The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal.
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.
Murdoch
David R
DR
Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. david.murdoch@cdhb.govt.nz
Woods
Christopher W
CW
Zimmerman
Mark D
MD
Dull
Peter M
PM
Belbase
Ram Hari
RH
Keenan
Andrew J
AJ
Scott
Robert Mcnair
RM
Basnyat
Buddha
B
Archibald
Lennox K
LK
Reller
L Barth
LB
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*