Rotavirus Nosocomial Infection in Children under 5 years of age: A Preliminary study in Nepal

Introduction: Rotavirus is one of the most common causes of acute gastroenteritis among infants and young children. The spread of rotavirus infection in pediatric wards can cause acute diarrhoea during hospitalization, and in turn, prolong hospitalization or need, rehospitalization. The aim of the study was to determine the prevalence of nosocomial infection due to rotavirus and other causal organisms among children less than 5 years of age. Methodology: A cross-sectional study between November 2009 and May 2010 was conducted among 96 pediatric patients in children hospital, Nepal. Stool samples were collected during hospitalization and up to 3 days after discharge from the hospital. Rotavirus antigens were detected by EIA and standard microbiological procedure were applied for other enteric pathogens. Results: The prevalence of nosocomial infection due to rotavirus was 30.2% (29/96). Of them, 16 (55.17%) of the 29 children with nosocomial infection during hospitalization and/or up to 72 hours after discharge developed diarrhoea. The prevalence of symptomatic cases of nosocomial infection was 55.17% (16/29), which involved 16.7% (16/96) of the study subjects, showing a prevalence of 44.82% (13/29) for asymptomatic nosocomial infection consisted of 13.54% (13/96) of the total subjects. Eleven of the 16 symptomatic subjects of nosocomial infection were affected by diarrhoea during hospitalization and five subjects after discharge. Bacteria (8.3%) and protozoa (5.2%) agents were also causing nosocomial infection in children. Conclusions: Children attending hospital may asymptomatically carry enteric pathogens and potentially act as source of nosocomial infection. Due to the relatively high frequency of nosocomial infection in the Children Hospital of Nepal, it is necessary to follow strictly hygienic rules such as isolation of patients with diarrhoea and hand-washing before and after the examination of each patient and cleaning the examination instruments after use in each patient. Key words: Diarrhoea; children; Rotavirus infection; Cross-sectional study; Nepal DOI: 10.3126/jnps.v31i1.3540J Nep Paedtr Soc 2010;31(1):30-34

Clinical features of HIV/AIDS and various opportunistic infections in relation to antiretroviral status among HIV seropositive individuals from Central Nepal

BACKGROUND

So far, antiretroviral therapy is the only effective treatment available to HIV/AIDS patients. Provision of combined package of treatment, care and support service as well as regular assessment of the therapy increases its effectiveness.

OBJECTIVE

The aim of this study was to establish the relationship between antiretroviral therapy status and clinical features/opportunistic infections among HIV seropositive individuals.

MATERIALS AND METHOD

This is a cross-sectional study. Study was carried out between October 2007 and May 2008 in 150 HIV patients of Kathmandu, Central Nepal. After taking informed consent pre-structured questionnaire was filled to assess clinical features and specimen were collected to investigate major OIs as per standard microbiological procedure. All the information were entered into SPSS 11.5 system and analysed.

RESULT

Of the 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. The age group 21-30 years was predominant followed by 31-40 years (42%). Significant relationship could be established between intake of ART and cardinal symptoms of HIV/AIDS (chi2 value ranging from 4.11 to 9.34). However, no significant relationship could be established between the intake of ART and distribution of different OIs (chi2 values ranging from 0.15 to 1.6).

CONCLUSION

Antiretroviral therapy was found to effective enough to reduce the clinical features of AIDS. Diagnosis and treatment of opportunistic infections should be routinely done for both groups of patients.

POLYMERASE CHAIN REACTION DETECTION OF MYCOBACTERIUM TUBERCULOSIS FROM SPUTUM

ABSTRACTTuberculosis has remained to be a major public health problem in Nepal. The risk of spread of infection andemergence of drug-resistant strain has created the need for a rapid, sensitive and specific diagnostic test.In addition, clinically suspicious cases that do not give positive result in conventional laboratory test needmore sensitive test for diagnosis.In order to evaluate the possibility of incorporation of Polymerase Chain Reaction (PCR) in the diagnosis oftuberculosis, we performed a comparative study of PCR to detect Mycobacterium tuberculosis in sputumspecimens, against Ziehl-Neelsen (Z-N) stain and culture as a standard method.A total of 103 specimens were subjected to Z-N staining, culture and PCR for detecting Mycobacteriumtuberculosis. Of these, 19 were positive by Z-N stain, 26 by PCR and 25 by culture. Four stain negativespecimens showed positive result in both culture and PCR. Two specimens of stain and culture positive werePCR negative. Five specimens showed positive result only with PCR. Two culture positive specimens gavenegative results by both Z-N stain and PCR. Sensitivity, specificity, positive predictive value and negativepredictive value of PCR which were 84%, 93.5%, 80.8% and 94.9% respectively.This study showed that there is no need for PCR test for the smear positive cases. However, PCR could be apossible diagnostic tool for the confirmation of the smear negative cases that show clinical symptoms of TB.Key Words: Mycobacterium tuberculosis, Z-N stain, PCR, sensitivity, specificity.

GASTRIC ADENOCARCINOMA AND HELICOBACTER PYLORI INFECTION

Gastric adenocarcinoma is of major importance worldwide as a cause of death frommalignant disease. It is the commonest malignant tumor in T.U. Teaching Hospital.Helicobacter pylori infection is an important risk factor for the development of gastriccancer. This prospective study was carried out to correlate H. pylori infection withgastric adenocarcinoma. This study was done from January 1999 to January 2000;included 38 cases of gastric adenocarcinomas of which 28 (73.69%) cases were tubulartype; 6 (15.79%) cases were signet-ring cell type; 2 (5.26%) cases were papillary typeand 2 (5.26%) cases were mucinous type. Gastric adenocarcinomas were more commonin male (73.68%) and after the age of 50 years. Giemsa staining revealed H. pylori in30 cases (78.95%) of adenocarcinomas; whereas H. pylori seropositivity (IgG) wasfound in 29 (76.31%) cases. H. pylori were histologically detected in 88.3% cases ofresected specimens and in 71.4% cases of endoscopic gastric biopsies. Both histologicalmethod and serological test showed positivity for H. pylori in 65.78% cases. Thus, H.pylori infection is associated with gastric carcinognesisKey Words: Gastric adenocarcinoma, Helicobacter pylori, Giemsa stain. 

Outbreaks of cholera in Kathmandu Valley in Nepal

An analysis of the seasonal outbreak of diarrhoea in children in Kathmandu, Nepal, is reported. Vibrio cholera, 01 biotype El Tor Ogawa was the major cause of this epidemic. The pattern of spread suggested a waterborne infection related to contaminated river water and this was confirmed by a field survey. Although the mortality rate was low, younger children were more susceptible. Enteropathogenic E. coli seems to be a major cause for diarrhoea after cholera amongst children in this study.

VNTR molecular typing of salmonella enterica serovar typhi isolates in Kathmandu valley

Background: Typhoid fever continues to be a worldwide health problem, especially in developing countries. Effective epidemiological surveillance is needed to monitor the presence and spread of disease. Materials and Methods: Variable number tandem repeats (VNTR) was performed for Salmonella enterica serovar typhi by multiplex-PCR in 28 Nepalese isolates of sporadic typhoid fever. Results: From all 28 total isolates, we could identify 12 VNTR profiles among the isolates, signifying multiple variants in circulation within the region. Conclusion: The VNTR-based typing assay for serovar typhi isolates can be used during an outbreak of enteric fever. The typing could eventually form the basis of an effective epidemiological surveillance system for developing rational strategies to control typhoid fever. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6026 JPN 2012; 2(3): 220-223

Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal

Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal. Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal. Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed. Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F. Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal. Key words: Antimicrobial susceptibility; Streptococcus pneumoniae; Serotyping; Nepal DOI: 10.3126/kumj.v8i2.3551 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 164-168