Yields from blood cultures of patients with suspected paratyphoid fever A

The yield and speed of detection of Salmonella enterica serotype Paratyphi A from the blood of patients with suspected paratyphoid fever A in 13 500 paired aerobic and anaerobic bottles (AEB, ANB) that were each filled with 5 ml of blood by the BacT/ALERT 3D system were compared, and the blood bacterial counts of 1 000 probable patients were estimated by pour plate method. A total of 4 060 isolates were recovered, of these, 3 149 were recovered from both AEB and ANB, 461 from the AEB only, and 450 from the ANB only. The estimating median bacterial count in blood from 400 patients was 0.5 CFU/ml. The research findings demonstrate that the blood volume drawn is an important factor determining the yields from blood cultures. Growth of significantly more isolates was detected earlier in AEB.

Isolation of Salmonella paratyphi A from renal abscess.

Intrarenal abscesses remain a significant cause of morbidity and mortality as well as a diagnostic dilemma because a plethora of microorganisms can cause this condition. A definitive diagnosis is made by demonstrating the organisms from the aspirate and the success or failure of therapy depends upon the antimicrobial sensitivity pattern. Enteric fever is a multisystem disorder caused by invasive strains of salmonella. Salmonellosis continues to be a major public health problem, especially in developing countries. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C. However, at times S. paratyphi is capable of causing serious and often life-threatening infections like infective endocarditis, pericarditis, empyma, sino-venous thrombosis, osteomyelitis, meningitis, bone marrow infiltration, hepatitis and pancreatitis. There are anecdotal case reports in world literature of abscesses being caused by this organism. Renal involvement like bacteriuria, nephrotic syndrome and acute renal failure have been reported due to S. parayphi A. S. paratyphi A has never been implicated in renal abscess, we report one such case that was managed successfully with medical therapy.

Nested PCR based diagnosis of salmonella enterica serovar paratyphi a directly from blood samples

Development of a rapid, reliable PCR - based method for molecular identification of Salmonella enterica serovar Paratyphi A directly from blood samples. S. Paratyphi A isolates were used for regular PCR targeting specific region of fliC-a gene. New primers were designed and conditions were optimized for a nested PCR that could be directly applicable on blood samples. The procedure was tested on 70 blood samples from suspected cases of typhoidal infection and comparison made with blood culture. Blood culture was able to diagnose only four patients as infected with S. Paratyphi A. Regular PCR was unable to detect S. Paratyphi A directly from blood where as nested PCR detected S. Paratyphi A in blood of thirteen patients. S. Paratyphi A, which is emerging as a major pathogen can be detected with better sensitivity by nested PCR as compared with blood culture

Paratyphoid sepsis.

A large for gestational age male baby was born to a healthy young primigravida, on L-thyroxime, at 40 weeks by caesarean delivery in a tertiary care hospital. The baby had episodes of hypoglycemia during his immediate four postnatal days in the nursery that were successfully managed with intravenous glucose administration. The baby became unwell on day 5 and had a positive sepsis-screening test. Blood culture revealed a multidrug susceptible S. Paratyphi A strain, which he probably acquired on the first or second postnatal day from the contaminated expressed breast milk or the formula feed.

Prospective evaluation of a rapid diagnostic test Typhidot for typhoid fever.

BACKGROUND & OBJECTIVE: Typhoid fever still continues to be a major public health problem around the world. A simple, reliable and affordable rapid diagnostic test has been a long felt need of the clinicians. We therefore prospectively evaluated the sensitivity and specificity of Typhidot test. METHODS: The study was carried out between January 2002 and December 2003, on a total of 563 samples from patients clinically suspected to have typhoid fever; blood culture as well as serum for Typhidot test were received. RESULTS: Of the 563 samples, Typhidot test and blood culture were positive in 36 patients, both the tests were negative for 503 patients. Typhidot test was positive for 9 patients with S. Paratyphi A infection. The sensitivity and specificity of the test using blood culture as gold standard were 92.3 and 98.8 per cent respectively for the typhoid fever. INTERPRETATION & CONCLUSION: Typhidot test is rapid, easy to perform and reliable test for diagnosing typhoid fever, useful for small less equipped laboratories as well as for those with better facilities.

Pancreatitis in enteric fever.

Pancreatitis in enteric fever is rare. We report two patients with enteric fever, one due to Salmonella typhi infection and other due to S. paratyphi, who on investigation were found to have pancreatitis. Both patients recovered uneventfully.

Fiebre paratífica: estudio de 107 pacientes / Paratyphoid fever: study of 107 patients

Se presenta un estudio en 107 pacientes con diagnóstico de fiebre paratífica, internados en el Hospital Central de la Sanidad de la Policía Nacional del Perú (HCSPNP) entre setiembre de 1988 y agosto de 1993. Noventa y siete pacientes (91 por ciento) tuvieron hemocultivo positivo, de los cuales el 95 por ciento (92 pacientes) correspondió a S. paratyphi A y el 5 por ciento a S. paratyphi B. El 76 por ciento (82 pacientes) se encontraban entre los 15 y 35 años de edad. El tiempo promedio de enfermedad al ingreso fue de 8 días. El 100 por ciento presentó fiebre, hepatomegalia 45 por ciento, esplenomegalia 36 por ciento, sensibilidad abdominal 38 por ciento y alrededor de 35 por ciento presentó diarrea o estreñimiento. Presentaron leucopenia el 50 por ciento y desviación izquierda el 73 por ciento. La TGO se elevó en el 58 por ciento y la TGP en el 65 por ciento. El examen de aglutinaciones fue positivo (>1/80) en sólo 34 por ciento de casos. Dentro de nuestros criterios de inclusión, ningún diagnóstico se basó en el hallazgo aislado de aglutinaciones positivas. El tratamiento de la mayoría de pacientes (78:73 por ciento) fue con cloramfenicol (sensibilidad antibiótica del 98 por ciento en los cultivos), seguido del cotrimazo (sensibilidad 89 por ciento) y de ampicilina (sensibilidad 53 por ciento). Con el inicio de la terapéutica la caída de la fiebre ocurrió en un promedio de 4,9 días y sólo se presentó recaída en 7 pacientes (6.5 por ciento); la mortalidad fue de cero. En conclusión la fiebre paratífica requiere para el diagnóstico de sospecha una buena historia clínica, el auxilio de un hemograma y el dosaje de transaminasas. El hemocultivo mantiene su importancia para el diagnóstico de certeza. El cloramfenicol y el cotrimoxazol aún son agentes de primera línea para su tratamiento.

Value of clinical features in the diagnosis of enteric fever.

There is no objective data on the value of individual clinical symptoms or signs in the diagnosis of enteric fever in a febrile patient. The purpose of the study was to assess the value of some clinical and simple laboratory features in the diagnosis of enteric fever. One hundred & six patients with microbiologically confirmed enteric fever and 170 patients with other established febrile illnesses were included in the evaluation. History of stepladder pattern of rise of temperature, loose motions, relative bradycardia and coated tongue proved to be powerful markers of enteric fever with high specificity (100%, 94.71%, 94.71%, 94.12% respectively), positive and negative predictive values. Headache, hepatomegaly and splenomegaly were moderately powerful. ESR and WBC count appeared to have little value in the diagnosis of enteric fever. Pattern of onset and loose motions did not discriminate between typhoid and paratyphoid fever. Most of these patients had illness persisting beyond one week by which viral infections and infectious enterocolitides were largely excluded. Elucidation of power of these markers in distinguishing enteric fever from other febrile illnesses with the help of better designed prospective studies would lessen our dependence on expensive and time consuming laboratory investigations.

Monoclonal antibodies against protein antigens of salmonellae causing paratyphoid fever and their diagnostic application.

Hybrid clones producing monoclonal antibodies (MAbs) specific for Salmonella paratyphi A (72 clones), S. paratyphi B (9 clones) and S. paratyphi C (8 clones) were produced by using the affinity purified Salmonella protein (Bp) as immunogens. MAbs to S. paratyphi A and S. paratyphi B reacted specifically with the 52 kDa homologous flagellin protein components while those to S. paratyphi C reacted with a 61 kDa flagellin protein component. The MAbs against S. paratyphi A and S. paratyphi B were used to establish a double antibody sandwich ELISA for detection of the 52 kDa flagellin antigens in serum samples from patients with acute paratyphoid A and paratyphoid B fever. With this assay system, 6.25 ng per ml of flagellin antigens of S. paratyphi A and S. paratyphi B could be detected. However, the assay system could not detect the flagellin antigens in patients' sera. The presence of IgM antibodies to the 52 kDa antigens of S. paratyphi A and S. paratyphi B in the acute sera from paratyphoid A or paratyphoid B patients suggested that the 52 kDa protein components of both salmonellae are good immunogens for human and might be used as antigens for early diagnosis of paratyphoid A and paratyphoid B fever.

Septicemias por salmonella en un recién nacido: caso clínico / Septicemia by salmonella in a newborn: clinical case

Un recién nacido, hijo de una madre infectada con salmonella paratyphi B, evoluciona en el período neonatal inmediato, con una sepsis por salmonella paratyphi B. El contagio ocurre en el período intrauterino. La sepsis se confirma con hemocultivos (+) en la madre y el hijo al mismo germen

Detection of salmonella typhimurium in a broiler chicken flock

Um surto de paratifo aviário, causado por Salmonella typhimurium, acometeu um lote de frangos de corte de uma granja comercial. Os sintomas começaram a aparecer a partir do quinto dia de vida das aves. As alteraçöes sofridas culminaram com perdas, devido a mortalidade e refugagem, acima do esperado

Typhoid and paratyphoid fever: a retrospective study.

Sixty-eight proved cases of typhoid and paratyphoid fever were reviewed in a retrospective study covering 5 years (1986-1990). Patients within the age range of 10 to 39 years constituted 82.3 per cent of cases and there was equal incidence in both sexes. The mean duration of illness before presentation was 9.67 days. The major clinical features were fever (97%), abdominal tenderness (-9.4%), headache and abdominal pain (70.58%) each). Intestinal perforation was the commonest complication (27.9%) with a male preponderance (M:F-3:1). Perforation occurred after the first week of illness in 73.7 per cent of cases. Fourteen out of the nineteen patients who perforated were not on therapy at the time of perforation and they constituted 80 per cent of those cases of mortality in which perforation played a role. Surgical management of perforation gave better results than conservative management (mortality rates of 16.7% and 40% respectively). Salmonella was sensitive to Chloramphenicol in all the cases where the organism was grown. There were 10 recorded deaths (14.9%) of whom 60 per cent (i. e. 6 patients) presented after two weeks of illness.

Estudio retrospectivo de la fiebre paratífica: clínica y complicaciones en el Centro Médico Naval 1986-1990

El presente es un estudio retrospectivo de 107 pacientes con fiebre partífica internados en el Centro Médico Naval del Callao, diagnósticados en el 90.7 por ciento de los casos por hemocultivo, que resultó positivo a S. paratyphi a en el 95.3 por ciento. Se encontró que el 88.35 por ciento de las viviendas de los pacientes son de material noble, con servicios de agua, desague y luz; el 16.5 por ciento de los pacientes fueron oficiales de la Marina (Plana Mayor). El 51.5 por ciento de los pacientes presentó el antecedente de alimentarse en la calle. La población mayormente afectada es la adulta joven, correspondiendo el 76.7 por ciento de los casos entre los 15 a 35 años de edad. La enfermedad se presenta como un cuadro agudo de grado leve a moderado, con un tiempo de enfermedad al ingreso promedio 8.2 días; con fiebre en 100 por ciento de los casos, malestar general 93.5 por ciento, cefalea 83.2 por ciento e hiporexia 80.4 por ciento. Los síntomas de diarrea, estreñimiento, náuseas, se presentaron en aproximadamente un tercio de casos. Al examen clínico se presentó fiebre en 86.1 por ciento de casos, con disociación pulso/temperatura en 12.9 por ciento. Compromiso del sensorio se encontró en el 7.5 por ciento de pacientes; hepatomegalia en el 44.9 por ciento y esplenomegalia en el 36.5 por ciento. Sensibilidad abdominal se halló en 38.3 por ciento de pacientes y borborigmos en FID en el 19.6 por ciento. En el hemograma de ingreso se encontró leucopenia en el 50 por ciento de casos, y desviación izquierda en el 72.7 por ciento. No se presentaron casos de leucocitosis. Se encontró alteración en las pruebas de bioquímica hepática en el 80.2 por ciento, y en el sedimiento de orina en el 14.1 por ciento de pacientes. las aglutinaciones muestran solo un 34 por ciento de positividad. El tratamiento instalado fué de cloranfenicol en el 72.9 por ciento de casos, con una sensibilidad antibiótica de 98.7 por ciento. Con el tratamiento la caída de fiebre se produce en 4.9 días en promedio. Se presentaron recaídas en el 6.5 por ciento de los casos. Se presentaron como complicaciones un paciente con perforación intestinal, uno con hemorragia intestinal, una paciente con aborto retenido y tres pacientes con sacroileítis considerada reactiva, esta última complicación no reporta anteriormente. La mortalidad entre los pacientes fué cero

Isolation of Salmonella paratyphi A from thyroid abscess--a case report.

S. paratyphi A isolated from aberrant site i.e. thyroid abscess which is an unusual manifestation of focal salmonella infection. It is reported for its rare complications.

Detection of Salmonella typhi protein antigen in serum and urine: a value for diagnosis of typhoid fever in an endemic area.

Using haemoculture as the gold standard, a double antibody sandwich ELISA for the detection of Salmonella typhi Barber protein antigen (BP) was compared with the Widal test. Specimens used were serum and urine obtained from normal healthy individuals and from patients with typhoid fever, paratyphoid fever, pyrexia caused by other bacteria and pyrexia with negative haemoculture. The ELISA for antigenuria gave a significantly higher sensitivity, specificity, accuracy and positive predictive value than the Widal test (p less than 0.05). The ELISA for antigenaemia gave a significantly higher sensitivity and positive predictive value only. All other values were not significantly different. The timing of specimen collection was critical for sensitivity in the ELISA for antigenaemia and antigenuria, and the best results could be obtained by carrying out both assays simultaneously. The clearance of BP from serum into urine occurred around 16 days after the onset of fever in one patient. In two patients, BP could be detected in sera up to 3 weeks after the onset of fever. In two patients, serum BP could still be detected although haemoculture was negative.

Fiebre paratifoidea en pacientes hospitalizados / Paratyphoid in hospitalizated patients

Se estudian 48 pacientes del Hospital Arzobispo Loayza (Lima) durante los años 1979 a 1986 con diagnóstico de fiebre paratifoidea confirmada con diferentes tipos de cultivo (hemo, mielo, bili, copro o urocultivo) positivos a S.paratyphi A,B o C. Hubo 44 pacientes del sexo femenino de enfermedad de 12.25 días. Los síntomas principales fueron sensación febril, cefalea, malestar general y anorexia presentes en más del 70 por ciento de casos; los signos clínicos: fiebre en 79.2 por ciento, dolor abdominal 39.6 por ciento, bradicardia relativa 36.8 por ciento, hepatomegalia 33.3 por ciento, esplenomegalia 6.3 por ciento y roseola tífica en 2 por ciento. El número de leucocitos estuvo dentro de límites normales en su mayoría, pero con desviación izquierda, 29 por ciento presentaron leucopenia y 18.7 por ciento leucocitosis; S. paratyphi A fue aislada en 71 por ciento de los casos, S.paratyphi B en 27 por ciento y ambas en 2 por ciento, el mielocultivo fue el procedimiento más sensible con 87.5 por ciento de positividad, siguiendo hemocultivo con 85.2 por ciento, bilicultivo con 75 por ciento, coprocultivo con 50 por ciento y finalmente urocultivo con 2.7 por ciento; las aglutinaciones al antígeno A y B respectivamente tuvieron sensibilidad del 18.2 por ciento y 35.7 por ciento y especificidad del 77 por ciento y 90.6 por ciento; los casos con falsos positivos a los antígenos O y H tíficos fueron más del 27 por ciento. Hubo focalización en 70.8 por ciento de los casos, siendo hepático (58.3 por ciento) el más frecuente. En 87.5 por ciento de los casos se utilizó terapia adecuada con cloramfenicol, cotrimoxazole, amoxicilina o ampicilina, siendo el cloramfenicol el antibiótico elegido con mayor frecuencia (69 por ciento)