Use of rK39 for diagnosis of post kala-azar dermal leishmaniasis in Nepal.

A recently developed nitrocellulose-based dipstick test, rK39, has been widely used for the diagnosis of kala-azar. In this study, we evaluated its use for the diagnosis of post kala-azar dermal leishmaniasis (PKDL). We also investigated the time taken by patients to develop PKDL after apparent cure of kala-azar (visceral leishmaniasis, VL) and the time taken by patients to come to the hospital after the appearance of symptoms of PKDL. A majority of patients developed the disease within three years after the apparent cure of kala-azar (KA). A majority of patients sought treatment within five years after the onset of PKDL. The amastigotes of Leishmania donovani bodies (LDBs) were demonstrated in 70, 20, and 20% of slit-skin smears (SSS) prepared, respectively, from nodular, papular, and macular forms. The presence of highest density (6+) LDBs in the SSS of 20% of nodular PKDL patients indicated that they may have acted as reservoir in the community. Other reservoirs are not known in Nepal. Only 8% cases were detected by aldehyde test. Although this test is obsolete it is still used in rural parts of Nepal. The dipstick (rK39) was 96% sensitive and 100% specific to diagnose PKDL. Its positive predictive value, negative predictive value, and diagnostic efficacy were 100, 91, and 97% respectively. Due to the advantage of cost compared with the direct agglutination test (DAT), and being easy to use and store in field conditions, rK39 is a good tool to diagnose PKDL in rural situations. All the PKDL patients were cured of the disease after treatment by SAG.

Analysis of blood culture isolates from hospitalized neonates in Nepal.

Clinically suspected 77 cases of neonatal septicemia admitted to the pediatric ward of BP Koirala Institute of Health Sciences, Dharan, Nepal, were evaluated by blood culture. The blood culture was positive for bacterial growth in 46 (59.7%) cases. Gram-negative bacteria were isolated in 33 (71.7%) cases, the most common being Escherichia coli, followed by Klebsiella spp, Enterobacter spp. Staphylococcus aureus was the most common gram-positive bacteria. The bacterial isolates were most sensitive to gentamicin (74.5%) and ciprofloxacin (74.5%) followed by chloramphenicol (59.9%). They were most resistant (78.8%) to ampicillin. This study for the first time underlines the pattern of bacterial isolates and their sensitivity pattern to antibiotics in this part of Nepal.

Cutaneous leishmaniasis in Nepal.

We report an imported case of cutaneous leishmaniasis in a 30 year old adult male from Nepal caused by Leishmania tropica. This case from Dharan is the first such report of imported cutaneous leishmaniasis in Nepal.