A hospital-based study of bloodstream infections in febrile patients in Dhulikhel Hospital Kathmandu University Teaching Hospital, Nepal.

The etiology of bloodstream infections in febrile patients remain poorly characterized in Nepal. A retrospective study of febrile patients presenting to Dhulikhel Hospital Kathmandu University Teaching Hospital from July 2002 to June 2004 was performed to evaluate the etiology of bloodstream infections and the drug sensitivity patterns of cultured organisms. The medical and laboratory records of all febrile patients with an axillary temperature > or = 38 degrees C who had a blood culture taken (n = 1,774) were retrieved and analyzed. Of these, 122 (6.9%) patients had positive blood cultures, of which 40.1% were age 11 to 20 years. The male to female ratio was 1.7:1. Antibiotics had been taken prior to hospital presentation by 39 (32%) patients. Salmonella enterica serovar Typhi and serovar Paratyphi A were isolated in 50 (41.0%) and 13 (10.7%) cases, respectively. All S. Typhi and S. Paratyphi isolates were susceptible to ceftriaxone, while susceptibility to ciprofloxacin and chloramphenicol was recorded in 94.8% and 94.5% of cases, respectively. Cephalexin and amoxicillin had the lowest rates of susceptibility (64.2% and 54.1%, respectively). Salmonella spp were usually sensitive to chloramphenicol. These findings provide clinicians in this region of Nepal with a better understanding of the spectrum of pathogens causing bloodstream infections and will help guide empiric antibiotic choice.

Peripheral gangrene in a fatal pediatric cerebral malaria: A case report.

A Thai male aged 10 years from Kanchanaburi, was referred to Paholpolpayuhasana hospital decause of ceredral malaria. During his hospital stay, the patient developed multiple complications including gangrene of both feet which was seen 24 hours after admission. This patient was haematemesis. The laboratory results revealed thrombocytopaenia and an abnormal coagulogram but there was no evidence of septicaemia. The patchy lesions of peripheral gangrenr progressed slowly and stoped after 48 hours. After 5 days of treatment, the patient became aparasitaemic but he developed acute renal failure on day 6 and died of pulmonary oedema on day 7. In agreement with a previous report, this report confirms that peripheral gangrene is a rare complication in Thai pediatric cerebral malaria patients. This complication can develop both in other multiple complications.