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Banu S, Rahman MT, Ahmed S, Khatun R, Ferdous SS, Hosen B, Rahman MM, Ahmed T, Cavanaugh JS, Heffelfinger JD. Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system. Int J Tuberc Lung Dis 2018; 21:12-17. [PMID: 28157459 DOI: 10.5588/ijtld.16.0384] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh. METHODS Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium. RESULTS Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years. CONCLUSIONS The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.
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Affiliation(s)
- S Banu
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - M T Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - S Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - R Khatun
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - S S Ferdous
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - B Hosen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - M M Rahman
- National TB Control Programme, Directorate General of Health Services, Mohakhali, Dhaka, Bangladesh
| | - T Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - J S Cavanaugh
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J D Heffelfinger
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Haider N, Sturm-Ramirez K, Khan SU, Rahman MZ, Sarkar S, Poh MK, Shivaprasad HL, Kalam MA, Paul SK, Karmakar PC, Balish A, Chakraborty A, Mamun AA, Mikolon AB, Davis CT, Rahman M, Donis RO, Heffelfinger JD, Luby SP, Zeidner N. Unusually High Mortality in Waterfowl Caused by Highly Pathogenic Avian Influenza A(H5N1) in Bangladesh. Transbound Emerg Dis 2015; 64:144-156. [PMID: 25892457 DOI: 10.1111/tbed.12354] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Indexed: 12/22/2022]
Abstract
Mortality in ducks and geese caused by highly pathogenic avian influenza A(H5N1) infection had not been previously identified in Bangladesh. In June-July 2011, we investigated mortality in ducks, geese and chickens with suspected H5N1 infection in a north-eastern district of the country to identify the aetiologic agent and extent of the outbreak and identify possible associated human infections. We surveyed households and farms with affected poultry flocks in six villages in Netrokona district and collected cloacal and oropharyngeal swabs from sick birds and tissue samples from dead poultry. We conducted a survey in three of these villages to identify suspected human influenza-like illness cases and collected nasopharyngeal and throat swabs. We tested all swabs by real-time RT-PCR, sequenced cultured viruses, and examined tissue samples by histopathology and immunohistochemistry to detect and characterize influenza virus infection. In the six villages, among the 240 surveyed households and 11 small-scale farms, 61% (1789/2930) of chickens, 47% (4816/10 184) of ducks and 73% (358/493) of geese died within 14 days preceding the investigation. Of 70 sick poultry swabbed, 80% (56/70) had detectable RNA for influenza A/H5, including 89% (49/55) of ducks, 40% (2/5) of geese and 50% (5/10) of chickens. We isolated virus from six of 25 samples; sequence analysis of the hemagglutinin and neuraminidase gene of these six isolates indicated clade 2.3.2.1a of H5N1 virus. Histopathological changes and immunohistochemistry staining of avian influenza viral antigens were recognized in the brain, pancreas and intestines of ducks and chickens. We identified ten human cases showing signs compatible with influenza-like illness; four were positive for influenza A/H3; however, none were positive for influenza A/H5. The recently introduced H5N1 clade 2.3.2.1a virus caused unusually high mortality in ducks and geese. Heightened surveillance in poultry is warranted to guide appropriate diagnostic testing and detect novel influenza strains.
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Affiliation(s)
- N Haider
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Section for Epidemiology, National Veterinary Institute, Technical University of Denmark, Copenhagen, Denmark
| | - K Sturm-Ramirez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - S U Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - M Z Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S Sarkar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M K Poh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - M A Kalam
- Department of Livestock Services, Ministry of Fisheries and Livestock, Dhaka, Bangladesh
| | - S K Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - P C Karmakar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A Balish
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - A Chakraborty
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A A Mamun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A B Mikolon
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,United States Department of Agriculture (USDA), Hawthorne, CA, USA
| | - C T Davis
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - M Rahman
- Institute of Epidemiology, Diseases Control and Research (IEDCR), Dhaka, Bangladesh
| | - R O Donis
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - J D Heffelfinger
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - S P Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Division of Infectious Disease and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - N Zeidner
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, Mabry LR, Musher DM, Plouffe JF, Rakowsky A, Schuchat A, Whitney CG. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Arch Intern Med 2000; 160:1399-408. [PMID: 10826451 DOI: 10.1001/archinte.160.10.1399] [Citation(s) in RCA: 464] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To provide recommendations for the management of community-acquired pneumonia and the surveillance of drug-resistant Streptococcus pneumoniae (DRSP). METHODS We addressed the following questions: (1) Should pneumococcal resistance to beta-lactam antimicrobial agents influence pneumonia treatment? (2) What are suitable empirical antimicrobial regimens for outpatient treatment of community-acquired pneumonia in the DRSP era? (3) What are suitable empirical antimicrobial regimens for treatment of hospitalized patients with community-acquired pneumonia in the DRSP era? and (4) How should clinical laboratories report antibiotic susceptibility patterns for S pneumoniae, and what drugs should be included in surveillance if community-acquired pneumonia is the syndrome of interest? Experts in the management of pneumonia and the DRSP Therapeutic Working Group, which includes clinicians, academicians, and public health practitioners, met at the Centers for Disease Control and Prevention in March 1998 to discuss the management of pneumonia in the era of DRSP. Published and unpublished data were summarized from the scientific literature and experience of participants. After group presentations and review of background materials, subgroup chairs prepared draft responses, which were discussed as a group. CONCLUSIONS When implicated in cases of pneumonia, S pneumoniae should be considered susceptible if penicillin minimum inhibitory concentration (MIC) is no greater than 1 microg/mL, of intermediate susceptibility if MIC is 2 microg/ mL, and resistant if MIC is no less than 4 microg/mL. For outpatient treatment of community-acquired pneumonia, suitable empirical oral antimicrobial agents include a macrolide (eg, erythromycin, clarithromycin, azithromycin), doxycycline (or tetracycline) for children aged 8 years or older, or an oral beta-lactam with good activity against pneumococci (eg, cefuroxime axetil, amoxicillin, or a combination of amoxicillin and clavulanate potassium). Suitable empirical antimicrobial regimens for inpatient pneumonia include an intravenous beta-lactam, such as cefuroxime, ceftriaxone sodium, cefotaxime sodium, or a combination of ampicillin sodium and sulbactam sodium plus a macrolide. New fluoroquinolones with improved activity against S pneumoniae can also be used to treat adults with community-acquired pneumonia. To limit the emergence of fluoroquinolone-resistant strains, the new fluoroquinolones should be limited to adults (1) for whom one of the above regimens has already failed, (2) who are allergic to alternative agents, or (3) who have a documented infection with highly drug-resistant pneumococci (eg, penicillin MIC > or =4 microg/mL). Vancomycin hydrochloride is not routinely indicated for the treatment of community-acquired pneumonia or pneumonia caused by DRSP.
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Affiliation(s)
- J D Heffelfinger
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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