Status of Intestinal Parasitic Infections in a Tertiary Care Center.

BACKGROUND: Intestinal parasitic infections (IPIs) are diseases of serious public health concern in low- and middle-income countries, including Nepal. Such infections can cause growth retardation and increased susceptibility to other parasitic infections. Hence, this study aims to assess the prevalence of IPIs among the patients attending a tertiary care hospital in central Nepal. METHODS: Clinical and laboratory records of patients, whose stool samples were collected and transported to the Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, during 2 years (January 2019 and December 2020) were examined for parasitological findings, by conventional microscopy using normal saline and iodine preparation. RESULTS: Out of 3,146 patients included in the study, 411 (13.1%) patients (median age[IQR]: 27[12-45]) were infected with the intestinal parasites. Patients of different age groups, such as 20-30 years (16.1%), 10-20 years (14.1%), and 30-40 years (13.3%) were mostly infected. Infection was more common in females (221/1572, 14.1%) than males (190/1574, 12.1%). There were 373 (90.8%) cases of IPIs due to Entamoeba histolytica, 34 (8.3%) cases due to Giardia lamblia, and 4 (0.9%) cases due to helminths. The prevalence of IPI in the first and second years was 14.5% (260/1794) and 11.2% (151/1352), respectively. IPIs were more common in summer (n=87, 12.8%) and spring(n=81, 10.8%). CONCLUSIONS: Present study showed a declined prevalence of helminth infection. However, a higher rate of protozoan infection indicated the water source contamination with fecal matters and therefore urgencies for awareness among the public about hygienic practices.

Microbiological and Clinicoepidemiological Profile of a Series of Patients with Infective Endocarditis at a Center in Eastern Nepal.

BACKGROUND: The microbiological and clinicoepidemiological profile of infective endocarditis (IE) has undergone significant change over time. The pattern of IE studied at local level provides broader vision in understanding the current scenario of this disease. This study aimed to depict the overall picture of IE and its changing profile by evaluating the microbiological and clinicoepidemiological features in the context of a tertiary care center of eastern Nepal. METHODS: The descriptive study was conducted from September 2017 to August 2018 among IE patients presenting to B. P. Koirala Institute of Health Sciences, Nepal. Detailed history and clinical manifestations of patients were noted. Microorganisms isolated from the blood culture were processed for identification by standard microbiological methods, and susceptibility testings were done. Each patient was assessed daily during hospital stay. RESULTS: Ten definite and 7 possible endocarditis cases were studied. The mean age was 41.4 ± 15.85 (17-70) years with predominance of male (4.7 : 1). Rheumatic heart disease (41.1%) was the most common underlying heart disease observed followed by injection drug user endocarditis (23.5%). All the cases had native valve endocarditis. Aortic valve was the most common valve involved (35.3%) followed by mitral, tricuspid, and pulmonary valves. Blood culture positivity was 53%. Staphylococcus aureus was the major causative agent responsible for 23.5% of the cases followed by Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. Mortality of 2 cases (11.8%) was associated with S. aureus and P. aeruginosa. Majority of patients developed acute kidney injury (35.3%) and congestive cardiac failure (23.5%). CONCLUSION: IE patients in our center exhibited differences from the west in terms of age at presentation and predisposing factors but held similarity in terms of commonly isolated microorganisms. The changing patterns of IE, etiological agents, and their antimicrobial susceptibility observed in this study may be helpful for clinicians in formulating a new empirical antibiotic treatment protocol.

Early-Onset Neonatal Meningitis Caused by an Unusual Pathogen-Moraxella catarrhalis.

INTRODUCTION: Moraxella catarrhalis are part of the normal flora of the human respiratory tract and are known to have low pathogenic potential. The organism is rarely reported in the literature as the causative agent of meningitis. We report the first case of early-onset neonatal meningitis associated with M. catarrhalis from Nepal. CASE REPORT: A 3-day-old baby with fever and yellowish discolouration of the body since 48 hrs was admitted to the neonatal ward. The baby developed 3 episodes of seizures in the form of uprolling of eyes on the first day of admission during phototherapy course for raised serum bilirubin. Sepsis screen was positive, and meningitis was confirmed as the cerebrospinal fluid culture grew M. catarrhalis. Cranial ultrasound scan was normal. The baby received a 21-day course of intravenous cefotaxime and amikacin. Recovery has been uneventful to date. CONCLUSION: Neonatal meningitis is a life-threatening infection. This case report presents an uncommon aetiology of neonatal meningitis which can be misidentified in the diagnostic bacteriology laboratory in resource constraints area like ours.