Khorshed Alam

Bacteremic Typhoid Fever in Children in an Urban Slum, Bangladesh

We confirmed a bacteremic typhoid fever incidence of 3.9 episodes/1,000 person-years during fever surveillance in a Dhaka urban slum. The relative risk for preschool children compared with older persons was 8.9. Our regression model showed that these children were clinically ill, which suggests a role for preschool immunization.

Sharing of virulence-associated properties at the phenotypic and genetic levels between enteropathogenic Escherichia coli and Hafnia alvei

Seven strains of Hafnia alvei isolated from diarrhoeal stools of children resembled enteropathogenic Escherichia coli (EPEC) in that they produced attaching-effacing (AE) lesions in rabbit ileal loops and fluorescent actin staining in infected HEp-2 cells. In addition, a DNA probe from a chromosomal gene required by EPEC to produce AE lesions, hybridised to chromosomal DNA from all seven H. alvei strains. These findings indicate that there is a sharing of virulence-associated properties at the phenotypic and genetic levels by H. alvei and EPEC. H. alvei strains with these properties should be considered diarrhoeagenic.

Prevalence of the Pandemic Genotype of Vibrio parahaemolyticus in Dhaka, Bangladesh, and Significance of Its Distribution across Different Serotypes

ABSTRACT Sixty-six strains of Vibrio parahaemolyticus belonging to 14 serotypes were isolated from hospitalized patients in Dhaka, Bangladesh, from January 1998 to December 2000. Among these, 48 strains belonging to four serotypes had the pandemic genotype and possessed the tdh gene. A marker (open reading frame ORF8) for a filamentous phage previously thought to correspond to the pandemic genotype was found to have a poor correlation with the pandemic genotype.

Altering Trends in the Dominance of Shigella flexneri Serotypes and Emergence of Serologically Atypical S. flexneri Strains in Dhaka, Bangladesh

ABSTRACT 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.

Viral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, Bangladesh

Limited information is available on the etiology of acute lower respiratory infection (ALRI) particularly pneumonia in the rural community of developing countries since most etiological studies are carried out in the hospital settings. This study examined the etiology of pneumonia among young children in a rural community of Bangladesh. A cohort of 252 newborns was followed till 24 months of age during 1993–1996. Community health workers (CHWs) identified cases of ALRI during household surveillance and recommended hospitalization. On admission, nasopharyngeal aspirates (NPA) and blood were collected for bacterial and viral identification, and chest x-rays were done. Multiple regression analysis identified factors associated with a viral etiology. Physicians diagnosed 67 pneumonia; 45% of NPA were positive for viral agents of pneumonia, and respiratory syncytial virus (RSV) was predominant (81%); 6 of 48 blood cultures were positive. X-ray was done for 58 cases; 52% had pneumonic consolidation. Of the RSV cases, 33% were found in children without pneumonic consolidation. Children living in a one-room house were 3 times more likely to develop viral pneumonia (odds ratio (OR) = 3.67, CI 1.05-12.83) than children living in a larger house. Counseling on avoiding crowding where a newborn is accommodated might reduce pneumonia incidence.

Temporal Shifts in the Dominance of Serotypes of Shigella dysenteriae from 1999 to 2002 in Dhaka, Bangladesh

ABSTRACT A total of 358 Shigella dysenteriae strains isolated from patients attending the Dhaka treatment center of the International Centre for Diarrheal Disease Research, Bangladesh, between the years 1999 and 2002 were included in this study. S. dysenteriae type 1, the dominant serotype in 1999 (76.4%), declined to 6.5% in 2002. On the other hand, S. dysenteriae types 2 to 12 were isolated with increasing frequencies of 19, 67, 73.5, and 87% in 1999, 2000, 2001, and 2002, respectively. Of these, types 2 and 4 were the most dominant serotypes, accounting for more than 18.7 and 28.5% of the total isolates, respectively. There was no isolation of serotypes 5, 7, 8, and 13 during this period. Twenty-eight (7.8%) of the isolates were atypical and agglutinated only with the polyvalent antiserum of S. dysenteriae. More than 98% of type 1 strains isolated between 1999 and 2001 were resistant to ampicillin, sulfamethoxazole-trimethoprim, and nalidixic acid. Among other serotypes of S. dysenteriae, Nalr type 2 strains were isolated in 2001 and 2002. Although heterogeneous plasmid profiles were obtained depending on the presence or absence of a single plasmid, core plasmids were defined for particular serotypes. On the other hand, the same plasmid profile was found to be shared by different serotypes. Interestingly, plasmid patterns of types 2 and 4 were almost identical except that a middle-range plasmid of 70 to 60 MDa was present in type 4 in addition to the core plasmids. All the strains harboring the 140-MDa plasmid were positive for the ipaH gene, had Congo red binding abilities, and were positive by the Sereny test, demonstrating their invasive properties.

DNA probe analysis of diarrhoeagenic Escherichia coli: detection of EAF-positive isolates of traditional enteropathogenic E. coli serotypes among Bangladeshi paediatric diarrhoea patients.

Escherichia coli isolates from all surveillance patients less than or equal to 20 months of age seen for diarrhoea at the Dhaka Clinical Treatment Facility of the International Centre for Diarrhoeal Disease Research, Bangladesh between March 1 and August 31, 1988, were collected and hybridized with DNA probes to assess the potential importance of diarrhoeagenic E. coli among paediatric patients in Bangladesh. Of 396 patients evaluated, 18% were infected with enteropathogenic E. coli (EPEC) adherence factor (EAF)-positive E. coli, 23% were infected with enterotoxigenic E. coli (ETEC), 9% were infected with Shiga-like toxin-positive E. coli, and 13% were infected with diffuse adhesiveness-positive E. coli. None were infected with enteroinvasive E. coli. Ten percent of patients were colonized with more than one type of potential diarrhoeagenic E. coli. The majority of EAF-positive isolates were of traditional EPEC O:H serotypes. Although this was not a case-control study, the large number of EPEC and ETEC, which are recognized enteric pathogens, suggests these organisms are important causes of diarrhoeal diseases in this pediatric population.

TnphoA mutants of Providencia alcalifaciens with altered invasiveness of HEp-2 cells

Recent studies have shown that Providencia alcalifaciens is a diarrhoeal pathogen. It may cause diarrhoea by an invasive mechanism, as it invades cultured mammalian cells in vitro and intestinal epithelial cells of experimentally inoculated rabbits in vivo. To locate the gene(s) involved in invasion, TnphoA mutants of a diarrhoeal isolate of P. alcalifaciens were generated. Compared with the parent strain, these mutants exhibited negligible invasion and actin condensation in HEp-2 cells. TnphoA insertion was located in fragments of 4.9 kb and 11.1 kb of the bacterial chromosome by Southern blot. These mutants did not secrete a 28-kDa protein, which may be involved in invasion. It should be possible now to study the gene(s) involved in invasion of P. alcalifaciens with these mutants. This investigation is another example of the usefulness of TnphoA mutagenesis in the study of bacterial virulence genes.

Cross-reaction between a strain of Vibrio mimicus and V. cholerae O139 Bengal

Of 200 isolates of Vibrio mimicus screened, one from water (N-57) agglutinated with V. cholerae O139 polyclonal antiserum (absorbed with a rough strain of V. cholerae only) and not with O139 polyclonal diagnostic antiserum (absorbed with the rough strain and V. cholerae O22 and O155). The antigenic relationship between V. cholerae 0139 and N-57 is of a,b-a,c type, where a is the common antigenic epitope and b and c are unique epitopes. Strain N-57 was assigned to a new serogroup of V. cholerae O194. It gave negative results in a monoclonal antibody-based rapid test and a PCR test specific for V. cholerae O139. It did not possess the ctx gene or produce cholera toxin. Antiserum to strain N-57 cross-protected infant mice against cholera on challenge with V. cholerae O139. Structural studies of the surface polysaccharides and studies of the rfb genes will shed more light on the extent of relatedness between V. mimicus N-57 and V. cholerae O139.