Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study).

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is a major human pathogen associated with nosocomial and community infections. Panton Valentine leukocidin (PVL) is considered one of the important virulence factors of S. aureus responsible for destruction of white blood cells, necrosis and apoptosis and as a marker of community acquired MRSA. This study was aimed to determine the prevalence of PVL genes among MRSA isolates and to check the reliability of PVL as marker of community acquired MRSA isolates from Western Nepal. METHODS: A total of 400 strains of S. aureus were collected from clinical specimens and various units (Operation Theater, Intensive Care Units) of the hospital and 139 of these had been confirmed as MRSA by previous study. Multiplex PCR was used to detect mecA and PVL genes. Clinical data as well as antimicrobial susceptibility data was analyzed and compared among PVL positive and negative MRSA isolates. RESULTS: Out of 139 MRSA isolates, 79 (56.8 %) were PVL positive. The majority of the community acquired MRSA (90.4 %) were PVL positive (Positive predictive value: 94.9 % and negative predictive value: 86.6 %), while PVL was detected only in 4 (7.1 %) hospital associated MRSA strains. None of the MRSA isolates from hospital environment was found positive for the PVL genes. The majority of the PVL positive strains (75.5 %) were isolated from pus samples. Antibiotic resistance among PVL negative MRSA isolates was found higher as compared to PVL positive MRSA. CONCLUSION: Our study showed high prevalence of PVL among community acquired MRSA isolates. Absence of PVL among MRSA isolates from hospital environment indicates its poor association with hospital acquired MRSA and therefore, PVL may be used a marker for community acquired MRSA. This is first study from Nepal, to test PVL among MRSA isolates from hospital environment.

The Socio-Demographic Characteristics of the Clients of Female Sex Workers and their Perspectives, Behaviours and Attitude on HIV and AIDS: A Questionnaire Based Survey from Pokhara, Nepal.

BACKGROUND: The clients of Female Sex Workers (FSWs) have been represented from different socio-demographic backgrounds and their risk behaviour depends upon their learning skills and attitudes and its impacts on practice. OBJECTIVE: The general objective of this study was to find the socio-demographic characteristics, background, knowledge, behaviour, and the attitude on STIs, HIV and AIDS of the clients of female sex workers. MATERIAL AND METHODS: This questionnaire based, cross sectional study was conducted on 109 clients of FSWs during the time period from January 2010 to July 2010 in Pokhara (submetropolitan city of the Kaski district), Nepal. The locations were the Baglung Bus Park, Lakeside and Mahendrapool. RESULT: Among the 109 respondents, the mininum and the maximum age were 18 and 50 years. According to the religion-wise distribution, 77.1% of the respondents were Hindus, 10.1% were Buddhists, 8.3% were Christians, 1% were Muslims and 3.7% were from other religions. 67.9% of the respondents were tested for HIV at least once, whereas nearly one third (32.1%) of the respondents were never tested for HIV. 49.5% of the respondents answered that there was no difference between HIV and AIDS. Among the respondents, 89.9% respondents knew how to be safe from STIs and the HIV infections and 99.1% knew about HIV and AIDS. CONCLUSION: HIV and AIDS is a cross cutting issue in the present situation rather than a health issue. One of the most at risk groups is the clients of female workers who frequently have risk behaviours like having sex with female sex workers. The sexual behaviour among these clients depends upon their attitude, knowledge and perception, which also influence several internal and external factors. In our study, the clients of the female sex workers had some extent of knowledge about the condom, sexually transmitted infections and HIV/AIDS. They were made aware on these by different organizations who were working in the field of HIV and AIDS, but still they intended to practise unsafe sex with the female sex workers.