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

Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction

Background: The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction. Methods: We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs). Results: Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children. Conclusions: Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea