Toxinology- an under reported problem in Bangladesh: Need to generate evidence Dr. Fazle Rabbi Chowdhury FCPS (Medicine) MSc. (Tropical & Infectious Disease, UK) © Chowdhury FR

 Toxinology is a specialized area of science that deals specifically with animals, plant and microbial toxins.  Evidence on Toxinology from Bangladesh is still scarce. So far considerable research had been done on snake bite.  Other sections of Toxinology like wasp, bee or ant bite; jelly fish intoxication; puffer fish poisoning; food toxins etc. are still under reported in Bangladesh though cases occurred through out the country.

 The objective is to reveal Toxinology related evidence in Bangladesh.  I tried to reveal those under reported poisonings after extensive online search through pub med, Google scholar and Scopus was done to find out the published data.  Some results mentioned here from personal communication.

Study at Sylhet  It was a cross sectional observational study where twenty cases of wasp bite patients admitted in the department of Medicine in Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh, during 15th September, 2013 to 14 th September, 2014 were enrolled.  Proper history of wasp sting had been taken from the patient or attendants. A set of photograph of different wasp species available in this region had been showed to every patient for species identification and to exclude the other species.  Species also identified by the wasp brought by the patients too.

Frequency (n=20)Percentage Age < >60210 Sex Male1575 Female525

Clinical features of wasp stings

Photograph of stung sites

wasp brought by the patient or party. Collected Vespa affinis in formalin filled glass jar

 A study on insect bite is currently undergoing at eastern (Chittagong) part of the country (personal communication). According to preliminary results, Hornet was found to be the commonest offending insect (40.7%) next to which were Honey bee (14.8%), Centipede (14.8%), Bumble bee (11.1%), Scorpion bite (11.1) and Wasp bite (7.4). Study at Chittagong Medical College

 Twelve patients were admitted to the Cox’s Bazar medical college hospital on 3 rd and 4 th June, 2013.They were stung while fishing in separate groups.  All of them were male and previously healthy, stung while piling nets on their fishing boats in which these were caught accidentally. Mainuddin M, Chowdhury FR. Jellyfish envenoming in south east coasts: First case series from Bangladesh. [In the press]

Results AgeMean 26 (19-38) SexMen, twelve (100%) OccupationFishermen, twelve (100%) H/O smokingEleven (91%) Site of fisheringTeknaf, twelve (100%) Previos H/O envenomation Five (41.6%) H/O DM, HTNNone Baseline characteristics

Local redness and burning sensation was the most common clinical feature followed by linear urticarial skin lesion, generalized aches, central colicky abdominal pain, nausea and muscular tenderness and paraesthesia of four limbs. Clinical features

 Routine investigations like CBC, ALT, serum creatinine, ECG, urine RME and chest X-ray was done in all patients which were normal.  Physalia physalis Linear urticarial skin lesion after stinging by jellyfish Serum CPK was done for seven patients with body ache which was normal.

 Though sporadic cases of above mentioned poisonings are encountered through out the country, our physicians of different levels are still not aware with the magnitude of the problem.  Majority of them even don’t know the appropriate management of the cases.  Mass people are not at all aware of the problem and that’s why many cases become complicated due to delay in presenting to hospital.

 Recently separate chapter on the management of Jelly fish poisoning and Insects bite were incorporated in the National guideline of poisoning management.  This addition is believed to bring awareness among our physicians.  They also need to report the cases frequently and more advance research in this field is the demand of time.