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Biomedical subjects

M U Khan

Publications and source records attributed to M U Khan.

At least 55 records · Page 3Linked to original sources
PubMed1984

Presence of vibrios in surface water and their relation with cholera in a community.

During an epidemic of cholera we simultaneously cultured water from 30 important ponds, tanks and rivers of Dhaka city, to determine the role of surface water as a reservoir of Vibrio cholerae and nonagglutinating (NAG) vibrios and whether their presence or absence can be used as an indicator of a cholera epidemic in the community. Out of 4.016 samples 1216 (30.3%) were positive for NAG vibrios and one (0.025%) for Vibrio cholerae. Ponds showed a higher rate of NAG isolation (31.6%) than did rivers (21.9%). NAG group II constituted 87% and group V 10% of all positives. There were mild-to-moderate seasonal variations in isolation rates. The NAG isolation rate from water was related to the incidence of hospitalized NAG diarrhoea cases, but not to simultaneous cholera cases. Surface water does not appear to be an efficient natural reservoir of Vibrio cholerae, as it is for NAG vibrios. The absence of V. cholerae or presence of NAG vibrios in public surface water sources has no relationship with the extent of cholera cases present in a community.

Bangladesh↗
PubMed1984

Breastfeeding, growth and diarrhoea in rural Bangladesh children.

It has been observed that breastfeeding protects infants from many illnesses. We examined whether breastfeeding alone or with a supplement maintained normal growth and whether the incidence of diarrhoea was different in the two groups. The study was conducted on 223 children in a rural area. Anthropometric measurements were obtained every month up to 12 months and then every 3 months. The history of feeding was recorded. The mothers were visited weekly to record information on diarrhoeal illness. Homemade supplements were used. The average weight of exclusively breastfed children was not significantly different from that of those who were breastfed with supplements. The average weight paralleled the Harvard standard up to the 4th month, and the increase in height showed the same pattern. During the first year the incidences and duration of diarrhoeal attacks were higher in the exclusively breastfed children than in the supplemented groups. On average there were 3.2 attacks of diarrhoea per child per year and the average duration was 15.9 days per child per year during the first 2 years.

Bangladesh↗
PubMed1983

Value of stool examination in patients with diarrhoea.

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.

Adolescent↗
PubMed1983

Classical Vibrio cholerae biotype displaces EL tor in Bangladesh.

The EL Tor biotype of Vibrio cholerae caused all endemic and epidemic cholera in Bangladesh from 1973 until Sept. 3, 1982, when the first classical strain was isolated from a patient in Matlab. Since then the number of isolations of the classical biotype has increased very rapidly and spread to other districts, replacing the EL Tor biotype as the main epidemic strain. The classical strains isolated in the 1982 outbreak were indistinguishable by the standard tests from those isolated a decade ago and the very few isolates in 1979, 1980, and 1981. This suggests that beyond the taxonomic traits used to identify the classical and EL Tor strains, there may be other more crucial biological characteristics that have given this new strain an advantage over the existing strains. The mechanism by which a new biotype of V. cholerae 01 achieves such a crucial biological advantage to displace the existing strains may be a key point in control of the global spread of cholera.

Bangladesh↗
PubMed1983

Seasonality of classical and El Tor cholera in Dhaka, Bangladesh: 17-year trends.

Data on the cholera patients admitted monthly to the ICDDR, B, hospital in Dhaka (Bangladesh) from 1964 through 1980 have been studied and analysed. Although Vibrio cholerae variant El Tor did not enter Bangladesh until 1963, it has completely displaced classical cholera since 1973. There have also been changes in seasonality, which are discussed.

Bangladesh↗
PubMed1983

Clinical illnesses and causes of death in a Burmese refugee camp in Bangladesh.

In 1978 almost 200 000 Burmese refugees entered Bangladesh. Thirteen camps were set up for refugees. Data for the camp at Leda is presented here. There were four medical clinics; including a diarrhoea clinic operated by the International Centre for Diarrhoeal Disease Research, Bangladesh. The four clinics recorded a total of 174 201 visits by the refugees, of which 28% were for watery diarrhoea, 32% for dysentery and 40% for other illnesses. Of 2321 diarrhoea stools cultured, 29.2% yielded pathogens of which 22% were Shigellae alone. Coliform count of water was extremely high. The death rate (89/1000/year) was higher than the birth rate (28/1000/year). Most of the deaths were among infants (640), children (357) and old people (131). Main causes of death were clinical diarrhoea (11.8%), fever (23%) and poor nutrition (52%). Prompt arrangements for food, identifying the vulnerable groups, and proper sanitation perhaps could have reduced the number of deaths considerably.

Adolescent↗
PubMed1983

The eltor cholera epidemic in Dhaka in 1974 and 1975.

Surveillance of hospitalized cholera cases from 1970 to 1977 in Dhaka, a matched control study in 1974, and a neighbourhood control study in 1975 were carried out and show a change from classical cholera to the eltor biotype during this period. Of all the hospitalized cholera cases, 9.1% in 1972 and 99.9% in 1973 were due to the eltor biotype. In 1974 and 1975 the distribution of eltor cholera cases in the city was uniform, except for areas with modern sanitation whose residents were spared. The incidence rates of cholera per 1000 infants (under the age of 1 year) were 1.16 and 0.93 for 1974 and 1975, respectively. On the whole, children below 10 years and females between 15 and 44 years of age were the ones most affected with eltor cholera. Higher rates of diarrhoea and hospitalization were noted among the contacts with cholera cases, compared with non-cholera controls. Contracting cholera was significantly associated with eating in places away from home, especially at charitable feeding centres.

Adolescent↗
PubMed1982

Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh.

In October 1979 a surveillance system was set up at the International Centre for Diarrhoeal Disease Research, Bangladesh, Hospital at Dacca to study a 4% systematic sample of the 100 000 patients with diarrhoea who come to the hospital for care each year. From December 1979 to November 1980 inclusive, 3550 patients were studied. A recognised pathogenic organism was identified for 66% of patients screened for all pathogens, one-third of whom had a mixed infection with two or more agents. Enterotoxigenic Escherichia coli was the most common enteropathogen detected in all age groups (detection rate 20%), followed by rotavirus (19%), Campylobacter jejuni (14%), and Shigella (12%). Infants and young children (up to 5 years) were most often infected with rotavirus, enterotoxigenic E coli, and C jejuni and older children (5-14 years) had more infections with enterotoxigenic E coli, Shigella, and E histolytica. Surveillance has helped to define the range of disease among patients attending the Dacca Hospital. Sixty-five per cent of patients complained of watery diarrhoea, a presentation that was significantly more common in patients with Vibrio cholerae 0:1 (91%), enterotoxigenic E coli (78%), rotavirus (77%), and C jejuni (71%) than in all patients studied. Dysentery, defined as a history of diarrhoea with blood, was the presenting complaint of 20% of all patients but 55% of those with Shigella. Only patients with V cholerae 0:1 and enterotoxigenic E coli were at increased risk for severe dehydration. In addition surveillance has been used to identify areas where patient care can be improved and to generate new ideas for research.

Adolescent↗
PubMed1982

Role of water and sanitation in the incidence of cholera in refugee camps.

The purpose of this study was to determine the prevalence of cholera in two groups: (i) people using covered latrine and piped water; (ii) people using uncovered surface latrine and pond and tubewell water. The study population consisted of cholera cases admitted to the ICDDR, B hospital from three refugee camps. In the one camp with sanitation facilities, the cholera rate was 1.6 per 1,000, whereas in the two camps without facilities the rates were 4.0 and 4.3 per 1,000. Following demolition of the camps, the cholera rates decreased significantly in the camps geographical zones. Cholera was not totally eliminated, even in the one camp with sanitation facilities, suggesting that health education, as well as proper sanitation, is necessary to eradicate cholera.

Bangladesh↗
PubMed1982

Interruption of shigellosis by hand washing.

High attack rates, increasing resistance to antibiotics and high mortality make shigellosis a serious problem. As Shigella is associated with poor hygiene we examined the effectiveness of a simple intervention, washing hands with soap and water, in checking the spread of the disease. The study population was comprised of confirmed cases of shigellosis. These and matched controls were followed up for 10 days. Several pieces of soap and earthenware pitchers for storing water were provided to the study families and they were advised to wash their hands with soap and water after defaecation and before meals. Compliance was monitored daily by observing the size of the soap and residual water. Rectal swabs of contacts of both the groups were obtained for culture. The secondary infection rate was 10.1% in the study group and 32.4% in the control group. The secondary case (symptomatic) rate was 2.2% in the study group and 14.2% in the control group. These results suggest that hand-washing has a positive interrupting effect, even in unsanitary environments.

Adolescent↗
PubMed1982

Epidemiologic and clinical features of patients infected with Shigella who attended a diarrheal disease hospital in Bangladesh.

The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.

Adolescent↗
PubMed1982

Endemic cholera in rural Bangladesh, 1966-1980.

Since 1963, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), formerly the Cholera Research Laboratory, has maintained a field station in Matlab to treat patients from a surveillance population of 240,000 who have cholera and other diarrheal diseases. Since 1966, the authors have analyzed hospital records of 7141 surveillance-area patients culture-positive for v. cholerae 01 to relate the seasonality, age and sex distribution, and geographic trends with hypotheses concerning transmission, immunity, and risk groups. From this review, they have found that: 1) children 2-9 years old and adult women are most commonly hospitalized for cholera; 2) V. cholerae 01 emerges simultaneously throughout the area of surveillance, with the early cases being of different phage types; 3) three patients were hospitalized twice for cholera compared with 29 expected on the basis of life-table analysis (p less than 0.01), suggesting that immunity to severe disease conferred by previous illness may be stable and long-lasting; 4) no constant relationship was found between the times of onset or peaks of the yearly cholera epidemic and the times of onset or peaks of the monsoon rains or river water levels; and 5) an outbreak of multiply antibiotic-resistant V. cholerae 01 infection documented in 1979 raises questions about the dissemination of resistance plasmids, antibiotic-use patterns, and the need for other drugs in addition to tetracycline. While little progress has been made in understanding the mode of transmission of v. cholerae 01, and in identifying practices for prevention, fluid therapy in this area has decreased the case fatality rate significantly and provides guidance for similar programs elsewhere.

Adolescent↗
PubMed1982

Endemic focus of Fasciolopsis buski infection in Bangladesh.

Stool surveys were conducted on children 2--10 years of age in 27 villages within Dacca District and around this index area (1,668 children were sampled), revealing an endemic focus of Fasciolopsis buski infection to the south and the east of Dacca District. In order to determine the seasonal variation in the total snail populations and the natural rate of F. buski infection in the snails, two species of planorbid snails, Segmentina (Trochorbis) trochoideus and Hippeutis (Helicorbis) umbilicalis, were periodically sampled for 12 months from a village endemic for F. buski infection. Gymnocephalous cercariae were found in S. (T.) trochoideus snails during August, September and October. The size of the snail population (n = 1,275) was significantly correlated with inches of rainfall (r = +0.62; P less than 0.05) and water temperature (r = +0.59; P less than 0.05). The natural infection rate of F. buski in the snails ranged from 0.5--2%. Snails from non-endemic areas were exposed to 3--10 miracidia. A total of 13 of 49 (27%) of H. (H.) umbilicalis and 6 of 14 (43%) of S. (T.) trochoideus had gymnocephalous cercariae present 4 to 6 weeks after exposure to miracidia. Thus, snail strain variation is unlikely to be a barrier to F. buski transmission.

Animals↗
PubMed1982

Efficacy of short course antibiotic prophylaxis in controlling cholera in contacts during epidemic.

During an epidemic of cholera, vaccination has limited applicability in controlling its spread. It has been seen that one out of every five to 10 V. cholerae-infected people develops diarrhoea severe enough to require hospital treatment. Most health authorities are concerned with this severely ill group in whom the majority of deaths occur. During the cholera epidemic of 1975 in Dacca two doses of tetracycline were administered to all family contacts of index cases. The control group of cholera cases did not receive the drug. The families were re-visited after 10-12 days and history of any diarrhoea and hospitalization was obtained. It was found that the subsequent diarrhoea or cholera cases occurring among the cholera contacts within 10-12 days were not different between the treated (13.5%) and the untreated (14.4%) groups. The occurrence of severe cases requiring hospitalization was, however, significantly reduced in the treated group (8.0% to 4.5%). In view of the emergence of V. cholera strains resistant to tetracycline, antibiotic sensitivity testing of epidemic strains would be needed before use of tetracycline for protecting cholera contacts as an immediate control measure.

Adolescent↗