Comparative genomic analyses of multi-drug resistant Mycobacterium tuberculosis from Nepal and other geographical locations.

Nepal exhibits a tuberculosis (TB) incidence rate that is comparable to neighbouring high TB incidence countries. In addition, it records >500 cases of multi-drug resistant (MDR) TB each year. The objective of this study was to perform whole-genome bioinformatic analysis on MDR-TB isolates from Nepal (n = 19) to identify the specific mutations underlying their phenotypic resistance. In addition, we examined the dominant genotype among the Nepal MDR-TB isolates, the East-Asian Beijing sub-lineage, to determine its relatedness to a panel of 1274 genomes of international strains available from public databases. These analyses provided evidence that the XDR-TB isolates in our collection were not derived from importation of primary XDR-TB to Nepal but were more likely the result of acquisition of second-line drug resistance in Nepal. Resistance to fluoroquinolones was detected among a high proportion of the Nepal isolates. This has implications for the management of TB, including appropriate antimicrobial stewardship and susceptibility testing for fluoroquinolones and other second-line TB drugs, to minimise the development of XDR-TB among Nepal TB cases.

Draft Genome Sequence of an Isolate of Extensively Drug-Resistant Mycobacterium tuberculosis from Nepal.

Extensively drug-resistant (XDR) Mycobacterium tuberculosis has become a challenge to the treatment of tuberculosis (TB) in several countries, including Nepal. Here, we report for the first time the draft genome sequence of an isolate of XDR-TB collected in Nepal and describe single-nucleotide variations associated with its extensively drug-resistant phenotype.

Pulmonary paragonimiasis.

A 27-year-old married male from Lamdeng village of Imphal West District, Manipur presented with cough, fever, haemoptysis, anorexia and weight loss, and was treated with antituberculosis drugs continuously for one year without improvement. He also had history of ingestion of raw crabs. Chest radiograph revealed right midzone lesion with cavitation. Laboratory investigations revealed peripheral blood eosinophilia, elevated erythrocyte sedimentation rate and sputum smear revealed eggs of Paragonimus westermani. He responeded well to treatment with praziquantel 25 mg/kg, three times a day for three days and is doing well on follow-up. Pulmonary paragonimiasis must be considered in the differential diagnosis of slowly resolving pneumonias, especially in the appropriate clinical setting because effective treatment with praziquantel can be rewarding.

Helminthic infestation of the primary school-going children in Manipur.

A total of 1010 stool samples collected from the primary school-going children between the age group of 5 to 10 years from September 1998 to October 2000, were studied to find out the prevalence of intestinal helminths in this paediatric age group and in the urban and rural areas of Manipur. The samples were processed in the Microbiology Department, RIMS, Imphal by wet film, iodine preparation and concentration techniques (formol-ether concentration) to find out the presence of eggs, larvae of the intestinal parasites (helminths). A total of 248 (24.5%) were positive for various helminths. Among the positive cases, 110 (26.3%) were from the urban area (city) and 138 (23.4%) from the rural areas of Manipur. Of the 552 males and 458 females tested, 136 (24.6%) males and 112 (24.5%) females respectively were positive for various helminths. Maximum number of parasitic infection occurred in the age group of 5 to 6 years (27.0%) in both sexes. Among the parasites, Ascaris lumbricoides was the commonest (19.6%) followed by Trichuris trichiura (2.18%), Hymenolepis nana (0.99%), Tapeworm (0.19%), Hookworm (0.09%), Strongyloides stercoralis (0.09%), Enterobius vermicularis (0.09%). Mixed infection of Ascaris lumbricoides with T. trichiura (1.08), T. trichiura with E. vermicularis (0.09%) and T. trichiura with S. stercoralis (0.09) were also encountered. Antihelminthic drugs were prescribed to those who were found positive for the helminths.