Multidrug resistance pattern and molecular epidemiology of pathogens among children with diarrhea in Bangladesh, 2019-2021.

Antimicrobial and multidrug resistance (MDR) pathogens are becoming one of the major health threats among children. Integrated studies on the molecular epidemiology and prevalence of AMR and MDR diarrheal pathogens are lacking. A total of 404 fecal specimens were collected from children with diarrhea in Bangladesh from January 2019 to December 2021. We used conventional bacteriologic and molecular sequence analysis methods. Phenotypic and genotypic resistance were determined by disk diffusion and molecular sequencing methods. Fisher's exact tests with 95% confidence intervals (CIs) was performed. Prevalence of bacterial infection was 63% (251 of 404) among children with diarrhea. E. coli (29%) was the most prevalent. E. coli, Shigella spp., V. cholerae, and Salmonella spp., showed the highest frequency of resistance against ceftriaxone (75-85%), and erythromycin (70-75%%). About 10-20% isolates of E. coli, V. cholerae and Shigella spp. showed MDR against cephem, macrolides, and quinolones. Significant association (p value < 0.05) was found between the phenotypic and genotypic resistance. The risk of diarrhea was the highest among the patients co-infected with E. coli and rotavirus [OR 3.6 (95% CI 1.1-5.4) (p = 0.001)] followed by Shigella spp. and rotavirus [OR 3.5 (95% CI 0.5-5.3) (p = 0.001)]. This study will provide an integrated insight of molecular epidemiology and antimicrobial resistance profiling of bacterial pathogens among children with diarrhea in Bangladesh.

High prevalence of norovirus GII.4 Sydney among children with acute gastroenteritis in Bangladesh, 2018-2021.

BACKGROUND: Active molecular surveillance and rapid diagnosis method to track an outbreak of norovirus in Bangladesh is lacking. This study aims to determine the genotypic diversity, molecular epidemiology and evaluate a rapid diagnosis method. METHODS: A total of 404 fecal specimens were collected from children aged below 60 months from January 2018 to December 2021. All samples were analyzed by reverse transcriptase polymerase chain reaction molecular sequencing of partial VP1 nucleotide. Immunochromatography kit (IC, IP Rota/Noro) was evaluated against reference test method. RESULTS: We found norovirus in 6.7 % (27 of 404) fecal specimens. A wide diversity of norovirus genotype including GII.3, GII.4, GII.5, GII.6, GII.7, and GII.9 were detected. Norovirus strain GII.4 Sydney-2012 was the most predominant (74 %, 20 of 27) followed by GII.7 (7.4 %), GII.9 (7.4 %), GII.3 (3.7 %), GII.5 (3.7 %) and GII.6 (3.7 %), respectively. Co-infection of rotavirus and norovirus (19 [4.7 %] of 404) was the most prevalent. We found higher odds of prolonged health impact [OR 1.93 (95 % CI 0.87-3.12) (p = .001)] among patients with co-infection. The incidence of norovirus was significant among the children below 24 months (p = 0.001). Significant relation of temperature with the cases of norovirus was detected (p = 0.001). The IC kit provided high specificity (99.3 %) and sensitivity (100 %) for the detection of norovirus. CONCLUSIONS: This study will provide an integrated insight on the genotypic diversity and rapid identification method of norovirus in Bangladesh.

A rare case of acute lymphoblastic leukaemia in pregnancy- unique maternal-fetal challenges.

Leukaemia in pregnancy is rare and lethal. Its incidence is estimated to be 1 in 75,000 pregnancies. Use of chemotherapeutic agents during pregnancy can give rise to maternal and fetal adversity; resulting in dilemma regarding proper management plan. A 25-year-old pregnant lady was presented at 24 wk of gestational age with cervical and inguinal lymphadenopathy and bicytopenia in complete blood counts. Diagnosis of acute lymphoblastic leukaemia was confirmed by bone marrow biopsy. Treated with appropriate chemotherapeutic regimen with some modification in the standard protocol due to pregnancy and delivered successfully by lower segment caesarean section at 34 wk of gestational age. Diagnosis of acute leukaemia during pregnancy need high index of suspicion and need prompt management with the proper chemotherapeutic regimen. Clinical judgement regarding the risk benefit ratio of using chemotherapeutic drugs ensures better mother and fetal outcome.

Assessment of Antepartum Fetal Growth by Customized "GROW" Curves Versus Noncustomized Growth Curves in Correlation with Neonatal Growth Pattern.

OBJECTIVE: To study the antepartum fetal growth between customized "GROW" curves and noncustomized growth curves with neonatal growth pattern. METHOD: Fetal growth scans are performed between 30 and 35 weeks to singleton mother. Estimated fetal weights (EFWs) were determined using ultrasound variables (biparietal diameter, head circumference, abdominal circumference, and femur length). This EFW is plotted on SONOCARE software [noncustomized growth curves developed by Medialogic solutions (P) Ltd., Chennai, India] and customized "GROW" curves to determine the type of antenatal fetal growth as AGA, small for gestational age (SGA), or large for gestational age (LGA). The fetuses were followed longitudinally till birth, and the newborns' growth patterns were determined according to birth weight at the gestational age of delivery (<10th percentile for gestational age as SGA and >90th percentile as LGA) and compared to antenatal prediction of fetal growth patterns determined by noncustomized growth curves and customized "GROW" curves. RESULTS: According to noncustomized growth curve at antenatal period, 93 % fetuses are AGA; 5.6 % are LGA, and 1 % are SGA. According to customized GROW curves, when the same EFW is plotted on GROW curves, 83 % are found to be AGA, 6.8 % LGA, and 10 % SGA. At postnatal period, according to newborn growth curve, 87.8 % are AGA, 8.8 % LGA, 3.4 % SGA. Sensitivity of customized "GROW" curves is more than that of noncustomized growth curves (45.45 vs. 18.18 %) for detection of SGA fetus. CONCLUSION: Antenatal predictions of SGA baby by ultrasonography can be almost doubled with customized "GROW" curves than noncustomized growth curves. Customized GROW curves also better predict perinatal morbidities like neonatal jaundice and NICU admission. Antenatal serial fetal growth monitoring should be done with customized GROW curves.