Sher Bahadur Pun

Detection of G12 human rotaviruses in Nepal

Of 731 stool specimens collected from children with diarrhea in Kathmandu, Nepal, from August 2004 through July 2005, 170 (23.3%) tested positive for rotavirus. Reverse transcription–PCR, including a revised G12-specific primer set, identified 56 (32.9%) as G2P[4] and 39 (23.0%) as G12 with P[6], P[8], or P[4].

The burden of parasitic zoonoses in Nepal: a systematic review

Background Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding. Methodology We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs. Principal Findings Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450–27,694] and 9255 DALYs [95% CrI: 6135–13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105–458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur. Conclusions/Significance In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases.

Case Report : Expansion of Visceral Leishmaniasis to the Western Hilly Part of Nepal

We report the first case of visceral leishmaniasis (VL) from the non-endemic western hilly region of Nepal. The patient presented with a history of high-grade fever, abdominal distension, anemia, and weight loss. The case was confirmed as VL by microscopical detection of the Leishmania species amastigote in bone marrow aspiration and by a positive result for the rK39 test. The patient was treated with 0.5-1.0 mg/kg of Amphotericin B for 14 days (total of 405 mg), and amastigotes were negative on discharge. Five months later, this patient again developed fever, abdominal distension, and anemia. Clinical and hematological examinations suggested a relapse of VL. The patient was treated with 1 mg/kg of Amphotericin B for 18 days (total of 515 mg) and was clinically improved on discharge.

Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review

Background Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal. Methods We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal. Findings So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle. Interpretation Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.

Changing trends in visceral leishmaniasis: 10 years' experience at a referral hospital in Nepal

Visceral leishmaniasis (VL) is mainly confined to the southeast area in the Terai region of Nepal. This study aimed to assess time trends and geographical distribution of VL at a referral hospital over a 10-year period in Kathmandu, Nepal. A total of 1521 patients were admitted to the hospital during the study period (April 1999 to March 2009). Overall, 88% of cases were from endemic areas and 10% were from non-endemic areas. There was a significant decreasing trend in the number of VL cases in this hospital during the study period. However, VL is being increasingly diagnosed in patients from non-endemic areas of Nepal. Whether VL in non-endemic areas is imported or autochthonous remains to be elucidated. This study therefore reinforces the need for urgent VL and entomological surveillance in newly reported areas to allow effective VL control strategies to be developed for the future.

An Outbreak of Vibrio cholerae in 2012, Kathmandu, Nepal

Globally, there are an estimated 3-5 million cholera cases and 100,000-120,000 deaths due to cholera each year [1]. Vibrio cholerae is the etiologic agent of cholera and is mainly spread through contaminated drinking water. It can be fatal within hours, if rehydration is not managed promptly. Inadequate water supplies, poor sanitation and poor hygiene behaviors are largely responsible for cholera diarrhea in resource poor settings. Diarrheal diseases have long been recognized as a major public health challenge in Nepal, putting diarrheal diseases in the second highest research priority area among infectious diseases [2]. Though cholera is considered to be endemic in south Asia, there have been relatively few studies on cholera to date in Nepal. We here report V. cholerae in hospitalized patients with acute diarrhea during July-August, 2012, admitted to Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal.

A Series of Case Reports of Autochthonous Visceral Leishmaniasis, Mostly in Non-Endemic Hilly Areas of Nepal

The government of Nepal has committed to eliminate visceral leishmaniasis (VL) by 2015. The expansion of VL into new areas would constitute a major obstacle to achieving this goal. We report a series of autochthonous VL cases from areas currently considered non-endemic, mostly in hilly regions of Nepal.

Critical phase among patients with dengue fever during the 2010 outbreak in Nepal

BACKGROUND Dengue virus infection has become an increasingly serious threat to public health in Nepal. Detection and/or serotyping of dengue virus has been reported in the past; however, little is known about the critical phase among dengue patients in Nepal. METHODS Rapid immunochromatographic tests and reverse transcription PCR (RT-PCR) were performed in order to diagnosis dengue fever. Ultrasonographic and chest radiography were used to identify the plasma leakage phase. RESULTS Of the total 264 patients with dengue, 8.7% (23/264) were admitted during the critical phase; 82.6% (19/23) of the patients were between 20 and 44 years of age. CONCLUSION Physicians need to be vigilant and attentive to young adult patients with dengue fever.

Relapse of kala-azar after use of multiple drugs: A case report and brief review of literature

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.