title: Dengue virus infection in a French traveller to the hilly region of Nepal in 2015: a case report.
abstract: BACKGROUND
  Dengue viral infections are known to pose a significant risk during travel to tropical regions, but it is surprising to find dengue transmission in the hilly region of Nepal, which is over 1800mtr above sea level.
  
  
  METHODS
  A 43-year-old Caucasian female traveler from France presented with fever and abdominal pain following a diarrheal illness while visiting the central hilly region of Nepal. Over the course of 9 days, she developed fever, body aches, and joint pain, with hemorrhagic manifestation. She was hospitalized in India and treated with supportive care, with daily monitoring of her platelets. An assessment by enzyme-linked immunosorbent assay showed that she was positive for dengue non-structural protein 1. Upon her return to France, dengue virus was confirmed by reverse transcriptase-polymerase chain reaction.
  
  
  CONCLUSIONS
  The district where this dengue case was reported is in the hilly region of Nepal, neighboring the capital city Kathmandu. To the best of our knowledge, there has previously been no dengue cases reported from the district. This study is important because it aims to establish a potential region of dengue virus circulation not only in the tropics, but also in the subtropics as well, which in Nepal may exceed elevations of 1800mtr. This recent case report has raised alarm among concerned health personnel, researchers, and organizations that this infectious disease is now on the way to becoming established in a temperate climate.
authors.affiliation: Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kritipur, Kathmandu, Nepal. birendraphd@gmail.com.
authors.forename: Birendra Prasad
authors.initials: BP
authors.lastname: Gupta
authors.affiliation: Asian Institute of Technology and Management, Purbanchal University, Lalitpur, Nepal.
authors.forename: Anurag
authors.initials: A
authors.lastname: Adhikari
authors.affiliation: Everest School of Applied Science, Kathmandu, Nepal.
authors.forename: Ramanuj
authors.initials: R
authors.lastname: Rauniyar
authors.affiliation: Bhawani Hospital and Research Center, Birgunj, Nepal.
authors.forename: Roshan
authors.initials: R
authors.lastname: Kurmi
authors.affiliation: National Public Health Laboratory, Teku, Kathmandu, Nepal.
authors.forename: Bishnu Prasad
authors.initials: BP
authors.lastname: Upadhya
authors.affiliation: National Public Health Laboratory, Teku, Kathmandu, Nepal.
authors.forename: Bimlesh Kumar
authors.initials: BK
authors.lastname: Jha
authors.affiliation: Leprosy Division, Ministry of Health, Government of Nepal, Kathmandu, Nepal.
authors.forename: Basudev
authors.initials: B
authors.lastname: Pandey
authors.affiliation: Virology Unit, Central Department of Biotechnology, Tribhuvan University, Kritipur, Kathmandu, Nepal.
authors.forename: Krishna
authors.initials: K
authors.lastname: Das Manandhar
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy / Q000821:virology*; D000328:Adult; D000330:Aedes; D000531:Altitude; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D003715:Dengue / Q000175:diagnosis / Q000628:therapy / Q000635:transmission*; D003716:Dengue Virus / Q000276:immunology / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy / Q000821:virology*; D006801:Humans; D007303:Insect Vectors; D009390:Nepal / Q000453:epidemiology; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral
keywords: Dengue virus; Hilly region; Nepal; Travel