BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a you...BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a young adult male presenting with febrile neutropenia whose blood and bone marrow cultures grew Salmonella typhi.He recovered before discharge from the hospital.The second was a primigravida who had an abortion following a febrile illness and was found to have pancytopenia.The Widal test showed high initial titers,and she was presumptively treated for typhoid.Convalescence showed a doubling of Widal titers.CONCLUSION Typhoid fever continued to show up as a fever with cytopenia demanding significant effort and time in working up such patients.In developing countries,the liaison with typhoid continues.展开更多
Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and...Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.0展开更多
Background: India carries one of the largest burdens of infectious diseases in the world. To estimate this, laboratory confirmation is vital. We estimated the lab capacity and effectiveness in the state of Gujarat for...Background: India carries one of the largest burdens of infectious diseases in the world. To estimate this, laboratory confirmation is vital. We estimated the lab capacity and effectiveness in the state of Gujarat for Enteric Fever, Infectious Hepatitis, and Dengue. Methods: We estimated the number of labs in the state through telephonic surveys and physical screening of a representative sample of labs. We created four levels of tests, Level-0 being no test and 3 being the best confirmatory test available in the state. For the profusion of rapid diagnostic test kits (RDTKs), we constructed Effective Diagnostic Scores (EDS) calculated from their sensitivity and specificity at disease prevalences specified in the literature. Tests with EDS > 0.51 were level-2 tests, and EDS Results: Our analysis showed that there are 4293 labs in the state (1765 public and 2528 private), 7/100,000 population. However, only 2878 labs contributed to a total pooled Effective Lab Diagnostic Score (ELDS) of 6776 in the state. Strikingly, 94% of the lab effectiveness lay in RDTs (level-2 and 1 tests) which are essentially screening tests. Ninety-six percent of the overall lab effectiveness of Gujarat existed in private and only 4% in public labs. Contrarily, the level-3 confirmatory testing effectiveness, through ELISA and culture constituted only 4% of private and 36% of public lab effectiveness. More than half of the private lab effectiveness was located in eight Tier 1 cities. Level-3 confirmatory testing effectiveness was present only in Tier 1 and 2 towns. Hepatitis B testing contributed 34% of the total ELDS, followed by Dengue (30%), Enteric Fever (26%) and Hepatitis A and E (10%). Conclusion: Our study has established that the capacity and effectiveness of the lab network in Gujarat lie predominantly in RDTKs. We need to adapt our systems to capture this data in a manner that will allow us to monitor the burdens of these diseases.展开更多
Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional...Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.展开更多
Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains.We report an outbreak of enteric fever caused by S...Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains.We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area,in city Chandigarh of North India.Twenty-seven strains of S.typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area.Maximum cases were in the age group 5-14 years(10 patients,55.5%) while 4(22.2%) cases were children under 5 years.All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid,intermediate to ciprofloxacin and sensitive to chloramphenicol,ceftriaxone,cefotaxime,cotrimoxazole and azithromycin on disc diffusion testing.Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised(≥2μg/mL).This nalidixic acid resistant S.typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.展开更多
Objective:To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Nino Southern Oscillations and Indian Ocean Dipo...Objective:To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Nino Southern Oscillations and Indian Ocean Dipole over enteric fever incidence.Method:A total of 29808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed.El Nino,La Nina,neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever.Results:Population-normalized average monthly enteric fever case rates were the highest for El Nino years(25.5),lower for La Nina years(20.5)and lowest for neutral years(17.6).A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Nino Southern Oscillations categories.However,visual profile plot of estimated marginal monthly means showed two distinct characteristics:an early rise and peaking of cases in the El Nino and La Nina years,and a much more restrained rise without conspicuous peaks in neutral years.Further analysis based on monthly El Nino Southern Oscillations categories was conducted to detect differences in median monthly case rates.Median case rates in strong and moderate El Nino months and strong La Nina months were significantly dissimilar from that during neutral months(P<0.001).Conclusions:El Nino Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad,and further investigation from more cities and towns is required.展开更多
Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and inci...Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through;vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sourcesof drinking water, good sanitation and hygiene, food safety and poverty alleviation.展开更多
文摘BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a young adult male presenting with febrile neutropenia whose blood and bone marrow cultures grew Salmonella typhi.He recovered before discharge from the hospital.The second was a primigravida who had an abortion following a febrile illness and was found to have pancytopenia.The Widal test showed high initial titers,and she was presumptively treated for typhoid.Convalescence showed a doubling of Widal titers.CONCLUSION Typhoid fever continued to show up as a fever with cytopenia demanding significant effort and time in working up such patients.In developing countries,the liaison with typhoid continues.
文摘Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.0
文摘Background: India carries one of the largest burdens of infectious diseases in the world. To estimate this, laboratory confirmation is vital. We estimated the lab capacity and effectiveness in the state of Gujarat for Enteric Fever, Infectious Hepatitis, and Dengue. Methods: We estimated the number of labs in the state through telephonic surveys and physical screening of a representative sample of labs. We created four levels of tests, Level-0 being no test and 3 being the best confirmatory test available in the state. For the profusion of rapid diagnostic test kits (RDTKs), we constructed Effective Diagnostic Scores (EDS) calculated from their sensitivity and specificity at disease prevalences specified in the literature. Tests with EDS > 0.51 were level-2 tests, and EDS Results: Our analysis showed that there are 4293 labs in the state (1765 public and 2528 private), 7/100,000 population. However, only 2878 labs contributed to a total pooled Effective Lab Diagnostic Score (ELDS) of 6776 in the state. Strikingly, 94% of the lab effectiveness lay in RDTs (level-2 and 1 tests) which are essentially screening tests. Ninety-six percent of the overall lab effectiveness of Gujarat existed in private and only 4% in public labs. Contrarily, the level-3 confirmatory testing effectiveness, through ELISA and culture constituted only 4% of private and 36% of public lab effectiveness. More than half of the private lab effectiveness was located in eight Tier 1 cities. Level-3 confirmatory testing effectiveness was present only in Tier 1 and 2 towns. Hepatitis B testing contributed 34% of the total ELDS, followed by Dengue (30%), Enteric Fever (26%) and Hepatitis A and E (10%). Conclusion: Our study has established that the capacity and effectiveness of the lab network in Gujarat lie predominantly in RDTKs. We need to adapt our systems to capture this data in a manner that will allow us to monitor the burdens of these diseases.
文摘Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.
文摘Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains.We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area,in city Chandigarh of North India.Twenty-seven strains of S.typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area.Maximum cases were in the age group 5-14 years(10 patients,55.5%) while 4(22.2%) cases were children under 5 years.All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid,intermediate to ciprofloxacin and sensitive to chloramphenicol,ceftriaxone,cefotaxime,cotrimoxazole and azithromycin on disc diffusion testing.Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised(≥2μg/mL).This nalidixic acid resistant S.typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.
基金funded by Public Health Research Initiative(PHRI)Research grant awarded by PHFI with the financial support of Department of Science and Technology(No.PHRI LN0019).
文摘Objective:To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Nino Southern Oscillations and Indian Ocean Dipole over enteric fever incidence.Method:A total of 29808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed.El Nino,La Nina,neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever.Results:Population-normalized average monthly enteric fever case rates were the highest for El Nino years(25.5),lower for La Nina years(20.5)and lowest for neutral years(17.6).A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Nino Southern Oscillations categories.However,visual profile plot of estimated marginal monthly means showed two distinct characteristics:an early rise and peaking of cases in the El Nino and La Nina years,and a much more restrained rise without conspicuous peaks in neutral years.Further analysis based on monthly El Nino Southern Oscillations categories was conducted to detect differences in median monthly case rates.Median case rates in strong and moderate El Nino months and strong La Nina months were significantly dissimilar from that during neutral months(P<0.001).Conclusions:El Nino Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad,and further investigation from more cities and towns is required.
文摘Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through;vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sourcesof drinking water, good sanitation and hygiene, food safety and poverty alleviation.
