Neonate with Rare Clinical Presentation of COVID-19: A Report of Two Clinically Distinct Cases

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world. We describe two cases of neonate, presenting with features like multisystem inflammatory syndrome (MIS-C), who presented to our neonatal unit of Dr. M R Khan Shishu Hospital, Bangladesh on August, 2020.Case 1 was a 7-day-old male infant presented at 14 hours of life with fever, poor feeding, per rectal bleeding and shock. Detailed examination revealed Down’s fancies and pallor. Case 2 was 15-day old neonate presenting with fever, rash and convulsion and his laboratory values were remarkable for high levels of C-reactive protein, D-dimer, ferritin and his Cerebrospinal fluid (CSF) findings were consistent with aseptic meningitis. Both babies were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First case was very critical and referred to tertiary care hospital after stabilization. 2nd case recovered completely and was discharged to home in 15 days. Though till date COVID 19 in neonate is not very well-known to us, it is essential to disseminate information among the medical community regarding severe and atypical presentations of COVID-19 in neonate as prior knowledge can help to quickly identify and treat these patients as they present in the neonatal department. Bangladesh Journal of Infectious Diseases 2020;7(2):102-106

Association of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) Grading on the Basis of Cycle Threshold Value with Conventional Microbiological Diagnosis in Pediatric Tuberculosis

Background: Microbiological confirmation of tuberculosis disease in children remains difficult due to paucibacillary disease and inability to obtain optimal samples. Recently introduced Cartridge based nucleic acid amplification test (CBNAAT) has improved microbiological diagnosis in pediatric tuberculosis. Objectives: We aimed to study association of CBNAAT grading based on cycle threshold value with conventional microbiological diagnosis. Methodology: This prospective study was conducted over a period from November 2016 to October 2017 in the Departments of Microbiology and Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi. CBNAAT positive pediatric TB cases ≤12 years were recruited and subjected to Ziehl-Neelsen staining for acid fast bacilli (AFB) & culture on Lowenstein Jensen medium. CBNAAT positivity was graded based on cycle threshold value: very low, low, medium and high. Results: Smear and culture positivity was highest (100%) among specimens with high positive CBNAAT result based on CT value. Time to culture positivity was inversely related to CBNAAT grading (p=0.000). Conclusion: CBNAAT grading has significant positive association with smear and culture positivity. Bangladesh Journal of Infectious Diseases 2020;7(2):72-77

Rabies Elimination Program of Bangladesh

not available Bangladesh Journal of Infectious Diseases 2020;7(2):34-35

Ivermectin the Promising Drug to Stave off the COVID-19 Crisis: A Review

The Coronavirus disease 2019 (COVID-19) outbreak, forcing us to face unprecedented moments in the world. The huge devastating impact of the world due to the covid-19 attack causes the brink of no return. However, there is no proven and specific treatment for Covid -19. Very few medications have received Emergency Use of Authorization. A recent in vitro study was the first time to find out and to assess the antiviral effect of Ivermectin on COVID-19. The study showed that Ivermectin was active against COVID- 19-infected cells, was able to kill effectively almost all viral particles within 48 h. In these moments of crisis, FDA-approved ivermectin is a ray of hope. Bangladesh Journal of Infectious Diseases 2020;7(2):95-98

Prediction of Length of Hospital Stay and Immediate Outcome of Children Suffering From Bronchiolitis on the Bases of Associated Risk Factors

Background: Bronchiolitis is the most common reason for hospitalization among children younger than 2 years. Objective: The aim of the study was to assess the possibility that the associated risk factors in children suffering from bronchiolitis could predict the length of hospital stay and also to observe the immediate outcome. Methodology: This prospective study was conducted in a district hospital of Bangladesh in a period of two years from January 2011 to December 2012. Patients aged 2 years or less fulfilling inclusion criteria for bronchiolitis and required admission were enrolled in this study. Patients having comorbidities and who were discharged before fulfilling the study criteria for discharge were excluded from the study. Treatment was given according to National Guidelines for the Management of Bronchiolitis. All demographic, clinical and laboratory data were recorded in a prefixed questionnaire and analyzed. Results: Among 100 patients, 60% cases were hospitalized for 4 days or more. Mean duration of hospital stay was 4.37±1.93 days. Patients of male sex (67%), younger than 6 months of age (71%), preterm birth (21%), weight-for-age was either ≥2SD (60%) or ≤3SD (23%) were hospitalized for longer duration. Length of hospitalization was also increased in patients with family history of asthma (37%), smoking (75%), using wood-burning stoves for cooking (89%) and no previous history of respiratory distress (81%). Exclusively breastfed infants (41%) stayed hospital for shorter duration than those who fed partially (53%) or not at all (6%). All patients were improved in this case series (100%). Conclusion: Bronchiolitis patients having male sex, age less than 6 months, preterm born, partially breast fed , family history of asthma, exposure to smoking and wood-burning stoves were deduced to be significant risk factors for prolongation of length of hospitalization. Further research is needed to determine how these risk factors contribute to the development of the disease and prolong the length of hospital stay. Bangladesh Journal of Infectious Diseases 2020;7(2):67-71

Exploration of Knowledge of Tuberculosis Patients Regarding their Disease in Quetta, Pakistan

Background: Knowledge of tuberculosis is very important for the patients. Objective: This study was aimed to assess and explore the knowledge of TB patients regarding their diseases in Quetta, Pakistan. Methodology: This questionnaire based, cross sectional analysis was conducted in Fatima Jinnah Chest Hospital, Quetta with in all TB patients. Knowledge was assessed by using a pre-validated self-administered questionnaire containing 22 disease related questions. Convenience sampling technique was used for data collection. Descriptive analysis was used to demonstrate the characteristics of the study population. Result: Mean age of respondents was 40.99±18.10. Study was dominated by 168 (60.00%) of females. Two hundred (71.40%) were married. One hundred sixteen (41.40%) had no any education. One hundred sixty-eight (60.00%) were Pashtun. One hundred thirty-two (47.10%) having income less than 10000 PKR and ranges between 10000 to 18000 PKR respectively. One hundred fifty-six (55.70%) were having rural residency. One hundred fifty-six (58.10%) having no any co-morbidity. Mean score of knowledge was 11.23±3.616. Conclusion: Knowledge is a key factor in understanding any particular disease. If the level of knowledge is low in some or all parts of the disease, it will actually affect the patient. It can be concluded that there is a need to raise awareness of TB symptoms, mode of transmission, prevention, diagnosis and treatment of the disease through health education. Bangladesh Journal of Infectious Diseases 2020;7(2):78-83

A Case Report of Streptomycin Induced Cochlear Toxicity in Tuberculosis Patients

Streptomycin is a semi-synthetic, oldest aminoglycoside. It is the first line drug for tuberculosis. It may adversely produce ototoxicity, nephrotoxicity, neuromuscular blockage. The initial isolation of streptomycin from Streptomyces griseus. A 51 year old female visited to the medicine OPD in hospital. On presentation she complained of vomiting and vertigo from last few days. The patient recently diagnosed for Pulmonary TB by chest X-ray 3 month back. She taken streptomycin 0.75mg IV bid. As these were the new symptoms, the physician requested for otolaryngologist consultation to rule out the other causes and was insignificant. But the audiometry report showed hearing loss. The ototoxicity caused by aminoglycosides is permanent and can negatively affect the individual’s quality of life. The early detection, management and therapeutic approaches for prevention of hearing loss is crucial. Reporting here is an interesting case of streptomycin induced cochlear toxicity. Bangladesh Journal of Infectious Diseases 2020;7(2):99-101

Association of Testosterone Level among Lepromatous and Borderline Leprosy Male Patients: Experience of 30 Cases in Bangladesh

Background: Hormonal dysfunction is reported among the leprosy patients. Objective: The purpose of the present study was to see the association of testosterone level among male patients presented with lepromatous and borderline leprosy. Methodology: This cross-sectional study was conducted in the Leprosy Hospital, Dhaka, Bangladesh from January to December 2016 for a period of one year. All patients with a known diagnosis of leprosy under follow up at the hospital were included in the study. The serum concentration of testosterone was measured using an enzyme immunoassay technique (ELISA) (DiaMetra, Spello, Italy). Result: A total number of 30 cases of leprosy were recruited for this study. The mean with SD of the study population was 39.20±9.065 years. Among 30 cases of study population 26 cases were lepromatous leprosy patents and the rest 4 cases were Borderline Leprosy patients. The mean with the standard deviation of testosterone level in serum was 6.41±4.756 mg/dL and 4.71±2.396 mg/L in lepromatous leprosy and borderline leprosy respectively (p=0.497). Conclusion: In conclusion there is no statistically significant relationship between leprosy and testosterone; however, lower level of testosterone is found among the study population Bangladesh Journal of Infectious Diseases 2020;7(2):36-39

Whooping Cough Followed by Lower Motor Neuron Facial Palsy: A Case Report

A 5 years old child with pertussis reported to us with a unique complication not mentioned in the literature. He was thoroughly examined and investigated to find out cause for his lower motor neuron (LMN) facial palsy but purtussis seemed to be the sole reason. With treatment of purtussis the patient showed marked improvement of neurological deficit. Bangladesh Journal of Infectious Diseases 2020;7(2):107-109

Knowledge of Biosafety Measures among Laboratory Personnel at Tertiary Level Public Hospitals in Dhaka City

Background: Biosafety is the principles, technologies and practices that are implemented to prevent the unintentional exposure to pathogens and toxins. Objective: The purpose of the present study was to assess the Status of biosafety safety measures practice by medical laboratory workers in public hospitals of Dhaka city. Methodology: This descriptive cross-sectional study was conducted with Data from Medical Laboratory Workers of Tertiary Level Public Hospitals of Dhaka City using a Semi-Structured Questionnaire. The study was conducted from May 2015 to November 2015. It was designed to assess the Status of Practicing Biosafety Safety Measures in Tertiary Level Public Hospitals of Dhaka City. The knowledge, training, level of education on Biosafety were assessed by medical laboratory workers. Result: The Data of this study is obtained from a total of 238 respondents. In this study it is observed that 224(94%) respondents could not say the concept of Biosafety as defined by WHO. In this study 118(49%) respondents do not know about biosafety cabinet and 84(35%) could say up to Biosafety Level IV and 36(15%) can say up to Biosafety Level 3. Orientation with biosafety tools is observed in 138(58%) respondents, 76(32%) got training during course and 78(33%) got training during service. Conclusion: In conclusion knowledge and training on biosafety of the laboratory worker are inadequate. Bangladesh Journal of Infectious Diseases 2020;7(2):49-56