The emerging strains of Shigella dysenteriae type 2 in Bangladesh are clonal.

A total of 113 strains of Shigella dysenteriae type 2 isolated from patients attending the Dhaka diarrhoea treatment centre of ICDDR,B: Centre for Health and Population Research during the period 1999-2004 were studied. Serotype of the isolates was confirmed using commercially available antisera. Except for arabinose fermentation, all the strains had similar biochemical reactions. More than 60% of the strains were sensitive to commonly used antibiotics; only 6% (n=7) of the strains were resistant to nalidixic acid, and none of the strains were resistant to mecillinam and ciprofloxacin. All strains were invasive as demonstrated by the presence of a 140 MDa plasmid, ial, sen and ipaH genes, Congo Red absorption ability and by the Sereny test performed on representative strains. Plasmid patterns were heterogeneous but more than 50% of strains were confined to a single pattern. All strains possessed a 1.6 MDa plasmid and 87% of the strains contained a 4 MDa plasmid. Middle-range plasmids (90 MDa to 30 MDa) present in 36% of the strains were not associated with antibiotic resistance. All the strains were clustered within a single type with four subtypes by pulsed-field gel electrophoresis while ribotyping patterns of all the strains were identical.

Detection of intra-familial transmission of shigella infection using conventional serotyping and pulsed-field gel electrophoresis.

Pulsed-field gel electrophoresis (PFGE) is commonly used in molecular epidemiology. However, this technique has never been used in studying intra-family spread of enteric diseases in Bangladesh. Our objective was to evaluate the intra-familial transmission of shigella infection using PFGE. Children of either sex, less than 10 years old, who were family contacts of shigella-infected index cases were the study population. PFGE was applied if the same serotypes/sub-serotypes of shigella were isolated from both the index case and the family contact children. In total, 227 index cases were studied. Shigella was isolated from 61 (27%) contact children on day 1 of enrolment, among which Shigella flexneri (41%) and S. boydii (41%) were dominant, followed by S. dysenteriae (10%), S. sonnei (3%), and shigella-like organisms (5%). Seventeen (28%) of the asymptomatic infections in contact children were caused by the same serotype of shigella as that found in the index case. The intra-familial shigella transmission rate was 8% (17/227). Of the 227 contact children, eight (4%) developed diarrhoea during a 10-day follow-up and shigella was isolated from five (2%) of these children, and three of them (S. flexneri 3a, 1b, and 3a) were identical to the strains from their respective index cases. Compared to children without asymptomatic carriage of shigella (2/166), the risk (odds ratio) of developing diarrhoea for the children with asymptomatic carriage of shigella identical to their cases (3/17) was 9.0 (95% CI 1.5-49.0, P=0.01). The attributable risk for symptomatic shigella infection by intra-familial transmission was 50%. Results of this study demonstrated that intra-familial transmission of shigella carries a higher risk for diarrhoea.

Altering trends in the dominance of Shigella flexneri serotypes and emergence of serologically atypical S. flexneri strains in Dhaka, Bangladesh.

Of 469 recently isolated Shigella flexneri strains, 452 agglutinated with Shigella flexneri-specific monoclonal antibodies. Of these, 396 could be assigned to 10 of the currently recognized 15 serotypes, with S. flexneri 2b dominating (23.2%). Of the 56 untypeable strains which showed invasive properties, 17 were serologically atypical and the remaining 39 belonged to a new serotype.

Treatment failure with the use of ciprofloxacin for gonorrhea correlates with the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae strains in Bangladesh.

Although ciprofloxacin is one of the recommended drugs of choice for the treatment of gonorrhea, in vitro resistance to this drug has been observed in surveillance studies and case reports from many parts of the world, including Bangladesh. However, to our knowledge, there have been no prospective studies of the correlation between in vitro response to the drug and treatment outcome. Therefore, a prospective study of 217 female sex workers in Dhaka, Bangladesh, was conducted to examine the correlation between the in vitro response of Neisseria gonorrhoeae and the outcome of ciprofloxacin treatment. Overall, 37.8% of the gonococcal isolates recovered from female sex workers were resistant to ciprofloxacin, and there was a good correlation between in vitro resistance and treatment failure. These findings suggest that in vitro resistance to ciprofloxacin is predictive of clinical treatment failure in patients with gonorrhea.

Evaluation of pulsed-field gel electrophoresis for typing of Shigella dysenteriae type 1.

Pulsed-field gel electrophoresis (PFGE) has been used successfully to discriminate between strains of many different bacterial species. In this study, digestion of bacterial DNA with the restriction endonuclease NotI and PFGE were evaluated for the typing of isolates of Shigella dysenteriae type 1, an important cause of epidemic dysentery. There were 27 isolates from four outbreaks of dysentery, and 44 isolates from endemic dysentery cases and a laboratory culture collection. The epidemic isolates yielded two types each with two subtypes, whereas the endemic isolates and culture collection yielded eight types with numerous subtypes. These findings suggest that S. dysenteriae 1 can be typed by PFGE.

Abdominal hysterectomy: a new approach for young gynaecologists.

Abdominal hysterectomy is performed for various gynaecological conditions. During operative procedures haemorrhage caused by trauma or slipping and retraction of uterine or ovarian artery has been a cause of great concern to gynaecologists specially in absence of adequate blood transfusion facilities. To overcome this problem, a new approach has been developed--ligation of the uterine artery and ovarian artery (in case of salpingo-oophorectomy) before going for conventional hysterectomy procedures. Abdominal hysterectomy was performed in 500 cases during last 7 years. Traumatic injury to left uterine vessels was seen in 2 cases (0.4%). No other injury to ovarian vessels, right uterine vessels, ureter and bladder was observed. Hence it is concluded that ligation of uterine artery, prior to conventional abdominal hysterectomy procedures, is an extremely safe procedure reducing the risk of haemorrhage and thus allowing young gynaecologists to perform this operation with less fear and more confidence.

Surgical management of genital prolapse in an industrial hospital.

Surgical management of 200 cases of genital prolapse was reviewed and analysed. Forty per cent cases had 3rd degree uterine prolapse, 42 per cent had 2nd degree uterine prolapse and 18 per cent had 1st degree uterine prolapse. Fothergill operation was performed in 91 cases (45.5%). Vaginal hysterectomy with pelvic floor repair was performed in 70 cases (35%) and was the choice of treatment in pre-and postmenopausal patients.

Metoclopramide and haloperidol in tardive dyskinesia.

The effect of single intravenous doses of metoclopramide (10 mg, 20 mg and 40 mg) and haloperidol (5 mg and 10 mg) have been compared to placebo (saline) in a double blind randomised study in 8 patients with tardive dyskinesia secondary to neuroleptic therapy. Tardive dyskinesia rating scores were improved significantly (P less than 0.01) 6 hours after dosing by metoclopramide 40 mg, and haloperidol 5 mg and 10 mg, when compared to placebo. Single doses of dopamine receptor blocking agents improve tardive dyskinesia. The dose of metochlopramide required to show a beneficial effect was high, and this therefore suggests that it is unlikely to be of therapeutic value as the incidence of adverse reactions would be greatly increased. By monitoring the effects of single doses of dopamine receptor blocking drugs in patients with tardive dyskinesia it is possible to compare the relative potencies of these drugs on dopaminergic systems in vivo in man.