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Udayar SE, Chengalarayappa NB, Madeshan A, Shivanna M, Marella K. Clinico Epidemiological Study of Human Leptospirosis in Hilly Area of South India-A Population Based Case Control Study. Indian J Community Med 2023; 48:316-320. [PMID: 37323738 PMCID: PMC10263044 DOI: 10.4103/ijcm.ijcm_316_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023] Open
Abstract
Background Leptospirosis is the most common zoonotic disease in the world affecting both animals and humans. Environmental, occupational, and sociocultural practices which vary from region to region favors the disease transmission in addition to lacunas in prompt diagnosis and treatment of cases. There are limited data on the seroprevalence of this neglected tropical disease in India. To assess the risk factors associated with Lepospirosis disease. Materials and Methods A population-based case control study was conducted in Kodagu district of southern India from January 2022 to March 2022. Of the 74 confirmed cases during the year 2021, 70 cases and 140 age group and gender-matched controls participated in the study. Data were collected by using semi-structured questionnaire containing details of sociodemographic, occupational, and environmental factors. The collected data were coded and exported to STATA (16.1) and analyzed by univariate and multivaiariate logistic regression to identify significant risk factors. Results Environmental factors such as flooding or collection of water near the house (adjusted Odds Ratio [aOR] = 4.9, confidence interval [CI]: 1.4-17.0), proximity to an open sewer (aOR = 4.9, CI: 1.2-19.1) and occupational factors such as presence of skin cuts or abrasion during work (aOR = 4, CI: 1.4-11.6), direct contact with mud or water during work (aOR = 9.7, CI: 3.3-27.7), animal farming (aOR = 3.4, CI: 1.0-11.6), presence of rodents in the house (aOR = 4, CI: 1.2-12.6), and presence of rodent habitats like grain storage area (aOR = 3.5, CI: 1.1-11.0) were significantly associated with leptospirosis. Conclusion Leptospirosis poses a potential public health problem in the district. Interventions like prompt diagnosis and treatment, sensitization programs, and rodent control measures will significantly control this neglected tropical disease.
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Affiliation(s)
- Sharvanan E. Udayar
- Department of Community Medicine, Kogagu Institute of Medical Sciences Government of Karnataka, Karnataka, India
| | - Narasimha B. Chengalarayappa
- Department of Community Medicine, Kogagu Institute of Medical Sciences Government of Karnataka, Karnataka, India
| | - Ashwini Madeshan
- Department of Community Medicine, Kogagu Institute of Medical Sciences Government of Karnataka, Karnataka, India
| | - Manjunatha Shivanna
- Department of Obstestrics and Gynaecology, Kogagu Institute of Medical Sciences Government of Karnataka, Karnataka, India
| | - Krishnaveni Marella
- Department of Consevrative and Endodontics, KVG Dental College and Hospital Sullia, Karnataka, India
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Durrance-Bagale A, Rudge JW, Singh NB, Belmain SR, Howard N. Drivers of zoonotic disease risk in the Indian subcontinent: A scoping review. One Health 2021; 13:100310. [PMID: 34458546 PMCID: PMC8379342 DOI: 10.1016/j.onehlt.2021.100310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Literature on potential anthropogenic drivers of zoonotic disease risk in the Indian subcontinent is sparse. We conducted a scoping review to identify primary sources, published 2000-2020, to clarify what research exists and on which areas future research should focus. We summarised findings thematically by disease. Of 80 sources included, 78 (98%) were original research articles and two were conference abstracts. Study designs and methods were not always clearly described, but 74 (93%) were quantitative (including one randomised trial), five (6%) were mixed-methods, and one was qualitative. Most sources reported research from India (39%) or Bangladesh (31%), followed by Pakistan (9%), Nepal (9%), Bhutan and Sri Lanka (6% each). Topically, most focused on rabies (18; 23%), Nipah virus (16; 20%) or leptospirosis (11; 14%), while 12 (15%) did not focus on a disease but instead on knowledge in communities. People generally did not seek post-exposure prophylaxis for rabies even when vaccination programmes were available and they understood that rabies was fatal, instead often relying on traditional medicines. Similarly, people did not take precautions to protect themselves from leptospirosis infection, even when they were aware of the link with rice cultivation. Nipah was correlated with presence of bats near human habitation. Official information on diseases, modes of transmission and prevention was lacking, or shared informally between friends, relatives, and neighbours. Behaviour did not correspond to disease knowledge. This review identifies various human behaviours which may drive zoonotic disease risk in the Indian subcontinent. Increasing community knowledge and awareness alone is unlikely to be sufficient to successfully change these behaviours. Further research, using interdisciplinary and participatory methods, would improve understanding of risks and risk perceptions and thus help in co-designing context-specific, relevant interventions.
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Affiliation(s)
- Anna Durrance-Bagale
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - James W. Rudge
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- Mahidol University, Faculty of Public Health, 420/1 Rajvithi Road, Bangkok, Thailand
| | - Nanda Bahadur Singh
- Tribhuvan University, Central Department of Zoology, Kathmandu, Nepal
- Mid-Western University, Surkhet, Nepal
| | - Steven R. Belmain
- Natural Resources Institute, University of Greenwich, Chatham Maritime, Kent ME4 4TB, United Kingdom
| | - Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore
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Seroprevalence and Clinical Features of Scrub Typhus among Febrile Patients Attending a Referral Hospital in Kathmandu, Nepal. Trop Med Infect Dis 2021; 6:tropicalmed6020078. [PMID: 34068402 PMCID: PMC8163188 DOI: 10.3390/tropicalmed6020078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: Scrub typhus (ST) is endemic to Nepal. It is often underdiagnosed and misdiagnosed due to non-specific clinical presentation coupled with limited microbiological facilities, leading to adverse clinical outcomes. This study aimed to assess the seroprevalence of scrub typhus in febrile patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH), Nepal, from August 2018 to April 2019. (2) Materials and Method: Blood/serum samples and clinical and demographic data of adult febrile patients (≥19 years) who attended or were referred to the hospital were collected after obtaining written informed consent from the participants excluding immunocompromised individuals. Collected blood/serum samples were subjected to hematological, biochemical, and serological tests. A serological test for scrub typhus was performed using the ImmuneMed scrub typhus rapid diagnostic test kit. Data generated were analyzed using SPSS software version 24.0. (3) Results: Amongst the 2070 febrile patients, 462 (22.3%) were seropositive to at least one etiological agent of febrile illnesses (scrub typhus: 253 cases, dengue: 101 cases, leptospirosis: 9, brucellosis: 52, malaria: 9 and kala-azar: 20 cases). Scrub typhus accounted for 12.2% (n = 253) of total febrile illnesses followed by dengue (4.9%, n = 101). Mixed seropositivity of scrub typhus with dengue, brucellosis, and typhoid was found in 12 (0.6%), 9 (0.4%), and 5 (0.2%) cases, respectively. Among 253 scrub typhus patients, 53.4% were female. Among the 154 patients, the most common symptoms were fever (100%), headache (79.2%), sweating (70.1%), breathing difficulty (51.3%), redness of the eye (43.5%), and pathognomonic eschar was observed in 9.1% patients. Fifty percent of scrub typhus patients had low platelet count and >30% of patients had an elevated level of liver enzymes (such as serum glutamic oxaloacetic transaminase (SGPT) and serum glutamic pyruvic transaminase (SGOT). (4) Conclusion: Scrub typhus is a considerable cause of febrile illness in Nepal. Females apparently have a higher chance of acquiring scrub typhus. ST presents nonspecific clinical presentation. The diagnostic dilemma of typhus patients can be minimized by the early monitoring of ST-associated symptoms. The country's health system needs to be strengthened for early outbreak detection, and immediate response actions against scrub typhus to control the future outbreak of ST.
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Dreyfus A, Ruf MT, Mayer-Scholl A, Zitzl T, Loosli N, Bier NS, Hiereth S, Ulrich S, Poppert S, Straubinger RK, Stenos J, Tshokey T. Exposure to Leptospira spp. and Associated Risk Factors in the Human, Cattle and Dog Populations in Bhutan. Pathogens 2021; 10:pathogens10030308. [PMID: 33800914 PMCID: PMC8000015 DOI: 10.3390/pathogens10030308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022] Open
Abstract
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).
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Affiliation(s)
- Anou Dreyfus
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, Antananarivo 101, Madagascar
- Correspondence:
| | - Marie-Thérèse Ruf
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Anne Mayer-Scholl
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.M.-S.); (N.S.B.)
| | - Theresa Zitzl
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University, 35392 Giessen, Germany;
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Nadine Loosli
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Nadja Seyhan Bier
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.M.-S.); (N.S.B.)
| | - Stephanie Hiereth
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Sebastian Ulrich
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Sven Poppert
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Reinhard K. Straubinger
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC 3220, Australia;
| | - Tshokey Tshokey
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu 11001, Bhutan;
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, Bhutan
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Poudel U, Dahal U, Upadhyaya N, Chaudhari S, Dhakal S. Livestock and Poultry Production in Nepal and Current Status of Vaccine Development. Vaccines (Basel) 2020; 8:vaccines8020322. [PMID: 32575369 PMCID: PMC7350241 DOI: 10.3390/vaccines8020322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022] Open
Abstract
The livestock and poultry sectors are an integral part of Nepalese economy and lifestyle. Livestock and poultry populations have continuously been increasing in the last decade in Nepal and are likely to follow that trend as the interests in this field is growing. Infectious diseases such as Foot and Mouth Disease (FMD), Peste des Petits Ruminants (PPR), hemorrhagic septicemia (HS), black quarter (BQ), swine fever, avian influenza, and Newcastle disease (ND) constitute one of the major health challenges to the Nepalese livestock and poultry industry. Vaccinations are an efficient means of preventing the occurrence and spread of several diseases in animals and birds. Considering this fact, the government of Nepal began the production of veterinary vaccines in the 1960s. Nepal is self-reliant in producing several vaccines for cattle and buffaloes, sheep and goats, pigs, and poultry. Despite these efforts, the demand for vaccines is not met, especially in the commercial poultry sector, as Nepal spends billions of rupees in vaccine imports each year. There is a need of strengthening laboratory facilities for the isolation and characterization of field strains of pathogens and capacity building for the production of different types of vaccines using the latest technologies to be self-reliant in veterinary vaccine production in the future in Nepal.
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Affiliation(s)
- Uddab Poudel
- Paklihawa Campus, Institute of Agriculture and Animal Science (IAAS), Tribhuvan University, Siddharthanagar-1, Rupandehi 32900, Nepal;
| | - Umesh Dahal
- National Vaccine Production Laboratory, Department of Livestock Services, Kathmandu 44600, Nepal; (U.D.); (S.C.)
| | - Nabin Upadhyaya
- Veterinary Standards and Drug Regulatory Laboratory, Budhanilkantha, Kathmandu 44600, Nepal;
| | - Saroj Chaudhari
- National Vaccine Production Laboratory, Department of Livestock Services, Kathmandu 44600, Nepal; (U.D.); (S.C.)
| | - Santosh Dhakal
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
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Koirala KD, Chappuis F, Verdonck K, Rijal S, Boelaert M. Persistent febrile illnesses in Nepal: A systematic review. Indian J Med Res 2019; 148:385-395. [PMID: 30666001 PMCID: PMC6362719 DOI: 10.4103/ijmr.ijmr_505_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background & objectives Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute febrile illnesses (AFIs). In contrast, there are limited data on the causes of persistent febrile illnesses (PFIs) in LMIC. Lack of clarity on the differential diagnosis of PFIs in the rural tropics leads to the absence of diagnostic guidance tools. Methods In this study, a review of the potential causes of persistent fever defined as fever of more than seven days was done in Nepal, with a focus on nine pathogen-specific conditions. The current knowledge on their burden, distribution and diagnosis was summarized. Results Limited data were found on the incidence and public health burden of leptospirosis, murine typhus and brucellosis due to the absence of diagnostic tools outside reference laboratories and the overlap of signs and symptoms with other febrile conditions. The incidence of malaria and visceral leishmaniasis (VL) was found to be decreasing in Nepal, with some changes of the geographical areas at risk. Interpretation & conclusions This review indicates a need for more research on the causes of PFIs in Nepal and in the region and for the development of clinical guidance tailored to current local epidemiology. Guidance tools should include specific clinical features (e.g. eschar), results of rapid diagnostic tests (e.g. malaria, VL), appropriate indications for more sophisticated tests (e.g. abdominal ultrasound, polymerase chain reaction) and recommendations for adequate use of empirical treatment.
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Affiliation(s)
- Kanika Deshpande Koirala
- Department of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal; Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - François Chappuis
- Institute of Global Health, University of Geneva; Division of Tropical & Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kristien Verdonck
- Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Suman Rijal
- Department of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - Marleen Boelaert
- Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Naing C, Reid SA, Aye SN, Htet NH, Ambu S. Risk factors for human leptospirosis following flooding: A meta-analysis of observational studies. PLoS One 2019; 14:e0217643. [PMID: 31141558 PMCID: PMC6541304 DOI: 10.1371/journal.pone.0217643] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/15/2019] [Indexed: 01/05/2023] Open
Abstract
Leptospirosis is probably the most widespread zoonotic disease in the world especially in tropical countries. There has been an increase in individual studies, which assessed the frequency of leptospirosis in flood conditions. Some studies showed contact with floods was significantly associated with the occurrence of leptospirosis while other studies reported differently. The objective of this meta-analysis was to synthesize the evidence on the risk factors which are associated with human leptospirosis following flooding. We set up the inclusion criteria and searched for the original studies, addressing leptospirosis in human with related to flood in health-related electronic databases including PubMed, Embase, Ovid Medline, google scholar and Scopus sources. We used the terms ‘leptospirosis’, ‘flood’, ‘risk factor’ and terms from the categories were connected with “OR” within each category and by “AND” between categories. The initial search yielded 557 citations. After the title and abstract screening, 49 full-text papers were reviewed and a final of 18 observational studies met the pre-specified inclusion criteria. Overall, the pooled estimates of 14 studies showed that the contact with flooding was a significant factor for the occurrence of leptospirosis (pooled OR: 2.19, 95%CI: 1.48–3.24, I2:86%). On stratification, the strength of association was greater in the case-control studies (pooled OR: 4.01, 95%CI: 1.26–12.72, I2:82%) than other designs (pooled OR:1.77,95%CI:1.18–2.65, I2:87%). Three factors such as ‘being male’(pooled OR:2.06, 95%CI:1.29–2.83), the exposure to livestock animals (pooled OR: 1.95, 95%CI:1.26–2.64), the lacerated wound (pooled OR:4.35, 95%CI:3.07–5.64) were the risk factors significantly associated with the incidence of leptospirosis following flooding in the absence of within-study heterogeneity (I2: 0%). We acknowledge study limitations such as publication bias and type 2 statistical errors. We recommended flood control and other environmental modifications that are expected to reduce the risk of leptospiral infection, and a multi-sectoral effort to this aspect would have long-term benefits.
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Affiliation(s)
- Cho Naing
- International Medical University, Kuala Lumpur, Malaysia
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Simon A. Reid
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Saint Nway Aye
- International Medical University, Kuala Lumpur, Malaysia
| | | | - Stephen Ambu
- International Medical University, Kuala Lumpur, Malaysia
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Jayathilaka PGNS, Mendis ASV, Perera MHMTS, Damsiri HMT, Gunaratne AVC, Agampodi SB. An outbreak of leptospirosis with predominant cardiac involvement: a case series. BMC Infect Dis 2019; 19:265. [PMID: 30885170 PMCID: PMC6423826 DOI: 10.1186/s12879-019-3905-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/14/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe leptospirosis is known to cause multi organ dysfunction including cardiac involvement. In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis is not reported as a common complication due to lack of diagnostic facilities, there are evidence to support myocarditis is more prevalent in post mortem studies of patients died due to leptospirosis. We present a case series of severe leptospirosis with cardiac involvement observed during a period of one month at Colombo-North Teaching Hospital, Sri Lanka. CASE PRESENTATION We report here five patients with severe leptospirosis complicated with cardiac involvement, admitted to a single medical ward, Colombo-North Teaching Hospital, Sri Lanka during a one-month period. Out of six suspected leptospirosis patients admitted during that period, five in a raw developed severe leptospirosis with cardiac involvement. In this case series, four patients were confirmed serologically or quantitative PCR and one patient had possible leptospirosis. All patients developed shock during their course of illness. Two patients developed rapid atrial fibrillation. One patient had dynamic T wave changes in ECG and the other two had sinus tachycardia. Two patients had evidence of myocarditis in 2D echocardiogram, whereas other two patients had nonspecific findings and one patient had normal 2D echocardiogram. All five patients had elevated cardiac troponin I titre and it was normalized with the recovery. All five patients developed acute kidney injury. Four patients needed inotropic/vasopressor support to maintain mean arterial pressure and one patient recovered from shock with fluid resuscitation. All patients were recovered from their illness and repeat 2D echocardiograms after recovery did not show residual complications. One patient had serologically proven dengue co-infection with leptospirosis. CONCLUSIONS Myocarditis and cardiac involvement in leptospirosis may be overlooked due to non-specific clinical findings and co-existing multi-organ dysfunction. Atypical presentation of this case series may be due to micro-geographic variation and unusual outbreak of leptospirosis. Co-infection of dengue with leptospirosis should be considered in managing patients especially in endemic areas.
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Affiliation(s)
| | | | | | | | | | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Diaz-Quijano FA, Figueiredo GM, Waldman EA, Figueiredo WM, Cardoso MRA, Campos SRC, Costa AA, Pannuti CS, Luna EJA. Comparison of clinical tools for dengue diagnosis in a pediatric population-based cohort. Trans R Soc Trop Med Hyg 2018; 113:212-220. [DOI: 10.1093/trstmh/try135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/29/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fredi A Diaz-Quijano
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, Brazil
| | - Gerusa M Figueiredo
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo, SP, Brazil
| | - Eliseu A Waldman
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, Brazil
| | - Walter M Figueiredo
- Serviço Especial de Saúde de Araraquara—School of Public Health, University of São Paulo, Rua Itália, 1617, Araraquara, SP, Brazil
| | - Maria R A Cardoso
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, Brazil
| | - Sergio R C Campos
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo, SP, Brazil
| | - Angela A Costa
- Serviço Especial de Saúde de Araraquara—School of Public Health, University of São Paulo, Rua Itália, 1617, Araraquara, SP, Brazil
| | - Claudio S Pannuti
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo, SP, Brazil
- Laboratório de Virologia (LIM-HC), Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo, SP, Brazil
| | - Expedito J A Luna
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo, SP, Brazil
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Khetan RP, Stein DA, Chaudhary SK, Rauniyar R, Upadhyay BP, Gupta UP, Gupta BP. Profile of the 2016 dengue outbreak in Nepal. BMC Res Notes 2018; 11:423. [PMID: 29970132 PMCID: PMC6029055 DOI: 10.1186/s13104-018-3514-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to obtain clinical, virological and demographic data detailing the 2016 dengue outbreak in Nepal. RESULTS Dengue disease was first reported in Nepal in 2004 and several major outbreaks have occurred since then, with a significant impact on public health. An outbreak of dengue fever occurred in Nepal during June to November 2016, with a peak number of cases reported in September. 1473 patients with laboratory confirmed DENV infections visited or were admitted to hospitals during this period. The most common clinical symptoms included fever, headache, joint pain and thrombocytopenia. Serotyping of 75 serum samples from patients having fever for less than 4 days was carried out with a dengue virus (DENV) serotype-specific RT-PCR strategy. Our results indicate that the dengue outbreak in Nepal during 2016 was caused predominantly, if not exclusively, by DENV-1, representing a shift in the prevailing serotype from DENV-2, the dominant serotype characterizing the 2013 dengue epidemic in Nepal. Hopefully, this report will assist Nepalese public health agencies in developing improved dengue-related programs including mosquito-vector control, DENV surveillance, and diagnosis and treatment of dengue fever patients, in order to reduce the impact of future dengue epidemics.
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Affiliation(s)
| | - David A. Stein
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR USA
| | | | - Ramanuj Rauniyar
- Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kathmandu, Nepal
| | - Bishnu Prasad Upadhyay
- National Public Health Laboratory, Ministry of Health, Government of Nepal, Kathmandu, Nepal
| | - Umesh Prasad Gupta
- Central Diagnostic Laboratory and Research Centre Pvt. Ltd, Kathmandu, Nepal
| | - Birendra Prasad Gupta
- Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kathmandu, Nepal
- Central Diagnostic Laboratory and Research Centre Pvt. Ltd, Kathmandu, Nepal
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Adhikari R, Thapa S. Changing Trend of Infectious Diseases in Nepal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1052:19-38. [PMID: 29785478 PMCID: PMC7122567 DOI: 10.1007/978-981-10-7572-8_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many infectious/communicable diseases (IDs) are endemic in Nepal. Until a decade and half ago, IDs were the major cause of both morbidity and mortality accounting 70% for both. However, as a result of various preventive measures implemented by both the state and non-state actors, the overall IDs have shown a changing (declining) trend. The most impressive decline has been seen in the intestinal helminth infection. Though the overall burden of IDs is decreasing, several newer infectious diseases (emerging infections) namely, dengue fever, scrub typhus, influenza (H5N1 and H1N1), and others are posing a great public health problem. On the other hand, though sporadic, outbreaks of endemic diseases together with HIV-TB coinfection and infection with drug resistance microbes during recent years have constituted a serious public health as well as medical problem. On the contrary, with the decline of IDs, noninfectious diseases (noncommunicable disease, NCD) namely, diabetes, cancer (and cancer therapy), and others are on the rise particularly in urban areas. Hence, currently Nepal is trapped in "double burden" of diseases. Risk of opportunistic infection has increased in immunocompromised person with NCD. To address the present situation, the multi-sectoral plan and strategies developed must be implemented effectively.
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Affiliation(s)
- Rameshwar Adhikari
- Research Center for Applied Science and Technology (RECAST), Tribhuvan University, Kathmandu, Nepal
| | - Santosh Thapa
- Department of Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, Texas USA
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