Comparative genomic analyses of multi-drug resistant Mycobacterium tuberculosis from Nepal and other geographical locations.

Nepal exhibits a tuberculosis (TB) incidence rate that is comparable to neighbouring high TB incidence countries. In addition, it records >500 cases of multi-drug resistant (MDR) TB each year. The objective of this study was to perform whole-genome bioinformatic analysis on MDR-TB isolates from Nepal (n = 19) to identify the specific mutations underlying their phenotypic resistance. In addition, we examined the dominant genotype among the Nepal MDR-TB isolates, the East-Asian Beijing sub-lineage, to determine its relatedness to a panel of 1274 genomes of international strains available from public databases. These analyses provided evidence that the XDR-TB isolates in our collection were not derived from importation of primary XDR-TB to Nepal but were more likely the result of acquisition of second-line drug resistance in Nepal. Resistance to fluoroquinolones was detected among a high proportion of the Nepal isolates. This has implications for the management of TB, including appropriate antimicrobial stewardship and susceptibility testing for fluoroquinolones and other second-line TB drugs, to minimise the development of XDR-TB among Nepal TB cases.

Draft Genome Sequence of an Isolate of Extensively Drug-Resistant Mycobacterium tuberculosis from Nepal.

Extensively drug-resistant (XDR) Mycobacterium tuberculosis has become a challenge to the treatment of tuberculosis (TB) in several countries, including Nepal. Here, we report for the first time the draft genome sequence of an isolate of XDR-TB collected in Nepal and describe single-nucleotide variations associated with its extensively drug-resistant phenotype.

Intestinal parasitic infections among HIV seropositive and high risk group subjects for HIV infection in Nepal.

Present study was carried out to find out the prevalence of intestinal parasites in HIV seropositive (HIV+) subjects and high risk group (HRG) for HIV infection in Nepal. A total 196 (HIV+: n = 112; Age: 16-52 years and HRG: n = 84; Age: 16-39 years) individuals were included. Stool specimens were examined by direct smear, formal-ether sedimentation, Sheather's sucrose floatation and Kinoyun modified Ziehl-Neelsen methods. Overall prevalence of intestinal parasites was 35.7% (70/196) (26.7% in HIV+ subjects and 47.6% in HRG subjects). Trichuris trichiura was the commonest parasite in HIV+ subjects (50.0%), whereas hookworm was most common among HRG subjects (56.8%). There was an association of parasitic infections with the gastrointestinal tract symptoms in both the study subjects. Tibeto-Burmans study subjects had marginally higher prevalence than Indo-Aryans study subjects (P > 0.05). Multiparasitic infections were relatively more common among HIV+ subjects (7.2%) in comparison to HRG subjects (4.8%). Similarly the protozoan infections were relatively higher in HIV+ subjects (4.5%) compared with HRG subjects (1.2%). The opportunistic protozoa Cryptosporidium parvum was detected only in 5.2% HIV+ subjects.

Microbial study of hospital environment and carrier pattern study among staff in Nepal Medical College Teaching Hospital.

The present study was done to see the microbial flora in the environment (air and surface) of Nepal Medical College Teaching Hospital and the staffs working in the hospital. Altogether 160 environmental (air n = 43, surface n = 117) samples were collected and studied from different wards. Similarly 150 samples (48 nasal swabs, 48 throat swabs and 54 hand samples) from the staffs were collected and studied following the standard microbiological protocols. Gram +ve cocci were the most predominant ones among the bacterial isolates from the environment followed by gram +ve bacilli and gram -ve bacilli. Among fungal isolates, yeast were the most common isolates while Aspergillus spp. were the most frequently occurring mold. Out of 150 samples collected for the study of carrier pattern, 32 out of 54 samples collected were found to have Staphylococcus aureus in their hands, 1 had Escherichia coli. Other isolates were Bacillus spp., Micrococci and coagulase negative staphylococci. Similarly 21 (43.8%) out of 48 nasal samples were found to have S. aureus while none of the staffs were found to have beta-hemolytic streptococci in their throat. In the study, 1.6% environmental isolates and 5.7% carrier isolates of S. aureus were found to be Methicillin resistant.

Antibiogram pattern of isolates from UTI cases in Eastern part of Nepal.

The present study was conducted to study antibiogram pattern of isolates from urinary tract infection (UTI) cases at a referral hospital in Eastern Nepal. Of the total 2,799 of urine samples studied, 720 (25.7%) were positive for some kinds of bacterial agents. Escherichia coli was most predominant organism (59.0%) followed by Klebsiella sp. (12.6%), Pseudomonas aeruginosa (6.9%), Acinetobacter sp. (5.9%), Enterococcus sp. (4.2%) and others (2.6%). Antimicrobial susceptibility testing was done by Kirby-Bauer's disc diffusion method following National Committee for Clinical Laboratory Services (NCCLS) guidelines. Most strains of Esch. coli and Klebsiella sp. were resistant to Ampicillin and Ciprofloxacin. Ps. aeruginosa and Acinetobacter sp. showed relatively higher resistance to Aminoglycosides. These organisms were often multidrug resistant. Ps. aeruginosa showed 68.0% resistance to even Ceftazidime. For Enterococcus sp. Nitrofurantion and Gentamicin were the drugs of choice. Of the all antimicrobial agents tested, Ciprofloxacin showed most disappointing result.