Efficacy of azithromycin in the treatment of childhood typhoid Fever.

An intervention study was carried out in Paediatric wards for a period of one year from January 2003 to December 2003 to determine the efficacy and safety of azithromycin in the treatment of uncomplicated childhood typhoid fever. A total of 50 cases were enrolled in the study. The inclusion criteria of the cases were: documented fever for more than 7 days plus two or more of the following clinical features: toxic appearance, abdominal tenderness, hepatomegaly, splenomegaly, diarrhoea, constipation and coated tongue plus positive Widal test and/or blood culture positivity. Patients who had complication like gastrointestinal tract (GIT) haemorrhage; intestinal perforation and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg /day for a period of 07 days. The time to defervescence was 3.82+/-1.49 days. The minimum defervescence time was 02 days and maximum was 07 days. Clinical cure rate was 94%. No serious adverse effect was noted related to azithromycin therapy except nausea, vomiting, and jaundice. Prior treatment with antibiotics did not affect defervescence time (P>0.05). Pre-treatment febrile period has got positive and linear correlation with clinical response (r = +0.593). It was found that once daily administration of oral azithromycin for seven days in the treatment of uncomplicated typhoid fever was effective and reasonably safe.

Streptococcal antibodies among rural school children in Bangladesh.

The upper limit of normal values of group A streptococcal antibodies should be known for a population concerned because it is influenced by many local conditions. As yet the reference value of the these antibodies has not been determined by using a quantitative method among Bangladeshi children. We determined the reference value of anti-streptolysin O and anti-deoxyribonuclease B among 361 apparently healthy rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.2 years). Anti-streptolysin O was measured by an auto-analyzer and antideoxyribonuclease B was measured by microtitre method. The geometric mean titres for the entire group was 241 IU/ml and 222 IU/ml for anti-streptolysin O and anti-deoxyribonuclease B respectively. The upper limit of normal values (80th percentile) was 390 and 340 for anti-streptolysin O and anti-deoxyribonuclease B, respectively. These limits should be of value to physicians, epidemiologists and clinical laboratory personnel as well.

Humoral immune response in a sample of Bangladeshi children with rheumatic fever.

Several researchers have investigated cellular response, and antibody response to different antigens of group A beta-haemolytic streptococci, cardiac tissues and B cell alloantigen in rheumatic fever (RF). However, immunoglobulins (Ig) which may indicate general immune status did not receive attention. This study was done in the outpatient clinic of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, to compare Ig levels in subjects with and without RF who have had recent group A beta-haemolytic streptococcal infections. We have recruited 44 RF cases aged 5 to 20 years, and 44 subjects without RF were randomly matched for age and sex as controls. Convalescent blood samples were used to measure antistreptolysin O and IgG, IgM, and IgA levels. The cases, as compared with the controls, had significantly higher levels of antistreptolysin O (mean 399 versus 321 IU/ml), IgG (mean 2386 versus 1885 mg/dl), IgM (mean 286 versus 222 mg/dl) and IgA (mean 258 versus 184 mg/dl). It is not clearly known why the immune response is higher in the RF cases. We have to elucidate factors responsible for higher immune response in children with RF.

Association of angiotensin converting enzyme (ACE) gene polymorphism with hypertension in a Bangladeshi population.

The association of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with hypertension has not been confirmed. Inconsistencies may be due to the differences of background population characteristics. Till date, there has been no report in Bangladeshi population. This study was to examine the association of ACE (I/D) polymorphism with hypertension. Fifty-one primary hypertensives and fifty-two normotensives were recruited from a hospital in Dhaka city. Height, weight and blood pressure were measured. ACE (I/D) genotypes was established using polymerase chain reaction protocol. The genotype and allele frequencies did not differ significantly (P > 0.05) between the groups. In logistic regression analysis, adjusted for age, sex and body mass index, the genotypes were not associated with hypertension (DD vs II: Adds ratio = 2.6, P = 0.34; ID vs II: 0.4, 0.23; ID + DD vs II: 0.8, 0.69). In this hospital-based sample of Bangladeshi people, significant association of ACE I/D genotype with hypertension was not observed.

Prevalence of streptococcal sorethroat in the school children of Dhaka.

Beta Haemolytic Streptococcal (BHS) infections and their sequelae Rheumatic Fever (RF) and Glomerulonephritis (GN) have a world wide distribution and so pose an important health problem. Reports show that there is considerable variation in the number of isolations from different groups. Present study intended to find out the health status of the school children in relation to streptococcal throat infection, in Dhaka Cantonment. It was a cross sectional, observational study. During one year period total six hundred and one (601) children were examined from one school of Dhaka Cantonment. Prevalence of streptococcus was found to be 22% among the study population with highest rate (67%) for group-G among BHS positive cases. True streptococcal infection was found in 8.7% cases & 2.2% cases were true GABHS positive cases. GABHS was significantly higher in large size families. Females and children from lower socioeconomic group were at higher risk. Females and children of large families may require special attention regarding prevention of streptococcal infection and RF/RHD prevention programme.