From animals to humans

Clearly we need to have reliable microbiological laboratories which can make a definitive diagnosis of these zoonotic illnesses.

June 16, 2013, 5:45 p.m. Published in Magazine Issue: Vol: 07 No. -1 June 14- 2013 (Jestha 31, 2070)

Zoonotic infections are those that pass from animals to humans. There are many examples of these diseases prevalent in Nepal. Japanese encephalitis, rabies, malaria, brucellosis, swine flu, leptospirosis, rickettsial illnesses (for example the different varieties of typhus infections) are just some of the common ones we know. Amazingly, typhoid, a common problem in Nepal has no connection with the animal kingdom in the spread of this disease, as the bacteria ( salmonella typhi and paratyphi) causing this illness are restricted to humans beings. Lucky for the dogs. Otherwise all of our street dogs would be dead of typhoid fever in Kathmandu, which has the dubious distinction of being the typhoid capital of the world. But, back to zoonotic infections—

Zoonotic infections are so common that they actually make up nearly two-thirds of human infectious diseases. The three recent worldwide viral outbreaks, namely SARS (Severe Acute Respiratory syndromes), the bird flu ( H5N1) and the swine flu ( H1N1) are all examples of infections passed from animals to humans. Even the HIV virus transferred from chimpanzee to humans in the last century. Clearly in countries like Nepal there is great difficulty in making a proper diagnosis of these seemingly new illnesses. In fact in most instances we have problems making a diagnosis of even well-established, old bacterial diseases. For example if you talk to clinicians in town, they will say that brucellosis, a bacterial disease which is transmitted by eating infected  meat or unsterilized milk may be important to consider in patients with long-standing fever. But, guess what, we are hardly ever able to make a clear microbiological diagnosis  which is what counts because clinical assessment alone is not enough to make a final diagnosis. So the diagnosis of brucellosis remains a hunchbecause we lack  proper, specific testing with properly spaced blood collections. We then treat the disease “empirically” to the best of our ability. Our treatment approach of this nature is not restricted to brucellosis but is almost standard practice. Indeed when there is a disease outbreak in Nepal, the laboratory set up is often deficient.

Clearly we need to have reliable microbiological laboratories which can make a definitive diagnosis of these zoonotic illnesses. Many new private and government medical laboratories have sprung up in Nepal in the last decade or so, but microbiological methodolgy requires a great deal of finesse and conscientious work. Without this kind of a back- up we will certainly be unprepared to handle zoonotic illnesses and dealeffectively with a pandemic, if this situation should arise.

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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