Papers by Shyam Prakash Dumre, PhD
Background: Thyroid disorder is one of the common endocrine dysfunctions in Human Immunodeficienc... more Background: Thyroid disorder is one of the common endocrine dysfunctions in Human Immunodeficiency Virus (HIV)-infected individuals under antiretroviral
The Korean Journal of Parasitology, 2015
Genetic polymorphisms of pvdhfr and pvdhps genes of Plasmodium vivax were investigated in 83 bloo... more Genetic polymorphisms of pvdhfr and pvdhps genes of Plasmodium vivax were investigated in 83 blood samples collected from patients in the Philippines, Bangladesh, and Nepal. The SNP-haplotypes of the pvdhfr gene at the amino acid positions 13, 33, 57, 58, 61, 117, and 173, and that of the pvdhps gene at the positions 383 and 553 were analyzed by nested PCR-RFLP. Results suggest diverse polymorphic patterns of pvdhfr alone as well as the combination patterns with pvdhps mutant alleles in P. vivax isolates collected from the 3 endemic countries in Asia. All samples carried mutant combination alleles of pvdhfr and pvdhps. The most prevalent combination alleles found in samples from the Philippines and Bangladesh were triple mutant pvdhfr combined with single mutant pvdhps allele and triple mutant pvdhfr combined with double wild-type pvdhps alleles, respectively. Those collected from Nepal were quadruple mutant pvdhfr combined with double wild-type pvdhps alleles. New alternative antifolate drugs which are effective against sulfadoxine-pyrimethamine (SP)-resistant P. vivax are required.
Introduction: Lymphatic filariasis(LF) is a neglected tropical disease, caused by Wuchereria banc... more Introduction: Lymphatic filariasis(LF) is a neglected tropical disease, caused by Wuchereria bancrofti parasite and pose potential risk to about 1.4 billion people in 73 countries. In Nepal, 60 out of 75 districts are endemic and nearly 90% of the population is at risk and mass drug administration (MDA) has been in place since 2003. Yet, information about the genetic diversity of W. bancrofti is largely lacking.
Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from southwestern parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under
microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR)from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed
and analyzed.
Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas.
Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program.
Keywords: Genetic variability, Lymphatic filariasis, Nepal, Wuchereria bancrofti
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2013
Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fev... more Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.
JNMA; journal of the Nepal Medical Association
BMC public health, 2014
Antimicrobial resistance (AMR) is a major global public health concern and its surveillance is a ... more Antimicrobial resistance (AMR) is a major global public health concern and its surveillance is a fundamental tool for monitoring the development of AMR. In 1998, the Nepalese Ministry of Health (MOH) launched an Infectious Disease (ID) programme. The key components of the programme were to establish a surveillance programme for AMR and to develop awareness among physicians regarding AMR and rational drug usage in Nepal. An AMR surveillance programme was established and implemented by the Nepalese MOH in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) from 1998 to 2003. From 2004 to 2012, the programme was integrated and maintained as a core activity of the National Public Health Laboratory (NPHL) and resulted in an increased number of participating laboratories and pathogens brought under surveillance. The main strategies were to build national capacity on isolation, identification and AMR testing of bacterial pathogens, establish laboratory networking and an External Quality Assessment (EQA) programme, promote standardised recording and reporting of results, and to ensure timely analysis and dissemination of data for advocacy and national policy adaptations. The programme was initiated by nine participating laboratories performing AMR surveillance on Vibrio cholerae, Shigella spp., Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae. The number of participating laboratories was ultimately increased to 13 and the number of pathogens under surveillance was increased to seven (Salmonella spp. was added to the surveillance programme in 2002 and extended spectrum β-lactamase producing Escherichia coli in 2011). From 1999 to 2012, data were available on 17,103 bacterial isolates. During the AMR programme, we observed changing trends in serovars/species for Salmonella spp., Shigella spp. and V. cholerae and changing AMR trend for all organisms. Notably, N. gonorrhoeae isolates demonstrated increasing resistance to ciprofloxacin. Additionally, the performance of the participating laboratories improved as shown by annual EQA data evaluation. This Nepalese AMR programme continues and serves as a model for sustainable surveillance of AMR monitoring in resource limited settings.
The American journal of tropical medicine and hygiene, 2013
We report on the changing epidemiology of two important flaviviruses in Nepal: Japanese encephali... more We report on the changing epidemiology of two important flaviviruses in Nepal: Japanese encephalitis (JE) and dengue viruses. Morbidity and mortality in Nepal is in the thousands since JE was introduced in 1978. Nepal launched an extensive laboratory-based JE surveillance in 2004. Nepal experienced a remarkable reduction in disease burden after mass immunizations from 2005 to 2010, when 2,040 JE infections and 205 JE-related deaths were confirmed. With its emergence in 2006, dengue has become a significant challenge in the country, highlighted by a sudden outbreak in 2010 that resulted in 359 confirmed dengue infections. Currently, both viruses cocirculate in Nepal. Here, we document the remarkable expansion of dengue in Nepal, which urgently requires national surveillance to refine the burden and make recommendations regarding control and prevention programs. We believe that the use of existing JE surveillance network for integrated dengue surveillance may represent the most appropriate alternative.
Malaria journal, 2013
Background: As per the World Malaria Report 2011, there was a 17% reduction in morbidity and 26% ... more Background: As per the World Malaria Report 2011, there was a 17% reduction in morbidity and 26% reduction in mortality in 2010, compared to 2000. In Bhutan, there were only 194 malaria cases in 2011 as compared to 5,935 cases in 2000. As the country moves towards an elimination phase, educating the community and empowering them on malaria prevention and control is imperative. Hence, this study was conducted to elucidate the effectiveness of the community-directed educational intervention on malaria prevention and control in malariaendemic areas of Sarpang district, Bhutan. Methods: This quasi-experimental study design was conducted using both qualitative and quantitative data collection methods. In-depth interviews and focus group discussions were carried out in addition to household survey using a structured questionnaire conducted before and after the intervention. Intervention was conducted using community action groups, who were provided with training and which then developed action plans for implementation of interventions within their communities. Results: The study resulted in a significant improvement in knowledge and attitude in intervention as compared to control during the post-intervention survey (p < 0.001). The practice score was higher in the control group both during pre-and post-intervention, however, the mean ( ±sd) score of practice in intervention group increased from 6.84 ± 1.26 in pre-intervention to 8.35 ± 1.14 in post-intervention (p < 0.001), where as it decreased from 9.19 ± 1.78 to 9.10 ± 1.98 in the control group (p = 0. 68). When comparing pre-and post-in the intervention group, there was significant improvement during post-intervention in knowledge, attitude and practice (p < 0.001). Conclusions: The findings from this study corroborate that community-directed interventions can be utilized as an effective means for improving knowledge, attitude and practice in the malaria-endemic areas of Bhutan. Further studies are needed to see the long-term effect and sustainability of such interventions.
World journal of microbiology & biotechnology, 2012
Cholera occurs in sporadic cases and outbreaks in Nepal each year. Vibrio cholerae O1 (n = 522) i... more Cholera occurs in sporadic cases and outbreaks in Nepal each year. Vibrio cholerae O1 (n = 522) isolated during 2007–2010 from diarrheal patients at 10 different hospital laboratories in Nepal were characterized. Biochemical and serologic identifications showed that all the isolates belonged to serogroup O1, El Tor biotype. Except 72 isolates of Inaba serotype isolated in the year 2007, all the remaining isolates were of Ogawa serotype. All isolates were resistant to nalidixic acid and furazolidone. Resistance to tetracycline, ciprofloxacin, erythromycin and co-trimoxazole were 21, 4, 16 and 90 % respectively. Seventy-seven of these isolates were selected for further characterization for ctxB gene and MLVA typing. Two different variants of classical type cholera toxin were observed. Ogawa strains from 2007 and 2010-Western Nepal outbreak harbored CTX-3 type cholera toxin, whereas Inaba serotypes in 2007 and the remaining Ogawa serotypes in 2008–2010 harbored CTX 3b-type toxin. MLVA analysis showed circulation of four different groups of altered V. cholerae O1 El Tor strains. Two different profiles were seen among 2007 Inaba (9, 3, 6, x, x) and Ogawa (10, 7, 6, x, x) isolates. The MLVA profile of 2008 and 2009 Ogawa isolates were similar to those of Inaba strains of 2007. Isolates from 2010 also showed three different MLVA profiles; profile 9, 3, 6, x, x in 3 isolates, 11, 7, 6, x, x among 2010 Western Nepal outbreak strains and profile 8, 3, 6, x, x among isolates from Butwal and Kathmandu.
Japanese journal of infectious diseases, 2010
The major objective of this study was to deliver vital statistics related to cholera to health au... more The major objective of this study was to deliver vital statistics related to cholera to health authorities so as to aid in their attempt to prioritize communicable diseases in Nepal. A laboratory-based surveillance was conducted from mid-June 2008 to mid-January 2009 at the National Public Health Laboratory, Nepal. Diarrheal samples alone were processed for Vibrio cholerae. Isolation and identification of the organisms were carried out as per standard protocol. Antimicrobial susceptibility tests were done according to the guidelines of the Clinical and Laboratory Standards Institute. The incidence of cholera was found to be 27.1%. Only V. cholerae O1 Ogawa biotype El Tor was found during the study. No variation was observed in the percentage of cases between genders (P&lt;0.05). The 15-30 year age group was found to be more susceptible to cholera (P&lt;0.05). The period from mid-June to mid-July had the highest incidence of cholera (P&lt;0.05). Ampicillin, tetracycline, ciprofloxacin, and erythromycin were highly effective, while 100% resistance was observed for furazolidone, nalidixic acid, and cotrimoxazole.
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH
The merit of a scientific writing is high only when it disseminates the new knowledge in a univer... more The merit of a scientific writing is high only when it disseminates the new knowledge in a universally accepted and logical manner. I, with great interest, have read a paper entitled "Bacteriology and antimicrobial susceptibility of adult chronic dacryocystitis" by . This paper of writing has raised few concerns after reading it and compelled me to bring the issues to the notice of the scientific community. The first issue concerns with the inappropriate way of citation and referencing observed in the paper. Accuracy of citation and referencing has been a questionable issue in Nepal (Adhikari, 2009). The authors (Chaudhary et al, 2010) have wrongly cited our paper in the discussion section for a misleading information regarding the vancomycin resistant Staphylococcus aureus (VRSA). The authors cited our work giving an impression that all the isolates we reported in our study were VRSA which information is totally wrong because we had reported only 5% as methillin resistant S. aureus (MRSA) and none of them were VRSA which is also clearly written in our abstract . Moreover, the way of citation in the text is also wrong as they cited our paper as "Malla et al, 2008" which should be "Dumre et al, 2008". The list of references contains inaccurate order of authors. This brings about a doubt whether the authors really read the cited paper.
Nepal Medical College journal : NMCJ, 2011
Extended Spectrum â-lactamase (ESBL) producing multidrug resistant bacteria complicate therapeuti... more Extended Spectrum â-lactamase (ESBL) producing multidrug resistant bacteria complicate therapeutic management and limit treatment options. Therefore, detection of ESBL-producing multidrug resistant (MDR) pathogens has a paramount importance. Between April 2009 and January 2010, a prospective study was carried out in National Public Health Laboratory with an objective to determine the status of ESBL producing MDR bacterial isolates from different clinical samples. Identification of the isolates was done by standard microbiological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening among MDR isolates was done using Ceftriaxone, Aztreonam, Cefotaxime, Ceftazidime and Cefpodoxime followed by confirmation using MASTDISCS ID ES2L Detection Discs (CPD10). Data analysis was done by SPSS 16 software. Of the 314 bacterial isolates from 1601 different clinical specimens, 199 (63.4%) were MDR. Cefotaxime was found the reliable screening agent for ESBL detection with sensitivity and positive predictive value of 98.6% and 76.4% respectively. Sixtey nine (62.7%) isolates of the 110 tested MDR isolates were ESBL positive with at least one of the Combined Disk (CD) Assays. Escherichia coli (80%) was the major ESBL producer followed by Klebsiella pneumoniae (5.8%). A statistically significant relationship was found between increasing spectrum of drug resistance and ESBL production (p&lt;0.05). Thus it is concluded that a higher rate of ESBL production prevail among MDR clinical bacterial isolates underscoring the need for routine ESBL detection in clinical laboratories.
Nepal Medical College journal : NMCJ, 2011
With an aim to evaluate the isolation rate and antibiotic susceptibility pattern in Salmonella en... more With an aim to evaluate the isolation rate and antibiotic susceptibility pattern in Salmonella enterica serovar Typhi and S. Paratyphi A, 656 blood samples collected from clinically diagnosed enteric fever patients at National Public Health Laboratory, Nepal during January through December 2008 were processed. Isolates were identified by standard microbiological procedures including serotyping. Antibiotic susceptibility testing was performed by disc diffusion method and minimum inhibitory concentration (MIC) to ciprofloxacin, ofloxacin and nalidixic acid was determined by agar dilution method following CLSI guidelines. Altogether 59 isolates of S. Typhi (49.15%) and S. Paratyphi A (50.85%) were recovered. A total of 80% isolates were resistant to nalidixic acid with S. Paratyphi A (93%) showing significantly higher resistance (P &lt; 0.05) compared to S. Typhi (66%). The nalidixic acid resistant S. Paratyphi A strains required significantly higher MICs (P &lt; 0.001) to quinolone (MIC expressed as mean +/- SD for nalidixic acid 477.87 +/- 87.02 microg/mL, ofloxacin 1.8 +/- 0.63 microg/mL, ciprofloxacin 0.62 +/- 0.3 microg/mL) compared with that of S. Typhi (nalidixic acid 173.18 +/- 72.03 microg/mL, ofloxacin 0.43 +/- 0.11 microg/mL, ciprofloxacin 0.25 microg/mL). Increased MIC of fluoroquinolone (FQ) is of particular concern in emerging strains of S. Paratyphi A as exposure to these drugs fuels up further development of full FQ resistant populations. Use of FQs as the first-line drugs for empirical therapy and management of enteric fever in areas where these strains are prevalent is questionable and requires an urgent review.
Nepal Medical College journal : NMCJ, 2011
Cholera continued to be a major diarrheal illness in Nepal and antibiotic resistance has appeared... more Cholera continued to be a major diarrheal illness in Nepal and antibiotic resistance has appeared as a serious problem in cholera management. The study aimed at analyzing the distribution pattern of the resistotypes (R-types) of Vibrio cholerae in the Kathmandu valley, Nepal. During June 2008 to January 2009, 210 diarrheal specimens received at National Public Health Laboratory from suspected cholera patients were subjected to standard bacteriological investigation including biotyping and serotyping. Antimicrobial susceptibility pattern of V. cholerae isolates was determined by Kirby Bauer disc diffusion method following CLSI guidelines. A total of 57 (27%) V. cholerae isolated were recovered, all of which belonged to 01 Ogawa Biotype EL Tor. Based on antibiogram, V. cholerae isolates in our study revealed three distinct R-types: R-type I, R-type II and R-type III. All three R types showed resistance to furazolidone, nalidixic acid and cotrimoxazole while sensitive to ciprofloxacin and tetracycline. Additional resistance to ampicillin and erythromycin was observed respectively in R-type II and III. Different R-types showed unique month wise variations (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Differentiation of V. cholerae strains into R-types is an important tool. In addition to direct patient management, it may have implication in identifying the source and spread of infection, and understanding the distribution pattern in a particular geographical region.
Kathmandu University medical journal (KUMJ)
Disc diffusion technique is the routine susceptibility testing procedure for isolates of enteric ... more Disc diffusion technique is the routine susceptibility testing procedure for isolates of enteric fever, the most common clinical diagnosis among febrile patients in Nepal.
Nepal Medical College journal : NMCJ, 2011
Syphilis screening by the nontreponemal rapid plasma reagin (RPR) test is not usually followed up... more Syphilis screening by the nontreponemal rapid plasma reagin (RPR) test is not usually followed up by specific treponemal tests in most of the resource poor healthcare settings of Nepal. We analyzed serum specimens of 504 suspected syphilis cases at the immunology department of the national reference laboratory in Nepal during 2007-2009 using RPR test and Treponema pallidum hemagglutination assay (TPHA). In overall, 35.7% were positive by both methods (combination) while 13.1% were RPR positive and TPHA negative, 8.7% were positive by TPHA only and 42.5% were negative by both methods. Among the RPR reactive (n = 246), 73.2% were positive by TPHA. Non-specific agglutination in RPR testing was relatively higher (26.8%) compared to TPHA (19.6%). Although TPHA was found more specific than RPR test, either of the single tests produced inaccurate diagnosis. Since the single RPR testing for syphilis may yield false positive results, specific treponemal test should be routinely used as confirmatory test to rule out false RPR positive cases. More attention needs to be paid on formulation of strict policy on the implementation of the existing guidelines throughout the country to prevent misdiagnosis in syphilis with the use of single RPR test.
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Papers by Shyam Prakash Dumre, PhD
Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from southwestern parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under
microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR)from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed
and analyzed.
Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas.
Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program.
Keywords: Genetic variability, Lymphatic filariasis, Nepal, Wuchereria bancrofti
Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from southwestern parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under
microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR)from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed
and analyzed.
Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas.
Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program.
Keywords: Genetic variability, Lymphatic filariasis, Nepal, Wuchereria bancrofti