Detection of Anti- Leptospira

Leptospirosis is a globally distributed zoonosis with varied clinical outcomes and multiorgan involvement in humans. In this study conducted from July 2011 to December 2011, 178 serum samples from patients suspected of leptospirosis were tested by Panbio IgM ELISA at National Public Health Laboratory, Kathmandu, out of which 51 (28.65%) were positive for anti-Leptospira IgM antibody. Leptospirosis was more common in people in their 2nd and 3rd decades of their life which together comprised 56.86% of the total positive cases. Most of those tested positive were farmers followed by students and housewives. Both animal contact and water contact seemed to play significant roles in disease transmission. Symptoms were vague with the most common being fever, headache, myalgia, abdominal pain, vomiting, jaundice, and diarrhoea. Life style heavily dominated by agronomical and farming activities in Nepal is conducive to leptospirosis transmission. Leptospirosis seems to be a significant public health problem in Nepal but is underestimated. In resource poor countries like Nepal where laboratories performing MAT or maintaining cultures are rarely available, serological test like ELISA could well depict the scenario of the disease prevalence

Study on Cyclospora Cayetanensis in Kathmandu Valley

Cyclospora caytanensis, a human pathogenic coccidian parasite owes its recognition as an emerging parasite, which continues to be found throughout the world. Its prevalence was investigated in Kathmandu valley, Nepal in 2003. Stool examination was performed with a total of 500 specimens from 3 Hospitals, 1 Geriatric Centre (Briddhaashram), 1 Infectious and Tropical Disease Research Center/Nepal and 8 Slum areas by direct smear technique. Out of these specimens, Cyclospora caytenensis oocysts were found in 7% of specimens with the age range from 2 months to 67 years. To identify possible sources for Cyclospora infection, water samples from 3 rivers, 134 fecael samples of animals and 43 samples of green leafy vegetables wash were collected and examined by formal-ether sedimentation and floatation technique. As a result, oocyst of Cyclospora was identified only in chicken stool sample, which could be possible reservoir host for Cyclospora infection. However, further studies are needed to shed light on possible sources of infection. Key Words: Cyclospora caytanensis, coccidian parasite, diarrhoea, faecal specimens

KAtex Test for the Detection of Urinary Antigens in Visceral Leishmaniasis Patients of Nepal

The rapid detection of parasitic antigens in body fluid including urine by immunological tests such as KAtex has been a valuable addition to clinical medicine. Existing method of microscopic bone-marrow examination and immunological test for antigen –enzyme-linked immunosorbent assay (ELISA) test for visceral leishmaniasis antigen are difficult to perform in the field, and this has limited use in rural areas of endemic countries like Nepal. In this study we have tested 276 urine samples from visceral leishmaniasis patients from different endemic areas of Nepal. Sixty-seven patients (24.3%) were found KAtex positive. The clinical picture of these patients was compared with the KAtex test and additional laboratory findings, knowledge, attitude and behaviour were assessed. High rate of KAtex positive (97.4%) was found in bone marrow confirmed patients with high degrees of sensitivity and specificity. Hence the study confirmed that the KAtex test is suitable for the confirmation of suspected cases in the field and hospital where bonemarrow facilities are limited or where there is a lack of trained manpower as well as microscopic diagnosis is not available. ORIGINAL ARTICLE Journal of Nepal Medical Association 2003; 42: 191-195 Sherchand J B*, Shah S N*, Hommel M** Key Words: Rapid diagnostic test, urinary antigen, visceral leishmaniasis, Nepal

Enteric Opportunistic Parasitic Infections Among HIVSeropositive Patients in Kathmandu, Nepal

Background Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV) infected patients. Objective The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods The present study was conducted in Dirgh-Jeevan Health Care Research Center and Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal between June 2010 and May 2011 involving 146 Human Immunodeficiency virus (HIV) positive patients. Serostatus from these patients were detected by Enzyme Linked Immunosorbent assay. CD4+ T cell counts were done by flow cytometry. Stool was examined for enteric parasites by microscopy with special staining methods. Results A total of 146 HIV sero-positive patients with and without diarrhea age between 20 to 45 years were included in the study. Of the 146 patients, the protozoan parasitic infection was found in 30.13% (44/146). Out of 146 patients, 78 had diarrhea in which parasitic infection was 39 (50%) and 7.35% (5/68) protozoal parasites positive cases did not have diarrhea. A significant difference (p&lt;0.05) was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Out of 43 patients whose CD4+ T cells were &lt;200/?l, 29 (67.4%) had opportunistic parasitic infection whereas out of 103 patients whose CD4+ T cells were ?200/?l, only 15 (14.56%) had opportunistic parasitic infection (P &lt; 0.05). Conclusion Enteric opportunistic parasitic infections were detected in 30.1% among HIV-seropositive patients and low CD4+ T count indicated high enteric opportunistic infection. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 14-17 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7336</jats:p

Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study

Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices