The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal.

Background: Antimicrobial resistance (AMR) is a major global public health concern and its surveillance is a fundamental tool for monitoring the development of AMR. In 1998, the Nepalese Ministry of Health (MOH) launched an Infectious Disease (ID) programme. The key components of the programme were to establish a surveillance programme for AMR and to develop awareness among physicians regarding AMR and rational drug usage in Nepal.

Intestinal parasitic infection among the HIV-infected patients in Nepal.

Introduction: Intestinal parasitic infection has been a significant problem in HIV patients, worldwide. In this study, we aimed to measure the prevalence and identify the factors associated with intestinal parasitic infection in people infected with HIV and attending National Public Health Laboratory in Kathmandu, Nepal, for CD4 T-cell count.

Methodology: An analytical cross-sectional study in 745 HIV-infected people attending for CD4 T-cell count was conducted.

Improvement in immunological parameters in patients receiving highly active anti-retroviral therapy in Nepal.

Highly active anti-retroviral therapy (HAART) has been freely available in Nepal since 2004. In the present longitudinal study, we followed two distinct cohorts of human immunodeficiency virus-infected participants, those receiving HAART and those under assessment of eligibility for HAART, during the period 2005-2007 in Kathmandu, Nepal. The median change in CD4+ T-cell count among participants receiving HAART after 12 months of the initiation of therapy was +118 T cells/μl (95% confidence interval [CI], +91 to +145 T cells/μl) and that among participants under assessment of eligibility for HAART was -74 T cells/μl (95% CI, -103 to -44 cells/μl).

Factors associated with high prevalence of pulmonary tuberculosis in HIV-infected people visiting for assessment of eligibility for highly active antiretroviral therapy in Kathmandu, Nepal.

Background: Tuberculosis is the leading cause of deaths among HIV patients. In this study, we estimated the prevalence of pulmonary tuberculosis (PTB) and identified the factors/co-morbidities associated with active PTB in HIV-infected people visiting the national public health laboratory to assess their eligibility to receive highly active antiretroviral therapy.

Methods: A cross-sectional study was conducted to measure the prevalence of pulmonary tuberculosis.

Phenotypic and genetic characterization of Vibrio cholerae O1 clinical isolates collected through national antimicrobial resistance surveillance network in Nepal.

Cholera occurs in sporadic cases and outbreaks in Nepal each year. Vibrio cholerae O1 (n = 522) isolated during 2007-2010 from diarrheal patients at 10 different hospital laboratories in Nepal were characterized. Biochemical and serologic identifications showed that all the isolates belonged to serogroup O1, El Tor biotype.

Antimicrobial susceptibilities of enteric bacterial pathogens isolated in Kathmandu, Nepal, during 2002-2004.

Introduction: The prevalence and antimicrobial susceptibility patterns of the bacterial enteropathogens Vibrio cholerae, Salmonella species and Shigella species were investigated.

Methodology: A total of 877 stool samples were received for culture at the National Public Health Laboratory (NPHL), Kathmandu, Nepal, during January 2002 to December 2004, from diarrhoea patients attending Shukraraj Tropical Infectious Hospital and referral outpatients. All samples collected were processed for isolation and antibiotic susceptibility testing of Vibrio cholerae, Salmonella spp.

Emergence and properties of fluoroquinolone resistant Salmonella enterica serovar Typhi strains isolated from Nepal in 2002 and 2003.

A total of 171 Salmonella enterica serovar Typhi strains isolated from Nepal, mostly from patients with typhoid fever in 2002-2003, were tested for antimicrobial susceptibility by disk diffusion assay. Selected S. enterica serovar Typhi isolates were tested for MICs by E-test for ceftriaxone, ciprofloxacin and ofloxacin.

Cholera incidence among patients with diarrhea visiting National Public Health Laboratory, Nepal.

The major objective of this study was to deliver vital statistics related to cholera to health authorities so as to aid in their attempt to prioritize communicable diseases in Nepal. A laboratory-based surveillance was conducted from mid-June 2008 to mid-January 2009 at the National Public Health Laboratory, Nepal. Diarrheal samples alone were processed for Vibrio cholerae.

Field evaluation of commercial immunoglobulin M antibody capture ELISA diagnostic tests for the detection of Japanese encephalitis virus infection among encephalitis patients in Nepal.

Objectives: Japanese encephalitis (JE) is a devastating disease with high rates of death and disability that occurs particularly in resource-limited, rural regions of Asia. Simple, accurate and inexpensive diagnostics tests are vital for quantifying the burden of illness. This field study evaluated two commercial JE immunoglobulin M antibody capture (MAC) ELISA kits using samples from routine JE surveillance.

Laboratory-based Japanese encephalitis surveillance in Nepal and the implications for a national immunization strategy.

We report on two years of Japanese encephalitis (JE) surveillance in Nepal and the implications for a national immunization strategy. From May 2004 to April 2006, 4,652 patients with encephalitis were evaluated. A serum or cerebrospinal fluid specimen was collected from 3198 (69%) patients of which 1,035 (32%) were positive by Japanese encephalitis IgM ELISA.

Typhoid fever: a massive, single-point source, multidrug-resistant outbreak in Nepal.

Background: In the summer of 2002, a total of 5963 cases of typhoid fever were recorded in Bharatpur, Nepal (population, 92,214) during a 7-week period. A team from the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand, and the CIWEC Travel Medicine Clinic (Kathmandu, Nepal) assisted the Nepal National Public Health Laboratory (Kathmandu, Nepal) in the further investigation of this large, explosive febrile disease outbreak.

Methods: Investigators conducted a thorough epidemiologic and laboratory investigation to assess the size and scope of the outbreak.

Genetic relatedness of ciprofloxacin-resistant Shigella dysenteriae type 1 strains isolated in south Asia.

Objectives: The aim of the present study was to determine the clonal relationships of ciprofloxacin-resistant Shigella dysenteriae type 1 strains isolated from south Asia, and S. dysenteriae 1 strains associated with epidemics in 1978, 1984 and 1994.

Methods: The antimicrobial susceptibilities were examined by NCCLS methods.