Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal

OBJECTIVES

Scrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.

STUDY DESIGN AND SETTING

This was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.

PARTICIPANTS

A total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study.

METHODS

A total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.

RESULTS

Out of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51-60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001).

CONCLUSION

High prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.

Burden of bacterial upper respiratory tract pathogens in school children of Nepal

INTRODUCTION

Respiratory tract infections are one of the most common human infections in all age group and important cause of mortality and morbidity worldwide. Most bacterial upper respiratory tract infections are vaccine preventable. This study aimed to determine the prevalence of carrier state of bacterial upper respiratory tract pathogens among school children. It also aimed to study their antibiograms.

METHODS

The specimen from posterior pharyngeal wall and tonsils were collected from 204 participants on calcium alginate coated swabs (HiMedia). Isolates were identified by standard microbiological methods and tested for in vitro antibiotic susceptibility testing by modified Kirby-Bauer disc diffusion method.

RESULTS

In this study, Streptococcus pneumoniae (16.6%) was the most common bacterial pathogen recovered, followed by Staphylococcus aureus (14.7%), β-haemolytic streptococci (non-Group A) (8.8%), Streptococcus pyogenes (5.3%) and Corynebacterium diphtheriae (3.4%). The Gram negative bacteria were Klebsiella pneumoniae (4.9%), Haemophilus influenzae (3.4%) and Neisseria meningitidis (1.4%). Important findings in antibiogram include high resistance of Streptococcus pneumoniae to penicillin (91.17%) and resistance of S. aureus to oxacillin (23.3%).

CONCLUSION

Pharyngeal colonisation by S. pneumoniae was found high among school children and this calls for an urgent need to include pneumococcal vaccine in routine national immunisation schedule of Nepal given the high burden of invasive pneumococcal disease. Despite expected universal vaccination, pharyngeal colonisation by C. diphtheriae is possible and there is possibility of transmission of these respiratory pathogens to other healthy children.

Correlation study of adenosine deaminase and its isoenzymes in type 2 diabetes mellitus

OBJECTIVE

Adenosine deaminase (ADA) plays an important role in cell-mediated immunity and modulation of insulin activity. Its clinical and diagnostic significance in Nepalese type 2 diabetes is not yet characterized. So, this study's objective was to determine the isoenzymatic activities of ADA (ADA1, ADA2, and total ADA) and show its correlation with demographic, anthropometric, and biochemical characteristics of type 2 Nepalese subjects with diabetes.

RESEARCH DESIGN AND METHODS

This is a hospital-based cross-sectional study including 80 type 2 diabetes mellitus (DM) patients and same number of age-matched and sex-matched healthy controls. Data were collected using preformed set of questionnaires and biochemical data were obtained from the laboratory analysis of the patient's blood samples. Statistical analysis was performed with SPSS V.20.

RESULTS

A significantly higher (p<0.001) mean values of body mass index (BMI), fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), and lipid profiles except high-density lipoprotein cholesterol (HDL-C) were found in type 2 diabetic cases compared with controls. Serum ADA activities were significantly higher in cases compared with controls (p<0.001) showing significant positive correlation (p<0.05) with FBS, PPBS, HbA1c, and alcoholism; while no correlation was found with age, sex, ethnicity, BMI, waist-hip ratio, dietary habits, smoking, and duration of diabetes.

CONCLUSIONS

Serum ADA activities were significantly higher in type 2 diabetic patients compared with controls having significant positive correlation with glycemic parameters. Serum ADA and its isoenzymes could be used as biomarkers for assessing glycemic status in patients with type 2 DM.

Prevalence of inducible clindamycin resistance in erythromycin resistant clinical isolates of Staphylococcus aureus and CONS at tertiary care hospital

Background & Objectives: The objective of this study was to isolate and identify Staphylococcus species from different samples clinical samples and to determine the current trend regarding the incidence and distribution of inducible clindamycin resistance in clinical isolates of Staphylococcus aureus and CONS.Materials & Methods: A total of 264 isolates of staphylococcus species were isolated from various clinical samples. Clinical samples were cultured and Staphylococcus species were identified using standard microbiological methods recommended by the American Society for Microbiology (ASM). Methicillin resistance was confirmed using cefoxitin and oxacillin disks. Inducible clindamycin resistance was identified using D-zone test.Results: Among 264 erythromycin resistant staphylococcus species, 213 (80.6%) were S. aureus and 51 (19.3%) were CONS. Out of 213 erythromycin resistant isolates of S. aureus, 140 (65.7%) were MRSA and 73 (34.2%) were MSSA whereas out of 51 erythromycin resistant isolates of CONS, 28 (54.9%) were MRCNS and 23 (45%) were MSCNS. Constitutive MLSB phenotype and Inducible MLSB phenotype was higher among both MRSA and MRCNS isolates. MS phenotype was more predominant among 11 (5.1%) MSSA and 5 (9.8%) MSCNS isolates compared to 9 (4.2%) in MRSA and 2 (3.9%) in MRCNS.Conclusion: The prevalence of constitutive & inducible clindamycin resistance in staphylococcus isolates was high among both MRSA and MRCNS. Hence the implementation of D-test routinely, will reveal the iMLSB & cMLSB phenotype & will guide the clinicians whether to use clindamycin in staphylococcal infections when erythromycin resistance is present.

Dipeptidyl-Peptidase IV inhibitors and glycemic control in type 2 Diabetes Mellitus

Background & Objectives: Type 2 diabetes mellitus (T2DM) is a progressive disease, characterized by insulin resistance, impaired glucose-induced insulin secretion, inappropriately elevated glucagon concentrations, and hyperglycemia. Many patients cannot obtain satisfactory glycemic control with current therapies. New and more effective agents, targeted not only at treatment, but also at prevention of the disease, its progression, and its associated complications, are, therefore, required. The dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral drugs for the treatment of T2DM. They inhibit the breakdown of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) thereby increasing the incretin effect in patients with T2DM. In clinical practice they are associated with significant reductions in HbA1c, no weight gain and a low risk of hypoglycemia. Since incretin response is markedly diminished in Asian populations, these agents can be used to achieve satisfactory glycemic control in Nepalese T2DM patients.JCMS Nepal. 2016;12(1):28-32.

Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study

BACKGROUND

Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine.

AIM

The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population.

PATIENTS AND METHODS

We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis.

RESULTS

The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine.

CONCLUSIONS

Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.