• 1

    Archibald LK, Reller LB, 2001. Clinical microbiology in developing countries. Emerg Infect Dis 7 :302–305.

  • 2

    Archibald LK, den Dulk MO, Pallangyo KJ, Reller LB, 1998. Fatal Mycobacterium tuberculosis bloodstream infections in febrile hospitalized adults in Dar es Salaam, Tanzania. Clin Infect Dis 26 :290–296.

    • Search Google Scholar
    • Export Citation
  • 3

    Ssali FN, Kamya MR, Wabwire-Mangen F, Kasasa S, Joloba M, Williams D, Mugerwa RD, Ellner JJ, Johnson JL, 1998. A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda. J Acquir Immune Defic Syndr Hum Retrovirol 19 :484–489.

    • Search Google Scholar
    • Export Citation
  • 4

    Archibald LK, McDonald LC, Rheanpumikankit S, Tansuphaswadikul S, Chaovanich A, Eampokalap B, Banerjee SN, Reller LB, Jarvis WR, 1999. Fever and human immunodeficiency virus infection as sentinels for emerging mycobacterial and fungal bloodstream infections in hospitalized patients ≥ 15 years old, Bangkok. J Infect Dis 180 :87–92.

    • Search Google Scholar
    • Export Citation
  • 5

    Archibald LK, McDonald LC, Nwanyanwu O, Kazembe P, Dobbie H, Tokars J, Reller LB, Jarvis WR, 2000. A hospital-based prevalence survey of bloodstream infections in febrile patients in Malawi: implications for diagnosis and therapy. J Infect Dis 181 :1414–1420.

    • Search Google Scholar
    • Export Citation
  • 6

    Bell M, Archibald LK, Nwanyanwu O, Dobbie H, Tokars J, Kazembe PN, Reller LB, Jarvis WR, 2001. Seasonal variation in the etiology of bloodstream infections in a febrile inpatient population in a developing country. Int J Infect Dis 5 :63–69.

    • Search Google Scholar
    • Export Citation
  • 7

    McDonald LC, Archibald LK, Rheanpumikankit S, Tansuphaswadikul S, Eampokalap B, Nwanyanawu O, Kazembe P, Dobbie H, Reller LB, Jarvis WR, 1999. Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries. Lancet 354 :1159–1163.

    • Search Google Scholar
    • Export Citation
  • 8

    Reller LB, Archibald LK, Jarvis WR, Grohskopf LA, 2002. Disseminated infection with simiaeavium group mycobacteria in persons with AIDS - Thailand and Malawi, 1997. MMWR Morb Mortal Wkly Rep 51 :501–502.

    • Search Google Scholar
    • Export Citation
  • 9

    National Committee for Clinical Laboratory Standards, 2000. Performance Standards for Antimicrobial Disk Susceptibility Tests. Seventh edition. Approved Standard M2-A7. Wayne, PA: NCCLS.

  • 10

    National Committee for Clinical Laboratory Standards, 2001. Performance Standards for Antimicrobial Susceptibility Testing. 11th Information Supplement M100-S11. Wayne, PA: NCCLS.

  • 11

    Liu Y-C, Huang W-K, Huang T-S, Kunin CM, 1999. Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use. J Clin Epidemiol 52 :539–545.

    • Search Google Scholar
    • Export Citation
  • 12

    Mérien F, Amouriaux P, Perolat P, Baranton G, Saint Girons I, 1992. Polymerase chain reaction for detection of Leptospira spp. in clinical samples. J Clin Microbiol 30 :2219–2224.

    • Search Google Scholar
    • Export Citation
  • 13

    Shlim DR, Schwartz E, Eaton M, 1995. Clinical importance of Salmonella Paratyphi A infection to enteric fever in Nepal. J Travel Med 2 :165–168.

    • Search Google Scholar
    • Export Citation
  • 14

    Sood S, Kapil A, Dash N, Das BK, Goel V, Seth P, 1999. Paratyphoid fever in India: an emerging problem. Emerg Infect Dis 5 :483–484.

  • 15

    Rodrigues C, Shenai S, Mehta A, 2003. Enteric fever in Mumbai, India: the good news and the bad news (letter). Clin Infect Dis 36 :535.

  • 16

    Thong K-L, Nair S, Chaudhry R, Seth P, Kapil A, Kumar D, Kapoor H, Puthucheary S, Pang T, 1998. Molecular analysis of Salmonella paratyphi A from an outbreak in New Delhi, India. Emerg Infect Dis 4 :507–508.

    • Search Google Scholar
    • Export Citation
  • 17

    Chandel DS, Nisar N, Thong KL, Pang T, Chaudhry R, 2000. Role of molecular typing in an outbreak of Salmonella paratyphi A. Trop Gastroenterol 21 :121–123.

    • Search Google Scholar
    • Export Citation
  • 18

    Goh Y-L, Puthucheary SD, Chaudhry R, Bhutta ZA, Lesmana M, Oyofo BA, Punjabi NH, Ahmed A, Thong KL, 2002. Genetic diversity of Salmonella enterica serovar Paratyphi A from different geographical regions in Asia. J Appl Microbiol 92 :1167–1171.

    • Search Google Scholar
    • Export Citation
  • 19

    Dorman J, Dickinson J, 1972. Experience with typhoid fever at Shanta Bhawan. J Nepal Med Assoc 10 :155–160.

  • 20

    Thapa JB, 1991. Drug sensitivity of enteric fever organisms. J Inst Med (Nepal) 13 :327–330.

  • 21

    Sharma S, Zimmerman M, 1997. Enteric fever in outpatients. J Nepal Med Assoc 35 :70–74.

  • 22

    Ansari I, Adhikari N, Pandey R, Dangal MM, Karanjit R, Acharya A, 2002. Enteric fever: is ciprofloxacin failing? J Nepal Paed Soc 20 :6–16.

    • Search Google Scholar
    • Export Citation
  • 23

    Crump JA, Barrett TJ, Nelson JT, Angulo FJ, 2003. Reevaluating fluoroquinolone breakpoints for Salmonella enterica sero-type Typhi and for non-Typhi salmonellae. Clin Infect Dis 37 :75–81.

    • Search Google Scholar
    • Export Citation
  • 24

    Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ, 2002. Typhoid fever. N Engl J Med 347 :1770–1782.

  • 25

    Brown GW, Shirai A, Gan E, Bernthal P, 1981. Antibodies to typhus in Eastern Nepal. Trans Roy Soc Trop Med Hyg 75 :586–587.

  • 26

    Eaton M, Cohen MT, Shlim DR, Innes B, 1989. Ciprofloxacin treatment of typhus. JAMA 262 :772–773.

  • 27

    Halle S, Dasch GA, 1980. Use of a sensitive microplate enzyme-linked immunosorbent assay in a retrospective serological analysis of a laboratory population at risk to infection with typhus group rickettsiae. J Clin Microbiol 12 :343–350.

    • Search Google Scholar
    • Export Citation
  • 28

    Brown GW, Madasamy M, Bernthal P, Groves MG, 1981. Leptospirosis in Nepal. Trans R Soc Trop Med Hyg 75 :572–573.

  • 29

    Silva MV, Camargo ED, Batista L, Vaz AJ, Brandao AP, Nakamura PM, Negrao JM, 1995. Behaviour of specific IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence. J Trop Med Hyg 98 :268–272.

    • Search Google Scholar
    • Export Citation
  • 30

    Murdoch DR, Laing RTR, Mills GD, Karalus NC, Town GI, Mirrett S, Reller LB, 2001. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol 39 :3495–3498.

    • Search Google Scholar
    • Export Citation
  • 31

    Suvedi BK, 1999. Mapping the trend of HIV/AIDS in Nepal. J Inst Med (Nepal) 21 :236–242.

  • 32

    Hawkes S, Santhya KG, 2002. Diverse realities: sexually transmitted infections and HIV in India. Sex Transm Infect 78 (Suppl 1):i31–i39.

    • Search Google Scholar
    • Export Citation
  • 33

    UNAIDS/WHO, 2002. Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: Nepal. Geneva: UNAIDS/WHO.

  • 34

    Shrestha IL, 1999. Seroprevalence of antibodies to HIV among injecting drug users in Kathmandu and HIV subtyping. J Inst Med (Nepal) 21 :11–14.

    • Search Google Scholar
    • Export Citation
  • 35

    Sherchand JB, Pandey BD, Haruki K, Jimba M, 2001. Sero-diagnosis of Japanese encephalitis and dengue virus infection from clinically suspected patients of Nepal. J Inst Med (Nepal) 23 :26–31.

    • Search Google Scholar
    • Export Citation
  • 36

    Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, Oun SA, Mahoney FJ, 2003. Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerg Infect Dis 9 :539–544.

    • Search Google Scholar
    • Export Citation
  • 37

    Zimmerman MD, Scott RM, Vaughn DW, Rajbhandari S, Nisalak A, Shrestha MP, 1997. An outbreak of Japanese encephalitis in Kathmandu, Nepal. Am J Trop Med Hyg 57 :283–284.

    • Search Google Scholar
    • Export Citation
  • 38

    Basnyat B, Zimmerman MD, Shrestha Y, McNair Scott R, Endy TP, 2001. Persistent Japanese encephalitis in Kathmandu: the need for immunization. J Travel Med 8 :270–271.

    • Search Google Scholar
    • Export Citation
  • 39

    Rolain JM, Maurin M, Vestris G, Raoult D, 1998. In vitro susceptibilities of 27 rickettsiae to 13 antimicrobials. Antimicrob Agents Chemother 42 :1537–1541.

    • Search Google Scholar
    • Export Citation
  • 40

    Strand O, Stromberg A, 1990. Ciprofloxacin treatment of murine typhus. Scand J Infect Dis 22 :503–504.

  • 41

    van der Kleij FGH, Gansevoort RT, Kreeftenberg HG, Reitsma WD, 1998. Imported rickettsioses: think of murine typhus. J Intern Med 243 :177–179.

    • Search Google Scholar
    • Export Citation
  • 42

    Laferl H, Fournier PE, Seiberl G, Pichler H, Raoult D, 2002. Murine typhus poorly responsive to ciprofloxacin: a case report. J Travel Med 9 :103–104.

    • Search Google Scholar
    • Export Citation
  • 43

    Shalit I, Barnea A, Shahar A, 1989. Efficacy of ciprofloxacin against Leptospira interrogans serogroup ictohaemorrhagiae. Antimicrob Agents Chemother 33 :788–789.

    • Search Google Scholar
    • Export Citation
  • 44

    Takashima I, Ngoma M, Hashimoto N, 1993. Antimicrobial effects of a new carboxyquinolone drug, Q-35, on five sero-groups of Leptospira interrogans.Antimicrob Agents Chemother 37 :901–902.

    • Search Google Scholar
    • Export Citation
 
 
 
 

 

 
 

 

 

 

 

 

 

THE ETIOLOGY OF FEBRILE ILLNESS IN ADULTS PRESENTING TO PATAN HOSPITAL IN KATHMANDU, NEPAL

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  • 1 Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

In Nepal, many infections remain poorly characterized, partly due to limited diagnostic facilities. We studied consecutive febrile adults presenting to a general hospital in Kathmandu, Nepal. Of the 876 patients enrolled, enteric fever and pneumonia were the most common clinical diagnoses. Putative pathogens were identified in 323 (37%) patients, the most common being Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A (117), Rickettsia typhi (97), Streptococcus pneumoniae (53), Leptospira spp. (36), and Orientia tsutsugamushi (28). Approximately half of the Salmonella isolates were resistant to nalidixic acid. No clinical predictors were identified to reliably distinguish between the different infections. These findings confirm the heavy burden of enteric fever and pneumonia in Kathmandu, and highlight the importance of murine typhus, scrub typhus, and leptospirosis. Given the lack of reliable clinical predictors, the development of cheap and accurate diagnostic tests are likely to be of great clinical utility in this setting.

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