HAPPY NEW YEAR-2023

 May this new year 2023 bring all good innovations in science for human welfare!!

What is public health?

 Useful and Nice one.

International Epidemiology and Public Health Emergency Training 2022

The importance of Epidemiology and Public Health is unavoidable in control of any infectious diseases.

Primary vs Secondary Dengue infection

 Figure 1: Clinical and Laboratory diagnosis of Dengue viral infection (Muller et al., 2017)

Key Facts of Dengue

Figure 1: Clinical sign and symptoms of Dengue

Figure 2: Dengue complications

Figure 3: Dengue complications and Antibody Dependent Enhancement

 

Dengue Outbreak in Nepal; WHO Updates

Outbreak at a glance

Dengue is endemic in Nepal. The country is experiencing a surge in cases that started from the week commencing 8 August to 26 August. Between January to 28 September 2022, a total of 28 109 confirmed and suspected dengue cases and 38 confirmed deaths due to dengue have been recorded, affecting all seven provinces. The causative serotype(s) is unknown. This represents the largest dengue outbreak in Nepal with regard to the cumulative number of cases reported nationwide per year.  

Description of the outbreak

Between January and 28 September 2022, a total of 28 109 suspected and confirmed cases of dengue fever including 38 confirmed deaths (overall CFR 0.13%) have been reported from all seven provinces of Nepal, affecting all 77 districts in Nepal (Figure 1). Bagmati province which is the second-most populous province has reported the highest number of cases (78.2%) and deaths (68.4%).

According to the Epidemiology and Disease Control Division (EDCD) of the Ministry of Health and Population, the highest number of new cases in 2022 have been reported in the districts of Kathmandu (n=9528; 33.8%), Lalitpur (n=6548; 23.2%), and Makwanpur (n=2776, 9.8%).

Data on demographics was available for 23% of cases (n= 6734) of which 76% (5175/6734) were aged 15-59 years old, and 54% were males (n=3637). As of 28 September, 38 deaths have been verified, of which males and cases aged 15 – 59 years old each accounted for 55% (n=21) of reported deaths. Cases aged over 60 years old accounted for 39% (n=15) of reported deaths.

Dengue cases have increased since July coinciding with the rainy season with majority of the cases reported during September (83.6%; n=23 514).

 

Figure 1.  Number of Dengue cases reported from districts of Nepal from 1 January- 28 September 2022.

 

 

Figure 2.   Number of dengue cases reported by months in Nepal from 1 January to 28 September 2022

Source: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON412#:~:text=Dengue%20is%20endemic%20in%20Nepal,recorded%2C%20affecting%20all%20seven%20provinces.

How to control Dengue?

If you know you have dengue, avoid getting further mosquito bites during the first week of illness. Virus may be circulating in the blood during this time, and therefore you may transmit the virus to new uninfected mosquitoes, who may in turn infect other people.

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for dengue.  At present, the main method to control or prevent the transmission of dengue virus is to combat the mosquito vectors. This is achieved through:

• Prevention of mosquito breeding:
• Preventing mosquitoes from accessing egg-laying habitats by environmental management and modification;
• Disposing of solid waste properly and removing artificial man-made habitats that can hold water;
• Covering, emptying and cleaning of domestic water storage containers on a weekly basis;
• Applying appropriate insecticides to water storage outdoor containers;

• Personal protection from mosquito bites:
• Using of personal household protection measures, such as window screens, repellents, coils and vaporizers. These measures must be observed during the day both inside and outside of the home (e.g.: at work/school) because the primary mosquito vectors bites throughout the day;
• Wearing clothing that minimizes skin exposure to mosquitoes is advised;

• Community engagement:
• Educating the community on the risks of mosquito-borne diseases;
• Engaging with the community to improve participation and mobilization for sustained vector control;

• Active mosquito and virus surveillance:
• Active monitoring and surveillance of vector abundance and species composition should be carried out to determine effectiveness of control interventions;
• Prospectively monitor prevalence of virus in the mosquito population, with active screening of sentinel mosquito collections;
• Vector surveillance can be combined with clinical and environment surveillance. 

In addition, there is ongoing research amongst many groups of international collaborators in search of novel tools and innovative strategies that will contribute in global efforts to interrupt transmission of dengue. The integration of vector management approaches is encouraged by WHO to achieve sustainable, effective locally adapted vector control interventions.

Source: https://www.who.int/nepal/news/feature-stories/detail/continuing-the-fight-against-dengue

The Story of Corona - Still need to fight against COVID-19

 

Cholera outbreak in Kathmandu - A short report by EDCD, Kathmandu, Nepal

Street food sale was banned in Kathmandu valley to control and further spread of cholera outbreak

Antibiogram and Biofilm Development among Klebsiella pneumoniae from Clinical Isolates

Antibiogram and Biofilm Development among Klebsiella pneumoniae from Clinical Isolates

Subash Paudel1, Laxmi Parajuli1, Prashanna Adhikari1, Sanjay Singh K.C.2, Upendra Thapa Shrestha3, Pradeep Kumar Shah1*

¹Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal

²Department of Microbiology, SahidGangalal National Heart Center, Kathmandu, Nepal

³Central Department of Microbiology, Kathmandu, Nepal

 

*Corresponding author: Pradeep Kumar Shah; Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal. Email: pkshah210@gmail.com

 

ABSTRACT

Objectives: This study was aimed to evaluate antibiotic resistance pattern and biofilm formation in K. pneumoniae strains isolated from different clinical specimens and to study on association of drug resistance pattern with biofilm formation.

Methods: A total of 944 clinical samples from patients attending Sahid Gangalal National Heart Center were processed from September 2019 to March 2020 to identify possible bacterial pathogens following standard microbiological procedures. K. pneumonaie isolates were further subjected to antibiotic susceptibility testing using modified Kirby Bauer disc diffusion technique. Biofilm formation was evaluated by tissue culture plate technique.

Results: Of the total 944 samples, 146 (15.47%) samples showed bacterial growth, among which 35 (23.97%) were K. pneumoniae. Out of 35 K. pneumoniae isolates, 16 (45.71%) were multidrug-resistant and 15 (42.86%) were extensively drug-resistant. Twenty-one (60%) K. pneumoniae feebly produced biofilm. Significant association was observed between biofilm production and exhibition of multidrug resistance (p < 0.05).

Conclusion: Prevalence of antibiotics resistant K. pneumoniae in hospital setting is high and alarming. Significant association between drug resistance pattern and biofilm production implicates need of an immediate response to limit growth and spread of drug resistant microbes in clinical settings.

 

Keywords: Kleibsella pneumoniae, multidrug resistance, biofilm, antibiotic susceptibility test, Nepal

 

Citation: Paudel et al. Antibiogram and Biofilm Development among Klebsiella pneumoniae from Clinical Isolates. 2021, TUJM 8(1): 83-92. DOI: https://doi.org/10.3126/tujm.v8i1.41198

 

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Cholera cases in Kathmandu - How to prevent yourself???

Preventive measures:

1. Environmental sanitation
2. Personal hygiene -regular hand washing
3. Avoid unknown sources of drinking water and street foods
4. Reasonable hygiene; use of disposable plates/glasses as much as possible for food serving, washing of food utensils with 0.5% hypochlorite water
5. Proper sewage disposal
6. Avoid raw vegetables
7. Use boiled or chlorinated water for drinking

The Story of Cholera

(Short and very informative)

Thank to Global Health Media for producing such a wonderful and informative short animation.

 

Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal

Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal

Riju Maharjan¹, Anup Bastola², Nabaraj Adhikari¹, Komal Raj Rijal¹, Megha Raj Banjara¹, Prakash Ghimire¹ Upendra Thapa Shrestha^1*

¹ Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

² Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal

 

*Corresponding author: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal, Email: upendrats@gmail.com /  upendra.thapashrestha@cdmi.tu.edu.np

 

ABSTRACT

Background: Bacterial opportunistic infections are common in people living with HIV/AIDS (PLHA). Besides HIV-TB co-infection, lower respiratory tract infections (LRTIs) due to multidrug-resistant (MDR) bacteria cause significant morbidity and mortality among PLHA. This study identified bacterial co-infection of the lower respiratory tract and detected plasmid-mediated bla_TEM and bla_CTX-M genes among Extended-Spectrum b-Lactamase (ESBL) producing isolates from sputum samples in PLHA.

Methods: A total of 263 PLHA with LRTIs were enrolled in this study, out of which, 50 were smokers, 70 had previous pulmonary tuberculosis, and 21 had CD4 count <200 cells/µl. Sputum samples collected from PLHA were processed with standard microbiological methods to identify the possible bacterial pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. In addition, plasmid DNA was extracted from MDR and ESBL producers for screening of ESBL genes; bla_CTX-M and bla_TEM by conventional PCR method using specific primers.

Results: Of 263 sputum samples, 67 (25.48%) showed bacterial growth. Among different bacterial pathogens, Klebsiella pneumoniae, (17; 25.37%) was the most predominant, followed by Haemophillus influenzae, (14; 20.90%)  and  Escherichia coli, (12; 17.91%). A higher infection rate (4/8; 50%) was observed among people aged 61 -70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis, and 52.38% (11/21) with CD4 count <200 cells/µl had bacterial LRTIs. Among 53 bacterial isolates excluding H. influenzae, 28 isolates were MDR and 23 were ESBL producers. All ESBL producers were sensitive to colistin and polymyxin B. Among ESBL producers, 47.83% (11/23) possessed bla_CTX-M, 8.6% (2/23) were positive for bla_TEM gene, and 43.48% (10/23) possessed both ESBL genes.

Conclusion: The increasing rate of MDR bacterial infections, mainly ESBL producers of LRTIs causes difficulty in disease management, leading to high morbidity and mortality of PLHA. Hence, it is crucial to know the antibiogram pattern of the isolates to recommend effective antimicrobial therapy to treat LRTIs in PLHA.

 

Keywords: PLHA, Lower respiratory tract infection, ESBL, bla_CTX-M, bla_TEM

Citation: Maharjan et al. Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal. BMC Infectious Diseases (2022) 22:526

https://doi.org/10.1186/s12879-022-07503-2

Fulltext Article: Download

Can SMALLPOX be re-emerged again ?

 MONKEYPOX

 

 

Classification:

Group:             Group I (double-stranded DNA virus)

Family:             Poxviridae

Subfamily:       Chordopoxvirinae 

Genus:             Orthopoxvirus

Species:           More than ten species including smallpox, monkeypox, cowpox, horsepox,

etc.     

 

Virion Structure:

Virion: Complex structure, oval or brick-shaped, 400 nm in length x 230 nm in diameter; external surface shows ridges; contains the core and lateral bodies 

Composition: DNA (3%), protein (90%), lipid (5%) 

Genome: Double-stranded DNA, linear; size 130–375 kbp; has terminal loops; has low G + C content (30–40%) except for Parapoxvirus (63%) 

Proteins: Virions contain more than 100 polypeptides; many enzymes are present in the core, including the transcriptional system

Envelope: Virion assembly involves the formation of multiple membranes 

Replication: Cytoplasmic factories 

Outstanding characteristics: 

Largest and most complex viruses; very resistant to inactivation

Virus-encoded proteins help evade the host immune defense system

Member of same genus with Smallpox which was the first viral disease eradicated from the world and also with cowpox and horsepox

 

 

Outbreak:

On 14 May 2022, a familial cluster of two cases of monkeypox was reported in the United Kingdom (UK) by the UK Health Security Agency (UKHSA). These cases have no relation to a travel-related case from Nigeria that was previously reported on 7 May 2022 in the UK. Since the UKHSA reporting of cases, several other European countries have reported cases of monkeypox.

As of 19 May 2022, 38 cases have been confirmed worldwide. Of these, 26 cases have been confirmed in the following EU/EEA countries: Belgium (2), France (1), Italy (1), Portugal (14), Spain (7), and Sweden (1). In the UK, nine cases have been confirmed. In North America, three cases have been confirmed in Canada (2), and the US (1). The majority of cases have been in young men, many self-identifying as men who have sex with men (MSM), and none with recent travel history to areas where the disease is endemic. No deaths have been reported so far, and only two cases have been admitted to hospital for reasons other than isolation. 

 

Epidemiological update:

Since the disease was first detected on 7 May 2022 in the United Kingdom, a total of nine cases have been confirmed in the United Kingdom. Eight of the nine cases have no travel history and have no relation to the travel related case confirmed on 7 May.  

Since the UKHSA reporting of cases, in the EU/EEA, a further 26 cases have been confirmed since 18 May in Belgium (2), France (1), Italy (1), Portugal (14), Spain (7), and Sweden (1). Portugal has reported another 20 suspected cases, and Spain has reported another 23 suspected cases which are awaiting laboratory confirmation. 

In total, since 14 May, there have been 37 confirmed, non-travel related cases of monkeypox worldwide, with 26 in EU/EEA countries. The majority of cases are in young men, self-identifying as MSM. There have been no deaths, and two hospitalizations for reasons other than isolation were reported worldwide. Health authorities across counties have stated that further cases are expected. Below is a breakdown of the reporting countries: 

• two cases have been confirmed in Belgium
• one case has been confirmed in France
• one case has been confirmed in Italy, with 2 suspected cases identified
• 14 cases have been confirmed in Portugal, with an additional 20 suspected cases identified all in the Lisbon & Tagus River region
• seven cases have been confirmed in Spain, with 23 suspect cases identified
• one case has been confirmed in Sweden
• nine cases have been confirmed in the United Kingdom
• two cases have been confirmed in Canada, with an additional 17 suspected cases identified
• one confirmed and one probable case in the US
• one confirmed case in Australia

The majority of cases have been in young men, many self-identifying as men who have sex with men (MSM), and none with recent travel history to areas where the disease is endemic. Most cases presented with lesions on the genitalia or peri-genital area, indicating that transmission likely occurs during close physical contact during sexual activities. This is the first time that chains of transmission are reported in Europe without known epidemiological links to West or Central Africa, where this disease is endemic. These are also the first cases worldwide reported among MSM.

 

Disease background and transmission:

This is the first time that chains of transmission are reported in Europe without known epidemiological links to West or Central Africa. These are also the first cases worldwide reported among MSM. The monkeypox virus is considered to have moderate transmissibility among humans and can be transmitted through droplets and/or contact with infected lesions. Transmission between sexual partners, due to intimate contact during sex with infectious skin lesions seems the likely mode of transmission among MSM.  

Given the unusually high frequency of human-to-human transmission observed in this event, and the probable community transmission without history of traveling to endemic areas, the likelihood of further spread of the virus through close contact, for example during sexual activities, is considered to be high. The likelihood of transmission between individuals without close contact is considered to be low. 

The clinical manifestation of monkeypox is usually mild. The West African clade, which has so far been detected in the cases reported in Europe, has been observed to have a  case fatality rate of about 3.3% in Nigeria. Mortality is higher among children and young adults, and immunocompromised individuals are especially at risk of severe disease. Most people recover within weeks. 

 

Immediate recommendations:

Public health institutions/authorities and community-based organizations should take steps to raise awareness on the potential spread of monkeypox in the community, especially among men who have sex with other men that engage in casual sex, or who have multiple sexual partners.  Individuals engaging in casual sex or who have multiple sexual partners who are not MSM should also be vigilant. Any persons presenting with symptoms indicative of monkeypox should seek specialist care and should abstain from sexual activities or any other type of activities involving close contact until monkeypox is either excluded or the infection is resolved.

 
Suspected cases should be isolated and tested and notified promptly. Back-wards and forwards contact tracing should be initiated for positive cases, and exposed mammalian pets should be quarantined. If smallpox vaccines are available in the country, vaccination of high-risk close contacts should be considered after a risk-benefit assessment. For severe cases, treatment with a registered antiviral can be considered, if available in the country. 

 

ECDC actions : 

ECDC will continue to monitor this event through epidemic intelligence activities and report relevant news on an ad-hoc basis. ECDC published a news item on 19 May, with initial recommendations. An epidemiological update will be posted on 20 May. Multi-lateral meetings between affected countries, WHO IHR and ECDC have taken place to share information and coordinate response. A process in EpiPulse has been created to allow countries to share information with one another, WHO, and ECDC. The production of a Rapid Risk Assessment has been launched with prospective publication on Monday 23 May. 

 

Source:https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak

Manuscript accepted in TUJM

Biofilm Producing Pseudomonas aeruginosa in Patients with Lower Respiratory Tract Infections

Sabina Chhunju¹, Tulsi Nayaju¹, Kabita Bhandari¹, Khadga Bikram Angbuhang¹, Binod Lekhak³, Krishna Govinda Prajapati², Upendra Thapa Shrestha^3*, Milan Kumar Upreti¹

 

¹GoldenGate International College, Battisputali, Kathmandu, Nepal

²B&B Hospital. Gwarko, Lalitpur, Nepal

³Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

 

*Corresponding author: Upendra Thaha Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal; Email: upendrats@gmail.com

 

ABSTRACT

 

Objectives: To determine the prevalence of Gram-negative bacteria in lower respiratory tract infections and study the biofilm producing Pseudomonas aeruginosa.

Methods: This study was conducted at B & B Hospital Pvt. Ltd., Lalitpur, Nepal from February to September 2018. The samples were collected from the patients (n=420) with signs and symptoms suggestive of LRTIs. The isolated organisms were identified and antimicrobial sensitivity was performed. Among all the isolates, P. aeruginosa isolates were subjected for biofilm detection by microtiter plate method.

Results: Out of 420 specimens, 90 (21.6%) were culture positive. Klebsiella pneumoniae (42.9%) was found to be the predominant organism with higher rate of resistance to antibiotics. A total of 25 isolates of P. aeruginosa were isolated among which 15 (60%) were biofilm producers. Biofilm-producing isolates of P. aeruginosa were found more resistant to the tested antibiotics.

Conclusion: Gram-negative bacteria were found to be the predominant etiological agents in causing the LRTIs; K. pneumoniae, being the most commonly isolated bacteria. Most P. aeruginosa were capable of producing the biofilm. The biofilm producers were more resistant to the antibiotics. The biofilm may help increase the resistivity nature of the bacteria.

Keywords: LRTI, Gram-negative bacteria, Biofilm, Antibiotic resistance, MDR

Importance of Vaccination

Reference: https://www.gavi.org/vaccineswork/routine-vaccinations-during-pandemic-benefit-or-risk

Manuscript accepted in TUJM

Microbial quality analysis of panipuri samples collected from different parts of Bhaktapur

 Punam Ghimire¹, Sujata Khand¹, Bhawana Chaulagain¹, Ashish Siwakoti¹, Dinesh Dhakal¹, Upendra Thapa Shrestha² *

¹Sainik Awasiya Mahavidhyalaya (affiliated to Tribhuvan University) Sallaghari, Bhaktapur

²Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

 

*Corresponding Author: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Email: upendra.thapashrestha@cdmi.tu.edu.np / upendrats@gmail.com

ABSTRACT

Objectives: The study was aimed to identify potential bacterial pathogens from the panipuri samples collected from different vendors of Bhaktapur district and determine their antibiogram patterns.

Methods: Altogether 120 (40 puri, 40 stuffing and 40 pani) samples of panipuri were collected from different vendors of Bhaktapur district in a cold chain and were transported to the microbiology laboratory. Puri and stuffing were then pre-enriched, enriched and cultured while pani samples were processed using the MPN method. All the isolates were identified following standard microbiological procedure and subjected to antibiotic susceptibility testing following CLSI guidelines.

Results: The result revealed contamination of 77.5% stuffing, 67.5% puri and 52.5%  pani samples with pathogenic bacteria. Among bacterial pathogens, the highest number was Staphylococcus aureus followed by Escherichia coli and Salmonella spp. 100% of S. aureus were found to be resistant to ampicillin and novobiocin. Similarly, 94.1% of E. coli were resistant to ampicillin followed by ciprofloxacin (64.7%). A very few isolates of Salmonella spp, Shigella spp and Vibrio spp were resistant to tetracycline. The highest number of multidrug-resistant bacteria were S. aureus, followed by Klebsiella spp and E. coli.

Conclusion: The study showed that the panipuri samples from street vendors were found to be highly contaminated with pathogenic bacteria which might affect consumers’ health. Thus, to prevent any food-borne illness in the future, frequent evaluation and regulation of the quality of such foods should be carried out.

Keywords: Street foods, panipuri, bacterial pathogens, antimicrobial-resistant, multidrug-resistant