Acute cholecystitis from typhic origin in children

Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings; confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever; abdominal pain; which predominated at the right upper abdominal quadrant; and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3); perforation (2) and empyema (1). All the patients made an uneventful recovery; and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice

Prevalence of Salmonella typhi and intestinal parasites among food handlers in Bahir Dar Town, Northwest Ethiopia

Background:Food borne diseases are a global public health problem. Food handlers play a major role for the transmission of food borne diseases. Objectives: This study was aimed at exploring the prevalence of intestinal parasites; S. typhi carrier rate and risk factors among food handlers at Bahir Dar town. Methods: A cross -sectional survey was conducted among food handlers working in different kitchens. A pre-tested structured questionnaire was used for collecting data. Stool samples were investigated for intestinal parasites and S. typhi as per the standard laboratory methods. Results: Among 384 food handlers; females comprised 300 (78). The majority 371 (96.6) were young adults (12 - 40 years). The median year of service was 1 year (1 month to 24 years). All food handlers had no previous medical checkup and 54 (14) were certified as food handlers. One hundred fifty eight (41.1) food handlers had intestinal parasites and 6 (1.6) were found positive for S. typhi. Of these; 25 (6.5) were suffering from diarrhoea. Nine species of intestinal parasites; 2 protozoa (E. histolytica/dispar 12.76and G. lamblia 7. 0) and 7 helminthes (A. lumbricoides; 11.7; Hookworm; 8.1; S. stercoralis; 2.86; S. mansoni; 1.8; Taenia species; 1.3; H. nana; 0.5and T. trichiuria; 0.5) were detected. Conclusion: Inexperienced and poor personal hygienic food handlers play a role for transmission of food borne infections. Local health authorities should implement food handler's training on food safety; institute periodic focused medical check up for food handlers and improve human waste disposal

Multidrug Resistance of Salmonella Enterica Serovars Typhi and Als in Western Kenya

Background: The threat to human health posed by antibiotic resistance is of growing concern. Many commensals and pathogenic organisms have developed resistance to well established and newer antibiotics. This is a cross-sectional study within two hospital settings to determine in vitro antibiotic susceptibilities of Salmonella species isolated in blood; cerebral spinal fluid; pus and stool collected from in- and out-patients. The inclusion criteria was non restrictive to in- and out-patient but preference to severe diarrhea cases with negligible changes to previous treatment regimen was observed. The study was carried out from February 2004 - June 2005. Fifty-three diarrhea patients within the hospital who were chosen by convenient sampling and consented to participate in the study were considered. Methodology: Either blood or pus was collected using vacutainer tubes and syringe; swabs respectively; and cerebral spinal fluid by lumbar puncture from patients who had fever (temp = 38oC) and diarrhea. Stool samples were also colle cted and all specimens analyzed for the presence of Salmonella by routine microbiological procedures. The isolates were subjected to antibiotic susceptibility testing using disc diffusion technique. Results: In St. Elizabeth Mukumu Mission Hospital; Salmonella enterica serovar Typhi was most common (56.6; n=33); followed by S. typhimurium (34; n=18); while in Maseno Mission Hospital only S. typhimurium was isolated. Whereas S. typhi was more commonly isolated in male adults and female children (P = 0.9); S. typhimurium was more common in female and male children (P=0.1). All the isolates were sensitive to ciprofloxacin. However; S. typhi was resistant to streptomycin; ampicillin; chloramphenical and cotrimoxazole; S. typhimurium to tetracycline; sulfamethoxazole; cotrimoxazole; ampicillin; chloramphenical and streptomycin. Conclusions: S. typhi displayed a high resistance pattern to most antibiotic screened than S. typhimurium

Typhoid Fever in Ethiopia

This review focuses on the reports of salmonellosis by investigators in different parts of Ethiopia; in particular focusing on the levels of typhoid fever. Many of the reports are published in local journals that are not available online. There have been seven studies which diagnosed typhoid fever by laboratory culture and there is no coordinated epidemiological surveillance. All conducted research and reports from different health institutions in Ethiopia indicate that typhoid fever was still a common problem up to the most recent study in 2000 and that the extensive use of first-line drugs has led to the development of multiple drug resistance. In the sites covered by this review; the total number of published cases of typhoid fever dropped over time reflecting the decline in research capacity in the country. Data on the proportion of patients infected by different serovars of Salmonella suggest that the non-Typhi serovars of Salmonella are increasing. The published evidence suggests that typhoid fever is a current public health problem in Ethiopia although population based surveys; based on good microbiological diagnosis; are urgently needed. Only then can the true burden of enteric fever be estimated and the benefit of public health control measures; such as health education; safe water provision; improved food hygienic practices and eventually vaccination; be properly assessed

Clinical Features of Typhoid Fever Observed in the Uganda African Patient in Mulago Hospital

Typhoid fever being a disease commonly consufed with other common febrile illnesses; especially when the diagnosis is based on clinical features alone prompted the author to look into the frequency of its presenting features. Methods: One hundred case notes confirmed by a positive blood culture for Salmonella typhi at Mulago Hospital; were retrieved and analysed for clinical features. the majority of the cases diagnosed and treated as typhoid on other evidence were excluded from the study. Results: The commonest features were fever; body weakness; headache and loss of appetite and were present in 98of the cases. The other features comprised of dizziness in 96; coated tongue in 96; dehydration in 94; abdominal pain in 92; abnormal tenderness in 86; low blood pressure on admission in 80; rise in blood pressure after admission in 76; anaemia in 68; splenomegaly in 68; backache in 66; typhoid state in 64; joint pains in 62; chills in 62; partial deafness in 52; muscular pain in 52; constipation in 40; disorientation in 36; delirium in 34; painful toes in 28; pea soup stools in 26; crepitations in lungs in 18; presence of a splenic rub in 8; jaundice in 8; death in 6; thrombo-embolism in 2and convulsions in 2. Apparently; rose spots were not observed in this series. Conclusion: the common clinical features of typhoid in 100 Ugandan confirmed cases of typhoid fever in Mulago Hospital consist of fever; body weakness; headache; loss of appetite; dizziness; features of dehydration; abdominal pain and tenderness; low blood pressure; anemia and joint pains. Pea soup stools commonly stressed by books were seen in only a quarter of the cases and the classical rose spots were not seen and accordingly desearve no emphasis in the Ugandan context

Faecal contamination level; survival of salmonella typhi and pH changes in 'Gari' and its potential public health hazard in Lagos

The pH changes; faecal contamination level; survival of nalidixic-acid resistant salmonella typhi in 'gari' soaked in water was examined. The pH values showed that 'gari' had a range of pH 3.76 to pH 6.24. The mean pH values showed that there were no appreciable change for gari types from various sources within the studied time period of 120 minutes. Faecal coliform contamination of 4 to 2;400/g using the MPN technique were recorded in 33of the 36 'gari' samples. This high faecal coliform contamination rate of gari; a popular fermented cassava food is unacceptable and it is of public health importance. Our survival experiment showed that the seeded enteric pathogen slightly decreased in colony-forming unit (cfu) with log(0.3 10) 0.3 within the studied 120 minutes. It is concluded that our local foods should be monitored regularly for public health safety; and improved hygienic practices should be emphasized as an intervention for diarrhoeal diseases in developing countries