Relapse of kala-azar after use of multiple drugs: A case report and brief review of literature.

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.

Rotavirus Disease Burden and Molecular Epidemiology in Children with Acute Diarrhoea Age Less than 5 Years in Nepal.

Introduction: Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. The aim of the study was to determine rotavirus disease burden and distribution of rotavirus genotypes in children less than five years of age. Methodology: Stool samples were collected from 1768 hospital admitted children under 5 years of age with acute watery diarrhea during November 2005 to October 2008. Rotavirus in stool samples was detected by Enzyme Immuno Assay (EIA) and positive specimens for rotavirus positive was genotyped by reverse transcription-polymerase chain reaction (RTPCR) and sequencing methods. Results: The prevalence of rotavirus was 36.59% (647/1768). Detection was higher in male (33.3%) than female (26.9%). The prevalence was higher during the month of January (2005-06) and February in other periods. During 2005-06, high prevalence of rotavirus was noted in children of age between 6-11 months while in 2006-07 and 2007-08 high prevalence was seen in age group 12-23 months. The most common genotyping of rotavirus identified 5 G types and 3 P types. Genotypes G12 and P [8] were most common during both periods studied (G12; 50%, 29% 33.7% in 2005-06, 2006-07 and 2007-08 respectively and P[8]; 47%, 35% and 43.5% in 2005-06, 2006-07 and 2007-08 respectively). Among six combined genotypes, G12P [6] was most prevalent (34%, 24% and 47.5% in 2005-06, 2006-07 and 2007-08 respectively) where as G1P [6] (4%) was seen in year 2007- 08 only. Conclusions: The study demonstrates the burden of rotavirus diarrhea in Nepal. The data on rotavirus genotypes will help inform decisions as to whether rotavirus vaccine should be considered for inclusion in to Nepal’s National Immunization Program.

Molecular evolution, distribution and genetic relationship among the dengue 2 viruses isolated from different clinical severity.

Twenty-two strains of dengue 2 virus, isolated in China, Latin America, New Guinea and Thailand were subjected to phylogenetic analysis. The UPGMA analysis was carried out on each gene region of dengue virus and demonstrated that outcome from most of the gene regions showed similar results except those from NS4B and YUTR with very short nucleotide length. Among ten regions examined, the results from E gene documented the geographical differences of the virus strains most clearly and all the American strains (Mara 4, IQT1797 and S1) were distantly related to the Asian isolates. As for the 16 Thai strains isolated in 1993, they were clustered into three groups and a strain from a DSS patient formed a distinct branch compared to the other two groups. This finding from phylogenetic analysis is consistent with earlier conclusion and support the severity related subtyping of dengue 2 virus based on amino acid changes.

Identification of a flavivirus isolated from mosquitos in Chiang Mai Thailand.

A virus isolate, ThCAr105/92, from a pool of mosquitos, Culex tritaeniorhynchus, collected in Chiang Mai, Thailand in 1992, appeared to be a member of the genus Flavivirus of the family Flaviviridae, based on the reverse transcription polymerase chain reaction (RT-PCR) using flavivirus cross-reacting primer pairs, electron microscopic examination, and serological tests. However, RT-PCR using Japanese encephalitis (JE) virus-specific primers showed that the isolate was different from JE virus. Sucrose density gradient sedimentation of the virus replicated in C6/36 cells indicated that the virus is relatively unstable in the infected culture fluids at 37 degrees C. Antibody prepared against this virus and a virus seed for the isolate were tested by cross neutralization against a panel of flaviviruses and the results showed that the new isolate was a distinct subtype of Tembusu virus.