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Gavi supports countries to introduce typhoid conjugate vaccine (TCV) with catch-up campaigns. Available TCVs are highly efficacious, equity-focused, and critical to curbing the expansion of antimicrobial resistance. Four Gavi-supported countries have introduced TCVs since 2018. In the wake of the COVID-19 emergency, momentum is building to scale up TCV introduction worldwide, supported by global partners and Gavi's funding for improved typhoid diagnostics.
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Typhoid fever is a significant global health problem that impacts people living in areas without access to clean water and sanitation. However, collaborative international partnerships and new research have improved both knowledge of the burden in countries with endemic disease and the tools for improved surveillance, including environmental surveillance. Two typhoid conjugate vaccines (TCVs) have achieved World Health Organization prequalification, with several more in the development pipeline. Despite hurdles posed by the coronavirus disease 2019 pandemic, multiple TCV efficacy trials have been conducted in high-burden countries, and data indicate that TCVs provide a high degree of protection from typhoid fever, are safe to use in young children, provide lasting protection, and have the potential to combat typhoid antimicrobial resistance. Now is the time to double down on typhoid control and elimination by sustaining progress made through water, sanitation, and hygiene improvements and accelerating TCV introduction in high-burden locations.
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The global response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic demonstrated the value of timely and open sharing of genomic data with standardized metadata to facilitate monitoring of the emergence and spread of new variants. Here, we make the case for the value of Salmonella Typhi (S. Typhi) genomic data and demonstrate the utility of freely available platforms and services that support the generation, analysis, and visualization of S. Typhi genomic data on the African continent and more broadly by introducing the Africa Centres for Disease Control and Prevention's Pathogen Genomics Initiative, SEQAFRICA, Typhi Pathogenwatch, TyphiNET, and the Global Typhoid Genomics Consortium.
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Objective: To describe a case of levo-dopa responsive parkinsonism secondary to combined COVID-19 and Enteric fever in a patient Background: The first link between viruses and parkinsonism comes from the possible relationship between lethargic encephalitis and the Spanish flu of 1918.In addition, other viruses, including West Nile virus, herpes viruses, influenza A virus, and human immunodeficiency virus (HIV), have been associated with parkinsonism Methods: A 31 years old presented with fever ,headache for 5 days followed by altered sensorium. At presentation he had neck rigidity ,was localizing to pain ,not fully oriented and not following verbal command but he had hypoxia and need nasal oxygen support.He had D-Dimer 12506,COVID-19 RTPCR positive and was treated with Remdesivir,ceftriaxone ,dexamethasone after which he had improvement in sensorium.At day 6 of illness he had generalized rigidity,bradykinesia with slow hypophonic speech and was needing support to sit and walk . A provisional diagnosis of infection related parkinsonism was considered and Cerebrospinal fluid study,MRI Brain and spine ,Blood culture were done .His Cerebrospinal fluid study has normal protein , glucose,cells, stains and culture and negative autoimmune and paraneoplastic plane . His urine culture,blood culture was positive for salmonella typhi and serum widal titre was 1:640.MRI Brain and spine does not show any new abnormalities except old trauma sequalae. He was treated with Levo-dopa carbidopa and titrated to a dose of 675 mg/day and had sustained improvement with levo-dopa carbidopa .There are 6 other case of COVID-19 associated parkinsonism in literature .There are also few case of typhoid associated case of parkinsonism described in literature . Our patient had combined infection of both COVID-19 and typhoid associated parkinsonism. Result(s): We report a case of Infection related parkinsonism secondary to combined COVID-19 plus typhoid infection Conclusion(s): Exploring the potential relationship of co-infection SARS-CoV-2 and Salmonella typhi infection with development of parkinsonism is essential because of the epidemiological implications,as well as to gain a better understanding of the pathophysiological aspects of these disorders.
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Hygiene is the most useful public health measure for preventing infections of important endemic and emerging diseases of global significance. This study aimed to assess the impact of these public health preventive measures on dirty hand diseases. A retrospective survey was conducted in the rural general hospitals of Taabo (south-central Côte d'Ivoire) and Marcory (urban Abidjan) to collect clinical data on dirty hand diseases in the patients' records from 2013 to 2020. In addition, focus group discussions (N = 8) were conducted in the communities in both settings to identify the sociocultural and economic hindering or fostering factors that affected the adoption of and the compliance with handwashing and disinfection practices. A total of 3245 and 8154 patients' records were examined in the general hospitals of Taabo and Marcory, respectively. Compared with women, men were more affected by typhoid fever (OR, 0.68 [95%CI, 0.53–0.88]) and influenza (OR, 0.87 [95%CI, 0.75–1]). Hygiene measures promoted during Ebola and COVID-19 outbreaks had no impact on the prevalence of typhoid fever in both settings;however, a positive impact was observed regarding influenza infections. Populations were aware of the importance of handwashing for public health but had difficulties adhering due to financial constraints, access to drinking water, and the absence or scarcity of handwashing facilities.
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Marshall reviews Snot, Sneezes and Super Spreaders by Marcter Horst, translated by Laura Watkinson and illustrated by Wendy Panders.
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Introduction: In critically ill patients with AKI, unacceptably high mortality rates reaching up to 50-80% in all dialyzed ICU patients are seen despite the availability of intensive renal support. At present there is no specific or targeted therapy for AKI. Pathophysiology of AKI is multifactorial. Systemic inflammation, mediated in part by cytokines, might be contributing majorly to the development of AKI. This mandates a multipronged approach to the treatment of AKI. There are hardly any studies on the use of ulinastatin in AKI. Our premise regarding the use of molecule in AKI was based on the fact that this molecule acts at multiple levels in the sepsis and can act to stop the cascade and thereby stop the "storm." Methods: We studied a total of 200 patients with AKI who needed ICU care in our hospital in the period between June 2017 - Jan 2020. Out of these, 100 patients received Injection ulinastatin 3 doses a day for 5 days, against a similar number of control patients. We included those patients with AKI who had SOFA scores more than 8. None of the patients had COVID 19 infection. We compared the same number of patients who had received ulinastatin with controls. Injection ulinastatin 1,50,000IU was given three times a day for 5 days. All the patients included had received dialytic therapy. We recorded the age of the patients, it varied from 11-94 years (mean age 52 years), > 60 % (120) of the patients being in the age group of 26-40 years. The ratio of males to females 1.8:1 (M: F 129:71). The etiologies were as follows: Malaria - complicated - P vivax, P falciparum (n= 76) 38% Enteric fever (n= 40) 20% UTI (n=30) 15% Post-partum (n=20) 10% Dengue (n = 14) 7% Acute gastroenteritis/diarrheal diseases (n= 12) 6% Pancreatitis (n= 6) 3% Obstructive uropathy (n= 3) 1.5% 33 % (n= 66) patients had diabetes as a co morbid condition. The renal function tests of all the patients along with liver function tests, sepsis parameters like d-dimer, serum procalcitonin levels, CRP-hs levels, coagulation tests, complete blood counts, and arterial blood gas analysis were done We recorded the length of stay, need and duration of renal replacement therapy, time to stoppage of renal replacement therapy, need for mechanical ventilation, mortality and post AKI recovery and progression to CKD. Result(s): The patients who received ulinastatin had a shorter stay in the ICU (p <0.01 vs control group);also, the time to stoppage of renal replacement therapy was shorter (p < 0.05). The recovery of renal function was seen in 84% (n=168). The progression to CKD was seen in 11% (n=22) of patients. The average number of sittings of dialysis needed were 11 (range3-20), lesser number of dialysis were needed in the ulinastatin group. The overall mortality was 36 %(n=72).The average follow up period post discharge has been 141 days (21 - 240 days) Conclusion(s): There definitely seem to be advantages in using ulinastatin and results look promising. But there are limitations to this study - this was a retrospective analysis hence not all the patients received ulinastatin. Moreover, the drug is expensive. This study was done in a semi urban set up where causes for AKI are predominantly infective. A larger prospective double-blind study will be needed to consider ulinastatin as a routine option for treating AKI. Till then preventing AKI should be the aim for us. No conflict of interestCopyright © 2023
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Food safety remains a major issue around the world particularly when the COVID-19 pandemic becomes the main issue nowadays. Food safety is essential to the human population worldwide because food is the primary energy source and nutrition for humans. Therefore, food handlers' personal hygiene is one of the factors that are necessary to maintain food safety. The purpose of this study was to assess the food handler's compliance with personal hygiene practices in randomly any food outlets across Malaysia including Kuching, Sarawak;Lawas, Sarawak;Johor Bahru, Johor;Kuala Penyu, Sabah, and Gurun, Kedah. A quantitative method, a cross-sectional descriptive study to one thousand and five (N = 1005) food handlers who participated in the questionnaire and observation checklist was developed by modifying questions in accordance with the Food Hygiene Regulations 2009. Overall, the mean percentage of conformity in adhering to food handler attire was the highest observed at Gurun, Kedah and Kuala Penyu, Sabah with 86.96% and 80.79%, respectively, followed by Kuching, Sarawak with 77.5%, Johor Bahru with 76.71%, and Lawas, Sarawak with 74.93%. Personal hygiene practices conformity showed a high mean percentage with all districts scoring >91% higher than non-conformity. The food handlers also show less unhygienic behaviour while on duty and scored a mean percentage of > 92%. Although in that positive behaviour, some of the food handlers did not perform some unhygienic practices (<= 8 %). In conclusion, there is no significant difference (p-value > 0.05) in the level of conformity between the mean percentages among all districts. Thus, this issue shall raise a concern to the food industries in order to make sure their workers comply with the legal requirement and to avoid any food poisoning outbreak related to food hygiene and food safety in the future.Copyright © 2023 The Authors.
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OBJECTIVES: Identifying clinical and laboratory indicators that differentiate multisystem inflam-matory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting. METHOD(S): 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. RESULT(S): 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(S): Older age group, presence of muco-cutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.
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Vaccination is effective in preventing the increase of disease, especially emerging infectious diseases (EIDs), and it is particularly important for people in close contact with infected sources and susceptible populations who are at increased risk of getting infectious diseases due to behavior, occupation or health. Despite targeted vaccination guidelines, inadequate vaccination of the key populations fails to receive widespread attention, resulting in a high-risk transition of disease from key populations to general populations. Strengthening the vaccination of the susceptible groups can effectively block the spread of pathogens to general populations, and reduce the consumption of medical resources in universal vaccination, which has significant economic value. In this review, we describe the prevalence of EIDs, analyze the experience and lessons of infectious disease vaccination in key populations through several cases, and further explore the causes for the decline in vaccination rates of key populations. According to the trends of EIDs, a plan to strengthen the vaccination of key populations is proposed to effectively prevent the transition of EIDs from key populations to general populations.
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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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Vaccination, the transmission of "vaccine", a benign disease of cows, to immunize human beings against smallpox, was invented by Jenner at the end of the eighteenth century. Pasteur, convinced that the vaccine microbe was an attenuated form of the smallpox microbe, showed that, similarly, attenuated forms of other microbes immunized against animal diseases. When applying this principle to rabies, he realized that, in this case, the vaccine was in fact composed of dead microbes. One of his students immediately exploited this result to devise a vaccine against typhoid. The vaccines against diphtheria and tetanus, in 1921, opened a new route, that of immunization with molecules from the pathogenic microbes. Molecular biology then allowed the production of the immunogenic molecules by microorganisms such as yeast, or immunization by genetically modified viruses or messenger RNA inducing our own cells to produce these molecules.
La vaccination, transmission de la vaccine, maladie bénigne des vaches, pour immuniser les humains contre la variole, a été inventée par Jenner à la fin du XVIII e siècle. Pasteur, convaincu que le microbe de la vaccine est une forme atténuée de celui de la variole, montre que des formes atténuées d'autres microbes immunisent des animaux contre des maladies. Lors de l'application à la rage, il comprend que la préparation vaccinale qu'il utilise dans ce cas est en fait constituée de microbes tués. Conclusion aussitôt exploitée par l'un de ses élèves dans la conception d'un vaccin contre la typhoïde. Les vaccins contre la diphtérie et le tétanos, en 1921, ouvrent une troisième voie, celle de l'immunisation par des molécules provenant des microbes pathogènes. La biologie moléculaire va permettre la production de ces molécules immunogènes par des micro-organismes tels que des levures, ou bien l'immunisation par des virus génétiquement modifiés ou par de l'ARN messager, conduisant nos propres cellules à produire ces molécules.
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Smallpox , Female , Male , Humans , Animals , Cattle , RNA, MessengerABSTRACT
The consequences of the COVID-19 pandemic are extensive and far-reaching. Non COVID communicable diseases continue to spread and non-communicable diseases continue to progress. People may access healthcare facilities little bit late due to fear of contracting COVID-19 and present with severe symptoms, even with complications. Nepal has been facing dual burden of both non-communicable and communicable diseases. The number of COVID-19 patients has continuously been rising in Nepal since the start of May 2020. There is an anticipated surge of infectious disease such as malaria, dengue fever, enteric fever, scrub typhus, leptospirosis during summer and monsoon seasons in Nepal. There will be surge of cases of acute undifferentiated febrile illness (AUFI) during monsoon. As fever is one of the very common symptoms of COVID-19, so COVID-19 needs to be considered in differential diagnoses of acute undifferentiated febrile illness. Copyright © 2020, Kathmandu University. All rights reserved.
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Aiming to further the Immunization Partners in Asia Pacific (IPAP)'s vision of a world where no one suffers from a vaccine preventable disease, the 8th Asian Vaccine Conference (ASVAC 2022) was held in Colombo, Sri Lanka and virtually from 15 to 18, September 2022 (www.asianvaccine.com). This conference followed those held in Siem Reap, Cambodia (2009), Manila, Philippines (2010), Jakarta, Indonesia (2011), Cebu, Philippines (2013), Hanoi, Vietnam (2015), Singapore (2017) and Naypyidaw and Yangon, Myanmar (2019). The ASVAC2022 themed "Immunization: in Era of Pandemics," commenced with the EPI Managers' Workshop, followed by pre-conference workshops and Vaccinology Masterclass, followed by the main conference featuring 5 plenary lectures, 6 partner-led symposia, free paper and poster presentations, and industry-supported lunch and evening sessions. There were over 1830 registered participants, with 112 attending in person and 998 virtually from 63 countries. The conference was organized by IPAP and hosted by the Vaccine and Infectious Disease Forum of Sri Lanka, Sri Lanka College of Pediatricians, Sri Lanka College of Microbiologists and College of General Practitioners of Sri Lanka, with the support of the Ministry of Health, Sri Lanka. The 9th ASVAC is scheduled to be held in Davao City, Philippines in late 2023.
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Vaccines , Humans , Philippines , Indonesia , Vaccination , Sri LankaABSTRACT
During second wave of COVID-19 pandemic, increase in incidence of typhoid was observed in different cities of Pakistan. Rapid diagnostic tests for COVID-19 and typhoid are less sensitive and confirmatory tests are required to diagnose the infection. Moreover, COVID-19 IgM mimic Salmonella typhi IgM and have same clinical presentations as typhoid. Muzaffargarh is a district of province Punjab. Being a hotspot for COVID-19, it also has high prevalence of Typhoid. Therefore, in this study we aim to evaluate the cross antigenicity of COVID-19 IgM with Salmonella typhi IgM. 593 patients were enrolled in study with informed consent. Blood samples were collected from patients and laboratory biomarkers were analyzed. Data was recorded and statistical analysis was done. Among study participants, 64% were males while 36% were females. All the laboratory biomarkers were elevated in all the patients. Different age groups didn't exhibit difference in all laboratory biomarkers except ferritin. Significant difference was observed in creatinine, LDH and ferritin levels in male and female patients. It can be concluded that all age groups are under same risk. However, disease severity is higher in male population.
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Since the advent of the COVID-19 pandemic in 2019, a mammoth research activity targeting the etiological features of COVID-19 has commenced. Many aspects of the disease have been studied, and various others are under consideration. The secondary microbial co-infections with COVID-19 have generated some serious concerns across the globe. This review mainly focuses on the notable secondary co-infections. The co-infection of influenza, tuberculosis, and typhoid may mimic the original COVID-19 symptoms. Physicians and clinicians must focus on the secondary co-infections which may aggravate the disease progression towards acute respiratory disorder syndrome (ARDS). Diagnostic strategies must also be redefined to determine the actual underlying secondary co-infection. There is a need for combination therapy and diagnostic approaches to minimize the risks associated with the COVID-19 pandemic effectively.
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Introduction: Typhidot has been known to cross-react with a variety of viral illnesses. There has been some communication throwing light on the possible false-positive results in COVID cases, but overall there is a dearth of studies directly investigating the association. This is a small-sized observational cohort study to detect and analyze the association between these two conditions. Materials and Methods: During a period of 1 month, starting from April 1, 2021, to April 30, 2021, all patients admitted with a Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR)- positive report for SARS-CoV-2 to a nursing home in Ghaziabad were prescribed typhidot immunoglobulin M (IgM) test. Other parameters such as the radiological computed tomography score, hemoglobin levels, total leukocyte counts, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase enzyme levels, and the cycle threshold values of the RT-PCR test were recorded. The data thus collected were entered into a structured electronic data collection system and analyzed. Results: Thirty-seven percent of patients who were admitted with a diagnosis of RT-PCR-positive mild-to-moderate COVID pneumonia were also positive for typhoid IgM antibody. The distribution of this positive typhidot test was equal among both genders and was not found to be significantly associated with any of the other test variables. Conclusion: Our study reveals the anamnestic response of typhoid IgM antibodies against SARS-CoV-2. A positive typhidot test should not mislead or delay the diagnosis of any other viral respiratory illness.
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Since the establishment of the National Environmental Health Association (NEHA) on June 25, 1937 in Long Beach CA under the name of the National Association of Sanitarians, they have stood strong offering shelter to the profession from literal and political storms while lifting up the science and expertise of the workforce. Whether championing the first water regulations to reduce cholera and typhoid or modern water regulations to eliminate lead exposure, they walk alongside their members to provide the best science and practice and to raise their collective environmental health voice for the communities they serve. In 2021, they embarked on a journey to reflect on where the organization--and the workforce--has been over the past 84 years, including the impact of the COVID-19 pandemic. To keep themselves centered, they returned to the original NEHA charter to reflect on the wisdom of their professional forebearers. From this charter, they developed a new mission anchored on their history that reaches toward their future: To build, sustain, and empower an effective environmental health workforce.
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SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula
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SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute bacterial myocarditis due to Salmonella bacteremia is a rare cause of ST-segment elevation that can manifest as acute decompensated heart failure, life threatening arrhythmias, and sudden cardiac death. CASE PRESENTATION: A 62-year-old male with a past medical history of HTN, HLD, DM2, and TIA presented with nausea, vomiting, nonbloody diarrhea, and right upper quadrant pain for five days. He quickly decompensated in the ED, becoming increasingly hypotensive, tachycardic, and lethargic concerning for sepsis. Broad spectrum antibiotics and IV fluids were initiated. Chest X-ray revealed multifocal pneumonia. Labs revealed a metabolic acidosis consistent with acute hypoxic respiratory failure warranting emergent intubation. CTA chest showed multifocal pneumonia and Covid-19 antigen testing was negative. Troponin I was elevated at.211 ng/mL (n <.08) and ECG showed new onset atrial fibrillation, for which cardiology was consulted. On admission to the ICU, repeat labs showed acute renal failure and he was anuric warranting hemodialysis initiation. Despite medical optimization, his Troponin I trended up to 1.458 ng/mL, and repeat ECG showed 2:1 atrial flutter with new ST-elevations in leads II, III, and aVF, consistent with an acute inferior STEMI. Labs did not show hyperkalemia nor hypercalcemia. Transthoracic echocardiography revealed normal systolic and diastolic function, with a left ventricle ejection fraction of 65-70%. A heparin infusion was started and he was taken for a cardiac catheterization which showed no evidence of occlusive CAD. His blood cultures revealed Salmonella enteritidis for which he was switched to ciprofloxacin. Abdominal ultrasound appeared benign, but CT abdomen with contrast showed findings of cholecystitis, which was confirmed on HIDA scan. Gastroenterology and Surgery were consulted who recommended a cholecystostomy tube placement, with a delayed laparoscopic cholecystectomy (LC) when stable. Repeat ECG following the LC showed complete resolution of the previous STEMI. He was discharged to a rehabilitation facility where he made a full recovery. DISCUSSION: Acute bacterial myocarditis can mimic acute coronary syndromes and warrants a high index of suspicion in the setting of Salmonella bacteremia. Our patient presented with signs of acute cholecystitis and an ECG concerning for acute STEMI. Bacterial etiologies of myocarditis are less reported in the literature compared to viral infections, and are seen more often in patients with severe sepsis such as our patients. Common findings associated with Salmonella myocarditis include ST-segment elevation on ECG and elevated troponin levels. Serial ECG findings can distinguish myocarditis from acute myocardial infarction. Early diagnosis is essential to improve outcomes and reduce mortality. CONCLUSIONS: Acute bacterial myocarditis can mimic acute coronary syndromes. Reference #1: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol. 2015;7(12):931-937. doi:10.4330/wjc.v7.i12.931 Reference #2: Sundbom P, Suutari AM, Abdulhadi K, Broda W, Csegedi M. Salmonella enteritidis causing myocarditis in a previously healthy 22-year-old male. Oxf Med Case Reports. 2018;2018(12):omy106. Published 2018 Nov 26. doi:10.1093/omcr/omy106 Reference #3: Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus. 2019;11(7):e5049. Published 2019 Jul 1. doi:10.7759/cureus.5049 DISCLOSURES: No relevant relationships by Mohamed Faher Almahmoud No relevant relationships by JONATHAN BROWN No relevant relationships by Hytham Rashid No relevant relationships by Syed Raza