Ma Jalil Chowdhury

Chikungunya – an emerging infection in Bangladesh: a case series

IntroductionChikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management.Case presentationThe six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases.ConclusionFrom this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly.

Sociodemographic Determinants of Low Fruit and Vegetable Consumption Among Bangladeshi Adults: Results From WHO-STEPS Survey 2010:

This study aimed to investigate factors affecting fruit and vegetables (FAVs) intake among Bangladeshi adults. Dietary data of 9275 adults from the Bangladesh Noncommunicable Disease Risk Factor Survey 2010 were analyzed. The mean age of the respondents was 42.4 (±13.5) years. Multistage cluster sampling was applied to identify samples. Demographics, personal habits, physical activity, diet, and anthropometric data were collected using the WHO-STEPs questionnaire. Average daily intake of <5 servings of FAVs combined was considered to be low FAV consumption, and its prevalence was 82.8%. A mixed-effect logistic regression model was fitted to assess association of factors with low FAV intake. Higher educational attainment, greater wealth, female sex, low physical activity, body mass index >25 kg/m2, and smokeless tobacco consumption were significantly associated with higher FAV consumption. Frequency of low FAV intake increased with increasing age and decreased with increasing educational attainment. Programs targeting people at risk of low FAV consumption are needed to promote consumption.

Cutaneous leucocytoclastic vasculitis in visceral leishmaniasis

In June 2014, a 50-year-old Bangladeshi woman presented for evaluation of her six-month history of irregular fever, significant weight loss and recurrent, painful purpuric lesions. The cutaneous eruptions were bilateral, painful, associated with leg oedema and used to disappear spontaneously. She had neither significant symptoms nor any past or family history, and she had not taken any recent medication. Physical examination revealed purpura, confined to her lower limbs (Figure 1), moderate anaemia and hepato-splenomegaly (4 cm and 8 cm from the right and left costal margins, respectively). Laboratory investigations revealed anaemia (Hb 79g/L), normal white cell count (2K/mcL) with normal differentials and normal platelet count (150K/mcL). The total protein was raised (108 g/L) but albumin was low (26 g/ L). The erythrocyte sedimentation rate and C-reactive protein were elevated (135mm/h and 440mg/L, respectively). Immuno-chromatography for VL was positive and the splenic aspirate also showed the presence of Leishman-Donovan (LD) bodies. The histopathological analysis of a skin biopsy taken from a purpuric lesion revealed leucocytoclastic vasculitis, but there was no deposition of immunoglobulin or complement in the immunofluorescence test. Serology for rheumatoid factor (RF) and anti-citrullinated peptide antibodies were positive, but antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative. Complement levels were normal and serological markers for hepatitis B and C were also negative. Polyclonal gammopathy was detected in protein electrophoresis. A diagnosis of cutaneous leukocytoclastic vasculitis, associated with VL, was made. Treatment with a single dose of liposomal amphotericin-B was given. The fever subsided and the rash disappeared after five days, leaving hyper-pigmented areas over the legs (Figure 2). On follow-up four months later, there was no LD-body in a repeat splenic aspirate. After eight months of treatment, both the spleen and the liver had reduced to 3 cm and 2 cm from the left and right costal margins, respectively, and there was no reappearance of purpura.

Alcohol consumption among adults in Bangladesh: Results from STEPS 2010

Background Alcohol use is a risk factor for the development of noncommunicable diseases. National data are needed to assess the prevalence of alcohol use in the Bangladeshi population. The objective of this study was to describe the prevalence and patterns of alcohol use among men and women of rural and urban areas of Bangladesh. Additionally, predictors of ever alcohol use were also identified. Methods A nationally representative cross-sectional survey (STEPS 2010) was conducted on 9275 adults between November 2009 and April 2010. Participants were selected using multi-stage random cluster sampling. Data on several risk factors for noncommunicable diseases, including alcohol use, were collected by an interviewer-administered questionnaire. Results Among the total population, 5.6% (n = 519) reported to have ever drunk alcohol and 94.4% (8756) were lifetime abstainers; 2.0% (n = 190) of participants reported to have drunk alcohol within the last 12 months. Of these, 94.7% (n = 180) were men. Only 0.9% (n = 87) of the total population had drunk alcohol within the last 30 days and were categorized as current drinkers. Among current drinkers, 77.0% (n = 67) were defined as binge drinkers, having had at least one episode of heavy drinking in this time period; 92.0% (n = 80) were current smokers and 59.8% (n = 52) had either no formal education or less than primary school education. Ever alcohol use was more common among men, those who live in urban areas and smokers. Conclusion Alcohol use is low in Bangladesh; however, those who do use alcohol frequently binge drink, which is a public health concern. Targeted efforts should be made on these specific groups, to control and prevent the continued use of alcohol in Bangladesh.

Acute arsenic poisoning diagnosed late

Acute arsenicosis, although having a ‘historical’ background, is not common in our times. This report describes a case of acute arsenic poisoning, missed initially due to its gastroenteritis-like presentation, but suspected and confirmed much later, when the patient sought medical help for delayed complications after about 2 months.