Bangladesh Journal of Medical Microbiology

Epidemiology, Clinical Conditions, Pathogenesis and Mechanism of Resistant of Acinetobacter baumannii: A Narrative Review

Bhuiyan Mohammad Mahtab Uddin — 2023-12-10

The world is facing a growing threat from multidrug-resistant (MDR) gram negative “superbugs,” such as Acinetobacter baumannii. This morbidity and mortality loss caused there of indirectly hampers the economic developments in countries. These multidrug-resistant A. baumannii worldwide represents a major public health problem. The development of antibiotics decreased the mortality among the human and animals leading to a better life expectancy. But the injudicious use of antimicrobials and selection pressure the microbes have developed resistance which became more prominent during last few decades. High antimicrobial resistance was observed against all β-lactam and non- β-lactam antibiotics by the MBL producers. In developing countries also, the misuse and underuse of antimicrobials due to lack of awareness of patients, medical workers and financial problems emerged the antimicrobial resistant strains. Due to rapid globalization of human population by travel and other factor these resistant strains spread easily between developed and developing countries making it a global problem.

Bangladesh Journal of Medical Microbiology, July 2023;17 (2):88-92

Importance of Standard Molecular and Clinical Microbiology Laboratory: Bangladesh Perspective

Mohammad Murshed — 2023-12-10

Abstract Not Available

Bangladesh Journal of Medical Microbiology, July 2023;17(2):48-49

Comparision of Clinical and Demographic Parameters of Bacterial and Viral Meningitis among Children

Umme Habiba — 2023-12-10

Background: Bacterial meningitis is an emergency condition that need rapid detection.

Objective: The purpose of the present study was to compare of clinical and demographics parameters of bacterial and viral meningitis among children.

Methodology: This cross sectional study was carried out in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from July 2010 to January 2012 for around 2 years. Clinically suspected patients with meningitis from paediatrics wards of Mymengh Medical College & Hospital (MMCH), Mymensingh, Bangladesh were included in this study. Based on cytological tests and biochemical tests of CSF the study subjects were categorized as bacterial meningitis.

Results: A total 115 clinically and laboratory confirmed meningitis patients were enrolled in this study. In this study, most of the cases of study population were in the age group 1 month to 5 years 97(84.3%) cases. Among 35 cases of bacterial meningitis male was predominant than female which was 23(62.8%) cases and 12(37.2%) cases respectively (p=0.05). The clinical findings of meningitis where all of the study population (115) were suffering from fever (100.0%) followed by nausea or vomiting (60.8%) and convulsion (64.3%).

Conclusion: In conclusion statistically significantly different is found in the age group, gender and clinical features among the bacterial and viral meningitis patients.

Bangladesh Journal of Medical Microbiology, July 2023;17(2):50-54

Diagnostic Value of Dipstick Test (Leukocyte Esterase and Nitrite) in Diagnosis of Urinary Tract Infection

Nasreen Huda — 2023-12-10

Background: The accurate UTI diagnosis is crucial in the laboratory.

Objective: The objective was to assess the sensitivity and specificity of the nitrite test, leukocyte esterase, both nitrite and leukocyte esterase, and urine microscopy in UTI diagnosis.

Methodology: This was a cross-sectional study in which 100 adult patients, who were suspected to have UTI and did not receive antibiotics for at least 1 week, were included in this study performed in Shahabuddin Medical College and Hospital, Gulshan-2, Dhaka. Urine samples were collected and sent to laboratory for urine analysis and urine culture. Nitrite and leukocyte esterase dipsticks tests were done as well. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured for nitrite, leukocyte esterase, both nitrite and leukocyte esterase.

Results: According to the results of the urine dipstick test, microscopy, and urine culture, nitrite was positive in 17.0% of the cases, leukocyte esterase was positive in 53.0% of the cases, both nitrite and leukocyte esterase were positive in 17.0% of the cases, urine microscopy was positive in 71.0% of the cases, and urine culture was positive in 41.0% of the cases. In the detection of urinary tract infections, the sensitivity, specificity, PPV, and NPV of leukocyte esterase were 87.8%, 71.2%, 67.9%, and 89.4% respectively, using urine culture as the gold standard test. Based on urine culture as gold standard test, the sensitivity, specificity, PPV, and NPV of both nitrite and leukocyte esterase were 34.1%, 94.9%, 82.4%, and 67.5% respectively, in detecting urinary tract infections.

Conclusions: Efficacy of leukocyte esterase was found better in detecting UTI comparing nitrite test. Escherichia coli is the most common isolated organism.

Bangladesh Journal of Medical Microbiology, July 2023;17(2):55-59

Post-Operative Wound Infection after Treatment of Open Fracture Type II and Type IIIA by Applying Ilizarov Fixator: A Single Centre Experience in Bangladesh

Md Nazrul Islam — 2023-12-10

Background: Treatment of open fracture type II and type IIIA is difficult problem as because there is chance of formation of infection (osteomyelitis) and ultimate nonunion of fracture.

Objective: The purpose of the present study was to assess the rate of post-operative wound infection by application of Ilizarov fixator among open fracture of tibia in type II and type IIIA.

Methodology: This was a non-randomized clinical trial which was conducted in the Department of Orthopedic Surgery at Ad-Din Sakina Women’s Medical College, Jashore, Bangladesh and at different private institutes in that area from January 2017 to December 2022 for a period of six years. The patients with the age group of 20 to 70 years were selected as study population.

Results: A total number of 25 patients were recruited for this study. Out of 25 patients, 20 cases were male and 5 cases were female. Out of 25 patients 3 patients were diabetic and 2 patients were hypertensive. Affected side were on both side. The patients were included in this study and obtained excellent result with ilizarov procedure. Success rate was considered almost 100 present. Three patent developed minor wound infection.

Conclusion: In conclusion no wound infection is found among the patients presented with open fracture of type II and type IIIA by application of Ilizarov fixator.

Bangladesh Journal of Medical Microbiology, July 2023;17(2):60-65

Gastrointestinal Manifestations of Dengue Fever among Children: A Multicenter Cross-Sectional Study in Bangladesh

Arifa Akram — 2023-12-10

Background: Dengue fever is an arboviral illness spread by mosquitoes and is now a major public health issue on a global scale. Unfortunately, only few studies have documented unusual clinical characteristics of dengue among children.

Objective: The objective of this study was to describe the gastro intestinal manifestations of dengue infected children during 2019 dengue outbreak in Dhaka city.

Methodology: This cross-sectional study was conducted at Department of Virology at National Institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh among confirmed cases of dengue fever (Children aged less than 12 years) admitted in the pediatric ward of Dhaka Medical College Hospital, Kurmitola General Hospital, Sir Sallimullah Medical College Hospital, Dr M R Khan Sishu Hospital and BSMMU in Dhaka from June 2019 to November 2019 for period of six months. Data was collected using a structured questionnaire via face-to-face interview from guardian of the children. The investigation profile was collected from their hospital records.

Results: Out of confirmed 200 pediatric dengue patients, children with dengue had an average age of 9.8±2.7 years with a slight female predominance. The majority (36.5%) of the children belonged to the age group of 5 to 9 years. Among 200 patients, 42 patients diagnosed as severe Dengue according to WHO classification. Gastrointestinal symptoms were the most common associated feature, including mostly Nausea/vomiting (81.0%), abdominal pain (61.0%), ascites (29.0%), hepatomegaly (19.0%), diarrhoea (13.0%) and others. Elevation of transaminases was found in 40.0% of the children. About 30% of the patients had platelet count more than or equal to 50000 and hematocrit more than 40 was observed in 12% patients. Atypical manifestations such as acalculous cholecystitis, acute fulminant hepatitis, acute pancreatitis, parotitis, AKI and paralytic ileus were noted in small number of patients.

Conclusion: In conclusion, fever with vomiting and abdominal pain are common presentations of dengue fever.

Bangladesh Journal of Medical Microbiology, July 2023;17(2):66-70

Demographic and Clinical Profiles of PCR Positive Rickettsia felis Infected Patients at A Tertiary Care Hospital in Bangladesh

Rajib Ahmed — 2023-12-10

Background: Rickettsial infections remain relatively unexplored, under recognized and under reported due to a lack of awareness and limited access to diagnosis.

Objective: The purpose of the present study was to evaluate the demographic and clinical profile of PCR positive Rickettsia felis infected patients attended at a tertiary care hospital.

Methodology: This cross-sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from July 2013 to June 2014 for duration of one year. Patients with fever (102° to 104°F) more than 15 days of any age and gender, not responding to commonly used antibiotics and any other additional complaints and clinical features including headache, rash, lymphadenopathy or myalgia and eschars on the skin were included in this study. Patients with evident cause of fever like malaria diagnosed by blood smear or immunochromatography were excluded from the study. Blood was collected according to blood collection guidelines. PCR from blood was performed using standard protocol with specific primers to detect Rickettsia up to species level.

Results: A total number of 50 respondents were recruited after fulfilling the inclusion and exclusion criteria. Among them 21(42%) cases were PCR positive. Among 21 PCR positive cases, the predominant age group was more than 15 to 30 years which was 11(52.4%), female patients were predominant than male patients which was 11(52.0%). All the cases with Rickettsial infection had fever 21(100.0%). Other associated features like headache was most commonly noticed in 10(47.6%) cases followed by body-ache, Cough and rash which was 7(33.3%) cases, 5(23.8%) cases and 1/21 (4.7%) cases respectively.

Conclusion: This study demonstrated high prevalence of Rickettsia felis infection in patients in Bangladesh with unidentified febrile illness and suggests that this infection is endemic to the north-central area of this country. Females are more prone to get infected and most commonly noticed associated features was headache.

Bangladesh Journal of Medical Microbiology, July 2023;17 (2):71-76

Prescription Pattern of Antibiotics at Outpatients Department of Gynaecology and Obstetrics in a Teaching Hospital in Bangladesh

Shabrina Shammi Shahnawaz — 2023-12-10

Background: Antibiotics are usually prescribed based on the clinical features of infections.

Objective: The purpose of the present study was to assess the prescription pattern of antibiotics at outpatients Department of Gynaecology and Obstetrics in a teaching hospital in Bangladesh.

Methodology: This cross-sectional study was carried out among patients attending the outpatients’ department (OPD) of Obstetrics and Gynaecology from October 2014 to April 2015 in Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. The demographic details, average number of drugs per prescriptions, percentage of drugs prescribed by generic names, percentage of encounters with an antibiotic and an injection prescribed, percentage of drugs prescribed from Essential Drug List (EDL) of Bangladesh, percentage of encounters with prescription of antiulcerant, NSAID, multivitamin and multimineral, iron preparation and a calcium preparation were noted.

Results: A total number of 384 women were recruited for this study. The age group of 20 to 29 years accounted for the highest number 180 (46.8%) and from the age group of 70 to 79 years accounted for the lowest number 2 (0.5%) patients. Groups of drug which commonly prescribed were anti-ulcerant 247. The other commonly prescribed group of drugs were iron preparations 235, calcium preparations 182, antimicrobials 160, multivitamins and multi-minerals 147, antispasmodics 120. The most commonly prescribed antibiotic was cefuroxime 56(36.36%) followed by cefixime, azithromycin, fluconazole, ciprofloxacin, nitazoxanide, roxithromycin, metronidazole, clindamycin and flucloxacillin were 28(18.18%), 21(13.63%), 12(7.79%), 11(7.14%), 9(5.84%), 8(5.19 %), 6(3.89 %), 5(3.24%), 4(2.59%) respectively.

Conclusion: In conclusion antibiotics are frequently using in the OPD of Obstetrics and Gynaecology department among the women.

Bangladesh Journal of Medical Microbiology, July 2023;17 (2):77-81

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

AKM Mustafizur Rahman — 2023-12-10

Background: Diabetes mellitus causes involvement of coronary artery diseases.

Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients.

Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and nonselective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views.

Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m²and in NDM was 26.38±2.05 kg/m². The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P>0.05).

Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides.

Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87