THE ETIOLOGY OF FEBRILE ILLNESS IN ADULTS PRESENTING TO PATAN HOSPITAL IN KATHMANDU, NEPAL

DAVID R. MURDOCH Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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CHRISTOPHER W. WOODS Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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MARK D. ZIMMERMAN Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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PETER M. DULL Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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RAM HARI BELBASE Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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ANDREW J. KEENAN Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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ROBERT MCNAIR SCOTT Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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BUDDHA BASNYAT Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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LENNOX K. ARCHIBALD Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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L. BARTH RELLER Department of Pathology, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Departments of Medicine and Pathology, Duke University School of Medicine, Durham, North Carolina; Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina; Patan Hospital, Kathmandu, Nepal; Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit-Nepal, Katmandu, Nepal; Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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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.

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