Exposure to Leptospira spp. and associated risk factors in the human, cattle and dog populations in Bhutan

Leptospirosis is a neglected worldwide zoonotic bacterial disease with a high prevalence in subtropical and tropical countries. The prevalence of Leptospira spp. in humans, cattle and dogs is unknown in Bhutan. Therefore, we sought to find out whether humans, cattle or dogs had been infected in the past with leptospires by measuring antibodies in the serum. We therefore collected blood from 864 humans >/=13 years of age, 130 bovines and 84 dogs from different rural and urban areas in Bhutan and tested the serum for antibodies specific for leptospires with a screening of enzyme-linked immunosorbent assays (ELISA) and a confirmatory microscopic agglutination test (MAT). In humans, 17.6% were seropositive by ELISA and 1.6% by MAT. The seropositivity was stronger in bovines (36.9%) and dogs (47.6%). "Having had a fever recently" (OR 5.2, p = 0.004), "working for the military" (OR 26.6, p = 0.028) and "being unemployed" (OR 12.9, p = 0.041) (reference category = housemaker) were statistically significantly associated with seropositivity when controlled for the effects of other risk factors. However, due to the small number of positive test results, the findings on risk factors should be interpreted with caution. Based on the serogroups found in the three species, dogs could be a source of infection for humans, or dogs and humans are exposed to the same environmental risk factors Clinical leptospirosis in humans and domestic animals should be investigated by testing blood and urine for the presence of leptospires by molecular methods (qPCR)

Posttransplant urinary tract infections and surgical site infections among renal transplant recipients in a transplant unit in Sri Lanka

Aim: Kidney transplant (KT) recipients are at higher risks of infections due to the chronic disease conditions, the surgical procedure and immunosuppressive therapy following transplantation. We aimed to assess the incidence and the microbiology of urinary tract infections (UTIs) and surgical site infections (SSIs) in KT recipients at the transplant unit in Kandy Teaching Hospital, Sri Lanka. Methods: A prospective, descriptive study was carried out in patients undergoing KT for 6 months postoperatively. A urine full report and culture were carried out before transplantation and on days 1, 3, 7 and monthly for 6 months posttransplantation. Urine specimens yielding growth of ≥105 CFU/ml were considered significant. In addition, patients were screened preoperatively for Staphylococcus aureus colonization by multi-site swabbing. The surgical sites were inspected daily for SSI. Results: Thirty-nine patients were recruited in the study. Two patients (5.1%) had preoperative UTI and 4 (10.3%) developed UTI within 6 months. Majority of post-KT UTI (75.0%) occurred in the 1st month. UTI was commonly due to coliforms (50.0%) while S. aureus and Pseudomonas spp. accounted 25% each. All screened patients were colonized with S. aureus and majority (62.9%) were methicillin-resistant S. aureus. Only 3 (8.6%) KT recipients had SSIs. Conclusion: The incidence of UTI in KT recipients within the first 6 months was 10.3%, and majority occurred in the 1st month. Patients, who were treated for UTI preoperatively, did not develop post-KT UTI. Coliforms were the most common organism. Although there was high S. aureus colonization index, the incidence of SSI in post-KT recipients was low

A descriptive analysis of clinico-demographic features and microbiological results of typhoid fever suspected patients in four large hospitals of Bhutan

Introduction: Bhutan reports about 2000 typhoid fever cases annually. We aimed at understanding the clinico-demographic features and microbiological results of patients with suspected typhoid fever. Methods: A yearlong (2012) study of typhoid fever suspects was conducted to describe and analyse associations of demographic and clinical features with laboratory findings. Results: A total of 457 patients were enrolled. Most patients were from Phuntsholing General Hospital (n=181; 39.6%) followed by Jigme Dorji Wangchuck National Referral Hospital (n=170; 37.2%), Eastern Regional Referral Hospital (n=56; 12.3%) and Central Regional Referral Hospital (n=50; 10.9%). Fever (n=420; 91.9 %) and headache (n=397; 86.9 %) were the commonest symptoms reported by the patients. Only 30% (n=137) and 11.2% (n=51) had diarrhoea and constipation respectively. Mean duration of illness was 11.2 days. Among the 457 Widal tests performed, 76.1% (n=348) were negative, 12.3 % (n=56) positive for O antigen, 8.5% (n=39) for H antigen and 3.1% (n=14) for both. Only 2 of the 109 (1.8%) patients with a positive Widal test had a positive blood culture. Widal test showed a sensitivity of 33.3% and specificity of 76.3%. There was no association of any symptoms to antibody titres. There were three peaks when suspected cases reported to hospitals. More than 97% (n=447) of blood were sterile and Salmonella Typhi was isolated only in 1.3% (n=6). Only one isolate showed resistance to amoxicillin and nalidixic acid. Conclusion: Typhoid fever was not being diagnosed satisfactorily but over-diagnosed and treated clinically. Widal test should be replaced by more sensitive and specific tests or used cautiously with well-defined cut-off titres. </p