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Roy E.,International Center for Diarrheal Diseases and Research | Hasan K.Z.,ICDDR | Haque R.,ICDDR | Fazlul Haque A.K.M.,ICDDR | Siddique A.K.,Consultant Epidemiologist
SAJCH South African Journal of Child Health | Year: 2011

Objectives. To obtain knowledge on the burden of infestation with soil-transmitted helminths (STHs) in rural children from birth to age 2 years. Methods. Household visits to enrolled children were made twice a week for 2 years, and stool samples were collected once a month. Stools were also collected during diarrhoeal episodes, and when STHs were identified, a single dose of pyrantel pamoate was administered to patients with diarrhoea. All stool samples were examined using the formalin-ether sedimentation technique. Results. About 70% of the children had had STH infestation by 2 years, and approximately 80% of these had STH ova identified on more than one occasion. The mean age at first acquisition was 14 months (standard deviation (SD) 4 months, range 1 - 24 months). Microscopic examination revealed ova of Ascaris lumbricoides (9%), Trichuris trichiura (0.6%), hookworm (0.06%) and mixed infestation (0.4%). In 41 of the 178 children with STH infestation, its first identification was associated with episodes of diarrhoea. Following pyrantel pamoate deworming, 66% of subjects were re-infested after a mean interval of 90 days (SD 79 days). Risk behaviours such as disposal of child faeces and defaecation by adult family members in open spaces and use of common source surface water for washing clothes and utensils were practised by 62%, 83% and 50% of the cohort families, respectively. Bivariate analysis shows that disposal of child faeces in a closed space resulted in a 35% reduction in helminth infestation (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.49 - 0.87), use of tube well water in a 48% reduction (OR 0.52, 95% CI 0.29 - 0.93, p<0.02) and breastfeeding in a 16% reduction (OR 0.84, 95% CI 0.64 - 1.10, p<0.2). Mutivariable analysis adjusted with risk variables shows a 5.06 times higher odds of recognising STH infestation during an episode of diarrhoea (OR 5.06, 95% CI 3.8 - 6.69, p<0.0001). Conclusion. Awareness building programmes and periodic deworming are crucial to prevent acquisition of, re-infestation with and spread of STH.


Ley B.,Charles Darwin University | Alam M.S.,International Center for Diarrheal Diseases and Research | Thriemer K.,Charles Darwin University | Hossain M.S.,International Center for Diarrheal Diseases and Research | And 6 more authors.
PLoS ONE | Year: 2016

Background: The Bangladeshi national treatment guidelines for uncomplicated malaria follow WHO recommendations but without G6PD testing prior to primaquine administration. A prospective observational study was conducted to assess the efficacy of the current antimalarial policy. Methods: Patients with uncomplicated malaria, confirmed by microscopy, attending a health care facility in the Chittagong Hill Tracts, Bangladesh, were treated with artemether-lumefantrine (days 0-2) plus single dose primaquine (0.75mg/kg on day2) for P. falciparum infections, or with chloroquine (days 0-2) plus 14 days primaquine (3.5mg/kg total over 14 days) for P. vivax infections. Hb was measured on days 0, 2 and 9 in all patients and also on days 16 and 30 in patients with P. vivax infection. Participants were followed for 30 days. The study was registered with the clinical trials website (NCT02389374). Results: Between September 2014 and February 2015 a total of 181 patients were enrolled (64% P. falciparum, 30% P. vivax and 6% mixed infections). Median parasite clearance times were 22.0 (Interquartile Range, IQR: 15.2-27.3) hours for P. falciparum, 20.0 (IQR: 9.5-22.7) hours for P. vivax and 16.6 (IQR: 10.0-46.0) hours for mixed infections. All participants were afebrile within 48 hours, two patients with P. falciparum infection remained parasitemic at 48 hours. No patient had recurrent parasitaemia within 30 days. Adjusted male median G6PD activity was 7.82U/gHb. One male participant (1/174) had severe G6PD deficiency (<10% activity), five participants (5/174) had mild G6PD deficiency (10-60% activity). The Hb nadir occurred on day 2 prior to primaquine treatment in P. falciparum and P. vivax infected patients; mean fractional fall in Hb was -8.8% (95%CI -6.7% to -11.0%) and -7.4% (95%CI: -4.5 to -10.4%) respectively. Conclusion: The current antimalarial policy remains effective. The prevalence of G6PD deficiency was low. Main contribution to haemolysis in G6PD normal individuals was attributable to acute malaria rather than primaquine administration. Trial Registration: ClinicalTrials.gov NCT02389374. © 2016 Ley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | University of California at San Francisco, International Center for Diarrheal Diseases and Research and Charles Darwin University
Type: Journal Article | Journal: PloS one | Year: 2016

The Bangladeshi national treatment guidelines for uncomplicated malaria follow WHO recommendations but without G6PD testing prior to primaquine administration. A prospective observational study was conducted to assess the efficacy of the current antimalarial policy.Patients with uncomplicated malaria, confirmed by microscopy, attending a health care facility in the Chittagong Hill Tracts, Bangladesh, were treated with artemether-lumefantrine (days 0-2) plus single dose primaquine (0.75mg/kg on day2) for P. falciparum infections, or with chloroquine (days 0-2) plus 14 days primaquine (3.5mg/kg total over 14 days) for P. vivax infections. Hb was measured on days 0, 2 and 9 in all patients and also on days 16 and 30 in patients with P. vivax infection. Participants were followed for 30 days. The study was registered with the clinical trials website (NCT02389374).Between September 2014 and February 2015 a total of 181 patients were enrolled (64% P. falciparum, 30% P. vivax and 6% mixed infections). Median parasite clearance times were 22.0 (Interquartile Range, IQR: 15.2-27.3) hours for P. falciparum, 20.0 (IQR: 9.5-22.7) hours for P. vivax and 16.6 (IQR: 10.0-46.0) hours for mixed infections. All participants were afebrile within 48 hours, two patients with P. falciparum infection remained parasitemic at 48 hours. No patient had recurrent parasitaemia within 30 days. Adjusted male median G6PD activity was 7.82U/gHb. One male participant (1/174) had severe G6PD deficiency (<10% activity), five participants (5/174) had mild G6PD deficiency (10-60% activity). The Hb nadir occurred on day 2 prior to primaquine treatment in P. falciparum and P. vivax infected patients; mean fractional fall in Hb was -8.8% (95%CI -6.7% to -11.0%) and -7.4% (95%CI: -4.5 to -10.4%) respectively.The current antimalarial policy remains effective. The prevalence of G6PD deficiency was low. Main contribution to haemolysis in G6PD normal individuals was attributable to acute malaria rather than primaquine administration.ClinicalTrials.gov NCT02389374.


Matsuda F.,Kyoto University | Matsuda F.,Pharmaceuticals and Medical Devices Agency | Chowdhury M.I.,International Center for Diarrheal Diseases and Research | Saha A.,International Center for Diarrheal Diseases and Research | And 7 more authors.
Vaccine | Year: 2011

To evaluate the probiotic, Bifidobacterium breve strain Yakult (BBG-01), for safety and enhancement of immunogenicity in an oral inactivated cholera vaccine, a randomized double-blind placebo-controlled study was performed. Bangladeshi children under 5-year-old received BBG-01 or placebo for 4 weeks with two doses of oral cholera vaccine. Serum/fecal antibodies and fecal bacterial flora in the study participants were monitored. All adverse events were mild and transient and had no significant difference between the two groups. Immunological responses were similar comparing the two groups. A negative correlation between Bifidobacterium and Enterobacteriaceae in the probiotic group suggests a possible involvement of BBG-01 in alteration of the enteric bacterial flora. In conclusion, BBG-01 is well tolerated by Bangladeshi children although the post vaccinal immunostimulatory effect of BBG-01 was not evident. © 2011 Elsevier Ltd.


Foongladda S.,Mahidol University | Banu S.,International Center for Diarrheal Diseases and Research | Pholwat S.,University of Virginia | Gratz J.,University of Virginia | And 11 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2016

BACKGROUND: Although phenotypic drug susceptibility testing (DST) is endorsed as the standard for secondline drug testing of Mycobacterium tuberculosis, it is slow and laborious. METHODS : We evaluated the accuracy of two faster, easier methodologies that provide results for multiple drugs: a genotypic TaqMan® Array Card (TAC) and the Sensititrew MYCOTBTM plate. Both methods were tested at three central laboratories in Bangladesh, Tanzania, and Thailand with 212 multidrug-resistant tuberculosis (MDR-TB) isolates and compared with the laboratories' phenotypic method in use. RESULT S : The overall accuracy for ethambutol, streptomycin, amikacin, kanamycin, ofloxacin, and moxifloxacin vs. the phenotypic standard was 87% for TAC (range 70-99) and 88% for the MYCOTB plate (range 76-98). To adjudicate discordances, we re-defined the standard as the consensus of the three methods, against which the TAC and MYCOTB plate yielded 94-95% accuracy, while the phenotypic result yielded 93%. Some isolates with genotypic mutations and high minimum inhibitory concentration (MIC) were phenotypically susceptible, and some isolates without mutations and low MIC were phenotypically resistant, questioning the phenotypic standard. CONCLUS IONS : In our view, the TAC, the MYCOTB plate, and the conventional phenotypic method have similar performance for second-line drugs; however, the former methods offer speed, throughput, and quantitative DST information. © 2016 The Union.


PubMed | Kilimanjaro Clinical Research Institute, University of Virginia, International Center for Diarrheal Diseases and Research, Mahidol University and Russian Academy of Medical Sciences
Type: Evaluation Studies | Journal: mBio | Year: 2015

Genotypic methods for drug susceptibility testing of Mycobacterium tuberculosis are desirable to speed the diagnosis and proper therapy of tuberculosis (TB). However, the numbers of genes and polymorphisms implicated in resistance have proliferated, challenging diagnostic design. We developed a microfluidic TaqMan array card (TAC) that utilizes both sequence-specific probes and high-resolution melt analysis (HRM), providing two layers of detection of mutations. Twenty-seven primer pairs and 40 probes were designed to interrogate 3,200 base pairs of critical regions of the inhA, katG, rpoB, embB, rpsL, rrs, eis, gyrA, gyrB, and pncA genes. The method was evaluated on 230 clinical M.tuberculosis isolates from around the world, and it yielded 96.1% accuracy (2,431/2,530) in comparison to that of Sanger sequencing and 87% accuracy in comparison to that of the slow culture-based susceptibility testing. This TAC-HRM method integrates assays for 10 genes to yield fast, comprehensive, and accurate drug susceptibility results for the 9 major antibiotics used to treat TB and could be deployed to improve treatment outcomes.Multidrug-resistant tuberculosis threatens global tuberculosis control efforts. Optimal therapy utilizes susceptibility test results to guide individualized treatment regimens; however, the susceptibility testing methods in use are technically difficult and slow. We developed an integrated TaqMan array card method with high-resolution melt analysis that interrogates 10 genes to yield a fast, comprehensive, and accurate drug susceptibility result for the 9 major antituberculosis antibiotics.

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