title: Invasive Haemophilus influenzae type B diseases in Bangladesh, with increased resistance to antibiotics.
abstract: OBJECTIVE
  To determine the prevalence, age-group distribution, serotype, and antibiotic susceptibility patterns of invasive Haemophilus influenzae type b (Hib) isolates in Bangladeshi children because data regarding Hib diseases in developing countries are scarce, which has led to delay of the introduction of Hib vaccine in these countries.
  
  
  METHODS
  Children diagnosed with meningitis (n = 1412) and pneumonia (n = 2434) were enrolled in this surveillance study for Hib invasive diseases. Cerebrospinal fluid (CSF) and blood specimens, and the subsequent isolates, were processed using standard procedures.
  
  
  RESULTS
  During 1993 to 2003, 455 H influenzae strains were isolated from patients with meningitis (n = 425) and pneumonia (n = 30), and an additional 68 Hib meningitis cases were detected by latex agglutination (LA) testing. Overall, 35% of pyogenic meningitis cases were a result of H influenzae, 97.1% of which were Hib. Most (91.4%) cases occurred during the first year of life. Resistance to ampicillin, chloramphenicol, and cotrimoxazole was 32.5%, 21.5%, and 49.2%, respectively. There was a trend toward increasing resistance for all three drugs. Resistance to ampicillin and chloramphenicol was almost universally coexistent and was associated with increased sequelae compared with the patients infected with susceptible strains (31% [23/75] vs 11% [21/183]; P <.001).
  
  
  CONCLUSIONS
  Hib is the most predominant cause of meningitis in young Bangladeshi children. Resistance to ampicillin and chloramphenicol and the high cost of third-generation cephalosporin highlight the importance of disease prevention through vaccination against Hib.
authors.affiliation: Department of Microbiology, Dhaka Shishu (Children) Hospital, Bangladesh Institute of Child Health, Dhaka, Bangladesh. sksaha@bangla.net
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: M
authors.initials: M
authors.lastname: Ruhulamin
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hanif
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oishi
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nagatake
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D019741:Haemophilus influenzae type b / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008583:Meningitis, Haemophilus / Q000188:drug therapy* / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents