Abstract

Background: Hodgkin's lymphoma (HL) with skin involvement is reasonably rare. It typically occurs late in the course and is associated with a poor prognosis; however, it may also be indolent in some cases. Case: We report a case of a 15-year-old previously healthy male with Hodgkin's lymphoma who presented with multiple lymphadenopathies of axilla and serpiginous ulcerative nodular lesions involving pectoral skin. A lymph node biopsy was performed following an initial diagnostic workup for a suspected active infectious disease, which revealed a neoplastic invasion from a mixed cellularity classical HL with skin involvement. A total of six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy regimen was administered to the patient. Conclusion: In comparison to other studies, this case demonstrates that a good response is possible with standard ABVD chemotherapy.

Abstract

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of postexposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P< 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n¼ 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P< 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy.

Abstract

Tuberculosis (TB) affects the most productive age group people, resulting in economic loss to the individual and their family, particularly in developing countries. This study aimed to assess the economic burden of TB in Hospitalized patients. We conducted a cross-sectional survey among hospitalized TB patients who visited the National Institute of Chest Disease and Hospital, Dhaka, Bangladesh from June 2017 through February 2018. Most TB patients were male (95%) with the age group between 36 and 50 years (42.3%). A majority of the patients (96%) came to the hospital for retreatment of TB. Two-third of the patients went to the hospital from rural areas. The average cost for treating individual TB patients was ~600 US$ (United States dollar). The average productive days lost of a TB patient were 141 days. TB patients from rural areas spent more money than patients living in urban and semi-urban areas. More awareness is needed, particularly in rural people about the current TB burden, nearest TB treatment facilities, and the National Tuberculosis Control Program to minimize economic loss. These study findings also demand the establishment of a specialized TB hospital at the sub-district level.

Abstract

Antimicrobial resistance is common in low-middle-income countries caused by inappropriate and irrational use of antibiotics in humans and animals. Bangladesh has very limited information on antibiotic use and associated resistance. This study explored the prescribing pattern of antibiotics uses among children visiting a tertiary care hospital in Bangladesh. We conducted a crosssectional study among 400 hospitalized children less than 5 years of age from February to April, 2019, in a tertiary hospital in Bangladesh. Among the 400 children, >50% belonged to the age group for less than 1 year and >60% were male. The average hospital stay period was 3 days (range 1–14 days). The majority of the children had a history of respiratory illnesses (32.2%) and 31% had diarrhea. Most of the children (81.7%) were prescribed one or more antibiotics. The average number of antibiotics per child was 1.17. A combined form of antibiotics was prescribed in 17.43% of children. A total of 14 different antibiotics were prescribed. The most common antibiotic was ceftriaxone (62.39%), followed by azithromycin (18.65%). The parental route was mostly preferred (74.92%) for antibiotic administration. The antibiotic prescription was common in children less than 5 years of age visiting a tertiary level hospital. Most of the prescribed antibiotics were broad spectrum that can promote bacterial resistance. The study’s finding is useful to draw attention to the public health policymakers for taking necessary actions on the appropriate use of antibiotics among children in Bangladesh.

Abstract

Salmonellosis in poultry is an important disease that seriously impedes the development of the poultry industry. The increased resistance to antimicrobials against Salmonella has been a major public health concern worldwide. We conducted a study from January to June 2016 in and around the Rajshahi district of Bangladesh on the commercial chicken to isolate, identify and characterize poultryspecific Salmonella, to assess the potential risk factors and to determine the antimicrobial resistance pattern of the isolates. The overall prevalence of Salmonella enterica was 41% (49/120) [95% CI: 31.95%– 50.17%] with 41.7% in broiler chicken (25/60) [95% CI: 29.06%– 55.12%] and 40% in layer chicken

Abstract

Zoonotic diseases cause repeated outbreaks in humans globally. The majority of emerging infections in humans are zoonotic. COVID19 is an ideal example of a recently identified emerging zoonotic disease, causing a global pandemic. Anthropogenic factors such as modernisation of agriculture and livestock farming, wildlife hunting, the destruction of wild animal habitats, mixing wild and domestic animals, wildlife trading, changing food habits and urbanisation could drive the emergence of zoonotic diseases in humans. Since 2001, Bangladesh has been reporting many emerging zoonotic disease outbreaks such as nipah, highly pathogenic avian influenza, pandemic H1N1, and COVID19. There are many other potential zoonotic pathogens such as Ebola, Middle East respiratory syndrome coronavirus, Kyasanur forest disease virus and Crimean– Congo haemorrhagic fever that may emerge in the future. However, we have a limited understanding of zoonotic diseases’ overall risk in humans and associated factors that drive the emergence of zoonotic pathogens. This narrative review summarised the major emerging, reemerging, neglected and other potential zoonotic diseases in Bangladesh and their associated risk factors. Nipah virus and Bacillus anthracis caused repeated outbreaks in humans. More than 300 human cases with Nipah virus infection were reported since the first outbreak in 2001. The highly pathogenic avian influenza virus (H5N1) caused more than 550 outbreaks in poultry, and eight human cases were reported so far since 2007. People of Bangladesh are frequently exposed to zoonotic pathogens due to close interaction with domestic and peridomestic animals. The rapidly changing intensified animal– human– ecosystem interfaces and risky practices increase the risk of zoonotic disease transmission. The narrative review's findings are useful to draw attention to the risk and emergence of zoonotic diseases to public health policymakers in Bangladesh and the application of onehealth approach to address this public health threat. We conducted a narrative review of the published literature with a focus on zoonotic diseases reported from Bangladesh. Relevant research articles, review articles, abstracts, case reports, communications, letters, book chapters, conference proceedings and other relevant documents were searched in MEDLINE, PubMed, PubMed Central and Google Scholar. Specific

Abstract

Community awareness regarding rabies and treatment seeking behaviours are critical both for the prevention and control of the disease in human and animals. We conducted a study to explore people’s awareness about rabies, their attitudes towards dogs and practices associated with treating dog bites in Satkhira Sadar, a southwestern sub-district of Bangladesh. Of the total 3200 households (HHs) surveyed, the majority of the respondents have heard about rabies (73%) and there was a high level of awareness that dog bite is the main cause of rabies (86%), and that rabies can be prevented by vaccination (85%). However, 59% of the dog bite victims first seek treatment from traditional healers instead of visiting the hospitals, 29% received the rabies vaccine, 2% practiced proper wound washing with soap and water, while 4.8% have not taken any measures. None of the victims have received rabies immunoglobulin (RIG). Of the respondents, 5.2% reported a history of dog bite in at least one family member, and 11.8% reported a history of dog bite in domestic animals during the previous year. The HHs having a higher number of family members (OR: 1.13, 95% CI: 1.07–1.2), having a pet dog (OR: 2.1, 95% CI: 1.4–3.2) and caring or feeding a community dog (OR: 2.1, 95% CI: 1.4–2.9) showed an increased risk of getting a dog bite. Among the bite victims, 3.6% (n= 6) humans and 15.8% (n = 60) animals died. As a measure for dog population management (DPM), 56% preferred sterilization while the rest preferred killing of dogs. The current treatment seeking behaviours of the respondents should be improved through additional education and awareness programme and better availability for the provision of post-exposure prophylaxis in Bangladesh. We recommend scaling up national mass dog vaccination and DPM to reduce the burden of rabies cases and dog bites in Bangladesh.

Abstract

Bangladesh has reported repeated outbreaks of highly pathogenic avian influenza (HPAI) A(H5) viruses in poultry since 2007. Because of the large number of live poultry markets (LPM) relative to the population density of poultry throughout the country, these markets can serve as sentinel sites for HPAI A(H5) detection. Through active LPM surveillance during June 2016–June 2017, HPAI A(H5N6) viruses along with 14 other subtypes of influenza A viruses were detected. The HPAI A(H5N6) viruses belonged to clade 2.3.4.4 and were likely introduced into Bangladesh around March 2016. Human infections with influenza clade 2.3.4.4 viruses in Bangladesh have not been identified, but the viruses had several molecular markers associated with potential human infection. Vigilant surveillance at the animal-human interface is essential to identify emerging avian influenza viruses with the potential to threaten public and animal health.

Abstract

ighly pathogenic avian influenza (HPAI) H5N1 has caused severe illnesses in poultry and in humans. More than 15,000 outbreaks in domestic birds from 2005 to 2018 and 861 human cases from 2003 to 2019 were reported across the world to OIE (Office International des Epizooties) and WHO (World Health Organization), respectively. We reviewed and summarized the spatial and temporal distribution of HPAI outbreaks in South Asia. During January 2006 to June 2019, a total of 1063 H5N1 outbreaks in birds and 12 human cases for H5N1 infection were reported to OIE and WHO, respectively. H5N1 outbreaks were detected more in the winter season than the summer season and PubMed to collect data from published articles using the following