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Introduction:Aprobiotic used as an adjunct in Salmonella typhi infection along with antibiotic is postulated to interfere with the virulence and growth of Salmonella. To determine the effectiveness of Lactobacillus rhamnosusGG (LGG), as an adjunct with intravenous ceftriaxone, compared with a placebo in defervescence and toxemia resolution in children with enteric fever. Settings and Design: This hospital‑based randomized double‑blinded controlled trial was conducted among 56 study participants who were children below the age of 12 years, admitted as inpatients with fever and whose blood culture grew S. typhi. Materials and Methods: Study participants were equally allocated into intervention or control group by simple randomization. The intervention group received injection ceftriaxone and oral LGG (probiotic) for 7 days while the control group received an injection ceftriaxone and oral placebo for 7 days. Statistical Analysis: Kaplan–Meier curves and mantel cox log‑rank test were used to compare the duration for defervescence and toxemia resolution after treatment initiation. Results: Mean duration for defervescence in the intervention and control groups was 3.87 (1.57) days and 3.35 (1.19) days, respectively. The mean time taken for the resolution of toxemia was 3.00 (1.15) days in the intervention group and 2.64 (0.87) days in the control group. Conclusions:The addition of oral LGG at a dose of 3 × 109 colony‑forming units for 7 days to the standard antibiotic therapy for enteric fever did not show a significant reduction in the time taken for defervescence (P = 0.099) or resolution of toxemia (P = 0.148)
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Objective: Identifying clinical and laboratory indicators that differentiate multisystem inflammatory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting. Methods: Review of hospital records done in a tertiary care exclusive children’s hospital for children admitted from April, 2020 till June, 2021. Laboratory values, severe acute respiratory syndrome coronavirus (SARS-CoV-2) serological status, and clinical signs and symptoms of patients with MIS-C, and those with similar presentations were analyzed. Results: 114 children fulfilled the inclusion criteria (age group of 1 mo-18 y) for whom a diagnosis of MIS-C was considered in the emergency room based on the clinical features. Among them, 64 children had the final diagnosis of MIS-C, and the remaining 50 children had confirmatory evidence of infections mimicking MIS-C such as enteric fever, scrub typhus, dengue and appendicitis. Conclusion: Older age group, presence of mucocutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.
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Background: Enteric fever is a major public health problem in developing countries like India. It affects all age groups but young children are at highest risk. Timely management with appropriate antimicrobial therapy can reduce both morbidity and mortality. In recent years, the emergence of antimicrobial resistance is a significant challenge. Therefore, this study was undertaken to study antibiotic sensitivity pattern of the Salmonella isolates. Aims and Objectives: The aim of this study was to estimate the prevalence of resistance to commonly used antibiotics in the Salmonella isolates. Materials and Methods: Children between 6 months and 14 years of age admitted for fever and whose blood culture was positive for Salmonella Typhi or Salmonella Paratyphi A, B, or C were included in the study over a period of 2 years (August 2018–July 2020). Results: There were 155 patients of enteric fever whose blood culture results were positive for S. Typhi/S. Paratyphi who were included in the study. Out of the 155 culture positive cases, S. Typhi was isolated in 135 (87.1%), S. Paratyphi A in 16 (10.3%) and S. Paratyphi B in 4 (2.6%) cases. All the 135 isolates of S. Typhi were sensitive to cephalosporins. High rate of sensitivity was noted for the first-line drugs – amoxicillin, ampicillin, and trimethoprim-sulfamethoxazole. All 16 isolates of S. Paratyphi A were sensitive to cephalosporins. All the isolates of S. Paratyphi B tested were sensitive to cephalosporins, azithromycin, nalidixic acid, and trimethoprim-sulfamethoxazole. Conclusion: At present, there is low prevalence of resistance to first-line drugs and third-generation cephalosporins and high resistance to fluoroquinolones, nalidixic acid, and azithromycin as noted in this region. Rational antibiotic selection should be based on sensitivity pattern to prevent emergence of resistant strains.
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Introducción: Las infecciones representan la etiología más frecuente del síndrome febril prolongado (SFP). Si bien las fiebres entéricas constituyen una causa posible, en Uruguay su prevalencia ha disminuido significativamente con la mejora de las condiciones socio sanitarias. Objetivo: Comunicar el caso de un adolescente con una etiología actualmente excepcional de SFP. Caso clínico 14 años, sano, zona suburbana. Comienza 2 semanas previo al ingreso con dolor en hemiabdomen superior. Agrega cefalea holocraneana leve y vómitos ocasionales. 5 días previos al ingreso fiebre 40°C axilar, un pico diario, sin otra sintomatología. Tránsito digestivo bajo y urinario normal. Examen físico: lúcido, buen aspecto general, abdomen doloroso a la palpación profunda en epigastrio. Sin irritación peritoneal. Resto normal. Analítica: Leucocitos 5200mm3, Proteína C reactiva 71.4mg/dL, hemocultivo sin desarrollo. Ecografía abdominal, radiografía de tórax y ecocardiograma normales. Serologías para Virus Epstein Barr, Citomegalovirus, y Bartonella henselae negativas. Orina normal, urocultivo sin desarrollo. Persiste con fiebre, agrega exantema macropapular evanescente en tronco, sin otros síntomas. Al 7° día de internación nuevo hemocultivo: Salmonella Typhi sensible a ampicilina que recibe por 14 días. Buena evolución. Discusión: La fiebre tifoidea es una enfermedad infectocontagiosa, aguda, potencialmente mortal. Las condiciones socioeconómicas son determinantes en su transmisión. La sensibilidad del hemocultivo es mayor durante la primera semana de enfermedad, por lo que en ocasiones es necesario reiterarlo. Sus manifestaciones clínicas inespecíficas y la baja incidencia hacen que esta etiología no sea habitualmente sospechada en nuestro medio. Por tanto, es importante aumentar el índice de sospecha y considerar entre los diagnósticos diferenciales de SFP esta etiología.
Introduction: Infections are the most frequent etiology of prolonged febrile illness (PFI). Although enteric fevers are a possible cause, their prevalence has significantly diminished in Uruguay, due to improved socio-sanitary conditions. Objective: To communicate the case of an adolescent with a currently exceptional etiology of PFI. Clinical case: 14 years old, healthy, suburban area. Two days prior to admission the patient has pain in upper hemi abdomen. Adds mild holocranial headache and occasional vomiting. 5 days prior to admission axilary temperature of 40°C, one daily peak, without other symptoms. Normal lower digestive and urinary transit. Physical examination: lucid, good general aspect, pain at deep palpation in epigastrium. No peritoneal irritation. Rest is normal. Laboratory: leukocytes 5200 mm3, C-reactive protein 71.4mg/dL, blood culture shows no growth. Abdominal sonogram, thoracic X-ray and echocardiogram are normal. Negative serology for Epstein Barr Virus, Cytomegalovirus and Bartonella henselae. Normal urine, urine culture with no growth. Fever persists, adds evanescent macropapular exanthema in on the trunk, without other symptoms. On the 7th day in hospital a new blood culture shows Salmonella Typhi sensitive to ampicillin, which he receives for 14 days. Good evolution. Discussion: Typhoid fever is an acute, life-threatening, infectious disease. Socioeconomic conditions are determinant in its transmission. Blood culture sensitivity is greater during the first week of the disease, that is why it must occasionally be repeated. Its unspecific clinical manifestations and low incidence make this etiology not be usually suspected in our surroundings. It is therefore important to increase our suspicion and to consider it amongst differential diagnosis in PFI.
Introdução: As infecções representam a etiologia mais frequente da síndrome febril prolongada (SFP). Embora as febres entéricas sejam uma causa possível, no Uruguai sua prevalência diminuiu significativamente com a melhoria das condições sociossanitárias. Objetivo: Relatar o caso de um adolescente com etiologia atualmente excepcional de SFP. Caso clínico 14 anos, saudável, zona suburbana. Começa 2 semanas antes da admissão com dor no abdome superior. Adiciona dor de cabeça holocraniana leve e vômitos ocasionais. 5 dias antes da admissão febre 40°C axilar, pico diário, sem outros sintomas. Trânsito digestivo inferior e trânsito urinário normais. Exame físico: lúcido, bom aspecto geral, abdome doloroso à palpação profunda no epigástrio. Sem irritação peritoneal. Resto normal. Análise: Leucócitos 5200mm3, proteína C reativa 71,4mg/dL, hemocultura sem desenvolvimento. Ultrassonografia abdominal, radiografia de tórax e ecocardiograma foram normais. As sorologias para vírus Epstein Barr, Citomegalovírus e Bartonella henselae foram negativas. Urina normal, urocultura sem desenvolvimento. Persiste com febre, acrescenta erupção macropapular evanescente no tronco, sem outros sintomas. No 7º dia de internação, nova hemocultura: Salmonella Typhi sensível à ampicilina, que recebeu por 14 dias. Boa evolução. Discussão: A febre tifóide é uma doença infecciosa aguda, potencialmente fatal. As condições socioeconômicas são decisivas na sua transmissão. A sensibilidade da hemocultura é maior durante a primeira semana da doença, por isso às vezes é necessário repeti-la. Suas manifestações clínicas inespecíficas e baixa incidência fazem com que essa etiologia não seja usualmente suspeitada em nosso meio. Portanto, é importante aumentar o índice de suspeição e considerar essa etiologia entre os diagnósticos diferenciais da SFP.
Subject(s)
Humans , Male , Adolescent , Typhoid Fever/diagnosis , Fever of Unknown Origin/etiology , Syndrome , Typhoid Fever/drug therapy , Amoxicillin/administration & dosage , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosageABSTRACT
We report a case of pyrexia of unknown origin (PUO) in a 19-year-old male, who was admitted with a history of pyrexia for 2 weeks. The diagnosis remained uncertain despite multiple investigations and the patient subsequently had various clinical manifestations similar to those seen in coronavirus disease 2019 (COVID-19). Since it was initially presumed to be pyrexia due to viral origin or enteric fever, patient was started on empirical treatment. The diagnosis of COVID-19 was confirmed by corroborating various biochemical markers that had a greater association with COVID-19. Patient was discharged after 21 days with empirical antibiotics, anticoagulants and other supportive medications. He required no further hospital admissions and has been on regular follow-up.
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Enteric fever commonly known as typhoid fever remains endemic in many developing countries with an estimate of more than 26.9 million cases recorded annually with 1% associated deaths. We conducted a study to evaluate clinico-epidemiological profile of enteric fever in a peripheral hospital of Kashmir North India. This was a hospital based cross sectional study conducted over a period of one year including a total of 100 patients between 1-12 years of age. All children who have documented fever of more than one week duration with widal titres of >160 were included in the study. Among 100 patients included in the study 94% had fever of >1 week of duration, 68% and 50% had anorexia and vomiting respectively. Diarrhea was present in 28% of the study population with constipation in 10%. 28% had hepatomegaly on examination while as 12% had spleenomegaly. Headache was present in 17% of population. Our study concluded that enteric fever continues to be a significant cause of morbidity and mortality in developing nations especially in the rural population. Poor hygiene, lack of proper community education, limited healthy care facilities and negligible typhoid vaccination are the main concerns which need to be addressed on priority to decrease the disease burden.
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Background : In the 19th Week of 2020, Integrated Disease Surveillance Programme (IDSP) noted an unusual increase in the number of fever cases in Routine Syndromic Surveillance. Objectives : The unusual increase of fever cases were investigated to identify the agent, the source of infection and to propose recommendations for control measures. Methods : Active surveillance of fever cases done, blood samples, stool samples and water samples were collected from the affected area. The secondary data of indoor and outdoor patient were collected from the nearest health facilities. Result : It was a single peak outbreak of typhoid, started from 1st May, 2020, had peaked during the 19th Week of May, 2020 and ended on 31st May, 2020. The epicentre of the outbreak was the residential colony of Industrial labour. The outbreak of Typhoid occurred due to conditions generated due to the pandemic of COVID -19. Two sources of active infection were found. First, contaminated supply of drinking water and second a food-handler, who was the carrier of Typhoid. Interpretation and Conclusion : It is a lesson to learn that the local communicable diseases should be monitor during the pandemic. Otherwise, that can cause the situation of co-epidemic
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Background:Current study aimed at s to delineate the etiology and clinical parameters associated with AUFIpresenting toemergency department in atertiary care hospital.Methods:This wasa prospectivehospital based study carried out atemergency medicine, SKIMS hospital, SouraKashmir, IndiaJuly2017 toaugust 2018. Patients with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean盨D for continuous variables like age of the patients and duration of fever, Frequency and percentage were used to analyse categorical variables such as causes of fever and gender, while as descriptive analysis was calculated in terms of mean盨D for continuous variables like ageof the patients and duration of fever.Results:Totalnumbers of patients included were 174, among these 112 (64.3%) were males and 62 (35.6%) were females. Most patientswere diagnosedenteric fever (N=59, 33.9%)followed byUTI (N=25, 14.3%) dengue (N=12, 6.8%) and malaria (N=8, 4.5%)while rest of cases were associated with other viral illnesses (N=70, 40.5%)based on clinicalbasisand inconclusive laboratory results.Conclusions:Enteric fever was found to be the most commoncause of acute undifferentiated fever followed by dengue andother viral illnesses, althoughcauses and clinic spectrumof AUFI is varied.
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Background: Enteric fever is a common public health problem with variable clinical presentation. The aim of study was to study the clinical spectrum of enteric fever in children.Methods: This was a prospective study conducted over period of one year from January 2019 to January 2020 in the Department of Paediatrics at Govt Medical College Srinagar. It included all patients in the age group of 1-18 years who were clinically suspected to have enteric fever and had either a positive blood culture for Salmonella or a positive Widal test.Results: This study included total of 76 patients out of which 36 were males and 40 were females. The most common presenting symptoms were fever anorexia, vomiting, diarrohea, abdominal pain, headache and constipation. The most common signs were coated tongue, toxic look, hepatomegaly, splenomeagly, pallor, jaundice and abdominal distension. Complications were seen in in 8 (10.5%) patients. Myocarditis was seen in 3 patients. Encephalopathy and hepatitis was seen in 2 patients each. Pneumonia was seen in 1 patient. Majority of patients had normal white blood cell count (4000-11000/cumm). Leukopenia (<4000/cumm) was seen in 10% patients and leukocytosis (>11000/cumm) was seen in 15% patients. Thrombocytopenia was seen in 9% patients. Blood culture was positive in 36 (47.36%) patients. Salmonella typhi was seen in 33 patients whereas Salmonella paratyphi A was seen in 3 patients. All culture positive cases were sensitive to ceftriaxone, cefixime and azithromycin. Ciprofloxacin resistance was seen in 11 (14.4%) patients.Conclusions: Enteric fever is a common public health problem with fever as most common presenting symptom. Culture yield can be increased in enteric fever by drawing blood culture prior to administration of antibiotics. Ceftriaxone is highly efficacious as monotherapy in enteric fever.
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Background: Intestinal perforation is a common surgical problem, which need proper attention. Typhoid is the most common cause of bowel perforation. With the concept of a correct diagnosis of perforation in reference to its etiology and further study of etiological factor (typhoid) in relation to epidemiology, surgical treatment and outcome, the present study has been undertaken.Methods: It is a prospective, observational study in which 50 cases of enteric perforation admitting in SMS Hospital at JAIPUR were observed. All patients of enteric perforation peritonitis were evaluated by detailed history, clinical examination and radiological as well as laboratory investigations. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality data were observed.Results: Mean age of patients was 26.38 years. Male to female ratio was 4:1. Enteric perforation is more common in patients with poor nutritional status and rural area. Primary repair of perforation was done in patient with small perforation with relatively healthy bowel, while ileostomy was done in patients with large perforation of longer duration, multiple perforations and edematous bowel with necrotic patches. Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (33.3%) and lowest in patients in which exteriorization of the perforation as loop ileostomy was done (10.3%).Conclusions: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.
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Background: In September 2019, a large number of fever cases among troops and families in a military station in Maharashtra were admitted to the local Military Hospital. Detailed epidemiological investigations revealed the cause to be an outbreak of enteric fever due to sewage contamination of drinking water.Methods: A detailed site survey was undertaken; and a descriptive epidemiological study was carried out. Routine haemogram, blood culture, antibiotic sensitivity test besides serotyping of the isolates were carried out.Results: In all 28 cases who fulfilled the case definition criteria were admitted in the month of September 2019. Out of these 21 (75%) were confirmed by blood culture, while the remaining were probable cases. Bacteriological examination reports of water samples taken from various source as well as consumer end points both prior to beginning of the outbreak and during the outbreak revealed a high presumptive coliform count. Spatial and temporal clustering of cases was suggestive of common source outbreak. On 16 September 2019 exploration by digging was carried out undertaken which revealed massive leakage of water in close proximity to the overflowing manholes. The outbreak was promptly controlled after detection of this pipeline and provision of alternative source of water supply to the affected area.Conclusions: Salmonella enterica serovar typhi has been implicated in many outbreaks through history. The present outbreak was a common source focal outbreak due to sewage contamination of drinking water in a few areas in the station.
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BACKGROUND Enteric fever is a feco-orally transmitted disease with significant morbidity and mortality in India. Isolation of responsible bacteria from blood or bone marrow is the gold standard method for Enteric fever but it is seldom used now a days due to long turnaround time and higher cost. In developing country like India, relatively cheaper Widal test is used to diagnose Enteric fever. There are two methods of Widal test- slide agglutination test and tube agglutination test. The present study was done to compare efficacy of the slide agglutination test and tube agglutination in diagnosing enteric fever.METHODSAn OPD and IPD based cross sectional study was conducted from May 2019 to Oct 2019. A total of 100 patients with clinical suspicion of Enteric fever were included in the study. 15 ml blood was collected. Blood culture of all the samples were also performed by inoculating 10 ml of blood into appropriate blood culture media. Serum was separated from rest of the blood and serum was tested by both slide agglutination test and Widal tube agglutination test.RESULTSAmong 100 patients, slide agglutination test demonstrated positive result in 40(40%) samples and Widal tube agglutination test demonstrated positive result in 27 (27%) samples only. Among 40 samples positive by slide test 12 samples were negative by blood culture test. The slide test had a sensitivity of 93.33%, specificity of 82.86%, positive predictive value of 70% and negative predictive value of 96.67% and tube test had a sensitivity of 86.67%, specificity of 98.57% positive predictive value of 96.30% and negative predictive value of 94.52% considering blood culture as gold standard.CONCLUSIONSDue to higher sensitivity but poor specificity, slide Widal test should be used for rapid screening test and positive samples should be confirmed by Widal tube agglutination test.
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Background: Viral hepatitis is one of the major public healthconcerns around the world. Every year millions of people diefrom viral hepatitis-related cirrhosis and liver cancer. Howeverthe fact is the majority of the infected populations are unawareof their condition.Objective: The objective of the study was to find out theproportion of the risk factors associated with gastrointestinalinfections among the inpatients attending in tertiary carehospital in Dhaka city.Materials & Methods: A cross-sectional study was carried outamong the hospital admitted patients at gastroenterologydepartment from January to April, 2019.A total of 193patientswere purposively selected who were above 18 years anddiagnosed case of hepatitis, diarrhoeal diseases, enteric fever,H. pylori infection.Results: The outcome of the study was that, majority82(42.5%) of the patients age was between 21-40 years.Maximum participants were male (65.3%). Study found thatamong 193 patients, 45 (23.3%) were diagnosed as hepatitisB, 31 (16.1%) were H. pylori infection, 29 (15.0%) diarrhoea,hepatitis C 19 (9.8%), hepatitis E 23 (11.9%) and hepatitis A 21(10.9%). It also found that mean duration of Gastro-Intestinal(GI) infection was 2.59 (± 3.22) years. Water borne diseaseslike hepatitis A, E, diarrhoea, typhoid and H. pylori infectionmostly presents due to 44 (34.4%) patients drunk water fromsupply water (Dhaka WASA), 73.4% eaten street juice and79.7% had eaten street food before diagnosed diseases.Commonest risk factors were hepatitis B and C. 37 (56.9%)patients had received blood previously, 11 (17.2%) had theirprevious history of operation, 42 (64.6%) had visited dentist fordental issues, 29 (44.6%) patients attended endoscopy orcolonoscopy test, 28 (43.1%) patients informed that they hadfaced minor skin injury when shaving in salon and 6 (9.2%)patients mentioned taken dialysis. According to the findings,20.3% patients having liver diseases, 5.7% heart diseases,4.1% respiratory diseases, 7.3% renal diseases, 26.4%diabetic, 22.8% hypertensive, 15.0% anemia and 26.9%smoker Street juice [OR: 95% CI, 4.9%] and Street food [OR:95% CI, 6.1%] risk of hepatitis A infection. The proportion ofrisk factors of hepatitis B infection revealed that the patientswho received blood previously [OR: 95% CI, 3.14%] has therisk of hepatitis, second hand razor use [OR: 95% CI, 7.76%],Dialysis [OR: 95% CI, 2.47%].Conclusion: Street foods & juice, unpurified water was thecommonest factors of hepatitis A &E, typhoid and diarrhea. Onthe other side, unscreened blood, dental procedure, skin injuryin saloon, dialysis and endoscopy/colonoscopy test were thecommonest risk of hepatitis B& C virus. H. pylori infection
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Objective: In this study our main aims to know the clinicalprofile of pediatric enteric fever and the sensitivity pattern ofthe disease to drugs in this region.Methodology: This prospective observational study conductedin a tertiary care hospital at Dhaka from March to December2016 among suspected case of Enteric fever as per casedefinition. Among 212 suspected enteric fever 117 childrenwere diagnosed as enteric fever by blood culture and/or Widaltest.Results: During the study, Male: female were 1.3: 1. Maximum(70%) children were in age group 5 years or more. Most of thechildren were from urban slum area (53.6%) of Dhaka city.Cases were admitted throughout the year. Commonpresentation were fever (100%), anorexia (100%), painabdomen (74.4%) and loose motions (46.1%). The commonsigns were hepatomegaly (41.9%), hepatosplenomegaly(5.1%) coated tongue (64.9%), pallor (74.4%). Thecomplications rate was 35.9% and commonest being UTI andpneumonia. The overall positivity of Widal test was 89.7% andthe culture positivity was 32.5%. Among isolates, 94.7%wereSalmonella typhi and 5.3% Salmonella paratyphi A. Amongthem18.1% isolates were multi drug resistant.Conclusion: Enteric fever is most prevalent during summer &rainy session. WASA supplied water may play a role.Hepatomegaly is common. UTI and pneumonia are thecommonest complication. Multidrug resistant cases are not soas high as other countries. Cefixime, Ceftriaxone. Meropenamand Ofloxacine are the drugs of choice. Ciprofloxacin is stillcould be chosen for the treatment of enteric fever. Higher rateof resistant to Azithromycin is alarming.
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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 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 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 sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.
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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 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 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 sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.
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Objective: To describe the demographic, clinical, laboratory and bacteriological profile ofchildren with diagnosis of typhoid fever over a six-year period. Methods: Case recordanalysis of hospitalized children (≤5 y) with culture positive typhoid fever. Results: Bloodculture was positive in 100 (61%) of 166 suspected cases, with 78 isolates of SalmonellaTyphi and 22 Salmonella Paratyphi A. Only 12 children were aged below two years.Hepatomegaly (32), splenomegaly (44), eosinopenia (42), positive widal (15, 21.1%) andpositive Typhidot IgM (18, 28.1%) were not consistently observed. High susceptibility toAmpicillin, Chloramphenicol, Cotrimoxazole (87, 89, and 94, isolates, respectively), 100%susceptibility to third generation cephalosporins and Azithromycin, and high resistance toNalidixic Acid [(S. Typhi 48 (61.5%)], S. Paratyphi A 16 (72.7%)) were observed. Conclusion:We observed a high isolation rate of salmonella in blood culture, despite prior use ofantibiotics. Most salmonella isolates were susceptible in vitro to standard drugs, exceptnalidixic acid.
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Gallbladder perforation usually occur in acute obstructive (calculus) cholecystitis, and its incidence is high in patients with diabetes mellitus, recent severe trauma, critical illness, severe burn. 2-11% patients of acute cholecystitis progress to gallbladder perforation. Acute cholecystitis is a rare complication of enteric fever and perforation of gallbladder in such cases is an uncommon occurrence in pediatric population. Clinical features of spontaneous gall bladder perforation are non-specific especially in children. Ultrasound as well as computerized tomography (CT) abdomen and pelvis lack specificity for detecting gallbladder perforations in enteric fever. Diagnosis is usually confirmed intraoperatively when the gallbladder is visualized and perforation is seen. Hence the treating surgeon must consider this rare condition in differential diagnosis while treating any child with acute abdomen.
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Enteric fever is a common but serious disease that affects mostly children and adolescents in the developing countries. Salmonella enterica serovar Typhi remains responsible for most of the disease episodes; however, S. Paratyphi A has also been reported as an emerging infectious agent of concern. The control measures for the disease must encompass early diagnosis, surveillance and vaccine to protect against the disease. Sanitation and hygiene play a major role in reducing the burden of enteric diseases as well. The current status of diagnostics, the surveillance practices in the recent past and the vaccine development efforts have been taken into account for suggesting effective prevention and control measures. However, the challenges in all these aspects persist and cause hindrance in the implementation of the available tools. Hence, an integrative approach and a comprehensive policy framework are required to be in place for the prevention, control and elimination of typhoid fevers.
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Background: Asterion Introduction: Enteric fever is a major concern in developing country. It is predominantly caused by serovars typhi and paratyphi of Salmonella enterica. Recently, an upsurge in antimicrobial resistant strains has worsened the management of enteric fever. So, aim of present study is to evaluate the clinical profile, antibiotic sensitivity and prescription pattern in blood culture proven cases of enteric fever in pediatric and adult patients.Methods: Single centre, prospective study was conducted at a tertiary care hospital. Demographic and clinical details of blood culture proven enteric fever admitted in hospital were collected over the period from August 2016 to November 2018.Results: Total 58 blood cultures grew Salmonella spp. , amongst them 84.48 % had growth of Salmonella typhi. Blood culture was sent after a mean period of 9 days and 10 days of fever in pediatric and adult patients respectively. All isolates of S. paratyphi A were pansusceptible, whereas 36.73 % isolates of S. typhi were multidrug resistant and nalidixic acid resistant. 68.97% patients received antibiotics before admission. The difference between mean time to defervescence in patients who received ceftriaxone and those who received more than one antibiotic was not statistically significant. (P value 0.87)Conclusion: Blood cultures are the important diagnostic tool to identify multidrug resistant Salmonellae. Study showed that combination therapy was not statistically superior and awareness of local antimicrobial susceptibility pattern significantly helps for better management of the patients.