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In Nepal, many infections remain poorly characterized, partly due to limited diagnostic facilities. We studied consecutive febrile adults presenting to a general hospital in Kathmandu, Nepal. Of the 876 patients enrolled, enteric fever and pneumonia were the most common clinical diagnoses. Putative pathogens were identified in 323 (37%) patients, the most common being Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A (117), Rickettsia typhi (97), Streptococcus pneumoniae (53), Leptospira spp. (36), and Orientia tsutsugamushi (28). Approximately half of the Salmonella isolates were resistant to nalidixic acid. No clinical predictors were identified to reliably distinguish between the different infections. These findings confirm the heavy burden of enteric fever and pneumonia in Kathmandu, and highlight the importance of murine typhus, scrub typhus, and leptospirosis. Given the lack of reliable clinical predictors, the development of cheap and accurate diagnostic tests are likely to be of great clinical utility in this setting.

Type

Journal article

Journal

The american journal of tropical medicine and hygiene

Publication Date

06/2004

Volume

70

Pages

670 - 675

Addresses

Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. david.murdoch@cdhb.govt.nz

Keywords

Humans, Gram-Negative Bacteria, Leptospira, Salmonella paratyphi A, Salmonella typhi, Orientia tsutsugamushi, Rickettsia typhi, Streptococcus pneumoniae, Bacterial Infections, Fever, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Hospitals, Urban, Nepal, Female, Male