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Mystery fevers


DHANVANTARI by BUDDHA BASNYAT, MD


Just like the predictable monsoon rains, unknown fever outbreaks are a common occurrence in Nepal during summer and reports of mysterious fever from across the country have started to pour in already. Many of these fevers may actually be common diseases like typhoid, typhus, and leptospirosis masquerading as raging fevers. However, as laboratory facilities throughout Nepal are pretty dismal, diagnosing fevers becomes tricky.

Almost a decade ago, about 900 consecutive fever patients were examined at Patan Hospital to find out what was causing their illness. Many well-known conditions such as typhoid (the number one aetiology) were correctly identified. But two diseases (typhus which is different from typhoid, and leptospirosis) were completely overlooked by all the physicians who were in-charge of treatment. Surprisingly, typhus and leptospirosis turned out to be the third and fourth laboratory-proven causes of fever in those 900 patients after pneumonia.

A crucial lesson that emerged from this milestone study was the importance of conducting investigative research to solve mysterious health conditions. Only when healthcare experts systematically study fevers in a given community will they be able to chronologically identify the causes of fever for that group.

Crucially, drugs for fever patients may have to be started on an empirical basis (ie relying on experience and observation) even before test results for blood culture, if available, are in. This pre-emptive strike with antibiotics is important to prevent complications associated with the organism causing the fever. Once again, figuring out the best drug to prescribe based on earlier studies done in the community is vital.

Large studies conducted in Nepal have shown that adequate doses of certain antibiotics are very effective in the empirical treatment of particular fevers. It is advisable that government health teams carry these antibiotics during their rescue missions to fever outbreak sites. Many of the studies regarding antibiotics and fever from institutions like Patan Hospital have been published in well-known medical journals and are easily accessible.

Clean drinking water and better sanitation would go a long way in curbing frequent outbreaks. However, as it will take many years for our government to provide all Nepalis with access to clean water, the next best treatment method is to febrile patients.



1. Dahi Kera
Dear Dr Saab,
thank you for your insightful columns.

Could you also please write about the relation between dahi and rugha. Is the myth of "eh rugha laako bela dahi khanu hunna" true or is it a recent development since the introduction of refrigerators into our homes?


LATEST ISSUE
638
(11 JAN 2013 - 17 JAN 2013)


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