea was 5.8 days. All patients passed liquid stool on their first day in the hospital, ranging in volume from 4 to 172 ml/kg with a mean of 45 ml/kg. Red blood cells were in the stools of 57% of the patients. All patients had fecal leukocytes with a mean of 4,950 leukocytes/mm3, predominantly polymorphonuclear leukocytes. In the stools, the mean protein concentration was 9.3 g/liter; the mean pH was 6.1, and the mean concentration of electrolytes was as follows: sodium, 47 mEq/liter; potassium, 48 mEq/liter; and chloride, 43 mEq/liter. The mean total CO2 was 24 mmol/liter. During treatment with chloramphenicol, this group of patients showed daily improvement with a drop in both fever and stool output. The results indicate that patients with diarrhea during typhoid fever have a wide range of rates of purging, and the diarrhea is characterized by liquid stool containing large quantities of leukocytes and protein and is resolved by treatment with chloramphenicol.
Journal Article•
TL;DR: This paper describes the primary health care and research activities of the Urban Volunteer Programme in Bangladesh and suggests that such an approach can be and should be used in other urban areas of developing countries.
Abstract: In response to a recognition that existing health facilities could not adequately reach the poorer sections of Dhaka city, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) established the Urban Volunteer Programme in 1981. This paper describes the primary health care and research activities of this program and suggests that such an approach can be and should be used in other urban areas of developing countries.
01 Jan 1985
TL;DR: There are few accurate health data for Bangladesh and crowding and water have a great influence and determine the patterns of life and illness in this country.
Abstract: Bangladesh is a small country of 55,598 square miles yet has nearly 100 million people. It lies on the Northeast portion of the Indian sub-continent (Fig. 1). The climate is sub-tropical with a dry and wet season (Fig. 2). It is situated on a delta formed by three great rivers-the Ganges, Brahmaputra and Meghna. At peak flow there is a flux of five million cubic feet per second which is twice that of the Mississippi River (1). Thus crowding and water have a great influence and determine the patterns of life and illness in this country. There are few accurate health data for Bangladesh. The International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) formerly the Cholera Research Laboratory (CRL) has kept careful records for nearly twenty years in a rural area in the centre of the country (Fig. 3). In addition, a Treatment Centre for diarrhoea has been in operation in Dacca, the largest city. The information presented in this paper is derived from these populations. Studies in Teknaf, another field area is different in many ways from other parts of Bangladesh started much later (Fig. 1).
TL;DR: Water, sediment, and bivalves collected from the Buriganga River at Dhaka, Bangladesh, were examined and fecal coliform counts were consistently higher for the bivalve tissue than those for water and sediment samples; in thebivalveLamellidens marginalis, they were ∼10.0- to 87.5-fold higher than those in water.
Abstract: Studies on the concentration of fecal coliforms in freshwater bivalves were carried out using a spread plate method and membrane fecal coliform medium. Water, sediment, and bivalves collected from the Buriganga River at Dhaka, Bangladesh, were examined. As demonstrated in many previous studies, fecal coliform counts were consistently higher for the bivalve tissue than those for water and sediment samples; in the bivalveLamellidens marginalis, they were ∼10.0- to 87.0-fold higher than those in water, and 2.0- to 11.0-fold higher than those in sediment.
TL;DR: The results indicate the safety of treatment of diarrhea of young infants with mild/moderate degrees of dehydration by standard ORS supplemented by early milk feeds instead of plain water at 2 hours after initiation of ORS therapy.
Abstract: This paper reports the treatment of diarrhea in infants of less than 6 months of age who were exclusively breast-fed with WHO standard ORS supplemented by breast milk or 1/2 strength formula milk instead of plain water at 2 hours after initiation of ORS therapy. 64 infants in Bangladesh were examined. The extent of dehydration was assessed clinically and classified into mild moderate and severe degrees according to WHO guidelines. Informed consent of the parents was obtained. The degree of dehydration was recorded on admission and every 2 hours for 24 hours. Rehydration with standard ORS was started immediately after completion of the clinical exam. Loss of fluids due to purging and vomiting was replaced by equal volumes of ORS. Supplemental feeding with breast milk or 1/2 strength formula milk was also started after 2 hours. The amount of breast milk consumed was determined by weighing breast-fed infants before and after feeding. The amount of stool vomiting and urine was measured every 2 hours for replacement. All the infants were successfully hydrated by clinical and biochemical criteria. There was no adverse effect of treatment with this regimen on the process of hydration or the serum levels during the phases of rehydration or maintenance. The results indicate the safety of treatment of diarrhea of young infants with mild/moderate degrees of dehydration by standard ORS supplemented by early milk feeds instead of plain water. The mean clinical hydration time was 3.06 hours in those who were breast-fed and 3.13 hours in the nonbreastfed. Milk intake was higher in the nonbreastfed children than in the breastfed group.
01 Jan 1985
TL;DR: Studies in Bangladesh have shown a close inverse relationship between attack rate of cholera and age and also with serum (vibriocidal) antibody titers, which indicates that second attacks of Cholera within a year or two are extremely rare.
Abstract: While all age groups have been susceptible to cholera when it has spread into new areas, cholera is predominantly a disease of childhood in endemic areas Studies in Bangladesh have shown a close inverse relationship between attack rate of cholera and age and also with serum (vibriocidal) antibody titers This kind of epidemiologic pattern is characteristic of infections which evoke immunity following either disease or inapparent infection There is also epidemiologic data from endemic areas which indicates that second attacks of cholera within a year or two are extremely rare (1, 2, R Glass et al, to be published)
TL;DR: This first report of evidence for chlamydial infection in this country should stimulate a search for a causal relationship between chlamydiae and prevalent diseases of Bangladesh.
Abstract: Anti-chlamydial antibodies were detected in 25 of 93 patients with diarrhoea in Bangladesh. This first report of evidence for chlamydial infection in this country should stimulate a search for a causal relationship between chlamydiae and prevalent diseases of Bangladesh.
TL;DR: Diarrhee et cecite sont dues a une carence en vitamine A et touchent de nombreux enfants au Bengla Desh.
Abstract: Diarrhee et cecite sont dues a une carence en vitamine A et touchent de nombreux enfants au Bengla Desh