Investigating the Association Between ABO Blood Groups and Rhesus Factors with Dengue and Chikungunya Virus Infections During the 2017 Outbreak in Bangladesh

This retrospective study was conducted in 2017 during the dual dengue and chikungunya outbreak in Bangladesh. Febrile participants underwent blood tests for chikungunya, dengue, and ABO groups and rhesus (Rh) factors. Blood grouping information was gathered from healthy donors. Males and those aged between 18 and 49 years had a higher risk of contracting dengue and chikungunya. Blood group O exhibited the highest infection rates at ∼50%, whereas group AB had the lowest at ∼9% among the participants in the study. Yet, when considering the general population's blood group distribution, the combined odds of infection were 2.0, 3.5, and 1.4 times higher in groups B, O, and AB, respectively, than in group A. Infection rates were greater in Rh-negative people. Blood groups B, O, and AB showed higher susceptibility than blood group A according to adjusted odds ratios. Blood groups ABO and Rh factor hold significance in disease susceptibility and vaccine effectiveness. Keeping these implications in mind, further investigations are necessary to understand the mechanisms underlying these connections and their effects on the efficacy of dengue and chikungunya vaccines.

Challenges in the establishment of a biosafety testing laboratory for COVID-19 in Bangladesh

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in Bangladesh, there was a scarcity of ideal biocontainment facilities to detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a risk group of 3 organisms. Molecular detection of SARS-CoV-2 must be performed in a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices. Establishing these facilities within a short timeframe proved to be an enormous challenge, including locating a remote space distant from the university campus to establish a laboratory, motivating the laboratory staff to work with a novel pathogen without any prior experience, allocation of funds for essential equipment and accessories, and arrangement of a safe waste management system for environmental hazard reduction. This report also highlights several limitations, such as the facility's architectural design that did not follow the biosafety guidelines, lack of continuous flow of funds, and an inadequate number of laboratory personnel. This article describes various efforts taken to overcome the challenges during the establishment of this facility that may be adopted to create similar facilities in other regions of the country. Establishing a BSL-2 laboratory with BSL-3-equivalent infection prevention and control practices will aid in the early detection of a large number of cases, thereby isolating persons with COVID-19, limiting the transmission of SARS-CoV-2, and promoting a robust public health response to contain the pandemic.

A tightly clustered hepatitis E virus genotype 1a is associated with endemic and outbreak infections in Bangladesh

BACKGROUND

Hepatitis E virus (HEV) infection is endemic in Bangladesh and there are occasional outbreaks. The molecular characteristics and pathogenesis of endemic and outbreak HEV strains are poorly understood. We compared the genetic relatedness and virulence associated mutations of endemic HEV strains with outbreak strains.

METHODS

We analyzed systematically collected serum samples from HEV immunoglobulin M (IgM) positive patients attended at Bangabandhu Sheikh Mujib Medical University, Dhaka from August 2013 to June 2015. HEV RNA positive samples were subjected to whole genome sequencing. Genotype and subtype of the strains were determined by phylogenetic analysis. Virulence associated mutations e.g. acute viral hepatitis (AVH), fulminant hepatic failure (FHF), chronic hepatitis, ribavirin treatment failure (RTF), B and T cell neutralization epitopes were determined.

RESULTS

92 HEV immunoglobulin M (IgM) antibody positive plasma samples (43 in 2013-2014 and 49 in 2014-2015) were studied. 77.1% (70/92) of the samples were HEV RNA positive. A 279 bp open reading frame (ORF) 2 and ORF 3 sequence was obtained from 54.2% (38/70) of the strains. Of these 38 strains, whole genome sequence (WGS) was obtained from 21 strains. In phylogenetic analysis of 38 (279 bp) sequence all HEV sequences belonged to genotype 1 and subtype 1a. Further phylogenetic analysis of 21 HEV WGS, Bangladeshi HEV sequences clustered with genotype 1a sequences from neighboring countries. Within genotype 1a cluster, Bangladesh HEV strains formed a separate cluster with the 2010 HEV outbreak strains from northern Bangladesh. 80.9 to 100% of the strains had A317T, T735I, L1120I, L1110F, P259S, V1479I, G1634K mutations associates AVH, FHF and RTF. Mutations in T cell recognition epitope T3, T5, T7 was observed in 76.1%, 100% and 100% of the strains respectively.

CONCLUSION

Strains of HEV genotype 1a are dominant in Bangladesh and are associated with endemic and outbreak of HEV infection. HEV isolates in Bangladesh have high prevalence of virulence associated mutations and mutation which alters antigenicity to B and T cell epitopes.

Experience in establishing a high-risk biocontainment facility in response to COVID-19 pandemic under resource constrain settings

The health care systems in resource limited countries are facing major challenges in dealing with Coronavirus disease (COVID-19). In Bangladesh, a steady increase in the number of COVID-19 cases since its first report on March 8, 2020, has led to an increased demand for COVID-19 detection facilities throughout the country. The detection of severe acute respiratory syndrome (SARS-CoV-2), the causative organism of COVID-19 and a highly infectious group 3(three) organism, requires a high biocontainment laboratory with a certain standard prerequisite infrastructure. This study describes the necessary steps for establishing and running a COVID-19 laboratory under resource constraint settings. Our experience indicates that, with collaborative efforts, funding, and technical support from locally available expertise, it is feasible to set up an optimally functional biocontainment facility with an acceptable quality performance despite several short comings. BSMMU J 2021; 14 (COVID -19 Supplement): 45-50

Persistence of SARS-CoV-2 RNA in a male with metabolic syndrome for 72 days: A case report

Coronavirus disease-19 (COVID-19) was first identified in Wuhan, China, and spread gradually throughout the world. There are multiple reports of prolonged viral shedding in people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, such findings have not been documented in Bangladesh. Herein, we present a case of metabolic syndrome that remained positive for SARS-CoV-2 RNA over a prolonged period. On clinical and laboratory examination, the patient was diagnosed with obesity, raised blood pressure, dyslipidemia, and uncontrolled glycemia. However, upon taking appropriate measures and controlling the plasma sugar level, he tested negative for SARS-CoV-2 RNA on the 72nd day since illness onset. We observed that COVID-19 patients with several comorbidities, such as metabolic syndrome, may shed the virus over a prolonged period. Therefore, strict public health measures and isolation rules should be followed by a high-risk population.

Acceptance of a Symptom-Based Approach for COVID-19 rtRT-PCR Testing to Conserve Resources in a Lower Middle-Income Setting

SARS-CoV-2 initially emerged in Wuhan, China in late 2019. It has since been recognized as a pandemic and has led to great social and economic disruption globally. The Reverse Transcriptase Real-Time Polymerase Chain Reaction (rtRT-PCR) has become the primary method for COVID-19 testing worldwide. The method requires a specialized laboratory set up. Long-term persistence of SARS-CoV-2 RNA in nasopharyngeal secretion after full clinical recovery of the patient is regularly observed nowadays. This forces the patients to spend a longer period in isolation and test repeatedly to obtain evidence of viral clearance. Repeated COVID-19 testing in asymptomatic or mildly symptomatic cases often leads to extra workload for laboratories that are already struggling with a high specimen turnover. Here, we present 5 purposively selected cases with different patterns of clinical presentations in which nasopharyngeal shedding of SARS-CoV-2 RNA was observed in patients for a long time. From these case studies, we emphasized the adoption of a symptom-based approach for discontinuing transmission-based precautions over a test-based strategy to reduce the time spent by asymptomatic and mildly symptomatic COVID-19 patients in isolation. A symptom-based approach will also help reduce laboratory burden for COVID-19 testing as well as conserve valuable resources and supplies utilized for rtRT-PCR testing in an emerging lower-middle-income setting. Most importantly, it will also make room for critically ill COVID-19 patients to visit or avail COVID-19 testing at their convenience.

Detection of SARS-CoV-2 RNA in conjunctival swab of a COVID-19 patient: The first report from Bangladesh

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 RNA (SARS-CoV-2 RNA). It usually manifests by fever and/or respiratory illness. Here, we present a case of COVID-19 patient who initially presented ocular symptoms like redness, itching, and watery discharge. Afterward, the patient developed fever and anosmia suggestive of COVID-19 disease. Nasopharyngeal swab and conjunctival swab test for SARS-CoV-2 RNA revealed positive by reverse-transcriptase real-time polymerase chain reaction. The patient was managed symptomatically at home and did not require any hospital admission. On day 12, the patient clinically recovered fully and his follow-up testing for SARS-CoV-2 RNA of both conjunctival swab and nasopharyngeal swab became undetected. This report emphasized that conjunctival mucosa may be considered as a portal of entrance for SARS-CoV-2 RNA in addition to the respiratory route. This study highlighted that any kind of ocular manifestations, such as conjunctival hyperemia, chemosis, watery discharge, periorbital erythema, and burning sensation should never be overlooked for probable COVID-19 in current pandemic settings. Moreover, strict eye protection using goggles/face shield should be used by all health care workers despite any working environment while caring for patients with or without COVID-19-related signs.

Study on Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.

Hepatitis C Virus Genetic Variability and Quasispecies

Hepatitis C virus (HCV) exists as a cloud of closely related sequence variants called a quasispecies, rather than as a population of identical clones. To date there is no preventive vaccine and though antiviral therapy has been improved in the past few years the HCV cannot be eradicated in all patients as a result of its quasispecies nature due to lack of proof reading activities and high error rate of RNA-dependent RNA polymerase and the pressure exerted by host immune system. This review focuses on the genetic diversity and quasispecies nature of HCV viral genomes, and briefly reviews the principles of quasispecies dynamics and the differences with classical population genetics and discusses the biological implications of this phenomenon, focusing on the hepatitis C virus.Delta Med Col J. Jan 2018 6(1): 45-52

Significance of Age-Spleen-Platelet Ratio Index (ASPRI) to Exclude Cirrhosis in Patients with Chronic Hepatitis B

Liver biopsy is an integral part of management of patients with Chronic Hepatitis B (CHB), which is helpful in confirming diagnosis, assessing grade of inflammation and stage of fibrosis and also in guiding treatment strategy. Although liver biopsy is relatively safe, morbidity occurs in 0.2-2% of patients. Hence various non-invasive markers, like AST-ALT Ratio (AAR), Age-Platelet Index (API), AST to Platelet Ratio Index (APRI), Fibroscan etc. have been developed worldwide to asses liver histology. Age-Spleen-Platelet Ratio Index (ASPRI) is new in this series. In this cross sectional study 51 (fifty one) patients with CHB, attending at Hepatology ward in Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2006 to May 2006, were studied. They were divided into two groups: Group I patients with ASPRI<5 and Group II patients with ASPRI>5. Clinical, serological, biochemical, virological parameters were analyzed and following liver biopsy, correlation of liver fibrosis with ASPRI was evaluated. Among 51 patients of CHB, 30 patients Group I with ASPRI<5 (mean 3.4) had mean fibrosis 1.3 using Knodell scoring system; while mean age, spleen size and platelet count were 23.2 years, 8.6cm and 278?10⁹/L accordingly. In Group II, 21 patients with ASPRI>5 (mean 5.8) had mean fibrosis 1.8; mean age was 30.6 years, spleen size 9.5cm and platelet count 195?10⁹/L. Mean liver fibrosis was significantly increased in Group II patients. In Group I patients, liver fibrosis showed significant correlation with platelet count (p=0.03) and ASPRI (p= 0.011), while none was observed in Group II patients. Age-Spleen-Platelet Ratio Index ASPRI can be used as a good tool for diagnosis of liver fibrosis in chronic hepatitis B. However, further study with larger study population is required to assess its validity.

Rubella Antibody Prevalence and Immunogenicity of Single Dose Rubella Vaccine Among 16 – 25 Years Girls from Bangladesh

Rubella virus infection during pregnancy is an important cause of blindness, deafness, congenital heart disease, and mental retardation of the foetus. Multiple sero-surveys of rubella antibody among reproductive aged females of Bangladesh showed that 20-30% of them remain susceptible to rubella as rubella vaccination is yet not included in our national immunization program for adolescent and adult girls. The present study was designed to conduct a sero-survey among unmarried girls of 16 to 25 years to assess their serological status in terms of natural rubella infection and vaccinate the rubella susceptible individuals with a single dose of rubella vaccine to evaluate the immunogenicity of the vaccine. A total of 344 randomly selected unmarried, apparently healthy college students were enrolled and investigated for rubella IgG and IgM antibodies at the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Girls who were found to be negative for both rubella IgG and IgM were vaccinated with a single dose of rubella vaccine and tested for rubella antibody after four to six weeks of vaccination. Quantitative analysis of rubella IgG showed that a total of 68.87% study population had protective rubella antibody, 29.36% were susceptible to rubella and 1.74% experienced recent rubella infection. After vaccination, rubella antibody positivity was found to be 100% among 99 (98.02%) of 101 vaccinated girls who were tested for anti rubella IgG. There was statistically significant increase (p <0.001, Paired t Test) in anti-Rubella IgG titres among pre-vaccination and post-vaccination sera. The findings of the study showed that it is mandatory to include young girls in the national immunization programme and immunize them with a single dose of rubella vaccine which was found to be 100% effective.