title: Invasive pneumococcal disease in Kanti Children's Hospital, Nepal, as observed by the South Asian Pneumococcal Alliance network.
abstract: BACKGROUND
  Pneumonia accounts for approximately 2 million deaths annually among children aged <5 years, with most of these deaths occurring in Africa and southern Asia. The South Asian Pneumococcal Alliance (SAPNA) network in Nepal is generating local epidemiological data to assist in the development of national and regional policies for prevention of pneumococcal and Haemophilus influenzae (Hib) disease.
  
  
  METHODS
  Children aged 2 months to 5 years with suspected invasive bacterial disease were recruited from Kanti Children Hospital, Kathmandu, Nepal. Specimens of blood, CSF, and normally sterile body fluids were cultured, and analysis of antimicrobial susceptibility patterns and serotyping of Streptococcus pneumoniae isolates were performed. CSF specimens were also tested for S. pneumoniae and Hib antigens by a latex agglutination test and an immunochromatographic test of pneumococcal antigen (NOW S. pneumoniae Antigen Test; Binax).
  
  
  RESULTS
  A total of 2528 children with suspected invasive bacterial disease were recruited, of whom 82% had pneumonia, 9.6% had meningitis, 2% had very severe disease, and 0.4% had bacteremia; the remainder received another diagnosis. Before hospitalization, 26.7% had received antibiotic treatment. Fifty children had S. pneumoniae identified as the etiological agent of invasive disease. Of 2461 blood cultures performed, 22 were positive for S. pneumoniae. Of 33 cases of S. pneumoniae meningitis, 11 were detected by CSF culture, and 21 were detected by latex agglutination and pneumococcal antigen tests. The rate of detection of S. pneumoniae in CSF was 3.6% by culture, compared with 7.8% by latex agglutination and 10% by pneumococcal antigen testing. The rate of detection of H. influenzae in CSF was 1.7% by culture and 6.5% by latex agglutination. The most common serotypes found were 1, 5, 2, and 7F, followed by 12A, 19B, and 23F. Of all the invasive isolates, 3.8% were resistant to penicillin, and 68% were resistant to trimethoprim-sulfamethoxazole.
  
  
  CONCLUSIONS
  The SAPNA network has identified Hib and pneumococci as causes of significant disease in Nepal.
authors.affiliation: Institute of Medicine and Kanti Children's Hospital, Kathmandu, Nepal. rajuladi@yahoo.com
authors.forename: A S
authors.initials: AS
authors.lastname: Shah
authors.forename: M Deloria
authors.initials: MD
authors.lastname: Knoll
authors.forename: P R
authors.initials: PR
authors.lastname: Sharma
authors.forename: J C
authors.initials: JC
authors.lastname: Moisi
authors.forename: P
authors.initials: P
authors.lastname: Kulkarni
authors.forename: M K
authors.initials: MK
authors.lastname: Lalitha
authors.forename: M
authors.initials: M
authors.lastname: Steinhoff
authors.forename: K
authors.initials: K
authors.lastname: Thomas
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000942:Antigens, Bacterial / Q000134:cerebrospinal fluid; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002673:Child, Hospitalized; D002675:Child, Preschool; D002846:Chromatography, Affinity; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007841:Latex Fixation Tests; D008586:Meningitis, Pneumococcal / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D009390:Nepal / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial