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Background: Pulmonary oedema is a feared and difficult to predict complication of severe malaria that can emerge after start of antimalarial treatment. Proinflammatory mediators are thought to play a central role in its pathogenesis. Methods: An exploratory study was conducted to evaluate the predictive capacity of biomarkers for development of clinical pulmonary oedema in patients with severe falciparum malaria at two hospitals in Bangladesh. Plasma concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor (TNF), soluble Receptor of Advanced Glycation End-products (sRAGE), surfactant protein-D (SP-D), club cell secretory protein (CC16), and Krebs von den Lungen-6 (KL-6) on admission were compared with healthy controls. Correlations between these biomarker and plasma lactate and Plasmodium falciparum histidine-rich protein 2 (PfHRP2) levels were evaluated. Receiver Operating Characteristic (ROC) curves were constructed to assess the predictive capacity for clinical pulmonary oedema of the biomarkers of interest. Results: Of 106 screened patients with falciparum malaria, 56 were classified as having severe malaria with a mortality rate of 29%. Nine (16%) patients developed clinical pulmonary oedema after admission. Plasma levels of the biomarkers of interest were higher in patients compared to healthy controls. IL-6, IL-8, TNF, sRAGE, and CC16 levels correlated well with plasma PfHRP2 levels (rs = 0.39; P = 0.004, rs = 0.43; P = 0.001, rs = 0.54; P < 0.001, rs = 0.44; P < 0.001, rs = 0.43; P = 0.001, respectively). Furthermore, IL-6 and IL-8 levels correlated well with plasma lactate levels (rs = 0.37; P = 0.005, rs = 0.47; P < 0.001, respectively). None of the biomarkers of interest had predictive capacity for development of clinical pulmonary oedema. Conclusions: IL-6, IL-8, TNF, sRAGE, SP-D, CC16 and KL-6 cannot be used in predicting clinical pulmonary oedema in severe malaria patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients. METHODS: IgM against 12 purified antigens and the Vi polysaccharide was measured by ELISA in plasma from patients with confirmed typhoid fever (n = 32), other confirmed infections (n = 17), and healthy controls (n = 40). ELISAs with the most specific antigens were performed on plasma from 243 patients with undiagnosed febrile disease. RESULTS: IgM against the S. Typhi protein antigens correlated with each other (rho > 0.8), but not against Vi (rho 0.85, respectively. Applying a dynamic cut-off to patients with undiagnosed febrile disease suggested that 34-58% had an IgM response indicative of typhoid. CONCLUSIONS: We evaluated the diagnostic potential of several S. Typhi antigens; our assays give good sensitivity and specificity, but require further assessment in differing patient populations.

Background: Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. Methods: The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. Findings: Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. Conclusions: Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country. Author summary: Snakebite envenoming is an important health problem in Bangladesh. A community-based survey conducted in 2009 indicated that around 700,000 snakebites/year may occur in this country. However, until now, there is no study estimating the incidence of snakebite in Bangladesh from the aspect of ecology. Considering the climatic, environmental, and human population variables, a large, 16-year clinico-epidemiological dataset of snakebite patients was analysed to portray snakebite occurrence probability in Chattogram Division, which comprises the south-eastern part of Bangladesh. Five species distribution models were used to map snakebite-prone areas. We found that the study area has large differences in the predicted incidence of snakebite. Our predictions indicate that around 200,000 snakebite cases per year might occur in the study area, where the latest estimate on 2009 estimated less than half that number for this division. Further, predictions for the year 2070 provide us with similar numbers, independent of the global increase in temperature. As snakebite will remain a major health problem for this country in the next 50 years, we propose the development of a sustainable management plan aiming to limit human-snake conflicts and their consequences while safeguarding also snakes and the ecosystem services they provide especially to agriculture. [ABSTRACT FROM AUTHOR]

Pesticide poisoning is a common medical emergency in the rural tropics, with significant associated mortality. Pesticide poisoning is an umbrella term that encompasses a wide variety of substances with differing clinical toxidromes and outcomes. Despite this, confirmation of the specific compound ingested is rarely performed. In this Lessons from the Field, we argue that pesticide-specific management is integral to optimise management. Using data from a quality improvement project in Chittagong, Bangladesh, we demonstrate that identifying the specific compound is possible in most patients through careful history taking and examination of the pesticide bottle. Identification of the specific compound is essential for anticipating and reducing complications, administering appropriate and timely management and reducing the length of hospital stay and cost of unnecessary medical intervention. [ABSTRACT FROM AUTHOR]

Background: Snakebite envenoming is a global health problem, mostly in tropical and subtropical countries. Bangladesh is a subtropical country facing thousands of snakebite envenoming death every year. Knowledge of the distribution of venomous snakes is necessary to identify snakebite-prone areas, develop strategies for prevention and management, and reduce venom-induced mortalities and morbidities. Methods: An integrated effort of direct observations of snakes, qualitative analysis of museum specimen records, clinical records of snakebites, and scholarly literature records were used to understand the pattern of distribution of venomous snakes in Bangladesh. Results: We enlist 65 venomous snake species from Bangladesh and present detailed documentation on their distribution pattern. However, only nine species were considered medically relevant species because of their venom potentiality to kill humans and available clinical records of envenomation. The distribution pattern of those species divides the country into two major portions. A portion consists of northern, northwestern, and western parts of the country, which are habitats of Naja naja, Bungarus caeruleus, and B. lividus. Another portion comprised of the northeastern, southeastern, and southern parts of the country provides habitats for N. kaouthia, B. niger, and Trimeresurus erythrurus. However, Daboia. russelii had a different distribution pattern along the bank of the Padma and Meghna, and some coastal districts. Moreover, B. walli had a scattered distribution over the country. The knowledge of this ecological distribution of venomous snakes across the country bears a significant practical effect on clinical management of snakebite. Treating physicians can have a better understanding of possible offending snake species using this knowledge and the clinical syndromes produced by venoms. Conclusion: Pattern of distribution of medically relevant venomous snakes in Bangladesh approaches to initiate concise and specific bite management strategies for two distinct distributional regions of the country. Moreover, the distribution of D. russelii and B. walli demands specific strategies for bite management. [ABSTRACT FROM AUTHOR]