Mucormycosis in a Typhoid Treated Patient: A Case Report with Review of Literature

Introduction: Mucormycosis is an opportunistic fungal infection which is a rapidly progressing disease, and often fatal. Various predisposing factors including uncontrolled diabetes mellitus, immunosuppression, and prolonged use of steroids influence the disease pathology. Case Presentation: In this article, we present a case of mucormycosis of the palate in a patient treated with prolonged dose of steroids for typhoid fever which led to the appearance of exposed maxillary bone, and subsequent histopathological examination showed mucor hyphae. The treatment included antifungal therapy of Amphoterecine B. Management: Treatment of typhoid fever with corticosteroids, leading to immunosuppression, may result in patients harbouring opportunistic infections. An insight into the changes of oral cavity caused by corticosteroids is necessary for better diagnosis of the disease and improved patient care. In addition, early diagnosis is critical in the treatment of patients with mucormycosis

In Silico Investigation of Phytochemicals against Typhoid: A Review

Typhoid fever is a serious bacterial infection caused by Salmonella enterica serovar Typhi, and is a major public health issue in developing countries. The emergence of multidrug-resistant strains of S. Typhi has raised concerns about the effectiveness of existing treatments and has prompted the exploration of alternative therapies. Phytochemicals, which are bioactive compounds found in plants, have been investigated as potential sources of new antibacterial agents against typhoid. In this review, we conducted an in silico investigation of phytochemicals and their potential activity against S. Typhi. Our review examined current literature on phytochemicals and their antibacterial activity against S. Typhi. Using molecular docking studies, we investigated the potential binding of these phytochemicals to the target protein, DNA gyrase, which is an important drug target in S. Typhi. Our results indicate that several phytochemicals exhibit promising binding affinities to DNA gyrase, suggesting their potential as effective antibacterial agents against typhoid. Overall, our findings highlight the potential of phytochemicals as a source of new therapeutics for typhoid fever, particularly in regions where multidrug-resistant strains of S. Typhi are prevalent. The in silico approach used in this review provides a valuable tool for screening and identifying potential candidates for further investigation. Further studies are needed to validate the results of in silico studies and to explore the potential of phytochemicals as antibacterial agents against typhoid.

DIAGNOSTIC DILEMMA IN TYPHOID ENCEPHALOPATHY

Using the immune system to its advantage, Salmonella Typhi initially invades the gut followed by the reticuloendothelial system and finally the nervous system, involvement of which usually occurs around the second week of fever. In developing countries, delayed diagnosis is predominantly due to hesitation in seeking treatment. Our subject presented with fever since one week, altered mentation, headache and neck pain; she was diagnosed with enteric fever. Although her neurological abnormality could be a complication of the infection, it appeared when she became afebrile- hence we evaluated her for autoimmune conditions. Positive results hinted at autoimmune encephalitis triggered by the infection; further studies were inconclusive. Association of enteric fever with autoimmune encephalitis has not been reported. Three months later, presence of antinuclear antibodies (ANA) was rechecked- a negative report led to a retrospective diagnosis of transient ANA positivity in a nonautoimmune inflammatory disease, the case in point being enteric fever.

La batalla decisiva contra la fiebre tifoidea en Santiago de Chile en el siglo XX

Hasta 1983, cuando alcanzaba la increíble tasa de 118 casos por 100.000 habitantes, la fiebre tifoidea era la peor amenaza infecciosa en Santiago, Chile, ciudad que figuraba junto a Ciudad de México, El Cairo y Bombay, como una de las con mayor endemia en el mundo. El Ministerio de Salud respondió formando el Comité de Tifoidea de Chile, con participación de expertos nacionales y del grupo de Myron Levine, de la Universidad de Maryland, que llevó a cabo ingeniosas investigaciones, culpando al río Mapocho, cuyas aguas contaminadas con Salmonella typhi regaban los predios agrícolas vecinos, conformando así un ciclo largo de infección. Las vacunas antitíficas ensayadas (oral Ty21a atenuada y polisacárido capsular Vi inyectable) no mostraron eficacia, los portadores crónicos no se trataron, pero una campaña sanitaria a través de la televisión contribuyó decisivamente a mejorar los hábitos higiénicos de la población, fortalecida por el pánico que causó la llegada del cólera en 1991, y la fiebre tifoidea prácticamente desapareció del escenario.

Until 1983, when reached the incredible frequency of 118 cases for 100.000 habitants, typhoid fever was the worst infectious threat in Santiago, Chile, city that appeared next to Mexico City, Cairo and Bombay, as one of the most endemic in the world. The Ministry of Health responded with the creation of The Chilean Typhoid Committee, with the participation of national experts and Myron Levine's group, which carried out ingenious investigations blaming the Mapocho River, whose waters contaminated with Salmonella typhi irrigated the neighboring farms, thus conforming a long cycle of infection. Typhoid vaccines tested (strain Ty 21a oral and Vi capsular polysaccharide) did not show efficacy, chronic carriers were not treated, but a health campaign on television made a decisive contribution to improving hygiene habits of the population, strengthened by the panic caused by the arrival of cholera in 1991, and typhoid fever practically disappeared from the stage.

Clinical features of an outbreak of extensive drug resistant typhoid fever / 中华传染病杂志

Objective:To analyze the clinical features of an outbreak of extensive drug resistant typhoid fever, and to provide experience for the diagnosis and treatment of drug resistant typhoid fever.Methods:Seven patients with confirmed diagnosis of extensive drug resistant typhoid fever who visited Beijing You′an Hospital, Capital Medical University, from January 27 to February 15, 2022 were included. The clinical characteristics, drug sensitivity tests, consultation and treatment history and prognosis of the patients were analyzed through descriptive study.Results:Of the seven extensive drug resistant typhoid fever patients, three were male and four were female, one of whom was pregnant (at 32-week gestation), aged (29.8±6.8) years, with a range of 22 to 42 years. There were seven cases with fever, and the course of fever ranged from six to 20 days. There were five cases with diarrhea and lack of typhoid-specific manifestations such as rose spot, apathetic facial expression and relatively slow pulse. Four cases were complicated with intestinal bleeding and six cases developed liver function injury. Six cases had loss or decrease in eosinophil ratio and two cases had decreased white blood cell count. The results of drug susceptibility tests showed that seven strains of Salmonella typhi were resistant to chloramphenicol, ampicillin, sulfamethoxazole-trimethoprim, quinolones, ceftriaxone, cefepime, ceftazidime, cefuroxime, and sensitive to carbapenem antibiotics, tigecycline and piperacillin/tazobactam. All seven cases had a history of antimicrobial use before admission. One case was administered with intravenous ceftizoxime for seven days after admission. After discharge, cefixime was administered orally for seven days. Six patients were given intravenous piperacillin sodium/tazobactam sodium for 14 days. All blood/fecal cultures were negative and the patients were cured and discharged. During the follow-up, one patient developed splenic abscess. All the seven patients were residents of the same apartment in Beijing City, and there were water cuts and turbid odors in the incubation period, which were considered as typhoid fever outbreak caused by waterborne transmission. Conclusions:With the use of antimicrobial agents, the typical clinical manifestations of typhoid fever are absent, and the drug resistance rates to quinolone and third-generation cephalosporins increase. Appropriate antimicrobial agents should be selected and the anti-infection course should be prolonged.

Fiebre tifoidea: una etiología poco frecuente de síndrome febril prolongado en pediatría / Typhoid fever: a rare etiology of prolonged febrile illness in pediatrics / Febre tifoide: uma etiología rara de síndrome febril prolongada em pediatría

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.

Isolation of Fluoroquinolones Resistant Salmonella spp. from Stool Samples of Patients Attending General Hospital Minna and Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria

Typhoid fever continues to be a major health problem despite the use of antibiotics and the development of newer antibacterial drugs. This study aim was to isolate fluoroquinolones resistant Salmonella spp from stool samples of informed and consenting patient attending General Hospital and Ibrahim Badamasi Babangida Specialist Hospital in Minna Niger State Nigeria. A total 450 stool samples were collected from the Hospital. The results showed that 69 (30.4%) of the sample collected were positive for Salmonella species. On the basis of age children within the age range of 0-10 recorded the highest prevalence of 22.7% followed by age range 51-60 having the prevalence of 19.4%, age range >60 had the prevalence of 16.7% and age range 21-30 and 11-20 had a similar prevalence of (10.1% and 10.3% respectively) while age range 31-40 had the least prevalence of 7.8%. There were 69 isolates of Salmonella species Identified, 65(94.2%) were Resistant to the antibiotics used. The highest resistance was shown to Pefloxacin 62 (89.9%) and the lowest was shown to Ciprofloxacin 27 (39.1%). Salmonella species exhibited 52 antibiotic resistant patterns for the ten antibiotics tested with multiple antibiotic resistance index (MARI) ranging from 0.3-1.0. Molecular analysis was carried out on 5 representative isolates to identify their strains. Polymerase chain reaction (PCR) assay showed the identified Salmonella strains were Salmonella enterica subsp. arizonae strain ATCC 13314, Salmonella enterica subsp. enterica serovar Typhi strain 2018K-0756, Salmonella bongori strain SL18, Salmonella bongori strain GH3Rp and Salmonella enterica subsp. arizonae strain ATCC 13314, they all showed resistance to fluoroquinolones.

Ascariasis complicada en un infante / Complicated ascariasis in an infant

Introducción: La ascariasis es una enteroparasitosis con alta prevalencia en la población pediátrica tercermundista, la cual puede asociarse a otras enfermedades intestinales y tener graves complicaciones que requieren tratamiento quirúrgico. Objetivo: Informar el caso de un infante operado por coinfección de ascariasis intestinal y fiebre tifoidea complicadas. Presentación del caso: Paciente masculino de 9 años de edad asistido y operado en el hospital provincial N´gola Kimbanda de la provincia Namibe, Angola, por presentar evidencia clínica de peritonitis aguda generalizada por perforación intestinal de causa tifoidea y por cuyo orificio salían además áscaris lumbricoides vivos. Su evolución no fue satisfactoria y falleció 24 horas después de la operación. Conclusiones: El diagnóstico y tratamiento quirúrgico oportuno de la coinfección letal de ascariasis y fiebre tifoidea complicadas permitirá disminuir la morbilidad y mortalidad por esta prevalente asociación(AU)

Introduction: Ascariasis is an enteroparasitosis with high prevalence in the third-world pediatric population, which can be associated with other bowel diseases and have serious complications that require surgical treatment. Objective: Report the case of an infant operated by the co-infection of complicated intestinal ascariasis and typhoid fever. Case presentation: 9-year-old male patient attended and operated at N'gola Kimbanda Provincial Hospital in Namibe Province, Angola, after presenting clinical evidence of generalized acute peritonitis due to intestinal perforation of typhoid-causing and through which live ascaris lumbricoide also came out. His evolution was unsatisfactory and he died 24 hours after the operation. Conclusions: The timely diagnosis and surgical treatment of lethal co-infection of complicated ascariasis and typhoid fever will reduce morbidity and mortality from this prevalent association(AU)

Typhoid fever presenting as acute psychosis in a young adult: case report and literature review of typhoid psychosis

@#The rarity of acute psychosis in typhoid fever can result in delayed and misdiagnosis of the condition. We report a case of a 20-year-old man who presented with fever and acute psychotic symptoms. This was associated with headache, dizziness, and body weakness. There were no other significant symptoms. Neurological examination revealed reduced muscle tone of bilateral lower limbs but otherwise unremarkable. The computed tomography (CT) scan of his brain showed no abnormality. Blood specimens for microbiological culture grew Salmonella Typhi. This isolate was susceptible to chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. He was treated with intravenous ceftriaxone for one week and responded well. He was discharged with oral ciprofloxacin for another week. The repeated blood and stool for bacterial culture yielded no growth of Salmonella Typhi.

Intestinal Parasites and Salmonella typhi Infection among Food-handlers in Port Harcourt Metropolis, Nigeria

Background: Intestinal parasites andSalmonellainfections are of main public health concerns in Nigeria and the world, especially in developing countries where access to safe water and hygienic food handling practices by food handlers is a challenge. Consequently, food-handlers play a major role in the transmission of these types of foodborne diseases.Objective: This study was to determine the preponderance of intestinal parasites and Salmonella typhiamong food-handlers in selected areas in Port Harcourt.Materials and Methods: A total of 480 food-handlers (195 males and 285 females) of various educational levels were sampled. Stool samples were collected and analyses were carried out using direct smear examination and formol-ether concentration technique -adopted for nvestigation of intestinal parasites and deoxycholate citrate agar and Salmonella-Shigella agar for the cultivation of Salmonella typhi.Results:Of 480 food-handlers examined, comprisesof 195(40.6%) males and 285(59.4%) females,-majority (85.4%) were young adults aged 20-40 years. 47.9% of them -had education above secondary educational level. The preponderance of intestinal parasites was 48(10.0%) and implicated were Ascaris lumbricoides(41.7%), hookworm (33.3%) and Trichuris trichiura(25.0%). No intestinal protozoa were identified. Prevalence of 30(6.3%) was recorded for Salmonella typhi.Conclusion:Prevalence of Intestinal Parasites and S.typhi infection is relatively low among food handlers in Port Harcourt, but indicates the important role food handlers play in the transmission of the infection. Therefore, awareness should be step-up forthe food handlers to avoid escalation of these infections

Seropositividad de H. pylori y Fiebre Tifoidea en Pacientes iraquíes con dispesia / Seropositivity of H. pylori and Typhoid Fever in Dyspesia Iraqi Patients

Background: There are many studies highlight the association between Helicobacter pylori seropositivity with typhoid fever in human populations and there is no study in Iraq. Aim: Our study designed to estimate the correlation between seroprevelace of H. pylori and Typhoid fever in clinically examined patients as dyspeptic and typhoid fever infected. Methods: From May (2016) to February (2018), a total of 213 patients (134 females and 79 male) attending an enterology outpatient clinic in AL-Najaf province, Iraq. The patients with age range from 10 to 90 years and with symptoms of dyspepsia and typhoid fever (as fever, diarrhea, headache), were referred to serologic diagnosis of antibodies against H. pylori (IgG) and Typhoid (IgG and/or IgM), using the Rapid Tests Cassette. Results: Of a total of 213 clinically examined as dyspeptic and typhoid fever infected patients,134 (63.0%) were females and 79 (37.0%) were males.In this study, 82 (38.5 %) of 213 patients were seropositive for typhoid fever and 131 patients were seronegative. Moreover, 128 (60.1 %) of 213 patients were seropositive for H.pylori IgG (51 case,39.8%, typhoid seropositive, and 77 case,60.2%, typhoid seronegative) and 82 were seronegative. The serologic co-infection diagnosed in 51 (24.0%) patients. The seropositivity of typhoid fever was higher in H. pylori seropositive patients, co-infections (62.2 %), than H. pylori seronegative patients (37.8%). The co-infection was more in female (64.7%) than male (35.3%). In respect of age H. pylori seropositivity was more prevelance (25.8%) in 30s age group where as co-infection was more prevalence in 40s age group (29.4%). But the statistical analysis showed insignificant association of H. pylori with typhoid fever (P value = 0.6203), gender (P value = 0.4770) and age groups (P value = 0.0745). Conclusion: Our study indicates that H. pylori seropositive dyspepsia more susceptiple to typhoid fever particularly in female and 40s ages and suggest there was insignificant relationship amongst seropositivity of H. pylori and typhoid fever within dyspepsia patient

Typhidot IgM as a reliable and rapid diagnostic test for typhoid fever among children in a tertiary care hospital

Background: Typhoid fever still continues to be a major public health problem in Nepal. A clinical spectrum of typhoid varies widely. It causes significant complication as well as mortality. A simple, reliable, affordable and rapid diagnostic test has been a long felt need of the clinicians to prescribe specific medication, adopt prevention of the emergence of antibiotics resistance and overall reduce the disease burden in the community.Methods: The prospective descriptive study was performed in 125 children between 2 years to 15 years of age admitted to the Pediatrics Department from September 2017 to September 2018. Blood culture, Typhidot rapid IgM were performed. MEDCALC software was used to calculate 95% confidence interval for sensitivity, specificity, predictive value positive, predictive value negative and accuracy. Kappa test was used to determine the agreement between Typhidot IgM and blood culture methods.Results: The study consisted of 125 children with acute febrile illness for more than 3 days with clinical symptomatology, consistent with typhoid fever. The reliability of Typhidot IgM in relation with blood culture and the study lighten that sensitivity 92.3% (95% CI: 63.9, 99.8), specificity 49.1% (95% CI: 39.5, 58.7), PPV 17.4% (95% CI: 14.2, 21.1), NPV 98.2% (95% CI: 89.2, 99.7) and accuracy 53.6% (95% CI: 44.5, 62.6). The two methods i.e. Typhoid IgM and blood culture shows significant agreement with p value 0.004.Conclusions: The present study demonstrates that Typhidot IgM has all the attributes of an ideal screening test.

Clinical profile and antibiotic sensitivity pattern of typhoid fever in children: a hospital based prospective study from a tertiary care center

Background: Typhoid fever is a serious public-health problem in many developing countries including India. There is a wide spectrum of clinical presentation and with the emergence of multidrug resistant typhoid now a days, the treatment has become still more complex. The present study authors describe the clinical profile and antibiotic sensitivity pattern of typhoid fever in children from a tertiary care in Mahabubnagar, Telangana, South India.Methods: This hospital based prospective observational study was done in Department of Pediatrics, SVS Medical College, Mahabubnagar, Telangana over a period of 3-year period from January 2017 to December 2019. The study was approved by institutional ethics committee. Written informed consent was obtained from children's parents. All pediatric patients diagnosed as typhoid fever if presented with fever (temperature >38'C) for at least 3 days with positive blood culture for S. typhi or paratyphi were included in the study. The demographic profile and clinical data were recorded and tests including antibiotic sensitivity and resistance were done.Results: A total of 136 patients were included in the study. Majority of the children were between 8 to 12-year age group (38.2%). Out of 136 children, 78 were males and 58 were females. Majority of the cases were from rural areas accounting for 69%. Drinking water source was tap water in 63% cases and bore well water in 37% cases. Majority (65%) belonged to lower socioeconomic class and 68% were during rainy seasons. The clinical findings observed were fever (100%), vomiting (98, 72%), diarrhea (55.8%), headache (45.5%), and splenomegaly (42.6%). Other clinical features found were coated tongue, abdominal pain, hepatomegaly, constipation, and dehydration. Six children had complications, 3 had enteric hepatitis, 2 had shock, and 1 had encephalopathy. Ampicillin, amoxicillin and chloramphenicol resistance was observed in 76%, 71% and 22% of patients with typhoid fever respectively. Maximum sensitivity was observed with ceftriaxone (95%), followed by aztreonam (92%), ciprofloxacin (84.5%), and azithromycin (77%).Conclusions: Clinical presentation in the study subjects was similar to available reports from literature. Increasing resistance of salmonella to Ampicillin and amoxicillin were observed.

Perfil de resistencia de la Salmonella sp durante un periodo de tres años en un hospital de Colombia / Resistance Profile of Salmonella SP During a Period of Three Years in a Hospital of Colombia / Perfil de resistência de Salmonella SP durante um período de três años em um hospital da Colômbia

Resumen Introducción: en Colombia, del 2000 al 2012, se describió un aumento progresivo en la resistência a betalactámicos y quinolonas en los aislamientos de Salmonella sp. A partir de esta fecha se desconoce la evolución de las tasas de resistencia en el país. El objetivo de este estúdio fue describir el perfil de suscep tibilidad durante el periodo 2014-2017 así como evaluar la asociación entre las características clínicas y sociodemográficas de la población con los patrones de resistencia de Salmonella sp. Materiales y méto dos: estudio de corte transversal del 2014 al 2017, realizado en la Fundación Cardioinfantil en mayores de 18 años, con aislamiento de Salmonella sp en cualquier tipo de muestra biológica. Resultados: se encontraron sesenta casos, ningún aislamiento fue resistente a quinolonas, uno mostró resistencia a ampicilina y uno se caracterizó como ; el 95 % tenia perfil de susceptibilidad usual. No se encontró asociación entre las variables estudiadas y la presencia de resistencia. Conclusión: los resultados pueden reflejar un cambio en el perfil de susceptibilidad de Salmonella sp en Colombia, con una disminución en la resistencia a betalactámicos y quinolonas a partir del 2014. Sin embargo, se requiere una mayor muestra poblacional para corroborar esta hipótesis.

Abstract Objective: In Colombia, from 2000 to 2012, a progressive increase in resistance to beta-lactams and quinolones was described in isolates of Salmonella As of this date, the evolution of resistance rates in the country is unknown. The objective of this study is to describe the susceptibility profile from 2014 to 2017, as well as to evaluate the association between the clinical and sociodemographic characteristics of the population with the resistance patterns of Salmonella Materials and methods: The study is a cross-sectional study between 2014 and 2017 at the Fundación Cardioinfantil, in patients over 18 years of age with Salmonella in any type of biologic sample. Results: The authors found 60 cases, no isolate was resistant to quinolones. One showed resistant to ampicillin, and añother one was characterized as amp-C; 95% had a usual susceptibility profile. No association was found between the variables studied and the presence of resistance. Conclusion: The results may reflect a change in the susceptibility profile of Salmonella in Colombia, with a decrease in resistance to beta-lactams and quinolones as of 2014; however, a larger population sample is required to corroborate this hypothesis.

Resumo Objetivo: Na Colômbia do ao 2000 ao 2012 se descreveu um aumento progressivo na resistência a beta-lactâmicos e quinolonas nos isolamentos de Salmonella sp. A partir desta data se desconhece a evolução das taxas de resistência no país. O objetivo deste estudo é descrever o perfil de susceptibilidade do ao 2014 ao 2017, assim como avaliar a associação entre as características clínicas e sociodemográficas da população com os patrões de resistência Salmonella sp. Materiais e métodos: Estudo de corte transversal do ano 2014 ao ao 2017 realizado na Fundación Cardioinfantil em maiores de 18 ao anos com isolamento de Salmonella sp, em qualquer tipo de amostra biológica. Resultados: se encontraram 60 casos, nenhum isolamento foi resistente a quinolonas, um mostrou resistência a ampicilina e um se caracterizou como AMP-C, o 95 % tinha perfil de susceptibilidade usual. Não se encontrou associação entre as variáveis estudadas e a presença de resistência. Conclusão: Os resultados podem refletir uma mudança no perfil de susceptibilidade de Salmonella sp. Na Colômbia, com uma diminuição na resistência a beta-lactâmicos e quinolonas a partir do año 2014, no entanto se requere uma maior amostra populacional para corroborar esta hipótese.

Study on ultrasound observations in children with typhoid fever in a tertiary care hospital

Background: Enteric fever continues to be endemic in poor countries globally, although it has been eradicated from the developed nations due to their well-organized sanitation and protected water supply. The five Fs most concerned with spread of typhoid disease are fingers, food, fomites, flies, and feces. Enteric fever is predominantly caused by Salmonella typhi and next in frequency is Salmonella paratyphi. Very less literature is available on radiological manifestations of typhoid fever in children on the basis of age difference in India. Hence, a study was conducted to observe the radiological findings and to correlate with laboratory manifestations in typhoid fever. Objectives of the study was to observe the ultrasound abdomen changes in Typhoid fever at rural area.Methods: The current study was conducted at Department of pediatrics of Narayana Medical College Hospital, Nellore, Andhra Pradesh state in a period of one year. All patients presenting with fever having positive for Widal test were included. In total 50 patients were included and divided into 2 age groups, <5 years and >5years. The laboratory results and abdominal ultrasound were conducted in the two groups and compared.Results: Total 20 patients in <5 years age and 30 patients in >5 years were enrolled. Male to female ratio was 2:1 in both groups. Common laboratory findings showed 32 patients (64%) with Anemia, elevated liver enzymes in 40 patients (80%), and elevated ESR in 42 patients (84%). 45 patients have Splenomegaly and hepatomegaly with normal parenchymal echotexture. Gallbladder sludge and biliary sludge was seen in 6 patients. Thickened gall bladder in 34 patients (68%) was observed. Bowel wall thickening seen in 32 patients (64%). mesenteric lymphadenopathy in 36 patients (68%) observed. All were recovered by treatment.Conclusions: On ultrasound, splenomegaly, hepatomegaly, and thick-walled gallbladder were observed in most of the childrens with typhoid fever. Therefore, ultrasound can also be used as supportive diagnose along with laboratory parameters due to it is a non-invasive and economical tool of diagnosing typhoid.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

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.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

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.

A study on clinical profile of typhoid fever at Government General Hospital, Nizamabad, Telangana, India

Background: The disease is most common in India. Children are most commonly affected. Typhoid fever, also known simply as typhoid, is a bacterial infection due to specific type of Salmonella that causes symptoms.Methods: Prospective observational study, 100 children with fever more than 7 days attending pediatric departed at GGH, Nizamabad were included in this study.Results: Total 100 children included in this study, male were 62, female were 38. More cases were (43) in 5-10 years age group, 53 children, belongs to middle class, 30 children belongs to lower class and 17 children belongs to upper class. Most common physical finding was toxic look (52), fallowed by coated tongue (41), hepatomegaly (32), pallor (12), spleenomegaly (11), hepatospleenomegaly (8).Conclusions: Safe drinking water, hand washing, proper sanitation, health education to children and food handlers in schools and hostels will decrease the incidence of typhoid fever in children.

Typhoid fever: Control & challenges in India

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.

Spatiotemporal Trend of Waterborne Disease in Enugu Urban, Nigeria: A Retrospective Study

Many water sources in Nigeria are contaminated with pathogens. Several towns have witnessed outbreaks of enteric diseases due to poor hygienic standards of available drinking water. This research was undertaken to determine the spatiotemporal trends of waterborne diseases (WBDs) in Enugu, Nigeria using retrospective records from January 2013 to December 2016. A total of 18,495 individual reported cases of WBDs were analysed. The analysis showed an increasing temporal trend from 2013 to 2015, with a slight decrease in 2016. Typhoid fever had the highest frequency (48.9%) followed by diarrhoea (40%) and then dysentery (11.1%). The highest (88.9%) incidence of waterborne diseases per 10,000 peoples was from Enugu North followed by Enugu South (62.6%) and least was Enugu East (44.4%). Highest occurrence of typhoid fever and dysentery per 10,000 peoples was also found in Enugu North while Enugu East had the highest occurrence of diarrhoea in the four-yeartrends. WBDs were highest between January and March and least in July. The months with peak occurrence of WBDs falls within the dry season. The importance of having drinking water in both quality and quantity cannot be overestimated as portrayed in this study. Drinking water quality in Enugu urban is very poor especially during the dry season. This suggests a need for setting up a modality to tackle challenges of limited water supply during the dry seasons of the year and to educate the populace on household water treatment and storage method