Emerging opportunistic protozoa and intestinal pathogenic protozoal infestation profile in children of western Nepal.

Intestinal parasitic infestation continues to be of public health importance in many tropical and subtropical countries for their high prevalence and effects on the morbidity in the population. This 5-year hospital-based retrospective analysis was aimed to find out the intestinal protozoal parasitic profile in 1790 pre-school and school-going children visiting the hospital with gastrointestinal illness. Giardia lamblia was the most prevalent pathogenic protozoan intestinal parasite (73.4%), followed by Entamoeba histolytica (24.4%). Interestingly, "newer" opportunistic pathogens like Cyclospora cayetanensis (1.0%) and Cryptosporidium sp. (1.0%) were detected from immunocompromised children below 2 years of age as a result of vertical transmission, which is alarming for a country like Nepal at the stage of 'concentrated epidemic' of HIV infection.

Salmonella bacteraemia in Pokhara: emergence of antibiotic resistance.

We undertook a retrospective hospital based study of 2,354 blood culture specimens from June 2000 to May 2003 in order to determine the isolation rates of Salmonella species and their antibiotic susceptibility patterns in western Nepal. Blood samples were cultured and identification of Salmonella species. and their antibiotic susceptibility testing were done as per standard protocol. Of the total 114 (4.8 %) yielded Salmonella species. Of them 76 (66.7%) Salmonella typhi and 38 (33.3%) S. paratyphi A. S. typhi was found to be the predominant species each year. Higher proportion of Salmonella bacteraemia was seen in adults, with a clearcut male to female preponderance (1.8:1). Monsoons enhanced the risk of acquiring enteric fever. There is also a rise in the number of multi-drug resistant strains in and around Pokhara Valley, with 40.7% S. typhi and 5.2% S. paratyphi A showing resistance to two or more antibiotics. These isolates were primarily resistant to the first line drugs namely Ampicillin, Chloramphenicol and Cotrimoxazole but susceptible to third generation Cephalosporins. Appearance of multi drug resistance poses considerable threat of increased morbidity and mortality in this region. This emphasizes the need for prudent use of antimicrobials.