Detecting Residual Chronic Salmonella Typhi Carriers on the Road to Typhoid Elimination in Santiago, Chile, 2017-2019.

BACKGROUND: In Santiago, Chile, where typhoid had been hyperendemic (1977-1991), we investigated whether residual chronic carriers could be detected among household contacts of non-travel-related typhoid cases occurring during 2017-2019. METHODS: Culture-confirmed cases were classified as autochthonous (domestically acquired) versus travel/immigration related. Household contacts of cases had stool cultures and serum Vi antibody measurements to detect chronic Salmonella Typhi carriers. Whole genome sequences of acute cases and their epidemiologically linked chronic carrier isolates were compared. RESULTS: Five of 16 autochthonous typhoid cases (31.3%) were linked to 4 chronic carriers in case households; 2 cases (onsets 23 months apart) were linked to the same carrier. Carriers were women aged 69-79 years with gallbladder dysfunction and Typhi fecal excretion; 3 had highly elevated serum anti-Vi titers. Genomic analyses revealed close identity (≤11 core genome single-nucleotide polymorphism [SNP] differences) between case and epidemiologically linked carrier isolates; all were genotypes prevalent in 1980s Santiago. A cluster of 4 additional autochthonous cases unlinked to a carrier was identified based on genomic identity (0-1 SNPs). Travel/immigration isolate genotypes were typical for the countries of travel/immigration. CONCLUSIONS: Although autochthonous typhoid cases in Santiago are currently rare, 5 of 16 such cases (31.3%) were linked to elderly chronic carriers identified among household contacts of cases.

La batalla decisiva contra la fiebre tifoidea en Santiago de Chile en el siglo XX / The decisive battle against typhoid fever in Santiago de Chile in the twentieth century

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.

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.

A Rare Case of Typhoid Fever in the United States Associated With Travel to Mexico.

Typhoid fever is an infectious febrile illness caused by Salmonella typhi that is rare in the United States but is endemic in regions of South Asia and Africa. Typhoid fever initially presents with nonspecific symptoms such as fever, malaise, and abdominal pain. We describe a case of typhoid fever in an adult in the United States with recent travel to Mexico. After a nonspecific presentation, the patient developed Faget sign and computed tomography (CT) of the abdomen revealed mesenteric adenitis, which prompted additional workup. Diagnosis of typhoid fever was established by blood culture and the patient was treated with ciprofloxacin.

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)

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

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.

Analysis of isolates from Bangladesh highlights multiple ways to carry resistance genes in Salmonella Typhi.

BACKGROUND: Typhoid fever, caused by Salmonella Typhi, follows a fecal-oral transmission route and is a major global public health concern, especially in developing countries like Bangladesh. Increasing emergence of antimicrobial resistance (AMR) is a serious issue; the list of treatments for typhoid fever is ever-decreasing. In addition to IncHI1-type plasmids, Salmonella genomic island (SGI) 11 has been reported to carry AMR genes. Although reports suggest a recent reduction in multidrug resistance (MDR) in the Indian subcontinent, the corresponding genomic changes in the background are unknown. RESULTS: Here, we assembled and annotated complete closed chromosomes and plasmids for 73 S. Typhi isolates using short-length Illumina reads. S. Typhi had an open pan-genome, and the core genome was smaller than previously reported. Considering AMR genes, we identified five variants of SGI11, including the previously reported reference sequence. Five plasmids were identified, including the new plasmids pK91 and pK43; pK43and pHCM2 were not related to AMR. The pHCM1, pPRJEB21992 and pK91 plasmids carried AMR genes and, along with the SGI11 variants, were responsible for resistance phenotypes. pK91 also contained qnr genes, conferred high ciprofloxacin resistance and was related to the H58-sublineage Bdq, which shows the same phenotype. The presence of plasmids (pHCM1 and pK91) and SGI11 were linked to two H58-lineages, Ia and Bd. Loss of plasmids and integration of resistance genes in genomic islands could contribute to the fitness advantage of lineage Ia isolates. CONCLUSIONS: Such events may explain why lineage Ia is globally widespread, while the Bd lineage is locally restricted. Further studies are required to understand how these S. Typhi AMR elements spread and generate new variants. Preventive measures such as vaccination programs should also be considered in endemic countries; such initiatives could potentially reduce the spread of AMR.

Thomas Mann y las enfermedades infecciosas en la primera mitad del siglo XX. Parte I: Fiebre tifoidea, meningitis y sífilis

Con seguridad Thomas Mann es hoy en día un escritor olvidado, para los infectólogos y para todo el mundo, con apenas un selecto grupo de poquísimos lectores entre nuestros jóvenes colegas. No les hará mal, a éstos y a aquéllos, sin embargo, adquirir algún conocimiento de las ideas sobre las enfermedades infecciosas en la primera mitad del siglo XX, período en que Mann escribió las obras aquí comentadas: por el contrario puede resultarles particularmente útil si este conocimiento les llega a través de la visión muy personal del germano, quien pone el foco más en el espíritu -la voluntad, el alma en suma- que en el componente físico de la enfermedad, en la miseria corporal, ignorando de paso, desdeñosamente, a las bacterias causantes.

Surely, Thomas Mann is today a forgotten writer, with only a little and precious group of readers between our young colleagues. However, perhaps could be useful for the others some knowledge about his vision of the infectious diseases in the first half of the twentieth century, when he wrote the novels here reviewed. Typhoid fever, meningitis, tuberculosis, syphilis and cholera are present in Mann's thematic from Buddenbrooks till Doktor Faustus, always with a personal focus, more on spirit -the will to live - rather than on flesh and bones… or bacteria. One of his later and minor works let us throw an ironical glance over transplant, no so named, indeed, by Mann, who speaks of "exchange". In this first part we present typhoid fever, meningitis and syphilis.

Aspectos relevantes sobre Salmonella sp en humanos / Relevant aspects of Salmonella sp in humans

Introducción: En el ámbito mundial, las infecciones por Salmonella sp poseen gran importancia por lo incapacitante de estas y los costos que implican para el sistema de salud de una nación, principalmente aquellas en vías de desarrollo donde persiste con mayor frecuencia este patógeno. Objetivo: Realizar una descripción de los principales aspectos relacionados con epidemiología, etiología, transmisión, patogénesis, diagnóstico y tratamiento de las especies de Salmonella que causan enfermedad en el humano. Métodos: Búsqueda de bibliográfica actual sobre Salmonella sp a través del uso de repositorios como Google Academics, Scielo y PubMed, utilizando las palabras de búsqueda: Salmonella, epidemiología, transmisión, patogénesis, diagnóstico, tratamiento. De 147 artículos consultados, 52 presentaron utilidad para el cumplimiento del objetivo de la revisión. : Las infecciones por Salmonella sp son un problema de salud en países en vías de desarrollo, siendo la resistencia bacteriana uno de los principales retos a enfrentar en los próximos años, al igual que como ocurre con otras infecciones bacterianas(AU)

Introduction: In the world, Salmonella sp infections have great importance due to their incapacitating nature and the costs associate for the health system in some nations, mainly those in development process where this pathogen persists frequently. Objective: To make a description of the main aspects related with the epidemiology, etiology, transmission, pathogenesis, diagnosis and treatment of Salmonella species that cause disease in humans. Method: Search current bibliography about Salmonella sp through the use of repositories such as Google Academics, Scielo and PubMed, and using the search words: Salmonella, epidemiology, transmission, pathogenesis, diagnosis, treatment. From 147 articles consulted, 52 were useful for the review objective. Conclusion: Salmonella sp infections are a health problem in developing countries, being bacterial resistance one of the main challenges to face in the coming years, as occurred with other bacterial infections(AU)

Erradicación de fiebre tifoidea en Holguín. Logro de la Medicina cubana 1972-2016 / Elimination of Typhoid Fever in Holguín. An achievement of cuban Medicine. 1972-2016

Introducción: la fiebre tifoidea es una infección sistémica causada por Salmonella tiphy, a través de la ingesta de alimentos contaminados (fecal-oral). Es un problema de salud pública, especialmente en países en vías de desarrollo. Objetivo: caracterizar la fiebre tifoidea en la provincia de Holguín durante los años 1972-2016. Método: se realizó un estudio descriptivo longitudinal de series de casos reportados de fiebre tifoidea por tarjeta EDO (Enfermedades de Declaración Obligatoria) en la provincia de Holguín desde el año 1972-2016. El universo estuvo constituido por 471 pacientes reportados por fiebre tifoidea, según tarjeta de EDO. Resultados: no se reportaron fallecidos desde el año 1974 y los menores de 15 años fueron los más afectados. El municipio que se mantuvo como de alto riesgo fue Holguín. La aplicación de la vacuna cubana de polisacárido Vi, mucho menos reactogénica y más efectiva que la utilizada anteriormente de calor-fenol, puede ser la causa o parte de la causa para la no ocurrencia de casos en los últimos 10 años en la provincia. Conclusiones: la morbilidad por fiebre tifoidea ha disminuido al igual que el número de brotes y afectados en brotes. Las medidas de control inmediatas y la existencia de un programa de control, además de la nueva vacuna de producción nacional, fabricada por los laboratorios Finlay, han hecho posible tales logros.

Introduction: typhoid fever is a systemic infection caused by Salmonella tiphy through ingestion of contaminated food (fecal-oral). It is a public health problem, especially in developing country. Objective: to characterize typhoid fever in Holguin province during the years 1972-2016. Method: a longitudinal descriptive study of series of reported cases of typhoid by EDO card (Notifiable Diseases) in Holguin province since 1972 to 2016, in order to characterize the typhoid in Holguin province was conducted. The universe consisted of 471 patients reported for typhoid Fever, according to EDO card. Results: no deaths were reported since 1974, children under 15 were the most affected, the Holguin municipality remained as high risk. The application of the Vi much less reactogenic and more effective polysaccharide Cuban vaccine used previously heat-phenol, may be the cause or part of the cause for the non-occurrence of cases in the last 10 years in the province. Conclusions: the morbidity due to typhoid fever has decreased as well as the number of outbreaks and affected in outbreaks. The immediate control measures and the existence of a control program, in addition to the new vaccine of national production, manufactured by the Finlay laboratories, have made such achievements possible.

Typhoid fever: case report and literature review. / Fiebre tifoidea: reporte de caso y revisión de la literatura.

Typhoid fever remains a major health problem worldwide, in contrast to Chile, where this disease is an isolated finding. Clinical presentation is varied, mainly presenting with fever, malaise, abdominal discomfort, and nonspecific symptoms often confused with other causes of febrile syndrome. We report a six-year-old, male patient presenting with fever of two weeks associated with gastrointestinal symptoms, malaise, hepatomegaly and elevated liver enzymes. Differential diagnoses were considered and a Widal reaction and two blood cultures were requested; both came back positive, confirming the diagnosis of typhoid fever caused by Salmonella typhi. Prior to diagnosis confirmation, empirical treatment was initiated with ceftriaxone and metronidazole, with partial response; then drug therapy was adjusted according to ciprofloxacin susceptibility testing with a favorable clinical response. We discuss diagnostic methods and treatment of enteric fever with special emphasis on typhoid fever.

La fiebre tifoidea continúa siendo un importante problema de salud a nivel mundial, en contraste con Chile donde esta patología es un hallazgo aislado. Las formas clínicas son variadas, se presenta principalmente con fiebre, compromiso del estado general, manifestaciones abdominales y síntomas inespecíficos, confundiéndose con otras causas de síndrome febril. Se presenta el caso clínico de un varón de seis años con fiebre de dos semanas de evolución, asociado a síntomas digestivos, compromiso del estado general, hepatomegalia y aumento de enzimas hepáticas. Para el diagnóstico diferencial, se solicitaron: una reacción de Widal y dos hemocultivos. Ambos con resultados positivos, confirmando el diagnóstico de fiebre tifoidea por Salmonella typhi. Previo a esto el paciente fue tratado empíricamente con ceftriaxona y metronidazol, con respuesta parcial; luego se ajustó el manejo, según antibiograma, a ciprofloxacino y la evolución fue satisfactoria. Se discuten métodos, diagnóstico y tratamiento de fiebre entérica con especial énfasis en fiebre tifoidea.

Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey.

OBJECTIVE: Typhoid fever can involve various organs, leading to a wide range of presentations: from uncomplicated to complicated typhoid fever. The haematological changes are common in typhoid fever and include anaemia, leucopaenia, thrombocytopaenia and bleeding diathesis. This study was undertaken in order to determine the clinical and haematological presentation of typhoid fever in children. METHODS: In this study, records of children and adolescents with typhoid fever aged under or equal to 16 years, admitted to Yuzuncu Yil University Hospital between 2010 and 2014, were analysed retrospectively. RESULTS: The cases (56%) were admitted to our hospital in July and October. Major symptoms of patients were abdominal pain (24%), arthralgia (21%) and fever (11%). In our study, decreased mean platelet volume (31%), eosinopaenia 20%), abnormal platelet count (19%), anaemia (16%), leucocytosis (16%) and eosinophilia (12%) were the most common haematological findings in the children. CONCLUSIONS: Typhoid fever is predominant in children at school age with a slight male predominance. Decreased mean platelet volume and abdominal pain might be useful as early diagnostic clues.

Progression of the load of waterborne and intestinal parasitic diseases in the State of Amazonas

In the State of Amazonas, Brazil, urban expansion together with precarious basic sanitation conditions and human settlement on river banks has contributed to the persistence of waterborne and intestinal parasitic diseases. Time series of the recorded cases of cholera, typhoid fever, hepatitis A and leptospirosis are described, using data from different levels of the surveillance systems. The sources for intestinal parasitosis prevalence data (non-compulsory reporting in Brazil) were Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana (LILACS) and the annals of major scientific meetings. Relevant papers and abstracts in all languages were accessed by two independent reviewers. The references cited by each relevant paper were scrutinized to locate additional papers. Despite its initial dissemination across the entire State of Amazonas, cholera was controlled in 1998. The magnitude of typhoid fever has decreased; however, a pattern characterized by eventual outbreaks still remains. Leptospirosis is an increasing cause of concern in association with the annual floods. The overall prevalence of intestinal parasites is high regardless of the municipality and the characteristics of areas and populations. The incidence of hepatitis A has decreased over the past decade. A comparison of older and recent surveys shows that the prevalence of intestinal parasitic diseases has remained constant. The load of waterborne and intestinal parasitic diseases ranks high among the health problems present in the State of Amazonas. Interventions aiming at basic sanitation and vaccination for hepatitis A were formulated and implemented, but assessment of their effectiveness in the targeted populations is still needed.

Sutura primaria en la población infantil con perforación intestinal por fiebre tifoidea / Primary Suture in Children with Intestinal Perforation by Typhoid Fever

Introducción: la perforación intestinal por fiebre tifoidea es una complicación grave frecuente en Ghana. Objetivo: describir el resultado del cierre primario de la perforación intestinal por fiebre tifoidea en una población infantil. Método: se realizó un estudio de serie de casos en el Hospital Sefwi Asafo, de Ghana. Se incluyeron 58 niños, atendidos entre 2009 y 2010, en los cuales se practicó la resección de los bordes de la lesión y sutura primaria en dos planos. Se consideraron las siguientes variables: edad, sexo, número de perforaciones, complicaciones postoperatorias y estadía hospitalaria. Se realizó análisis de frecuencia y de asociación entre variables. Resultados: los grupos de mayor edad estuvieron entre los 10 y 14 años (55,17 %), sin diferencias con respecto al sexo, predominaron las perforaciones únicas 67,24 %, se observaron infecciones post operatorias en el 22,4 %, y la estadía hospitalaria se situó entre siete y 14 días (74,1 %). Conclusiones: los resultados concuerdan con otras investigaciones. La técnica utilizada mostró ser un procedimiento confiable, rápido y sencillo para el tratamiento de la perforación intestinal por fiebre tifoidea.

Introduction: intestinal perforation caused by typhoid fever is a common severe complication in Ghana. Objective: to describe the outcome of primary closure of typhoid intestinal perforation in children. Method: a case series study was conducted in the Sefwi Asafo Hospital in Ghana. Fifty eight children admitted between 2009 and 2010 were included, in which resection of the edges of the lesion and primary suture was performed in two planes were included. Age, sex, number of perforations, postoperative complications and hospital stay were the variable considered for the study. Frequency analysis of association between variables was done. Results: older age groups were between 10 and 14 years (55.17 %), with no differences regarding sex predominated the only drilling 67.24 %, postoperative infections were observed in 22.4 % and hospital stay was between seven and 14 days (74.1 %). Conclusions: the results are reliable with other research. The technique proved to be a reliable, fast and simple for the treatment of typhoid intestinal perforation procedure.

Typhoid fever vaccination strategies.

Typhoid vaccination is an important component of typhoid fever prevention and control, and is recommended for public health programmatic use in both endemic and outbreak settings. We reviewed experiences with various vaccination strategies using the currently available typhoid vaccines (injectable Vi polysaccharide vaccine [ViPS], oral Ty21a vaccine, and injectable typhoid conjugate vaccine [TCV]). We assessed the rationale, acceptability, effectiveness, impact and implementation lessons of these strategies to inform effective typhoid vaccination strategies for the future. Vaccination strategies were categorized by vaccine disease control strategy (preemptive use for endemic disease or to prevent an outbreak, and reactive use for outbreak control) and vaccine delivery strategy (community-based routine, community-based campaign and school-based). Almost all public health typhoid vaccination programs used ViPS vaccine and have been in countries of Asia, with one example in the Pacific and one experience using the Ty21a vaccine in South America. All vaccination strategies were found to be acceptable, feasible and effective in the settings evaluated; evidence of impact, where available, was strongest in endemic settings and in the short- to medium-term. Vaccination was cost-effective in high-incidence but not low-incidence settings. Experience in disaster and outbreak settings remains limited. TCVs have recently become available and none are WHO-prequalified yet; no program experience with TCVs was found in published literature. Despite the demonstrated success of several typhoid vaccination strategies, typhoid vaccines remain underused. Implementation lessons should be applied to design optimal vaccination strategies using TCVs which have several anticipated advantages, such as potential for use in infant immunization programs and longer duration of protection, over the ViPS and Ty21a vaccines for typhoid prevention and control.

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.

La historia clínica de Wolfang Amadeus Mozart / Medical record of Wolfgang Amadeus Mozart

Resumen Las hipótesis en torno a las patologías que tuvo Wolfang Amadeus Mozart (1756-1791) en su vida, la enfermedad final y la causa de su muerte han generado alrededor de 160 diagnósticos diferentes. En este trabajo se analizan las causas más pertinentes desde el punto de vista de la medicina interna y se plantea que es improbable que fuese un enfermo crónico, o un paciente psiquiátrico, o tuviese un síndrome genético, o hubiese sido envenenado. Se concluye que en los dos últimos meses de su existencia presentó una posible hipertensión arterial sistémica severa y luego desarrolló un síndrome nefrótico o nefrótico-nefrítico causado, quizá, por una fiebre tifoidea y aparecieron las complicaciones de una insuficiencia renal aguda en sus últimos días y un accidente cerebrovascular hemorrágico final. (Acta Med Colomb 2013; 38: 244-254).

Abstract The hypotheses in regard to the pathologies that had Wolfgang Amadeus Mozart (1756-1791) in his life, the final illness and the cause of his death have generated about 160 different diagnoses. This paper analyzes the most relevant causes from the point of view of internal medicine and suggests that it is unlikely that he were a chronically ill patient or a mental patient, or that he had a genetic syndrome or had been poisoned. We conclude that in the last two months of its existence he had a possible severe systemic arterial hypertension and then developed a nephrotic syndrome or nephrotic - nephritic caused perhaps by typhoid fever, and that in his last days the complications of an acute renal failure appeared and had a final hemorrhagic cerebrovascular accident. (Acta Med Colomb 2013; 38: 244-254).

Ecoepidemiología de la infección por rickettsias en roedores, ectoparásitos y humanos en el noroeste de Antioquia, Colombia / Ecoepidemiology of rickettsial infection in rodents, ectoparasites and humans in northeastern Antioquia, Colombia

Introducción. Las rickettsias son bacterias patógenas usualmente transmitidas por ectoparásitos, como garrapatas, piojos o pulgas. En la última década se presentaron tres brotes de rickettsiosis con casos fatales en la región noroccidental de Antioquia y en un municipio limítrofe de Córdoba. Objetivo. Describir la ecología y la epidemiología de las infecciones por Rickettsia spp. en el Urabá antioqueño. Materiales y métodos. Se obtuvieron muestras de 354 roedores y se recolectaron 839 ectoparásitos de estos en los municipios de Apartadó, Turbo y Necoclí. Asimismo, se obtuvieron 220 sueros humanos. Estas muestras fueron estudiadas por reacción en cadena de la polimerasa (PCR) e inmunofluorescencia indirecta (IFI) para la detección de infección por rickettsias. Resultados. Por IFI se detectaron anticuerpos antirickettsias en 130 (43 %) de los roedores y en 53 (24 %) de los sueros humanos estudiados. Además, se amplificaron secuencias del gen gltA específicas del género Rickettsia en 23 (6,8 %) muestras de hígado de roedores, las cuales mostraron una similitud del 98,7 % con R. prowazekii . Una secuencia de gltA obtenida de larvas de garrapatas del género Amblyomma sp., tuvo una identidad mayor de 99 % con las secuencias de R. tamurae . Conclusión. Estos resultados demuestran la circulación de rickettsias en roedores, ectoparásitos y humanos en los municipios estudiados.

Introduction: Rickettsia spp. are tick, flea or lice-borne pathogenic bacterium, usually carried by rodents. In the last decade three outbreaks of rickettsial disease including fatalities, occurred in the provinces of Antioquia and Córdoba in northwestern Colombia. Objective: The purpose of this study was to perform an ecological and epidemiological description of the Rickettsia spp infection in the recently affected region of Colombia. Materials and methods: Samples were obtained from 354 rodents and their parasites captured in the municipalities of Apartadó, Turbo and Necoclí. Likewise, 220 human sera were also collected, for detection of infection by Rickettsia spp. Results: Indirect immunofluorescence assay (IFA) revealed that 130 (43%) of the rodents and 53 (24%) of the humans produced antibodies to Rickettsia spp. Additionally, rickettsial DNA was amplified by PCR from 23 (6.8%) rodent liver samples using primers directed to the genus specific gltA gene. While gltA sequences from rodent samples exhibited a 98.7% similitude with R . prowazekii, a sequence amplified from larvae of Amblyomma sp exhibited identities of >99% similarity with R. tamurae . Conclusion: These results demonstrate the presence of rickettsia in rodents, ectoparasites and humans throughout the municipalities studied.