Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group.

The goal to eliminate malaria from the Asia-Pacific by 2030 will require the safe and widespread delivery of effective radical cure of malaria. In October 2017, the Asia Pacific Malaria Elimination Network Vivax Working Group met to discuss the impediments to primaquine (PQ) radical cure, how these can be overcome and the methodological difficulties in assessing clinical effectiveness of radical cure. The salient discussions of this meeting which involved 110 representatives from 18 partner countries and 21 institutional partner organizations are reported. Context specific strategies to improve adherence are needed to increase understanding and awareness of PQ within affected communities; these must include education and health promotion programs. Lessons learned from other disease programs highlight that a package of approaches has the greatest potential to change patient and prescriber habits, however optimizing the components of this approach and quantifying their effectiveness is challenging. In a trial setting, the reactivity of participants results in patients altering their behaviour and creates inherent bias. Although bias can be reduced by integrating data collection into the routine health care and surveillance systems, this comes at a cost of decreasing the detection of clinical outcomes. Measuring adherence and the factors that relate to it, also requires an in-depth understanding of the context and the underlying sociocultural logic that supports it. Reaching the elimination goal will require innovative approaches to improve radical cure for vivax malaria, as well as the methods to evaluate its effectiveness

Detection of extended spectrum β-lactamase producing Gram-negative organisms: hospital prevalence and comparison of double disc synergy and E-test methods

Background and objectives: Emergence of extended spectrum beta-lactamase (ESBL) producing bacteria is a major public health concern. Detection of multi drug resistant (MDR) ESBL producing organisms is necessary to prevent its spread and effective treatment. The purpose of the present study was to determine the magnitude of ESBL producing organism in hospital setting and to compare the suitability of double disc synergy test (DDST) and cefepime-clavulanate E-test method for the detection of ESBL producing organisms in routine microbiology laboratory. Materials and methods: The study was carried out in the Department of Microbiology, Sir Salimullah Medical College, Dhaka from January 2011 to December 2011. Clinical samples included urine and pus from patients with suspected urinary tract and wound infections respectively. Standard microbiological methods were employed for isolation and identification of the organisms. DDST and E-test were used to detect ESBL producing Gram negative organisms. Results: A total of 186 Gram-negative organisms were isolated from various samples. Among the 186 Gram negative bacteria, 120 (64.5%) were Esch. coli while 33 (17.7%), 20 (10.8%) and 11 (5.9%) were Pseudomonas sp, Klebsiella sp and Proteus sp respectively. Out of total 186 isolates, 77 (41.4%) and 73 (39.2%) isolates were found ESBL producers by DDST and E-test method (p=0.674) respectively. Compared to Escherichia coli, Pseudomonas and Proteus, significantly high (p<0.01) proportion of Klebsiella were ESBL positive by both DDST and E-test methods. The detection rate of ESBL producing organisms was not significantly different by DDST and E-test (41.4% vs 39.2%). Non-determinable result was obtained for 4 (2.2%) isolates by E-test method. Conclusion: In our present study, a substantially large number of clinical isolates were found ESBL producers. Compared to E-test, DDST was found as a reliable, convenient and inexpensive method for detection of ESBL producing organism in routine microbiology laboratory practice. IMC J Med Sci 2018; 12(1): 32-3

Antimicrobial Sysceptibility Pattern of Enteropathogenic Escherichia coli (EPEC) in Paediatric Diarrhoeal Patients

Enteropathogenic Escherichia coli (EPEC) mediated infantile diarrhoea among children is an important cause of morbidity and mortality in developing countries. The antimicrobial susceptibility pattern of EPEC strains isolated from children under 5 years of age was studied. Stool samples from 272 patients with diarrhoea were collected from two tertiary care hospitals. Out of 272 stool samples, 20 (7.35%) isolates were identified as EPEC on the basis of presence of bfpA gene detected by polymerase chain reaction and antibiotic susceptibility testing was performed on these EPEC strains by Kirby-Bauer disc diffusion method. The antimicrobial susceptibility test revealed that the EPEC isolates were highly resistant to ampicillin (100%), nalidixic acid (95%) and tetracycline (95%) and were sensitive to ceftazidime (95%), cefotaxime (90%), ceftriaxone (95%), imipenem (100%) and levofloxacin (85%). Isolation of EPEC is of great importance since they are responsible for acute diarrhoeal diseases in large number of children under the age of five years. The high antimicrobial resistance observed in our study indicates indiscriminate or improper use of antimicrobials, besides the risks of self-medication. Ibrahim Med. Coll. J. 2014; 8(1): 12-1

Evaluation of MRSA chrome agar for the detection of methicillin resistant staphylococcus aureus

The aim of this study was to evaluate the efficacy of MRSA Chrome agar to detect methicillin resistant Staphylococcus aureus (MRSA) and compare it with 1µg oxacillin disc diffusion tests and detection of mecA gene by PCR. A total 116 Staphylococcus aureus (S. aureus), isolated from various clinical samples, were obtained from three tertiary care hospitals of Dhaka city. S. aureus was identified by colony characters, Gram stain and standard biochemical procedures. MRSA was detected by susceptibility to 1µg oxacillin disc, growth of denim blue color colonies of S. aureus on the Brilliance MRSA Chrome agar at 24 and 48 hours of incubation. PCR was performed for amplification of mecA gene as a gold standard method. Out of 116 isolated S. aureus, 33 (28.44%) were MRSA by oxacillin disc diffusion test where mecA gene was detected in 28 strains. On MRSA Chrome agar, 29 (25.0%) S. aureus produced denim blue colonies at 24 hours, of which 28 isolates possessed mecA gene. At 48 hours incubation, an additional 4 isolates yielded denim blue colonies from which mecA gene could not be identified. All the strains of S. aureus that produced denim blue colonies at 24 and 48 hours were resistant to oxacillin. The sensitivity, specificity and accuracy of oxacillin disc diffusion test were 100%, 94.31% and 95.68% and Chrome agar at 24 hours were 100%, 98.86% and 99.13% respectively. Thus MRSA Chrome agar could be good choice in clinical microbiology laboratory for rapid and accurate identification of MRSA. Ibrahim Med. Coll. J. 2013; 7(1): 1-

Dengue Situation in Bangladesh: An Epidemiological Shift in terms of Morbidity and Mortality

The escalating dengue situation in Bangladesh has been emerging as a serious public health problem in terms of morbidity and mortality. Results of analysis of 40,476 cases of Bangladesh occurring during 2000–2017 indicated that 49.73% of the dengue cases occurred during the monsoon season (May–August) and 49.22% during the post-monsoon season (September–December). However, data also showed that, since 2014, these trends have been changing, and dengue cases have been reported during the pre-monsoon season. During 2015–2017, in the pre-monsoon season, the dengue cases were reported to be more than seven times higher compared to the previous 14 years. The findings closely correlate with those of the pre-monsoon Aedes vector survey which revealed the presence of high density of larva and pupa of the dengue vectors in the environment all the year round. In our study, climate changes, such as average rainfall, humidity, and temperature, after 2014, and rapid unplanned urbanization were the strong predictors of an imbalance in the existing ecology that has led to increase in dengue cases in 2016 and the emergence of the chikungunya virus for the first time in Bangladesh in 2017. Although 2018 dengue data are relevant but not included in this study due to study time frame, it is interesting to report an increase in the number of dengue cases in pre (2016) and post (2018, which is highest within 18 years) chikungunya outbreak, which favors the study hypothesis. Despite the efforts to control dengue, based primarily on the vector control and case management, the burden and costs of the disease and similar vector-borne diseases will continue to grow in future in our country. Developing a cost-effective vaccine against all the 4 strains of dengue remains a challenge. The CDC, in collaboration with other research organizations, may come forward to initiate and coordinate a large-scale randomized clinical trial of an effective dengue vaccine in Bangladesh