International Centre for Diarrhoeal Disease Research, Bangladesh

About: International Centre for Diarrhoeal Disease Research, Bangladesh is a facility organization based out in Dhaka, Bangladesh. It is known for research contribution in the topics: Population & Vibrio cholerae. The organization has 3103 authors who have published 5238 publications receiving 226880 citations. The organization is also known as: SEATO Cholera Research Laboratory & Bangladesh International Centre for Diarrhoeal Disease Research.

Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.

Abstract: Objectives To support the Bangladesh National Kala-azar Elimination Programme (NKEP), we investigated the feasibility of using trained village volunteers for detecting post-kala-azar dermal leishmaniasis (PKDL) cases, using polymerase chain reaction (PCR) for confirmation of diagnosis and treatment compliance by PKDL patients in Kanthal union of Trishal sub-district, Mymensingh, Bangladesh. Methods In this cross-sectional study, Field Research Assistants (FRAs) conducted census in the study area, and the research team trained village volunteers on how to look for PKDL suspects. The trained village volunteers (TVVs) visited each household in the study area for PKDL suspects and referred the suspected PKDL cases to the study clinic. The suspected cases underwent physical examinations by a qualified doctor and rK39 strip testing by the FRAs and, if positive, slit skin examination (SSE), culture, and PCR of skin specimens and peripheral buffy coat were done. Those with evidence of Leishmania donovani (LD) were referred for treatment. All the cases were followed for one year. Results The total population of the study area was 29,226 from 6,566 households. The TVVs referred 52 PKDL suspects. Probable PKDL was diagnosed in 18 of the 52 PKDL suspect cases, and PKDL was confirmed in 9 of the 18 probable PKDL cases. The prevalence of probable PKDL was 6.2 per 10,000 people in the study area. Thirteen PKDL suspects self-reported from outside the study area, and probable and confirmed PKDL was diagnosed in 10 of the 13 suspects and in 5 of 10 probable PKDL cases respectively. All probable PKDL cases had hypopigmented macules. The median time for PKDL development was 36 months (IQR, 24–48). Evidence of the LD parasite was documented by SSE and PCR in 3.6% and 64.3% of the cases, respectively. PCR positivity was associated with gender and severity of disease. Those who were untreated had an increased risk (odds ratio = 3.33, 95%CI 1.29–8.59) of having persistent skin lesions compared to those who were treated. Patients' treatment-seeking behavior and treatment compliance were poor. Conclusion Improved detection of PKDL cases by TVVs is feasible and useful. The NKEP should promote PCR for the diagnosis of PKDL and should find ways for improving treatment compliance by patients.

Spousal Violence in Bangladesh: A Call for a Public-health Response

Abstract: Spousal violence against women is a serious public-health issue. Although there is a growing body of literature on this subject, there are still many unanswered questions regarding the prevalence of this violence, the risk factors, the consequences, and how to address the issue. The purpose of this literature review is to organize and synthesize the empirical evidence on spousal violence against women in Bangladesh and to provide direction for both researchers and practitioners for future work in this area. The review suggests that spousal violence against women is high in Bangladesh. The list of correlates is long and inconclusive. Although there is evidence on adverse consequences of this violence on health of women and their children, more research is needed to explore the multifaceted consequences of violence for women, children, families, and communities. Action research is needed to develop and test preventive and curative interventions.

Bacterial contamination of weaning foods and drinking water in rural Bangladesh

Abstract: The aim of this study was to determine what weaning foods and food preparation practices expose children to a high risk of diarrhoeal disease through exposure to a contaminated diet. Bacterial contamination of 897 food and 896 drinking water samples was assessed in a water and sanitation intervention project. The geometric mean of faecal coliforms per g or ml was 7.5 x 10(3) in left-over rice. 1.4 x 10(2) in other types of boiled rice, 2.5 x 10(2) in milk, 4.8 in household drinking water, and 3.5 in bread. Multiplication of faecal coliforms occurred when there was a delay of more than 4 h between preparation and consumption of food. All samples were more contaminated in the rainy than in the dry season. Strategies to reduce contamination should therefore focus on 'wet' foods, early consumption after preparation, and re-heating of left-over foods. Understanding the reasons for the faulty practices is also essential to the formulation of effective measures.

Role of Zooplankton Diversity in Vibrio cholerae Population Dynamics and in the Incidence of Cholera in the Bangladesh Sundarbans

Abstract: Vibrio cholerae, a bacterium autochthonous to the aquatic environment, is the causative agent of cholera, a severe watery, life-threatening diarrheal disease occurring predominantly in developing countries. V. cholerae, including both serogroups O1 and O139, is found in association with crustacean zooplankton, mainly copepods, and notably in ponds, rivers, and estuarine systems globally. The incidence of cholera and occurrence of pathogenic V. cholerae strains with zooplankton were studied in two areas of Bangladesh: Bakerganj and Mathbaria. Chitinous zooplankton communities of several bodies of water were analyzed in order to understand the interaction of the zooplankton population composition with the population dynamics of pathogenic V. cholerae and incidence of cholera. Two dominant zooplankton groups were found to be consistently associated with detection of V. cholerae and/or occurrence of cholera cases, namely, rotifers and cladocerans, in addition to copepods. Local differences indicate there are subtle ecological factors that can influence interactions between V. cholerae, its plankton hosts, and the incidence of cholera.

Emergence of multidrug-resistant strain of Vibrio cholerae O1 in Bangladesh and reversal of their susceptibility to tetracycline after two years.

Abstract: Sir, Cholera is endemic and follows a distinct seasonality in Bangladesh (1). Early administration of rehydration therapy using appropriate oral or intravenous fluid(s) saves the lives of patients with cholera. Therapy with an effective antimicrobial agent significantly shortens the duration of diarrhoea and hospitalization, reduces the volume of watery stool and the requirement of maintenance fluids, and shortens the duration of faecal excretion of Vibrio cholerae reducing transmission of infection to other family members and nosocomial infections in the clinic setting (2). Tetracycline and doxycycline (long-acting tetracycline) have long been the antibiotics of choice for treating severe cholera in Bangladesh and in other parts of the world, except for young children and pregnant women (1,2). Furazolidone, erythromycin, trimethoprim-sulphamethoxazole, and chloramphenicol have also been effective in treating severe cholera caused by strains of V. cholerae susceptible to these agents (3). During October 2004–December 2005, 953 (565 Ogawa and 388 Inaba) and 344 (197 Ogawa and 147 Inaba) strains of V. cholerae O1 isolated from cholera cases admitted to the Dhaka Hospital (urban area) and Matlab Hospital (rural area) of ICDDR,B respectively were examined for susceptibility to tetracycline, erythromycin, trimethoprim-sulphamethoxazole, furazolidone, and ciprofloxacin. Antimicrobial susceptibility was performed using the disc-diffusion technique on Mueller-Hinton agar (Difco, Detroit, Michigan, USA) with commercial discs (Oxoid, UK) and appropriate control strains (4). Overall, 525 (55%), 420 (44%), 944 (99%), 948 (100%), and no strains from Dhaka and 186 (54%), 165 (48%), 332 (97%), 343 (100%), and no strains from Matlab were resistant to tetracycline, erythromycin, trimethoprim-sulphamethoxazole, furazolidone, and ciprofloxacin respectively. Prior to October 2004, most strains were resistant to trimethoprim-sulphamethoxazole and furazolidone but were uniformly sensitive to tetracycline, erythromycin, and ciprofloxacin. The first multidrug-resistant strains of V. cholerae (strains resistant to furazolidone, trimethoprim-sulphamethoxazole, tetracycline, and erythromycin) were observed in Matlab in October 2004 among the Ogawa serotype, and the isolation of such strains increased dramatically to reach 100% by February 2005. In Dhaka, the multidrug-resistant strains appeared one month later in November 2004 among both Ogawa (13%) and Inaba (5%) strains of V. cholerae, and by February 2005, all the Ogawa strains demonstrated the multidrug-resistant phenoytpe. By March 2005, nearly all the El Tor Ogawa isolates, 5 of 6 (83%) at the Matlab Hospital, and 43 of 45 (96%) at the Dhaka Hospital were multidrug-resistant. The figure shows the resistance patterns of V. cholerae in Dhaka and Matlab by month and site. Fig. Resistance patterns of V. cholerae O1 in Dhaka and Matlab by month and site Based on the multidrug-resistant phenotype, it appeared that there were two or more clones of V. cholerae O1 in circulation at different time points, and we are in the process of understanding the clonality by subjecting representative strains to molecular typing analysis. We determined antimicrobial susceptibility using both disc-diffusion technique and E-test method. In the absence of a reference zone size for V. cholerae resistance to erythromycin and azithromycin, we used the zone size for other organisms to determine the susceptibility (zone of inhibition ≥23 mm for erythromycin and ≥18 mm for azithromycin) of the V. cholerae strains to these drugs. Seventeen of the 35 (49%) V. cholerae strains were resistant to both erythromycin and azithromycin, while the remaining 18 (51%) strains were susceptible to both erythromycin and azithromycin. The strains resistant to erythromycin exhibited minimum inhibition concentrations (MICs) of 8 to 32 μg/mL, while the MIC of those susceptible to the drug ranged from 0.25 to 1 μg/mL. The MIC of the strains resistant to azithromycin ranged from 0.75 to 3 μg/mL, while the MIC of those susceptible to the drug was from 0.047 to 0.125 μg/mL. These findings suggest that resistance to erythromycin could be a marker for resistance to azithromycin. Similarly, resistance to tetracycline is considered a proxy indicator for resistance to doxycycline (5). We have, for the first time, encountered this unique, multidrug-resistant pattern, including resistance to erythromycin, among V. cholerae O1 in Bangladesh. Throughout the period of this investigation, all isolates from Matlab and Dhaka were susceptible to ciprofloxacin. The MIC for ciprofloxacin was determined using E-test (AB-BIODISK, Sweden) with the zone size interpretive criteria for susceptibility corresponding to 0.06 μg/mL (5). We noted a consistent increase in the median MIC of V. cholerae O1 strains isolated at the Dhaka Hospital over the years: 0.003 μg/mL in 1994, 0.023 μg/mL in 2001, and 0.38 to 0.5 μg/mL in 2005 (6,7). In a recent study in adults infected with V. cholerae O1, we observed clinical success (resolution of diarrhoea by 48 hours of initiation of therapy) rate of 68% with 500-mg 12-hourly dose of ciprofloxacin for three days—a rate substantially lower than that observed with a single one-gramme dose of the drug in an earlier study (8). The findings are disturbing since a further increase in the MIC may render ciprofloxacin ineffective in the management of cholera caused by such multidrug-resistant strains of V. cholerae O1. Further studies are being conducted at ICDDR,B to determine the mechanism of resistance of these multidrug-resistant strains to ciprofloxacin. In August 2006, we observed a re-emergence of the Inaba serotype and a sharp reduction in the isolation rate of the Ogawa serotype. In Bangladesh, such changes in serotypes and the appearance of short-lasting, multidrug-resistance, have also been noted in the past (9,10,11). The proportion of V. cholerae strains resistant to tetracycline decreased substantially (from 75% in January 2006 to 10% in August 2006). Resistance to tetracycline persisted for nearly two years, a finding that we have not observed earlier (12,13). The current situation clearly demonstrates the need to monitor MIC in areas where cholera is endemic to assess the clinical efficacy of ciprofloxacin in the treatment of cholera. There is also a need to identify effective alterative antimicrobials for the management of cholera caused by such strains. Through this communication, we would also like to alert our neighbouring countries and the region of circulation of this new multidrug-resistant strain of V. cholerae O1.