CyClOSPOriaSiS iN NEPal

Abstract. Nepal is one of the most highly endemic areas for cyclosporiasis in the world. Initial studies of the parasitosis in Nepal were among expatriates and tourists in the country. The present report, however, is a review of studies carried out since 1995 on the epidemiology of Cyclospora cayetanensis and infection in the Nepali populations. The parasitosis was found to occur mostly in children 2-11 years of age. Stools from several thousands of patients with diarrhea were examined, and approximately 6-30% were positive for oocysts of the parasite. The majority of patients were seen during the rainy season. Stool specimens from animals were examined, and oocysts were recovered from six chickens, two monkeys, three dogs, and five rats. PCR/RFLP analysis of oocysts from one monkey, one dog, and 2 chickens were positive for Cyclospora sp. Oocysts of Cyclospora were also found in sewage, a pond and two irrigation canals, and the washwater of cabbage, lettuce, mustard leaves, and basil. Basil may be an important source of infection since it is often eaten raw

Mapping of lymphatic filariasis in Nepal

BACKGROUND: Human infection with Wuchereria bancrofti causes a disabling parasitic disease known as lymphatic filariasis, which is a major public health and socio-economic problem in many parts of the world. At the onset of the study, little was known of the distribution of filariasis and its current importance as a public health problem in Nepal. METHODS: Epidemiological mapping was undertaken to determine the prevalence of infection by Wuchereria bancrofti in 37 districts of Nepal between July to December 2001. The study population above 15 years of age was selected, and the immunochromatographic test (ICT Filariasis) was used to screen for circulating filarial antigen (CFA). RESULTS: The overall prevalence of lymphatic filariasis from a 4,488-sample population was 13% and 33/37 districts were found to be endemic. On the basis of geographical data, the highest number of cases was found at altitudes between 500–700 m; however, a substantial number of infected individuals were found in the highly populated Kathmandu valley, at altitudes between 900–1,500 metres where transmission appears to take place. Prevalence rates above 20% were found in 11 districts (with the highest rate of 40%), 6–19% were found in 15 districts, and 0.1–5% were in 7 districts. Information on people's knowledge, attitudes and behaviour towards filariasis was also collected by means of a structured questionnaire, which is presented and discussed in the study. CONCLUSIONS: This is the most extensive study of lymphatic filariasis undertaken to date in Nepal. The study indicates that the prevalence of infection is far greater that was previously reported and that lymphatic filariasis should be a much higher health priority than currently given

Cyclospora cayetanensis: An Infestation among Diarrheal Children in Kathmandu Valley, Nepal

Cyclospora cayetanensis, a coccidian parasites which is responsible for recurring diarrhea and gastroenteritis especially among children living under poor hygienic condition in developing country like Nepal. Aimed of this research is to find out the prevalence of intestinal parasites and C. cayetanensis among diarrheal children in a Pediatric Hospital in Kathmandu valley, Nepal. Cross-sectional type of study was done. Altogether 196 stool specimens were collected from June to September 2013 among outpatient diarrheal children in Kanti Children’s Hospital. Modified Ziehl Neelson staining method was applied for detection of oocysts of Cyclospora after formal-ether sedimentation. Parasites were detected in 13.7% (27/196) of stool samples from ≤ 15 year old diarrheal patients. C. cayetanensis was detected in 4.8% (8/196). In genderwise, infection rate of C. cayetanensis 4.5 % (5/112), in male were higher than 3.6% (3/84) in female. In agewise, infection rate of C. cayetanensis in 5.7 % (3/52) 11-15 year old were highest followed by 4.1% (3/78) in 0-5 year old and 3.0% (2/66) in 6-10 year old. In seasonwise, infection rate of Cyclospora was highest in the month of August 7.4% (4/54) followed by 3.9% (2/51) in July, 2.3% (1/44) September and 2.1% (1/47) in June. Altogether five different type of parasites were detected. Infection rate of Giardia lamblia were highest 5.1 % (10/196) whereas lowest was Cryptosporidium parvum 1.0 % (2/196). Prevalence of C. cayetanensis is highly probable to infant, neonate, toddler and diarrheal children. Therefore, attention should be made in laboratory investigation of C. cayetanensis while suspecting the diarrheal patients infected with other parasites

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

Pilot study on wastewater surveillance of dengue virus RNA: Lessons, challenges, and implications for future research

Dengue virus (DENV) is an enveloped, single-stranded RNA virus that causes approximately 390 million infections, leading to 40,000 deaths annually. Due to the increasing trend of urbanization, water supply scarcity, and climate change, dengue is regarded as the “disease of the future,” requiring robust surveillance for the early detection of DENV infection. Since the virus is shed in urine and saliva and persists in wastewater at different temperatures, our study conducted wastewater surveillance as a novel approach to monitor dengue outbreaks in the Kathmandu Valley, Nepal. The viral concentrates (n = 34), which were previously collected and concentrated from municipal and hospital wastewater, and river water using the electronegative membrane-vortex method, were tested for DENV using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and digital PCR (RT-dPCR). Pepper mild mottle virus, a process control and endogenous biomarker, was detected in all the samples with concentrations ranging from 8.0 to 10.0 log10 copies/L, whereas DENV was not detected in any sample using RT-dPCR and RT-qPCR. The undetected DENV in this study could be attributed to the collection of grab wastewater samples during a low relative prevalence of dengue infection in the region, insufficient sample volume processed, probable viral nucleic acid degradation due to storage of viral concentrate at -25 °C for a long period of time, or inefficiency of the primary concentration method used. This study highlights critical gaps in knowledge and provides recommendations for future implementation of wastewater surveillance of dengue outbreaks, especially in regions where dengue was recently introduced, clinical surveillance is limited, and wastewater surveillance for polio has been adopted.Peer reviewe

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

Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers?

Available online 10 January 2020Although Nepal has been identified as a country highly vulnerable to adverse health and socioeconomic impacts arising from climate change, extant research on climate sensitive infectious diseases has yet to develop the evidence base to adequately address these threats. In this opinion paper we identify and characterise basic requirements that are hindering the progress of climate change and infectious disease research in Nepal. Our opinion is that immediate attention should be given to strengthening Nepal's public health surveillance system, promoting inter-sectoral collaboration, improving public health capacity, and enhancing community engagement in disease surveillance. Moreover, we advocate for greater technical support of public health researchers, and data sharing among data custodians and epidemiologists/researchers, to generate salient evidence to guide relevant public health policy formulation aimed at addressing the impacts of climate change on human health in Nepal. International studies on climate variability and infectious diseases have clearly demonstrated that climate sensitive diseases, namely vector-borne and food/water-borne diseases, are sensitive to climate variation and climate change. This research has driven the development and implementation of climate-based early warning systems for preventing potential outbreaks of climate-sensitive infectious diseases across many European and African countries. Similarly, we postulate that Nepal would greatly benefit from a climate-based early warning system, which would assist in identification or prediction of conditions suitable for disease emergence and facilitate a timely response to reduce mortality and morbidity during epidemics.Dinesh Bhandari, Peng Bi, Jeevan Bahadur Sherchand, Meghnath Dhimal, Scott Hanson-Ease

Cryptosporidium infection among the school children of Kathmandu Valley

Introduction: Cryptosporidium, a coccidian protozoan genus has emerged as an important cause of parasitic diarrhea among children living in developing countries. The present study aimed to determine the infection of Cryptosporidium and other intestinal parasites among the school children of Kathmandu Valley. Methods: Ethical approval for this research was obtained from Institutional review board, Institute of Medicine. A total of five hundred and seven stool samples from children between the age group 3-14 years, studying in 13 different schools of Kathmandu were collected during the study period (May- November, 2014) and processed in the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified Acid Fast staining technique (Kinyoun’s method) was used to detect oocysts of Cryptosporidium from the formal-ether concentrated stool samples. Result: The overall, prevalence of intestinal parasites among children was found to be 22.68% (115/507)with Giardia lamblia being the most predominant parasite showing the incidence of 10.45% (53/507). Cryptosporidium oocysts were detected in 0.79% (4/507) of the students investigated with the highest occurrence during the month of July i.e., 2 followed by single positive case for each, June and September. Conclusion: The detection of Cryptosporidium oocysts and observance of diarrheal symptoms, together with the pattern of age-specific occurrence, livestock presence at home, consumption of untreated drinking water and raw vegetables/fruits consumption habit among infected children suggest that in low-income Kathmandu communities, cryptosporidiosis coupled with poor sanitary practice is a public-health issue causing potentially serious consequencesBhandari D, Tandukar S, Sherchand S, Thapa P, Shah P

Non-linear effect of temperature variation on childhood rotavirus infection: A time series study from Kathmandu, Nepal

Available online 30 July 2020Introduction: This study aimed to investigate the effects of temperature variability on rotavirus infections among children under 5 years of age in Kathmandu, Nepal. Findings may informinfection control planning, especially in relation to the role of environmental factors in the transmission of rotavirus infection. Methods: Generalized linear Poisson regression equationswith distributed lag non-linearmodelwere fitted to estimate the effect of temperature (maximum,mean and minimum) variation onweekly counts of rotavirus infections among children under 5 years of age living in Kathmandu, Nepal, over the study period (2013 to 2016). Seasonality and long-term effects were adjusted in the model using Fourier terms up to the seventh harmonic and a time function, respectively. We further adjusted the model for the confounding effects of rainfall and relative humidity. Results: During the study period, a total of 733 cases of rotavirus infection were recorded, with amean of 3 cases per week. We detected an inverse non-linear association between rotavirus infection and average weekly mean temperature, with increased risk (RR: 1.52; 95% CI: 1.08–2.15) at the lower quantile (10th percentile) and decreased risk (RR: 0.64; 95% CI: 0.43–0.95) at the higher quantile (75th percentile). Similarly, we detected an increased risk [(RR: 1.93; 95% CI: 1.40–2.65) and (RR: 1.42; 95% CI: 1.04–1.95)] of rotavirus infection for both maximum and minimum temperature at their lower quantile (10th percentile). We estimated that 344 (47.01%) cases of rotavirus diarrhoea among the children under 5 years of age were attributable to minimum temperature. The significant effect of temperature on rotavirus infectionwas not observed beyond lag zero week. Conclusion: An inverse non-linear association was estimated between rotavirus incidence and all three indices of temperature, indicating a higher risk of infection during the cooler times of the year, and suggesting that transmission of rotavirus in Kathmandu, Nepal may be influenced by temperature.Dinesh Bhandari, Peng Bi, Meghnath Dhimal, Jeevan Bahadur Sherchand, Scott Hanson-Ease

Prevalence of Arcobacter and other pathogenic bacteria in river water in Nepal

Published: 10 July 2019This study aims to determine the diversity of pathogenic bacteria in the Bagmati River, Nepal, during a one-year period. A total of 18 river water samples were collected from three sites (n = 6 per site) along the river. Bacterial DNA, which were extracted from the water samples, were analyzed for bacterial 16S rRNA genes by next-generation sequencing for 13 of 18 samples, and by quantitative PCR targeting Arcobacter for all 18 samples. The 16S rRNA sequencing identified an average of 97,412 ± 35,909 sequences/sample, which were then categorized into 28 phyla, 61 classes, and 709 bacterial genera. Eighteen (16%) genera of 111 potential pathogenic bacteria were detected with abundance ratios of >1%; Arcobacter, Acinetobacter, and Prevotella were the dominant genera. The Arcobacter abundance ratios were 28.6% (n = 1), 31.3 ± 15.8% (n = 6), and 31.8 ± 17.2% (n = 6) at the upstream, midstream, and downstream sites, respectively. Arcobacter was detected in 14 (78%) of 18 samples tested, with concentrations ranging from 6.7 to 10.7 log10 copies/100 mL, based on quantitative PCR. Our results demonstrate the poor bacterial quality of the Bagmati River water, suggesting a need for implementing more measures to reduce fecal contamination in the river water.Rajani Ghaju Shrestha, Sarmila Tandukar, Dinesh Bhandari, Samendra P. Sherchan, Yasuhiro Tanaka, Jeevan B. Sherchand and Eiji Haramot