Pattern of Dermatophytes in Patients Attend in Mymensingh Medical College Hospital

Dermatophytosis is a common fungal disease which involves the keratinized tissue. This is an attempt to observe the spectrum of dermatophytes among the clinically suspected cases of dermatophytosis attending the outpatient department of Dermatology and Venereology, Mymensingh Medical College Hospital, Mymensingh during the period of July 2013 to December 2014. Two hundred thirty (230) clinically suspected cases of dermatophytosis were subjected in this study. Sixty three cases (27.39%) were positive for fungus in direct microscopy while 53(23.04%) were culture positive. Among the clinical types tinea unguium was the most common followed by tinea corporis. Dermatophytosis was more common in the age group of 21-30 years. The male to female ratio was 1.53:1. Trichophyton rubrum 44(83.04%) was found common etiological dermatophyte species followed by Trichophyton mentagrophytes 5(9.43%) and Epidermophyton floccosum 4(7.55%).

Use of modified blood agar plate for identification of pathogenic campylobacter species at Mymensingh Medical College

This cross sectional study was carried out from July 2011 to June 2012 in the Department of Microbiology, Mymensingh Medical College to diagnose etiology of diarrhea caused by Campylobacter species. A total of 200 clinically diagnosed diarrheal pediatric patients were included in this study. Among the 200 stool specimens evaluated, 23(11.5%) samples were positive for Campylobacter species, isolation rate was 15(65.2%) in upto 1 year age group and 08(34.7%) in more than 1 year age group. Among 23 positive cases, 20(86.95%) were C. jejuni and 03(13.05%) were C. coli. The prevalence of Campylobacter infection found in the present study was higher below 1 year age group and was very much close to other countries of this Sub continent.

Culture of pathogenic campylobacter species at Mymensingh Medical College

Childhood diarrhea represents a major public health problem in developing countries, where campylobacteriosis is widespread and causes significant morbidity and mortality in infants and children. Despite the increasing importance of campylobacteriosis, most developing countries and even many developed countries do not have surveillance systems to measure the health and economic burden of human campylobacteriosis, nor detect trends in outbreaks. The present study was carried out to diagnose etiology of diarrhea caused by Campylobacter species. A total of 150 clinically diagnosed diarrheal pediatric patients were included in this study, of which 98(65.3%) were male and 52(34.6%) female from the Department of Pediatrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2011 to April 2012. Stool specimens were collected from each of the cases. The specimens were cultured in appropriate media and Campylobacters were isolated and identified by recommended tests. Among 150 cases, 17(11.3%) were culture positive for Campylobacter species, of which 15(88.2%) were C. jejuni and 02(11.7%) were C. coli. Of the cases, below 1 year of age group were 106(70.6%) cases showing 12(70.5%) positive for Campylobacters and 44(29.33%) cases were above 1 year of age group showing 05(29.41%) positive. The prevalence of Campylobacter infection found in the present study was higher below 1 year age group and was very much close to other countries of this subcontinent.

Efficacy of Peppermint oil in diarrhea predominant IBS - a double blind randomized placebo - controlled study

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder which is associated with considerable sufferings of patient and Peppermint oil is volatile oil, its active principle is menthol-contain a cyclic monoterpine which has anti-spasmotic properties due to its ability to block calcium channel of intestinal smooth muscles. This study observed the efficacy of peppermint oil for relieving the symptoms and changes of quality of life (QOL) in diarrhea predominant IBS. This was a prospective double blind randomized placebo-controlled study conducted in the Bangabandhu Sheikh Mujib Medical University during July 2008 to September 2009. Patients who fulfilled ROME II were initially selected but those had red flag signs or any organic disease was excluded from the study. Seventy four patients were enrolled in the study and randomly allocated to receive either peppermint oil or placebo three times daily for six weeks. Changes of symptoms were assessed three week interval during treatment and two weeks after the end of treatment. Data were analyzed by paired and unpaired 't' test. Finally sixty five patients completed the trial. It was observed that, at six weeks of therapy abdominal pain is markedly improved (mean±SD) 4.94±1.30 in peppermint oil group compared with 6.15±1.24 in placebo group and the difference was statistically highly significant (p>0.001). But two weeks after end of trials pain score again increased (6.09±1.93). Other symptoms and quality of life did not improve significantly. So the study result concludes that peppermint oil is effective in reliving only abdominal pain in diarrhea predominant IBS transiently.

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500μl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.

Human thelaziasis in Bangladesh

Very few cases of Human Thelaziasis are reported worldwide. This is the first case of its kind from Bangladesh. A 58 years old man was admitted to Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, with itching, redness, foreign body sensation, lacrimation & filamentary discharge from right eye (R/E). He had visual acuity <6/60, conjunctival congestion & advanced bi-headed pterygium of R/E. After exposure of R/E ball with universal eye's speculum, a thin white nematode was found into the right lower conjunctival fornix. It was taken out by a plain forceps, placed into a bottle containing Hartman's solution & immediately sent to Microbiology department of Mymensingh Medical College for proper identification. Subsequently with the joint collaboration & detailed examination by the Parasitology department of Bangladesh Agricultural University (BAU), Mymensingh, the nematode was identified as an adult Thelazia callipaeda worm.

Instability of human rotavirus G genotypes circulating in a rural area of Bangladesh

A total of 280 fecal specimens from patients with acute gastroenteritis attending one rural hospital (Dharmapasha health complex, Sunamgonj) in Bangladesh from August 2004 to May 2006 were tested for rotavirus by Polyacrylamide Gel Electrophoresis (PAGE). The diversity of rotavirus was investigated using electropherotyping and reverse transcription-PCR amplification of the VP7 and VP4 genes. The electrophoretic patterns of dsRNA of rotavirus showed 9 different migrations (6 long and 3 short) by PAGE. In the year 2004-2006, group A rotavirus was detected in 112 out of 280(40.0%) specimens. G and P genotyping was performed among the 46 representative positive specimens, 20(43.5%) were emerging strain G9P[8], which were associated with VP6 genotype II (subgroup II), and NSP4 genotype B, followed by 16(34.8%) G2P[4], 8(17.4%) G1P[8] and 2(4.4%) G4P[8] strains. G9P[8] was found to be the most predominant strain in 2004, but the prevalence rate abruptly decreased during the period 2005-2006. In addition G2P[4] was the most prevalent strain in 2005 and 2006. G1P[8] was less prevalent in the study period then the previous years. Nucleotide Sequence identity of VP7 gene of G9 rotaviruses were higher than 99.4% with each other and all the G9 rotavirus strains in this study clustered in a single branch of the phylogenetic tree. Nucleotide sequence identity of complete VP4 gene of P[8] rotaviruses were more than 99.7% with each other and all the P[8] rotavirus strains in this study grouped in a single cluster suggesting recent emergence from a common ancestor. An important finding of this study is that the genetic profile of rotavirus is changing within very short period in Bangladesh and continued surveillance of the circulating strains is necessary to detect new strains or new variants which can escape immune protection induced by available vaccines.

Molecular characterization of group A human rotavirus among hospitalized children and adults in Bangladesh: finding of emerging G12 strain

Between July 2004 and June 2006, a total of 1438 fecal samples were collected from Hospitalized children and adults with diarrhea at an Infectious Disease Hospital (SK Hospital) in Mymensingh, Bangladesh. The diversity of rotavirus strains were investigated using electropherotyping and reverse transcription-PCR amplification of the VP7 and VP4 genes. Group A rotavirus was detected in 171 of 1438(11.9%) specimens: 13.3%(72/543) from children 6 months to </=15 years of age and 11.0%(99/895) from individuals aged >15-76 years. The electrophoretic patterns of dsRNA of rotavirus showed 11 different migrations (7 long and 4 short) by polyacrylamide gel electrophoresis (PAGE). Representative 60 positive samples were selected for PCR genotyping. For the entire period, the common rotavirus G types G1 (27%), G2 (45%), and G9 (7%), comprised 79% of the strains, and common P types, P[4] (43%), P[6] (12%), and P [8] (20%), comprised 75% of the total P types. Of note, we detected a high percentage of unusual G-type P-type combination (11%) strains and specimens with mixed (10% G and 23% P) rotavirus infection with a variety of genomic constellation. Overall, the most frequent rotavirus strains were G2P[4] (36.7%) both in children and adults which were mostly associated with VP6 genotype I (subgroup I), and NSP4 genotype A or B, followed by G1P[8] (10.0%), G9P[8] (6.7%). G12 was detected for the first time in the study area and the detection rate was G12P[6] (3.4%), and G12P[4] (1.7%). The nucleotide sequence of VP7 gene was highly homologous among G12 strains isolated in Mymensingh suggesting recent emergence from a common ancestor. The study highlighted the diversity of rotaviruses isolated from children and adults. Due to the effect of antigenic diversity on rotavirus vaccines, it is important to continue careful monitoring of these strains as rotavirus vaccine programs are being implemented in Bangladesh.

Seroprevalence of human brucellosis among the population at risk in rural area

This study was performed to evaluate the seroprevalence of brucellosis among the risk group of population. A cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, between the period from July 2007 to June 2008. A total of 210 samples were included in this study from risk group of population. A variety of serological tests have been applied for detection of antibodies against Brucella spp. Among the 210 subjects from risk group of population, 9(4.28%), 7(3.33%) and 7(3.33%) were positive for brucellosis by slide agglutination test, rose bengal plate agglutination test (RBPA) and standard tube agglutination test (STAT) respectively. Out of total specimen 10 positive and 29 negative serum as detected by slide agglutination, rose bengal plate agglutination test (RBPT) and STAT were also examined by Enzyme linked immunosorbent assay (ELISA) for detection of IgG. Among them, 10 were positive by ELISA IgG. Seroprevalence among occupational groups were 11.11% in veterinary personnel, 6.45% in dairy workers and 4.67% in animal farmers. This study indicated that brucellosis is not uncommon at rural area of Mymensingh region in Bangladesh. It was suggested to conduct community survey and to plan properly the measures of control and prevention.

Role of immunochromatographic test for rapid diagnosis of malaria

The study was conducted to compare among the different diagnostic procedures for malaria in the department of Microbiology, Mymensingh Medical College, Mymensingh during the period from July 2005 to June 2006. In this study a total of 98 malaria patients were included as cases. Another 30 age and sex matched healthy people were included as controls. Blood sample from each of the case and control was collected and examined for malarial parasite by microscopic examination of peripheral blood film. Subsequently antigen and antibody were detected by immuno-chromatographic test (ICT). Out of 98 clinically suspected cases 59(60.20%) were positive for malarial parasite by microscopic examination of peripheral blood film, 57(58.16%) were positive by ICT for antigen and 58(59.19%) were positive by ICT for antibody. Sensitivity and specificity of ICT for antigen were 93.22% and 94.87% respectively. For antibody, sensitivity and specificity were 89.83% and 87.17% respectively. From this study, sensitivity and specificity of ICT for malaria was found quite satisfactory, so it is suggested that ICT for malaria could be an alternative to peripheral blood film for the diagnosis of malaria where parasite could not be detected in peripheral blood film.

Preliminary report on anaerobic culture at Mymensingh Medical College Hospital in Bangladesh

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. This study was undertaken to isolate and identify the anaerobic bacterial agents of puerperal sepsis among the patients admitted in Mymensingh Medical College Hospital (MMCH) during the period from July 2006 to June 2007. Endocervical swabs/secretions were collected from 50 cases of puerperal sepsis and were cultured anaerobically. Anaerobiasis was done by using gas pack (BD GAS PAK TM EZ) in anaerobic jar. Out of 50 samples, 42(84%) yielded growth in cultures. Among 42 culture positive cases, 20(40%) were Aerobic organisms and 22(44%) were mixed, i.e., Aerobic and Anaerobic bacteria. The isolated Anaerobic organisms were Peptostreptococcus 14(63.63%), Bacteroides fragilis 3(13.64%), Prevotella melaninogenica 3(13.64%) and Clostridium perfringens 2(9.09%). As a preliminary study, it was observed that anaerobic culture could be carried out with available logistic arrangement. So, it was recommended to design further study on anaerobic bacterial isolation with particular emphasis on their antimicrobial susceptibility.

Anti H.pylori IgM in symptomatic and asymptomatic population

To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.

Comparison between DOT EIA IgM and Widal Test as early diagnosis of typhoid fever

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

Genetic characterization of Staphylococcus aureus isolates carrying Panton-Valentine leukocidin genes in Bangladesh

To assess the spread and genetic characteristics of Panton-Valentine leukocidin (PVL) gene-carrying Staphylococcus aureus in Bangladesh, we investigated 59 strains (49 isolates from clinical specimens and 10 isolates colonized in the nasal cavities of medical staff), including 26 methicillin-resistant S. aureus (MRSA) strains. The PVL gene was detected only in methicillin-susceptible S. aureus (MSSA) strains (7 clinical strains and 2 colonizing strains). PVL gene-positive MSSA strains were found to belong to coagulase serotypes III or VI and were classified into sequence types ST88 (CC88), ST772, and ST573 (CC1) by multilocus sequence typing, and agr types 2 or 3. These types were different from those determined for MRSA (coagulase serotypes I and IV, ST240 and ST361, and agr type 1). PVL gene-positive MSSA possessed a larger number of virulence factor genes than MRSA, although they were susceptible to more antimicrobials. These findings suggest that the PVL gene is distributed to limited populations of S. aureus clones with specific genetic traits that are distinct from MRSA in Bangladesh, but genetically close to CA-MRSA clones in the CC1 lineage reported in the United States and European countries.

Resistance pattern of bacteria isolated from acute respiratory tract infection (ARI) cases

Out of 350 acute respiratory tract infection (ARI) patients 110 (31.4%) were positive on culture. Among then (35.5%) yielded from upper respiratory tract infection (URI) and 64.5% yielded from lower respiratory tract infection (LRI). Predominant bacterial isolates from URI were Staph aureus (12.4%) and Strepto. pyogen (9.8%) whereas predominant agent from LRI were Strepto. pneumoniae (14.7%) and Haemophilus influenzae (8.6%). Capsular typing by polymerase chain reaction (PCR) and type specific antisera revealed that 64.7% of the isolates were type-b and rest were non-b. The most frequent resistance pattern of H. influenzae was found resistant to penicillin-ampicillin (64.7%) followed by SMX-TMP (14.7%) and tetracycline (5.9%). Among penicillin-ampicillin resistant strains, 81.8% were beta lectamase positive and 18.2% were beta lectamase negative. Among beta lectamase positive strains 66.7% were capsular type-b and 33.3% were non-b, had MICS < or = 8 microgram/ml. and < or = 4 microgram/ml. respectively. 5.9% strains of Strepto. pneumoniae was found resistant to SMX-TMP, 5.9% to penicillin-ampicillin and 2.9% to cephalexin. Common resistance pattern of Staph aureus was penicillin-ampicillin (60%), SMX-TMP (37.2%) and tetracycline-erythromycine-cephalexin (11.4%). Strepto. pyogen was found resistant to tetracycline in 12.2% cases and to SMX-TMP in 8.3% cases.

Increasing trend of ciprofloxacin resistance amongst common bacterial isolates at Mymensingh Medical College and Hospital

Ciprofloxacin resistance among common bacterial pathogen comprising Esch.coli, Staph.aureus and Pseudomonas spp. isolated from different clinical samples of Mymensingh Medical College Hospital during the periods of September, 1999 to March, 2001 and September, 2001 to August, 2002 were recorded. Values of two periods were compared and increased rate of ciprofloxacin resistance were noted in every bacterial species, e.g. 32.0% in Esch.coli, 8.7% in Staph.aureus and 5.1% in Pseudomonas spp. It was suggested to be aware and careful regarding use of ciprofloxacin in clinical practice so as to limit emergence of bacterial strains resistance towards the drug.