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Mysterious fevers are common in Nepal, especially in the summer. Sherlock Holmes and Watson would have had a field day here, figuring out the causes of these unknown fevers. But these outbreaks are in fact diseases such as typhoid, typhus, and leptospirosis, which are all mistakenly thought to be common fever. As our laboratory facilities are too weak to make proper diagnoses, Nepal has become a site for case studies that have revealed the lack of systematic curative practices here.

Almost a decade ago, about 900 fever patients were studied at Patan Hospital. Many well-known conditions such as typhoid were correctly identified. However, two diseases, typhus (not typhoid) and leptospirosis were completely overlooked by the physicians. Surprisingly, these turned out to be the third and fourth most common proven causes of fever after the pneumonias.

This discovery has helped in treating fever patients in Nepal more effectively, for the results led to proper therapy � the right drug for the right disease. It also proved that unknown causes of fever can be determined only through systematic study. In medical parlance, this is known as 'differential diagnosis'.

Thanks to the research, typhus and leptospirosis are now listed as one of the main causes of fever in Nepal. Typhus, which is a flea, louse, mite, or tick-borne illness, can be acquired after being bitten by any of these organisms. This should not be mistaken for typhoid, which is caused by contaminant bacteria in our food or drinking water. Leptospirosis on the other hand, is acquired from rat urine in puddles of water getting into abrasions in our skin � not impossible in Nepal. An effective drug for both typhus and leptospirosis is doxycycline.

There are, of course, many other infectious fevers in Nepal such as malaria, kalazar, tuberculosis, and now dengue, but typhus and leptospirosis had always been off the radar until the ground-breaking study at Patan Hospital. A crucial lesson learnt from this study is the importance of investigative research in medicine � much like Holmes' and Watson's work in solving mysteries.

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