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DR. BERKSON : This was back in the 70s. My wife had several miscarriages, and I still did not want to be a medical doctor. She had had 5 miscarriages, and at that point, I thought that, if a person was the head of a department at the University of Chicago or Harvard or Stanford, they really knew more than anybody else. We went to doctors like this and she’d have these miscarriages in the 4th to the 6th month, in the 2nd trimester. Their answer was always, “These babies are normal; just get her pregnant again. Maybe next time she’ll be able to carry the baby.”
Little is known about the epidemiology of typhoid and paratyphoid fever in Nepal. We aimed to elucidate the molecular and clinical epidemiology of Salmonella Paratyphi A in Nepal. Isolates were collected from 23 cases of bacteremia due to S. Paratyphi A between December 2014 and October 2015. Thirteen patients (57%) were male, and the median age was 21 years. None of the patients had an underlying chronic disease. All S. Paratyphi A isolates were sensitive to ampicillin, trimethoprim/sulfamethoxazole, ceftriaxone, and chloramphenicol. All isolates were resistant to nalidixic acid and were categorized as intermediately susceptible to levofloxacin. Phylogenetic analysis revealed close relatedness among the isolates, including several clonal groups, suggesting local spread. Patients with bacteremia due to S. Paratyphi A in Kathmandu, Nepal, were relatively young and nondebilitated. Improving control of S . Paratyphi infections should focus on effective infection control measures and selection of empirical therapy based on current resistance patterns.