Nipah Virus (NiV) Infection: Is Nepal Prepared for the Possible Outbreak?

 After 20 years of the first Nipah Virus (NiV) outbreak in the world, it re-emerged as the outbreak in India. WHO has recognized NiV as a potent epidemic threat to human health. Both animal-to-human and human-to-human transmission of zoonotic NiV has been documented. Fruit bat of Pteropodidae family is the natural reservoir of the virus. Thus, the territorial habitat of these bats is the high risk zone of NiV outbreak. The symptoms are very nonspecific and the pathogenicity of NiV is yet to be fully understood. Diagnosis of NiV infection still relies on molecular techniques. Till date, no drugs or vaccines against NiV has been approved. Some research have presented arrays of the possible treatment and prevention option, but without sure shot implications. So, appropriate precautions are the only currently available prevention option. Nepal is yet to experience a NiV outbreak but that does not undermine the risk posed to the general population. High risk countries including Nepal should be well prepared to tackle the possible outbreak in future

Avian/Bird flu: A review: H5N1 outbreaks in Nepal

Avian/Bird flu is a viral disease of birds, caused by avian influenza virus (AIV). A highly pathogenic avian influenza (HPAI) H5N1 has breached the barrier of species to humans and other animals escalating the pandemic threat. If the H5N1 evolves to a human-to-human transmissible virus retaining its pathogenicity, it can trigger an influenza pandemic. H5N1 has a mortality rate of about 60%, varying with strains. Meaningful antigenic alteration in hemagglutinin (HA) and/or neuraminidase (NA) results in recurring pandemics. The HPAI H5N1 subtype alone has outreached more than 77 nations around the world since the first human case and death was reported in 1997. Wild and migratory birds are the AIV reservoirs. Poultry is primarily impacted by incidents and outbreaks of the disease. A wide range of serological and molecular methods have substantially aided in the identification of bird flu in humans. Candidate vaccines have been developed, yet are not ready for widespread use. Oseltamivir (brand name: Tamiflu) is the preferred drug for the management of human Influenza-like illness (ILI). Surveillance, mass awareness, and pandemic preparedness abiding WHO recommendations are of paramount importance for the prevention of bird flu outbreaks

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

Phenotypic characterization of beta-lactamases producing Gram-negative bacteria in a tertiary hospital, Nepal

Infections caused by beta-lactamases producing Gram-negative bacteria are increasing, thus posing a challenge to the management of such infections. The surveillance data of such bacteria is limited in Nepal so this study aimed to detect the beta-lactamase producing Gram-negative bacteria in a tertiary setting. A total of 604 clinical samples, including urine, blood, sputum and body fluids, were cultured and identified by the routine standard laboratory protocols. Antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute guidelines (2014). Extended-spectrum beta-lactamases (ESBL) producers were identified by combined disk method and metallo-beta-lactamases (MBL) producers were identified by Imipenem- EDTA combined disk method. Out of 604 samples, 282 (46.7%) samples showed significant growth, of which 229 (81.2%) were Gram-negative bacteria. Of 229 Gram-negative bacteria, 200 (87.3%) were multidrug resistant, 67 (29.3%) were ESBL producers and 16 (7.0%) were MBL producers. Klebsiella pneumoniae were among higher ESBL producers and Pseudomonas aeruginosa were among higher MBL producers. The findings suggest higher antibacterial resistance among Gram-negative bacteria with the added burden of beta-lactamase production. Imipenem was effective against 125 of 229 Gram-negative bacteria tested. Thus, imipenem can be the drug of choice for empirical management. The higher multidrug resistance and higher beta-lactamases production among Gram-negative bacteria warrant the continuous monitoring, surveillance, early detection, and infection control practices of such bacteri

Hepatitis B and C Virus Infections among Blood Donors in Blood Transfusion Center, Pokhara, Nepal: Seroprevalence and its Associated Risk Factors

Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections lead to chronic diseases and are the most common causes of liver cirrhosis and cancer in developing countries like Nepal. The study is carried out to determine the seroprevalence of HBV and HCV by using a Rapid kit method and Elisa Method to find out its risk factors. The cross-sectional study was done among blood donating people from 16th August 2016 to 19th November 2016. Blood donors in Pokhara Valley were screened for anti-HCV antibodies, anti-HBV antibodies using third generation ELISA kits and automated ELISA Processor in serology laboratory at Central Blood Transfusion Service (CBTS) of Nepal Red Cross Society (NRCS) in Pokhara, Nepal. 1777 (87.2%) units were male blood donors and 260 (12.6%) units were female donors out of 2037 participants. Gender wise, the ratio between male and female was 1:0.1. HBV and HCV infection rate in blood donors were detected at 0.7% (15/2037) and 0.5% (8/2037) respectively. HBV infection rate in volunteer blood donor people was 0.7% (14/1881) which was higher than the replacement donors i.e. 0.6% (1/156). Similarly, in HCV infection rate in volunteer donor were 0.4% (8/1881). HBV infected people are detected higher than the HCV infected people among the blood donors. In addition, there was no significant relationship between positive results of HBV and HCV tests with the gender, age, tattoo, donor type

Antibiotic Resistance Pattern of Shigella spp. Among Gastroenteritis Patients at Tertiary Care Hospital in Pokhara, Nepal

Shigellosis, a disease caused by Shigella species. It is a major public health problem in developing nations like Nepal, where communities having poverty; poor sanitation, personal hygiene, and water supplies. The main aim of our study is to isolate and identify Shigella spp. from gastroenteritis patients and to find out its drug resistance pattern.A cross-sectional study was carried out based on routinely attending outpatients and inpatients.  A total of 225 stool samples collected from gastroenteritis patients were processed from 20 April to 24 September 2014 in Western Regional Hospital, Pokhara, Nepal. Standard microbiological procedures were followed for the isolation of Shigella spp. After that slide agglutination kit method was used for identification of Shigella spp.  Finally, Kirby-Bauer disc diffusion method was done for an antimicrobial resistance test.Of the total 225 gastroenteritis patients, 133 were detected as bacterial positive cases.  Among positive cases, Shigella spp. was identified in 10.5%.  Age wise, an infection rate of Shigella in patients <15-years old was found higher i.e. 7.3% than in patients ≥ 15 years old i.e. 4.5% with the (p = 0.432) at 95% CI. The infection rate of S. dysenteriae, S. flexneri, and S. sonnei was detected in 28.6%, 57.1%, and 14.3% respectively. For the antimicrobial test, eight types of antibiotics were used.  The most resistance pattern of isolated Shigella spp. was found in nalidixic acid, and co-trimoxazole 92.8% followed by ampicillin 64.3% and ciprofloxacin 42.8% etc.Our study reported that endemicity of Shigellosis with S. flexneri is the predominant group in gastroenteritis patients. This finding suggests that co-trimoxazole, nalidixic acid, ciprofloxacin and ampicillin should not be used experimentally as first-line drugs for shigellosis treatment

Fecal carriage of Extended Spectrum β-Lactamases (ESBL) Producing Escherichia coli and Klebsiella spp. among School Children in Pokhara, Nepal

Extended-spectrum β-lactamases (ESBL) producing microbes in recent years have been a major problem in developing countries like Nepal, with limited treatment options. This study aimed to determine the prevalence of ESBL producing E. coli and Klebsiella spp. in school children in Pokhara, Nepal. The study was conducted from June to October, 2015 at the microbiology laboratory of Manipal Teaching Hospital, Pokhara, Nepal. Antibiotic Susceptibility Test (AST) was done after isolation and identification of bacterial isolates. Then, presence of ESBL enzymes in E. coli and Klebsiella spp. were tested by combination disc diffusion test using cefotaxime and ceftazidime alone and with clavulanic acid. Out of total 309 school children, 211 (68%) bacterial isolates were detected from stool samples. Among them, E. coli and Klebsiella spp. were detected in 97 (46%) and 39 (19%) stool samples respectively. Bacteria isolated from 14 (5%) stool samples were multi-drug resistant (MDR) positive. After applying combined disk method, 88 (29%) isolates were found to be ESBL producer. Emerging prevalence rate of ESBL producing E. coli and Klebsiella spp. are major problem in medical history. Therefore, rapid need of surveillance for effective management of such MDR-strain is required

Detection of Pyuria by Microscopic Urinalysis as a Marker of Pediatric Urinary Tract Infection

Globally, different diagnostic tests of urinary tract infection (UTI) are in clinical practices. A reliable test can increase the efficiency of the healthcare system, especially in a developing country like Nepal, reducing cost and time. Thus, we accessed the possibility of pyuria detected by microscopic urinalysis as a marker of pediatric UTI. The prospective study was conducted fromJuly2014 to January 2015 at Alka hospital, Lalitpur. Microscopic urinalysis of 353clean-catch urine samples was done by the wet mount method, followed by urine culture by a semi-quantitative method. We confirmed 64 (18.1%) UTI cases by culture, the gold standard for UTI diagnosis. Fever was the most common clinical manifestation in UTI cases. The sensitivity, specificity, positive predictive value and negative predictive value of pyuria detected by microscopic urinalysis to identify UTI were 50%, 70.9%, 27.6% and 86.5% respectively. In 318 febrile cases, the sensitivity, specificity, positive predictive value and negative predictive value of pyuria detected by microscopic urinalysis to identify UTI were 73.2%, 72.6%, 28.3% and 94.8% respectively. The findings suggest pyuria detected by microscopic urinalysis as not a worth while marker of pediatric UTI. But it is a trust worthy marker in febrile pediatric cases

Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal

Abstract Background Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. Methods This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18–24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. Results Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. Conclusions E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency