Pulmonary tuberculosis decreased remarkably by anti-tuberculous chemotherapy, but we have had a lot of patients associated with sequelae who need medical treatment for many symptoms. We also have a lot of patients diagnosed as an extra pulmonary tuberculosis where diagnosed is usually based on histological findings and treatment duration was based on expert opinion. Besides, some patients presented with extensive tuberculosis or with so many complications that predict nonresponsive to CAT-1 tuberculosis drugs. Moreover, in these days the delayed detection of pulmonary tuberculosis that is still an important problem may cause new sequelae.

Background: Melioidosis is not widely recognized in Bangladesh which is evident from the paucity of published reports on melioidosis from this region. Here, we summarize the clinical presentation, laboratory results, prevention and control policies and make important recommendations for patient management.

Case Presentation: A 35-years-old diabetic male forest officer from Gazipur Sadar located north-west of Dhaka city got admitted to Shaheed Suhrawardy Medical College Hospital, Dhaka with history of recurrent fever for last 1 year. Initially the fever was high grade (up to 1050F), intermittent nature and lasted for a few days to week. About five months back, the patient developed a parietal abscess over the left lumber region and was treated surgically accordingly. The patient then gradually recovered and remained afebrile for about one month. Fever again recurred, high grade, quotidian in nature and has been persistent for the last 3 months. The patient had also developed marked loss of appetite, altered bowel habit with occasional vomiting and lost about 15kg of his body weight. The patient noticed profuse watery diarrhea for last 2 days and got himself admitted. On examination, the patient was found wasted, conscious but slow mentation, dehydrated and moderately anaemic. His pulse was 116/min, blood pressure 80/60 mm Hg, respiration 24/min and oral temperature was 1030
F but no palpable lymph nodes. The patient had moderate hepato-splenomegaly with left sided pleural effusion and bilateral depressed ankle jerks. B.pseudomallei was isolated and identified by blood and urine culture as well as with serological test.

Conclusion: We should be more alert among the diabetic patients who are presented with fever with high ESR and neutrophilic leucocytosis, even if radiography or cytopathology is indicative of tuberculosis.

Background and Objective: In post-treatment phase of the Human African Trypanosomiasis (HAT), some clinical manifestations might imply a relapse resulting sometimes in unnecessary patient exposure to adverse effects of trypanocidal treatments. The aim of this study is to identify clinical and biological markers easily accessible for discrimination between relapse and non-relapse.

Methods: Retrospective analysis compared clinical and laboratory data of 20 subjects with suspected relapse and 53 non-relapses. For all of the participants the research of the trypanosome on CSF was negative by direct parasitological techniques, but they presented with abnormal clinical manifestations in post-treatment phase of HAT in stage-2. As appropriate, the following analyzes were applied with significance level of 5%: Fischer’s exact test, chi-square test of Pearson and U-test of Mann-Whitney.

Results: Relapse is more likely in patients with clinical signs of progressive installation after a lag of at least three months, associated with a Cerebrospinal Fluid (CSF) profile of meningitis type, and a leukocyte count of ≥120 cells/mm3 and a score >0. Non relapse seems more feasible when symptoms appeared earlier, regardless of clinical latency, the cytology and chemistry profile of the CSF showed increased albumin level in CSF with a normal leukocyte count of ≤5 cells/mm3 and a variable score. Different phenotypes are suggested in the latter group, whose validation is essential.

Conclusion: The present investigation strongly suggests that the analysis of clinical data and the cyto-biological profile of the CSF have a discriminatory power to differentiate between relapse and non-relapse when HAT parasitological tests are negative. Multicenter investigations should be considered to strengthen the power of the observed associations.

Background: One of the major clinical problems regarding Pseudomonas aeruginosa is attributed to the production of Metallo-Betalactamase (MBL) enzymes. This group of enzymes is members of beta-lactamases which constitute Ambler class B that hydrolyze-carbapenems. This study was carried out to find out the predominant resistance mechanisms among MDRPA and the prevalence of corresponding resistance genes.

Materials and methods: MDRPA isolates collected from various clinical samples for a period of one year from March 2015 to February 2016 were included to detect the predominant mechanism of resistance using phenotypic and molecular methods. Molecular characterization of all these isolates was done by Polymerase Chain Reaction (PCR) for the presence of blaVIM2, blaIMP-1, blaOXA-23, and blaNDM-1 genes with specific primers.

Results: Among 120 MDRPA isolates 70 (58.33%) were MBL producers. Molecular characterization studied by PCR showed 15 (12.5%) of vim2 gene and only 2 (1.66%) of IMP 1 gene. None of the 120 MDRPA has produced OXA 23 and NDM gene in our study.

Conclusion: The prevalence of MBLs has been increasing worldwide, particularly among P. aeruginosa, leading to severe limitations in the therapeutic options for the management. Thus, proper resistance screening measures and appropriate antibiotic policy can be strictly adopted by all the healthcare facility providers to overcome these superbugs.