title: The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal.
abstract: In Nepal, many infections remain poorly characterized, partly due to limited diagnostic facilities. We studied consecutive febrile adults presenting to a general hospital in Kathmandu, Nepal. Of the 876 patients enrolled, enteric fever and pneumonia were the most common clinical diagnoses. Putative pathogens were identified in 323 (37%) patients, the most common being Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A (117), Rickettsia typhi (97), Streptococcus pneumoniae (53), Leptospira spp. (36), and Orientia tsutsugamushi (28). Approximately half of the Salmonella isolates were resistant to nalidixic acid. No clinical predictors were identified to reliably distinguish between the different infections. These findings confirm the heavy burden of enteric fever and pneumonia in Kathmandu, and highlight the importance of murine typhus, scrub typhus, and leptospirosis. Given the lack of reliable clinical predictors, the development of cheap and accurate diagnostic tests are likely to be of great clinical utility in this setting.
authors.affiliation: Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. david.murdoch@cdhb.govt.nz
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.forename: Mark D
authors.initials: MD
authors.lastname: Zimmerman
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dull
authors.forename: Ram Hari
authors.initials: RH
authors.lastname: Belbase
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Keenan
authors.forename: Robert Mcnair
authors.initials: RM
authors.lastname: Scott
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
authors.forename: Lennox K
authors.initials: LK
authors.lastname: Archibald
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000382:microbiology*; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006786:Hospitals, Urban; D006801:Humans; D007919:Leptospira / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009390:Nepal; D012285:Orientia tsutsugamushi / Q000302:isolation & purification; D012286:Rickettsia typhi / Q000302:isolation & purification; D012482:Salmonella paratyphi A / Q000302:isolation & purification; D012485:Salmonella typhi / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*