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.

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

Typhoid ileal perforation in children: does clinical diagnosis alone justify laparotomy?

Introduction: Typhoid ileal perforation is one of the most common surgical complications of typhoid fever, with high morbidity and mortality in resource poor tropical areas in Africa and other developing countries. Objective: The aim of this study was to evaluate clinical diagnosis of typhoid ileal perforation as justification for laparotomy. Method: A retrospective study from January 2008 to December 2011 in the Paediatric Surgery Division of the University of Abuja Teaching Hospital. Results: The age group most commonly affected was aged 6-9 years (43.5%); there were 20 (43.5%) males and 26 (56.5%) females. The commonest clinical features were fever, vomiting, abdominal pain, tenderness and distension (52.3%). Thirty one (67.4%) of the patients did not have any diagnostic radiological investigations. Fifteen (32.6%) patients had superficial wound infection, ten (21.7%) died, eleven (23.9%) had no complications. Conclusion: We advocate that under circumstances where urgent diagnostic radiological and laboratory investigations are not available promptly, clinical diagnosis of typhoid ileal perforation, especially signs of peritonitis should justify an emergency laparotomy

Algunas notas sobre el desarrollo histórico de la fiebre tifoidea en Chile / Some information regarding the historical development of typhoid fever in Chile

Resumen En el desarrollo histórico de la fiebre tifoidea en Chile, destaca su confusión con otras patologías infecciosas, especialmente con el tifus exantemático, problema que se resolvió mayormente con ocasión de la epidemia de 1918 de dicha enfermedad. Además se resalta la importancia del tratamiento con cloranfenicol, que significó una mejoría extraordinaria de las fiebres tifo-paratíficas, además de las acciones de salud pública y educación sanitaria, que permitieron prácticamente terminar con dichas patologías infecciosas en el país.

During the historical development of typhoid fever in Chile, its confusion with other infectious diseases is particularly noteworthy, especially with murine typhus, a problem that was mainly resolved during the 1918 epidemic. The importance of chloramphenicol treatment is also highlighted, which meant an enormous improvement in typhoid/paratyphoid fevers, in combination with public health and health education actions that allowed to almost eliminate these infectious diseases in our country.

Difficultés diagnostiques de la fièvre typhoïde en milieu urbano-rural congolais. Etude menée à Kalemie, province du Tanganyika (République Démocratique du Congo)

Introduction : La fièvre typhoïde est un problème de santé publique qui affecte surtout la population des pays en voie de développement suite aux déficits des mesures d'hygiène. L'objectif de cette étude consistait à déterminer ses modalités diagnostiques.Patients, matériel et méthodes : C'est une étude rétrospective, descriptive et analytique de 2013 à 2014 à l'hôpital général de référence de Kalemie (RD Congo). Elle concernait les cas diagnostiqués et traités de fièvre typhoïde en médecine interne et pédiatrie.Résultats : La fréquence des patients chez qui le diagnostic de la fièvre typhoïde a été évoqué représente 3,3% avec 3,0% en pédiatrie et 4,1% en médecine interne. Les enfants étaient les plus affectés, surtout de sexe féminin. La clinique restait dominée par la fièvre, asthénie physique, anorexie, céphalée et troubles digestifs. Le test de Widal-Félix sur plaque a été demandé dans 82,9% avec 70,1% de positivité alors que 17,1% des patients étaient diagnostiqués sur base des arguments cliniques. Il a été noté une forte association diagnostique (traitée) paludisme-fièvre typhoïde (73,8%).Conclusion : Dans notre série, le diagnostic de la fièvre typhoïde pose de sérieux problèmes liés notamment aux explorations de biologie médicale. Cette dernière devrait contribuer à appuyer la clinique. Les efforts devraient être fournis pour améliorer le diagnostic et prise en charge adéquate des patients, épargnant ainsi au malade des antibiothérapies inutiles

Rapid detection of Salmonella Typhi by loop-mediated isothermal amplification (LAMP) method

An in-house loop-mediated isothermal amplification (LAMP) reaction was established and evaluated for sensitivity and specificity in detecting the presence of Salmonella Typhi (S. Typhi) isolates from Kelantan, Malaysia. Three sets of primers consisting of two outer and 4 inner were designed based on locus STBHUCCB_38510 of chaperone PapD of S. Typhi genes. The reaction was optimised using genomic DNA of S. Typhi ATCC7251 as the template. The products were visualised directly by colour changes of the reaction. Positive results were indicated by green fluorescence and negative by orange colour. The test was further evaluated for specificity, sensitivity and application on field samples. The results were compared with those obtained by gold standard culture method and Polymerase Chain Reaction (PCR). This method was highly specific and -10 times more sensitive in detecting S. Typhi compared to the optimised conventional polymerase chain reaction (PCR) method.

Síndrome febril prolongado: un desafío para el infectólogo pediatra / Fever of unknown origin: a challenge for the pediatric infectious diseases specialist

Introduction: Prolonged febrile syndrome (PFS) is defined as fever 7-10 days, with initial study does not allow etiologic diagnosis. Objective: To describe the main causes of the PFS and its temporal behavior in Pediatric Infectious Diseases Unit Outpatient Care of Complejo Asistencial Dr. Sótero del Río (CASR). Patients and Methods: A descriptive, prospective study between january 2007-december 2012, about 153 patients from 6 weeks to 14 years 11 months old, diagnosed with PFS, tab completing clinical and laboratory monitoring. Results: etiology was obtained in 67.9%, the causes were infection (88.4%), neoplasms (4.8%), rheumatological (4.8%) and Kawasaki disease (2.8%). The most important infectious causes were enteric fevers (typhoid and paratyphoid) (18.4%), urinary tract infection (11.9%), Bartonella henselae infections and adenovirus (8.7%) each one and Epstein Barr virus (7.6%). Ninety eight percent of patients had complete resolution, 60.7% did not require hospitalization and mortality was 0%. Discussion: As in previous pediatric clinical series the infections were the most frequent causes. Enteric fever persists as principal cause, however, the epidemiological evidence is oscillating in time endorsing the local statistics can count over the years to improve the diagnostic and therapeutic approach.

Introducción: El síndrome febril prolongado (SFP) se define como fiebre entre 7-10 días, con estudio inicial que no permite un diagnóstico etiológico. Objetivo: Describir las principales etiologías del SFP y su comportamiento temporal en la unidad de infectología pediátrica ambulatoria del Complejo Asistencial Dr. Sótero del Río (CASR). Pacientes y Método: Estudio descriptivo, prospectivo, entre enero de 2007-diciembre de 2012. Análisis de 153 pacientes entre 6 semanas y 14 años 11 meses de edad, con diagnóstico de SFP, que completaron ficha de seguimiento clínico-laboratorial. Resultados: Se obtuvo diagnóstico etiológico en 67,9%, las causas fueron: infecciones (88,4%), neoplasias (4,8%), reumatológicas (4,8%) y enfermedad de Kawasaki (2,8%). Las causas infecciosas más importantes fueron: fiebres entéricas (tifoidea y paratifoidea) (18,4%), infección del tracto urinario (11,9%), enfermedades por Bartonella henselae y adenovirus (8,7%) cada uno y virus de Epstein Barr (7,6%). El 98% de los pacientes tuvo resolución completa, 60,7% no requirió hospitalización y no se registraron decesos. Discusión: Como en las series clínicas antes publicadas, las infecciones fueron la causa más frecuente de SFP. La fiebre entérica persiste como causa principal; sin embargo, se evidencia una situación epidemiológica oscilante en el tiempo justificando la necesidad de contar con estadísticas locales a lo largo de los años para mejorar el enfoque diagnóstico y terapéutico.

A Prevalence Study of Typhoid Fever in Taiz and Al-Hodiedah cities in Yemen.

Aims: Typhoid fever is an acute illness associated with fever that is most often caused by the Salmonella typhi bacteria. This study was carried out to determine the prevalenece of typhoid fever and distribution among different groups in Al-hodiedah and Taiz hospitals, and to determine the relation between the two governorates. Study Design: Seroprevalence survey. Place and Duration of Study: This study was carried out in Taiz hospitals and Al- Hodiedah hospitals in Yemen for about 1500 cases during September to December 2012. Methodology: A total of 1500 cases were randomly collected and examined by Widal test and blood samples for WBC to detect the typhoid fever. Also, the questionnaire data was used for determine the correlation between typhoid fever and other factors such as age, sex, and clinical symptoms, then the data analyzed by spss program. Results: This study found that 151 cases of typhoid fever are positive for widal test from total 1500 specimens was collected from Al-hodiedah hospitals and Taiz hospitals. Also found from 151 positive cases 57 cases for male and 94 cases for female. There were 55 cases the main complain was fever follow by diarrhea 42 cases then abdominal pain 31 cases. Conclusion: The results of the study indicate that there is no significant different in the prevalence of typhoid fever between cases collected from Taizhospitals and Al-Hodeida hospitals. Also, no significant different between sex or age and the positive cases. The positive cases were come with different manifestations such as fever, abdominal pain and diarrhea.

Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta [CHQ] from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot [Trade Mark] tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 [18.6%] patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever

Acute cholecystitis from typhic origin in children

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

Early diagnosis of typhoid fever by nested PCR for flagellin gene of Salmonella enterica serotype Typhi.

Background & objectives: Typhoid fever caused by Salmonella Typhi continues to be a major health problem in spite of the use of antibiotics and the development of newer antibacterial drugs. Inability to make an early laboratory diagnosis and resort to empirical therapy, often lead to increased morbidity and mortality in cases of typhoid fever. This study was aimed to optimize a nested PCR for early diagnosis of typhoid fever and using it as a diagnostic tool in culture negative cases of suspected typhoid fever. Methods: Eighty patients with clinical diagnosis of typhoid fever and 40 controls were included in the study. The blood samples collected were subjected to culture, Widal and nested PCR targeting the flagellin gene of S. Typhi. Results: The sensitivity of PCR on blood was found to be 100 per cent whereas the specificity was 76.9 per cent. The positive predictive value (PPV) of PCR was calculated to be 76.9 per cent with an accuracy of 86 per cent. None of the 40 control samples gave a positive PCR. Interpretation & conclusions: Due to its high sensitivity and specificity nested PCR can be used as a useful tool to diagnose clinically suspected, culture negative cases of typhoid fever.

Detection of chronic typhoid carriers among food handlers in Wad Medani, Gezira state, Sudan

Typhoid fever remains a disease of major public health importance in the tropics. This cross sectional prospective descriptive study was carried out between July 2005 to July 2008 in Wad Medani Town. The objective of the study was to identify chronic typhoid carriers among food handlers in Wad Medani. To achieve this objective, Vi agglutination test was used to determine suggested typhoid carriers among food handlers then stool culture was performed on those with a positive Vi agglutination test. A questionnaire was designed to collect data from suggested typhoid carriers about hygienic practices during food handling and processing. The collected data were reviewed and coded. Data were analyzed using SPSS versions 10.0 software for tabulation and statistical analysis. The results showed that, ten percent of the examined food handlers were found positive typhoid carriers by Vi agglutination test, 48.5% of the suspected of typhoid carriers were found positive by stool culture, street vendors were more common among suspected typhoid carriers, all of whom had not received any health education about typhoid disease. The study suggested the following recommendations: Regular health authority inspection visitor food handling personnel specially street vendors to exclude typhoid carriers among them, education and training course in good hygienic practices should be provided to all food handlers specially typhoid carriers Food Control Department, Ministry of Health, Gezira State

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3 percent of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90 percent (95 percent CI = 74.4-96.5), 100 percent (95 percent CI = 90.1-100), 100 percent (95 percent CI = 87.5-100), and 92.1 percent (95 percent CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7 percent (95 percent CI = 70.3-94.7), 85.7 percent (95 percent CI = 70.6-93.7), 83.9 percent (95 percent CI = 67.4-92.9), 88.2 percent (95 percent CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3 percent (95 percent CI = 19.8- 36.3), 64.6 percent (95 percent CI = 55.3-72.9), 89.1 percent (95 percent CI = 81.9-93.7), 80.9 percent (95 percent CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2 percent (95 percent CI = 69.4-94.5)] followed by Diazo [79 percent (95 percent CI = 61.6-90.2)], Widal [41.4 percent (95 percent CI = 25.5-59.3)] and blood culture [31 percent (95 percent CI = 17.3-49.2)]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Avaliação da completitude dos registros de febre tifóide notificados no Sinan pela Bahia / Assessment of completion of typhoid fever notification forms registered at Sinan by health services in the state of Bahia

Este estudo avaliou a completitude das fichas de investigação epidemiológica (FIE) de Febre Tifóide, na Bahia (2003-2006), e discutiu implicações para a vigilância e perfil epidemiológico da doença, tendo o Sistema de Informação de Agravos de Notificação (Sinan) e prontuários médicos como fontes de dados. O indicador empregado foi a proporção de cada campo preenchido, classificado como excelente (>90 por cento); regular (70 por cento-89 por cento) ou de baixa (<70 por cento) completitude. A maioria dos campos apresentou regular (70 por cento-89 por cento) ou baixa (<70 por cento) completitude. Somente nas variáveis de identificação verificou-se 100 por cento de completitude. Foram estatisticamente significantes as diferenças entre antes e após o encerramento de casos pendentes referentes ao número de casos confirmados (aumento anual médio de 15 por cento, em 2004-2006) e as proporções de FIE cujo campo “classificação final”encontrava-se preenchido (de 81,9 por cento em 2003 e 67,0 por cento em 2005, para 89,5 por cento e 77,6 por cento, nesses mesmos anos). O estudo evidenciou a necessidade de investimentos na melhoria do preenchimento das FIE da febre tifóide na Bahia e esclarecimento dos profissionais de saúde sobre a importância da informação.

This study assessed the filling out of typhoid fever epidemiological investigation forms (EIF) from 2003 to 2006 in the State of Bahia, Brazil and indicated its impact on surveillance and epidemiological profile of the disease. Data consisted of cases registered in the Information System for Notifiable Diseases (Sinan) and hospital medical records. The indicator used was each field completion rate which was classified as excellent (>90 percent), average (70 percent-89 percent) or low (<70 percent). Completion of variables ranged mostly from average (70 percent-89 percent) to low (< 70 percent) and only identification data were fulfilled 100 percent. Statistically significant differences were observed comparing data before and after resolving pending cases (with a 15 percent average annual increase of confirmed cases from 2004 to 2006). Also, the percentage of completion of the “final classification” field increased from 81.9 percent to 89.5 percent in 2003 and from 67.0 percent to 77.6 percent in 2005). Findings show the need to invest on data quality improvement related to the completion of all fields of typhoid fever investigation forms in Bahia and to instruct professionals on the importance of health information.

Co-infection of hepatitis A and E with Salmonella infection; a case report

Ours is a developing country so infectious diseases contribute maximum to the morbidity and mortality. Among these, water borne diseases like diarrhea, typhoid, infectious hepatitis etc. are on rise. Sometimes more than one type of infection coexists which makes the diagnosis and management a challenging task. We report a case of Coinfection of Salmonella typhi with Hepatitis A and E. A 5 year old male child came to us with complaints of fever and jaundice for last 9 days. Blood culture of patient was positive for Salmonella typhi. Viral markers turned out to be positive for Hepatitis A and E. To the best of our knowledge coinfection of Hepatitis A and E with Salmonella has rarely been reported earlier. In view of the restricted finances in our country vaccines against typhoid and Hepatitis A can not be incorporated in the national immunization schedule at present but these vaccines can be offered on an individual basis