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Saha T, Arisoyin AE, Bollu B, Ashok T, Babu A, Issani A, Jhaveri S, Avanthika C. Enteric Fever: Diagnostic Challenges and the Importance of Early Intervention. Cureus 2023; 15:e41831. [PMID: 37575696 PMCID: PMC10423039 DOI: 10.7759/cureus.41831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Enteric fever is a systemic infection caused by highly virulent Salmonella enterica serovars: Typhi and Paratyphi. Diagnosis of enteric fever is challenging due to a wide variety of clinical features which overlap with other febrile illnesses. The current diagnostic methods are limited because of the suboptimal sensitivity of conventional tests like blood culture in detecting organisms and the invasive nature of bone marrow culture. It emphasizes the need to develop improved and more reliable diagnostic modalities. The rising rates of multidrug-resistant Salmonella strains call for an accurate understanding of the current management of the disease. Proper public health measures and large-scale immunization programs will help reduce the burden of the disease. A comprehensive surveillance system can help detect the chronic carrier state and is crucial in understanding antibiotic susceptibility patterns. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar till May 2022. The following search words and medical subject headings (MeSH) were used: "enteric fever," "Salmonella Typhi," "multidrug-resistant Salmonella," chronic carrier state," "Salmonella detection, "and "typhoid vaccine." We reviewed the literature on clinical features, pathophysiology, new diagnostic tests, and interventions to prevent the disease. This article explores enteric fever and its various clinical features and addresses the emerging threat of multidrug resistance. It focuses on novel methods for diagnosis and prevention strategies, including vaccines and the use of surveillance systems employed across different parts of the world.
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Affiliation(s)
- Tias Saha
- Internal Medicine, Samorita General Hospital, Faridpur, BGD
- Internal Medicine, Diabetic Association Medical College, Faridpur, BGD
| | | | - Bhaswanth Bollu
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tejaswini Ashok
- Internal Medicine, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, IND
| | - Athira Babu
- Pediatrics, Saudi German Hospital, Dubai, ARE
| | - Ali Issani
- Emergency Medicine, Aga Khan University, Karachi, PAK
| | - Sharan Jhaveri
- Internal Medicine, Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
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Mutombo CS, Bakari SA, Ntabaza VN, Nachtergael A, Lumbu JBS, Duez P, Kahumba JB. Perceptions and use of traditional African medicine in Lubumbashi, Haut-Katanga province (DR Congo): A cross-sectional study. PLoS One 2022; 17:e0276325. [PMID: 36256659 PMCID: PMC9578634 DOI: 10.1371/journal.pone.0276325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
In the Democratic Republic of Congo, the desire of the Ministry of Health to integrate Traditional African Medicine into the Official Health System remains limited by the lack of reliable data on several aspects of this medicine. This study aims to determine the perceptions of the Lubumbashi population towards Traditional African Medicine and the contexts of recourse to these therapeutic modalities. We conducted semi-structured interviews of population samples in each of the 7 Lubumbashi municipalities, which were semi-randomly selected in proportions to each population size, from January to June 2017 and from February to July 2018. A total of 4278 people (average age, 32.1 ± 10.4 years; 36.5% of women) have been surveyed. Among them, 75.8% define "Traditional African Medicine" as "herbal-based treatments"; 79.4% have resorted to traditional medicine, for several pathologies and social problems. This medicine was preferred for efficiency, speed of healing and low cost, as well as the presence of the diseases against which it would be the only one used. Most, (52.1%) have started with Conventional Medicine, then resorted to Traditional African Medicine, 34.7% started directly with Traditional African Medicine, while 13.2% combined these two medicines. From those who have resorted to Traditional African Medicine (n = 3396), 55% declare no concern towards traditional medicine, while 42.5% fear looseness, overdose, intoxication, and lack of hygiene; from those who have not resorted to Traditional African Medicine (n = 882), 78% are fearful of fear looseness, witchcraft, and fetishism. Traditional African Medicine remains an important health care resource for the Lubumbashi people. It is essential that decision-makers consider the importance of this health sector for the population, but also the reported fears and hindrances, and work towards the regulation, sanitization, and control of this medicine to ensure its safe use.
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Affiliation(s)
- Cedrick S Mutombo
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Salvius A Bakari
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Vianney N Ntabaza
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Amandine Nachtergael
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Jean-Baptiste S Lumbu
- Service de Chimie Organique, Département de Chimie, Faculté des Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Pierre Duez
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Joh B Kahumba
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
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Mwololo D, Nthiwa D, Kitala P, Abuom T, Wainaina M, Kairu-Wanyoike S, Lindahl JF, Ontiri E, Bukachi S, Njeru I, Karanja J, Sang R, Grace D, Bett B. Sero-epidemiological survey of Coxiella burnetii in livestock and humans in Tana River and Garissa counties in Kenya. PLoS Negl Trop Dis 2022; 16:e0010214. [PMID: 35239658 PMCID: PMC8923444 DOI: 10.1371/journal.pntd.0010214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/15/2022] [Accepted: 01/28/2022] [Indexed: 01/17/2023] Open
Abstract
Background Coxiella burnetii is a widely distributed pathogen, but data on its epidemiology in livestock, and human populations remain scanty, especially in developing countries such as Kenya. We used the One Health approach to estimate the seroprevalance of C. burnetii in cattle, sheep, goats and human populations in Tana River county, and in humans in Garissa county, Kenya. We also identified potential determinants of exposure among these hosts. Methods Data were collected through a cross-sectional study. Serum samples were taken from 2,727 animals (466 cattle, 1,333 goats, and 928 sheep) and 974 humans and screened for Phase I/II IgG antibodies against C. burnetii using enzyme-linked immunosorbent assay (ELISA). Data on potential factors associated with animal and human exposure were collected using a structured questionnaire. Multivariable analyses were performed with households as a random effect to adjust for the within-household correlation of C. burnetii exposure among animals and humans, respectively. Results The overall apparent seroprevalence estimates of C. burnetii in livestock and humans were 12.80% (95% confidence interval [CI]: 11.57–14.11) and 24.44% (95% CI: 21.77–27.26), respectively. In livestock, the seroprevalence differed significantly by species (p < 0.01). The highest seroprevalence estimates were observed in goats (15.22%, 95% CI: 13.34-17.27) and sheep (14.22%, 95% CI: 12.04–16.64) while cattle (3.00%, 95% CI: 1.65–4.99) had the lowest seroprevalence. Herd-level seropositivity of C. burnetii in livestock was not positively associated with human exposure. Multivariable results showed that female animals had higher odds of seropositivity for C. burnetii than males, while for animal age groups, adult animals had higher odds of seropositivity than calves, kids or lambs. For livestock species, both sheep and goats had significantly higher odds of seropositivity than cattle. In human populations, men had a significantly higher odds of testing positive for C. burnetii than women. Conclusions This study provides evidence of livestock and human exposure to C. burnetii which could have serious economic implications on livestock production and impact on human health. These results also highlight the need to establish active surveillance in the study area to reduce the disease burden associated with this pathogen. Q fever caused by Coxiella burnetii is a significant zoonotic disease that affects wildlife, domestic animals and humans. This study determined the prevalence of antibodies to C. burnetii in livestock (cattle, sheep, and goats) and human populations in arid and semi-arid areas of Kenya between December 2013 and February 2014. We also identified potential factors that were associated with exposure among the above-targeted hosts. Results from this study showed considerable exposure in both livestock and human populations. However, human exposure to this pathogen at the household level was not correlated with herd-level seropositivity. Further studies are needed to elucidate the transmission routes of this pathogen among humans.
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Affiliation(s)
- Damaris Mwololo
- Directorate of Veterinary Services, Ministry of Agriculture, Livestock, Fisheries and Cooperatives, Nairobi, Kenya
| | - Daniel Nthiwa
- Department of Biological Sciences, University of Embu, Embu, Kenya
- International Livestock Research Institute, Nairobi, Kenya
- * E-mail:
| | - Philip Kitala
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Tequiero Abuom
- Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Salome Kairu-Wanyoike
- Department of Veterinary Services, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Johanna F. Lindahl
- International Livestock Research Institute, Nairobi, Kenya
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Enoch Ontiri
- International Livestock Research Institute, Nairobi, Kenya
| | - Salome Bukachi
- Institute of Anthropology, University of Nairobi, Nairobi, Kenya
| | - Ian Njeru
- Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Kenyatta National Hospital, Nairobi, Kenya
| | - Joan Karanja
- Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
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Bonnewell JP, Rubach MP, Madut DB, Carugati M, Maze MJ, Kilonzo KG, Lyamuya F, Marandu A, Kalengo NH, Lwezaula BF, Mmbaga BT, Maro VP, Crump JA. Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019. JAMA Netw Open 2021; 4:e2136398. [PMID: 34913982 PMCID: PMC8678687 DOI: 10.1001/jamanetworkopen.2021.36398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022] Open
Abstract
Importance Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low- and middle-income settings such as sub-Saharan Africa. Objective To assess the performance of the Universal Vital Assessment (UVA) score, derived in 2017, compared with other illness severity scores for predicting in-hospital mortality among adults with febrile illness in northern Tanzania. Design, Setting, and Participants This prognostic study used clinical data collected for the duration of hospitalization among patients with febrile illness admitted to Kilimanjaro Christian Medical Centre or Mawenzi Regional Referral Hospital in Moshi, Tanzania, from September 2016 through May 2019. All adult and pediatric patients with a history of fever within 72 hours or a tympanic temperature of 38.0 °C or higher at screening were eligible for enrollment. Of 3761 eligible participants, 1132 (30.1%) were enrolled in the parent study; of those, 597 adults 18 years or older were included in this analysis. Data were analyzed from December 2019 to September 2021. Exposures Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) assessment, and UVA. Main Outcomes and Measures The main outcome was in-hospital mortality during the same hospitalization as the participant's enrollment. Crude risk ratios and 95% CIs for in-hospital death were calculated using log-binomial risk regression for proposed score cutoffs for each of the illness severity scores. The area under the receiver operating characteristic curve (AUROC) for estimating the risk of in-hospital death was calculated for each score. Results Among 597 participants, the median age was 43 years (IQR, 31-56 years); 300 participants (50.3%) were female, 198 (33.2%) were HIV-infected, and in-hospital death occurred in 55 (9.2%). By higher risk score strata for each score, compared with lower risk strata, risk ratios for in-hospital death were 3.7 (95% CI, 2.2-6.2) for a MEWS of 5 or higher; 2.7 (95% CI, 0.9-7.8) for a NEWS of 5 or 6; 9.6 (95% CI, 4.2-22.2) for a NEWS of 7 or higher; 4.8 (95% CI, 1.2-20.2) for a qSOFA score of 1; 15.4 (95% CI, 3.8-63.1) for a qSOFA score of 2 or higher; 2.5 (95% CI, 1.2-5.2) for a SIRS score of 2 or higher; 9.1 (95% CI, 2.7-30.3) for a UVA score of 2 to 4; and 30.6 (95% CI, 9.6-97.8) for a UVA score of 5 or higher. The AUROCs, using all ordinal values, were 0.85 (95% CI, 0.80-0.90) for the UVA score, 0.81 (95% CI, 0.75-0.87) for the NEWS, 0.75 (95% CI, 0.69-0.82) for the MEWS, 0.73 (95% CI, 0.67-0.79) for the qSOFA score, and 0.63 (95% CI, 0.56-0.71) for the SIRS score. The AUROC for the UVA score was significantly greater than that for all other scores (P < .05 for all comparisons) except for NEWS (P = .08). Conclusions and Relevance This prognostic study found that the NEWS and the UVA score performed favorably compared with other illness severity scores in predicting in-hospital mortality among a hospitalized cohort of adults with febrile illness in northern Tanzania. Given its reliance on readily available clinical data, the UVA score may have utility in the triage and prognostication of patients admitted to the hospital with febrile illness in low- to middle-income settings such as sub-Saharan Africa.
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Affiliation(s)
- John P. Bonnewell
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Matthew P. Rubach
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Programme in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore
| | - Deng B. Madut
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Manuela Carugati
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michael J. Maze
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Kajiru G. Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Furaha Lyamuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | | | | | | | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - John A. Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
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5
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Strittmatter N, Kanvatirth P, Inglese P, Race AM, Nilsson A, Dannhorn A, Kudo H, Goldin RD, Ling S, Wong E, Seeliger F, Serra MP, Hoffmann S, Maglennon G, Hamm G, Atkinson J, Jones S, Bunch J, Andrén PE, Takats Z, Goodwin RJA, Mastroeni P. Holistic Characterization of a Salmonella Typhimurium Infection Model Using Integrated Molecular Imaging. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2021; 32:2791-2802. [PMID: 34767352 DOI: 10.1021/jasms.1c00240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A more complete and holistic view on host-microbe interactions is needed to understand the physiological and cellular barriers that affect the efficacy of drug treatments and allow the discovery and development of new therapeutics. Here, we developed a multimodal imaging approach combining histopathology with mass spectrometry imaging (MSI) and same section imaging mass cytometry (IMC) to study the effects of Salmonella Typhimurium infection in the liver of a mouse model using the S. Typhimurium strains SL3261 and SL1344. This approach enables correlation of tissue morphology and specific cell phenotypes with molecular images of tissue metabolism. IMC revealed a marked increase in immune cell markers and localization in immune aggregates in infected tissues. A correlative computational method (network analysis) was deployed to find metabolic features associated with infection and revealed metabolic clusters of acetyl carnitines, as well as phosphatidylcholine and phosphatidylethanolamine plasmalogen species, which could be associated with pro-inflammatory immune cell types. By developing an IMC marker for the detection of Salmonella LPS, we were further able to identify and characterize those cell types which contained S. Typhimurium.
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Affiliation(s)
- Nicole Strittmatter
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Panchali Kanvatirth
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, U.K
| | - Paolo Inglese
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, U.K
| | - Alan M Race
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Anna Nilsson
- Medical Mass Spectrometry Imaging, Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
- Science for Life Laboratory, Spatial Mass Spectrometry, Uppsala University, 751 24 Uppsala, Sweden
| | - Andreas Dannhorn
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Hiromi Kudo
- Division of Digestive Diseases, Section of Pathology, Imperial College London, St. Mary's Hospital, London W2 1NY, U.K
| | - Robert D Goldin
- Division of Digestive Diseases, Section of Pathology, Imperial College London, St. Mary's Hospital, London W2 1NY, U.K
- Department of Cellular Pathology, Charing Cross Hospital, London W6 8RF, U.K
| | - Stephanie Ling
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Edmond Wong
- Biologics Engineering, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Frank Seeliger
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Maria Paola Serra
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Scott Hoffmann
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, U.K
| | - Gareth Maglennon
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Gregory Hamm
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - James Atkinson
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Stewart Jones
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Josephine Bunch
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, U.K
- National Centre of Excellence in Mass Spectrometry Imaging (NiCE-MSI), National Physical Laboratory, Teddington TW11 0LW, U.K
| | - Per E Andrén
- Medical Mass Spectrometry Imaging, Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
- Science for Life Laboratory, Spatial Mass Spectrometry, Uppsala University, 751 24 Uppsala, Sweden
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, U.K
| | - Richard J A Goodwin
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, U.K
| | - Pietro Mastroeni
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, U.K
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6
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Appiah GD, Mpimbaza A, Lamorde M, Freeman M, Kajumbula H, Salah Z, Kugeler K, Mikoleit M, White PB, Kapisi J, Borchert J, Sserwanga A, Van Dyne S, Mead P, Kim S, Lauer AC, Winstead A, Manabe YC, Flick RJ, Mintz E. Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness-Uganda, 2016-2019. Am J Trop Med Hyg 2021; 105:37-46. [PMID: 33999850 DOI: 10.4269/ajtmh.20-1453] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/19/2021] [Indexed: 12/23/2022] Open
Abstract
Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1-4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P < 0.001). Children with Salmonella BSIs did not differ significantly in length of hospitalization or mortality from children with BSI resulting from other organisms. Serotype and antimicrobial susceptibility results were available for 49 Salmonella isolates, including 35 (71%) non-typhoidal serotypes and 14 Salmonella serotype Typhi (Typhi). Among Typhi isolates, 10 (71%) were multi-drug resistant and 13 (93%) had decreased ciprofloxacin susceptibility. Salmonella strains, particularly non-typhoidal serotypes and drug-resistant Typhi, were the most common cause of BSI. These data can inform regional Salmonella surveillance in East Africa and guide empiric therapy and prevention in Uganda.
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Affiliation(s)
- Grace D Appiah
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arthur Mpimbaza
- 2Infectious Disease Research Collaboration, Kampala, Uganda.,3Child Health and Development Center, Makerere University, Kampala, Uganda
| | | | - Molly Freeman
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry Kajumbula
- 5Department of Microbiology, Makerere University, Kampala, Uganda
| | - Zainab Salah
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kiersten Kugeler
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Matthew Mikoleit
- 7Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Porscha Bumpus White
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Kapisi
- 2Infectious Disease Research Collaboration, Kampala, Uganda
| | - Jeff Borchert
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | - Susan Van Dyne
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Mead
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Sunkyung Kim
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ana C Lauer
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Winstead
- 8Division of Parasitic Disease and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yukari C Manabe
- 9Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert J Flick
- 9Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Mintz
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Steele AD, Carey ME, Kumar S, MacLennan CA, Ma LF, Diaz Z, Zaidi AKM. Typhoid Conjugate Vaccines and Enteric Fever Control: Where to Next? Clin Infect Dis 2021; 71:S185-S190. [PMID: 32725223 PMCID: PMC7388705 DOI: 10.1093/cid/ciaa343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
After the unprecedented success and acceleration of the global agenda towards typhoid fever control with a strong World Health Organization recommendation and the approval of funding from Gavi, the Vaccine Alliance (Gavi), for the use of a new typhoid conjugate vaccine (TCV), we should turn our minds to the challenges that remain ahead. Despite the evidence showing the safety and clinical efficacy of TCV in endemic populations in developing countries, we should remain vigilant and explore hurdles for the full public health impact of TCV, including vaccine supply for the potential global demand, immunization strategies to optimize the effectiveness and long-term protection provided by the vaccines, potential use of TCV in outbreak settings, and scenarios for addressing chronic carriers. Finally, challenges face endemic countries with poor surveillance systems concerning awareness of the need for TCV and the extent of the issue across their populations, and how to target immunization strategies appropriately.
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Affiliation(s)
- A Duncan Steele
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Megan E Carey
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Supriya Kumar
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Calman A MacLennan
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Lyou-Fu Ma
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Zoey Diaz
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Anita K M Zaidi
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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Enteric Fever Diagnosis: Current Challenges and Future Directions. Pathogens 2021; 10:pathogens10040410. [PMID: 33915749 PMCID: PMC8065732 DOI: 10.3390/pathogens10040410] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 12/21/2022] Open
Abstract
Enteric fever is a life-threatening systemic febrile disease caused by Salmonella enterica serovars Typhi and Paratyphi (S. Typhi and S. Paratyphi). Unfortunately, the burden of the disease remains high primarily due to the global spread of various drug-resistant Salmonella strains despite continuous advancement in the field. An accurate diagnosis is critical for effective control of the disease. However, enteric fever diagnosis based on clinical presentations is challenging due to overlapping symptoms with other febrile illnesses that are also prevalent in endemic areas. Current laboratory tests display suboptimal sensitivity and specificity, and no diagnostic methods are available for identifying asymptomatic carriers. Several research programs have employed systemic approaches to identify more specific biomarkers for early detection and asymptomatic carrier detection. This review discusses the pros and cons of currently available diagnostic tests for enteric fever, the advancement of research toward improved diagnostic tests, and the challenges of discovering new ideal biomarkers and tests.
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Hin S, Lopez-Jimena B, Bakheit M, Klein V, Stack S, Fall C, Sall A, Enan K, Mustafa M, Gillies L, Rusu V, Goethel S, Paust N, Zengerle R, Frischmann S, Weidmann M, Mitsakakis K. Fully automated point-of-care differential diagnosis of acute febrile illness. PLoS Negl Trop Dis 2021; 15:e0009177. [PMID: 33630852 PMCID: PMC7906357 DOI: 10.1371/journal.pntd.0009177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background In this work, a platform was developed and tested to allow to detect a variety of candidate viral, bacterial and parasitic pathogens, for acute fever of unknown origin. The platform is based on a centrifugal microfluidic cartridge, the LabDisk (“FeverDisk” for the specific application), which integrates all necessary reagents for sample-to-answer analysis and is processed by a compact, point-of-care compatible device. Methodology/Principal findings A sample volume of 200 μL per FeverDisk was used. In situ extraction with pre-stored reagents was achieved by bind-wash-elute chemistry and magnetic particles. Enzymes for the loop-mediated isothermal amplification (LAMP) were pre-stored in lyopellet form providing stability and independence from the cold chain. The total time to result from sample inlet to read out was 2 h. The proof-of-principle was demonstrated in three small-scale feasibility studies: in Dakar, Senegal and Khartoum, Sudan we tested biobanked samples using 29 and 9 disks, respectively; in Reinfeld, Germany we tested spiked samples and analyzed the limit of detection using three bacteria simultaneously spiked in whole blood using 15 disks. Overall during the three studies, the FeverDisk detected dengue virus (different serotypes), chikungunya virus, Plasmodium falciparum, Salmonella enterica Typhi, Salmonella enterica Paratyphi A and Streptococcus pneumoniae. Conclusions/Significance The FeverDisk proved to be universally applicable as it successfully detected all different types of pathogens as single or co-infections, while it also managed to define the serotype of un-serotyped dengue samples. Thirty-eight FeverDisks at the two African sites provided 59 assay results, out of which 51 (86.4%) were confirmed with reference assay results. The results provide a promising outlook for future implementation of the platform in larger prospective clinical studies for defining its clinical sensitivity and specificity. The technology aims to provide multi-target diagnosis of the origins of fever, which will help fight lethal diseases and the incessant rise of antimicrobial resistance. Infectious diseases in tropical regions may have a variety of viral, bacterial or parasitic origins and a patient may suffer from several diseases simultaneously, each presenting with acute fever as a clinical symptom. This makes it difficult to determine the origin of the pathogen causing the disease(s). In addition to the endemic infectious diseases, outbreaks of epidemics frequently complicate diagnostic demands. Accurate diagnosis for proper patient management requires the utilization of highly sensitive and specific, rapid, easy-to-use diagnostic tools compatible with point-of-care settings. We describe the use of a disk-shaped microfluidic platform, the “FeverDisk”, for differential diagnosis of acute fever. Our FeverDisk platform demonstrated its capability to detect bacteria, viruses and parasites that are typical of tropical single and co-infections from biobanked samples within only 2 hours and in very good agreement with reference method results. This, in combination with its easy-to-use and point-of-care compatible nature, render our platform a promising candidate for detection of tropical diseases and precise identification of the cause of acute fever, in endemic and epidemic settings. Future work will involve extensive clinical characterization of the platform in prospective studies.
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Affiliation(s)
- Sebastian Hin
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Benjamin Lopez-Jimena
- Institute of Aquaculture, University of Stirling, Scotland, United Kingdom
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | | | - Vanessa Klein
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Seamus Stack
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | - Cheikh Fall
- Arbovirus and viral haemorrhagic fever unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Amadou Sall
- Arbovirus and viral haemorrhagic fever unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Khalid Enan
- Department of Virology, Central Laboratory-The Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Mohamed Mustafa
- Department of Virology, Central Laboratory-The Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Liz Gillies
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | - Viorel Rusu
- MagnaMedics Diagnostics BV, Geleen, The Netherlands
| | - Sven Goethel
- MagnaMedics Diagnostics BV, Geleen, The Netherlands
| | - Nils Paust
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
| | - Roland Zengerle
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
| | | | - Manfred Weidmann
- Institute of Aquaculture, University of Stirling, Scotland, United Kingdom
| | - Konstantinos Mitsakakis
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
- * E-mail:
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10
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Qamar FN, Yousafzai MT, Dehraj IF, Shakoor S, Irfan S, Hotwani A, Hunzai MJ, Thobani RS, Rahman N, Mehmood J, Hemlock C, Memon AM, Andrews JR, Luby SP, Garrett DO, Longley AT, Date K, Saha SK. Antimicrobial Resistance in Typhoidal Salmonella: Surveillance for Enteric Fever in Asia Project, 2016-2019. Clin Infect Dis 2020; 71:S276-S284. [PMID: 33258934 PMCID: PMC7705872 DOI: 10.1093/cid/ciaa1323] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. METHODS From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. RESULTS We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal. CONCLUSIONS Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine.
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Affiliation(s)
- Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad J Hunzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | | | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kashmira Date
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu (Children) Hospital, Bangladesh
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11
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Rossi O, Vlazaki M, Kanvatirth P, Restif O, Mastroeni P. Within-host spatiotemporal dynamic of systemic salmonellosis: Ways to track infection, reaction to vaccination and antimicrobial treatment. J Microbiol Methods 2020; 176:106008. [PMID: 32707153 DOI: 10.1016/j.mimet.2020.106008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022]
Abstract
During the last two decades our understanding of the complex in vivo host-pathogen interactions has increased due to technical improvements and new research tools. The rapid advancement of molecular biology, flow cytometry and microscopy techniques, combined with mathematical modelling, have empowered in-depth studies of systemic bacterial infections across scales from single molecules, to cells, to organs and systems to reach the whole organism level. By tracking subpopulations of bacteria in vivo using molecular or fluorescent tags, it has been possible to reconstruct the spread of infection within and between organs, allowing unprecedented quantification of the effects of antimicrobial treatment and vaccination. This review illustrates recent advances in the study of heterogeneous traits of the infection process and illustrate approaches to investigate the reciprocal interactions between antimicrobial treatments, bacterial growth/death as well as inter- and intra-organ spread. We also discuss how vaccines impact the in vivo behaviour of bacteria and how these findings can guide vaccine design and rational antimicrobial treatment.
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Affiliation(s)
- Omar Rossi
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK.
| | - Myrto Vlazaki
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Panchali Kanvatirth
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Olivier Restif
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Pietro Mastroeni
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK.
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12
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Halliday JEB, Carugati M, Snavely ME, Allan KJ, Beamesderfer J, Ladbury GAF, Hoyle DV, Holland P, Crump JA, Cleaveland S, Rubach MP. Zoonotic causes of febrile illness in malaria endemic countries: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 20:e27-e37. [PMID: 32006517 PMCID: PMC7212085 DOI: 10.1016/s1473-3099(19)30629-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/03/2019] [Accepted: 10/29/2019] [Indexed: 01/04/2023]
Abstract
Fever is one of the most common reasons for seeking health care globally and most human pathogens are zoonotic. We conducted a systematic review to describe the occurrence and distribution of zoonotic causes of human febrile illness reported in malaria endemic countries. We included data from 53 (48·2%) of 110 malaria endemic countries and 244 articles that described diagnosis of 30 zoonoses in febrile people. The majority (17) of zoonoses were bacterial, with nine viruses, three protozoa, and one helminth also identified. Leptospira species and non-typhoidal salmonella serovars were the most frequently reported pathogens. Despite evidence of profound data gaps, this Review reveals widespread distribution of multiple zoonoses that cause febrile illness. Greater understanding of the epidemiology of zoonoses in different settings is needed to improve awareness about these pathogens and the management of febrile illness.
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Affiliation(s)
- Jo E B Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.
| | - Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael E Snavely
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Kathryn J Allan
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Julia Beamesderfer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Georgia A F Ladbury
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Deborah V Hoyle
- Roslin Institute and Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Paul Holland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - John A Crump
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Centre for International Health, University of Otago, Dunedin, New Zealand; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Matthew P Rubach
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, NC, USA; Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore
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13
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Bhutta ZA. Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia? Clin Infect Dis 2020; 68:S34-S41. [PMID: 30767006 PMCID: PMC6376087 DOI: 10.1093/cid/ciy957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several decades following the first estimates of the global burden of typhoidal salmonellosis (infections caused by Salmonella Typhi and Salmonella Paratyphi), this disorder remains a major cause of morbidity worldwide with an estimated 17 million cases annually. The risk factors for typhoid include poverty, poor living conditions with unsafe water and lack of adequate sanitation, and unsafe foods-all reasons for the disease burden being highest among such populations including urban slums. A recent review of typhoid trends globally and in specific countries suggests that the relative contributions of these risk factors to disease burden reduction as well as persistence have varied. There is also the risk of periodic outbreaks related to introduction of relatively virulent drug-resistant strains or movements of vulnerable populations, including those in conflict zones. Most countries of the world are now aligning their health and multisectoral strategies to address the Sustainable Development Goals (SDGs) and targets, which were agreed upon by all countries of the world in September 2015. Though neglected so far, there are huge opportunities for mainstreaming typhoid prevention and control strategies within the SDGs. This article reviews some of the approaches that may help elevate typhoid to a higher level of awareness in public health programs and policy and to ensure that investments in major public health preventive measures are made part of the universal health coverage agenda.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Browne AJ, Kashef Hamadani BH, Kumaran EAP, Rao P, Longbottom J, Harriss E, Moore CE, Dunachie S, Basnyat B, Baker S, Lopez AD, Day NPJ, Hay SI, Dolecek C. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis. BMC Med 2020; 18:1. [PMID: 31898501 PMCID: PMC6941399 DOI: 10.1186/s12916-019-1443-1] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention. METHODS We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. FINDINGS We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified. INTERPRETATION Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice. TRIAL REGISTRATION PROSPERO CRD42018029432.
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Affiliation(s)
- Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Bahar H Kashef Hamadani
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Emmanuelle A P Kumaran
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Puja Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joshua Longbottom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Catrin E Moore
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Susanna Dunachie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit Nepal, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Baker
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit Vietnam, The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Alan D Lopez
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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15
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Bundalian R, Valenzuela M, Tiongco RE. Achieving accurate laboratory diagnosis of typhoid fever: a review and meta-analysis of TUBEX® TF clinical performance. Pathog Glob Health 2019; 113:297-308. [PMID: 31778097 DOI: 10.1080/20477724.2019.1695081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This review discusses currently available serological diagnostic methods for typhoid fever with a focus on the clinical utility of TUBEX® TF as an alternative to the Widal or Typhidot test. A literature search was conducted in PubMed for related publications written in English. A qualitative analysis was done to determine various serological tests used for typhoid fever diagnosis with emphasis on TUBEX® TF in comparison to the Widal of Typhidot test. Further, a meta-analysis was performed to obtain a pooled estimate of diagnostic accuracy (sensitivity and specificity) using different analysis models. A total of sixteen studies was included in the qualitative analysis. Further screening of these studies yielded ten studies that were used for the meta-analysis. The sensitivity/specificity range of different commonly used serological tests in typhoid patients is between 55-100%/58-100% for TUBEX® TF, 54-67%/54-95% for Typhidot, and 32-95%/4-98% for the Widal test. As for the pooled meta-analysis estimates, the TUBEX® TF showed superior results when differentiating individuals with febrile illness of unknown origin from those with typhoid fever. Overall, the results of this review and meta-analysis suggest that the TUBEX® TF is more advantageous to use as a serological test for typhoid fever diagnosis due its accuracy and simplicity. However, further studies are still needed to validate our results.
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Affiliation(s)
- Reynaldo Bundalian
- Center for Research and Development, Angeles University Foundation, Angeles City, Philippines
| | - Madonna Valenzuela
- Public Health Program, Graduate School, Angeles University Foundation, Angeles City, Philippines
| | - Raphael Enrique Tiongco
- Department of Medical Technology, College of Allied Medical Professions, Angeles University Foundation, Angeles City, Philippines
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Abstract
Salmonella enterica subspecies enterica serovar Typhi (Salmonella Typhi) is the cause of typhoid fever and a human host-restricted organism. Our understanding of the global burden of typhoid fever has improved in recent decades, with both an increase in the number and geographic representation of high-quality typhoid fever incidence studies, and greater sophistication of modeling approaches. The 2017 World Health Organization Strategic Advisory Group of Experts on Immunization recommendation for the introduction of typhoid conjugate vaccines for infants and children aged >6 months in typhoid-endemic countries is likely to require further improvements in our understanding of typhoid burden at the global and national levels. Furthermore, the recognition of the critical and synergistic role of water and sanitation improvements in concert with vaccine introduction emphasize the importance of improving our understanding of the sources, patterns, and modes of transmission of Salmonella Typhi in diverse settings.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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17
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Mitsakakis K, D'Acremont V, Hin S, von Stetten F, Zengerle R. Diagnostic tools for tackling febrile illness and enhancing patient management. MICROELECTRONIC ENGINEERING 2018; 201:26-59. [PMID: 32287568 PMCID: PMC7114275 DOI: 10.1016/j.mee.2018.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Most patients with acute infectious diseases develop fever, which is frequently a reason to visit health facilities in resource-limited settings. The symptomatic overlap between febrile diseases impedes their diagnosis on clinical grounds. Therefore, the World Health Organization promotes an integrated management of febrile illness. Along this line, we present an overview of endemic and epidemic etiologies of fever and state-of-the-art diagnostic tools used in the field. It becomes evident that there is an urgent need for the development of novel technologies to fulfill end-users' requirements. This need can be met with point-of-care and near-patient diagnostic platforms, as well as e-Health clinical algorithms, which co-assess test results with key clinical elements and biosensors, assisting clinicians in patient triage and management, thus enhancing disease surveillance and outbreak alerts. This review gives an overview of diagnostic technologies featuring a platform based approach: (i) assay (nucleic acid amplification technologies are examined); (ii) cartridge (microfluidic technologies are presented); (iii) instrument (various detection technologies are discussed); and at the end proposes a way that such technologies can be interfaced with electronic clinical decision-making algorithms towards a broad and complete diagnostic ecosystem.
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Affiliation(s)
- Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Corresponding author.
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4002 Basel, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, 1011 Lausanne, Switzerland
| | - Sebastian Hin
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- BIOSS – Centre for Biological Signalling Studies, University of Freiburg, Schaenzlestr. 18, 79104 Freiburg, Germany
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Antillon M, Saad NJ, Baker S, Pollard AJ, Pitzer VE. The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis. J Infect Dis 2018; 218:S255-S267. [PMID: 30307563 PMCID: PMC6226661 DOI: 10.1093/infdis/jiy471] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Blood culture is the standard diagnostic method for typhoid and paratyphoid (enteric) fever in surveillance studies and clinical trials, but sensitivity is widely acknowledged to be suboptimal. We conducted a systematic review and meta-analysis to examine sources of heterogeneity across studies and quantified the effect of blood volume. Methods We searched the literature to identify all studies that performed blood culture alongside bone marrow culture (a gold standard) to detect cases of enteric fever. We performed a meta-regression analysis to quantify the relationship between blood sample volume and diagnostic sensitivity. Furthermore, we evaluated the impact of patient age, antimicrobial use, and symptom duration on sensitivity. Results We estimated blood culture diagnostic sensitivity was 0.59 (95% confidence interval [CI], 0.54-0.64) with significant between-study heterogeneity (I2, 76% [95% CI, 68%-82%]; P < .01). Sensitivity ranged from 0.51 (95% CI, 0.44-0.57) for a 2-mL blood specimen to 0.65 (95% CI, 0.58-0.70) for a 10-mL blood specimen, indicative of a relationship between specimen volume and sensitivity. Subgroup analysis showed significant heterogeneity by patient age and a weak trend towards higher sensitivity among more recent studies. Sensitivity was 34% lower (95% CI, 4%-54%) among patients with prior antimicrobial use and 31% lower after the first week of symptoms (95% CI, 19%-41%). There was no evidence of confounding by patient age, antimicrobial use, symptom duration, or study date on the relationship between specimen volume and sensitivity. Conclusions The relationship between the blood sample volume and culture sensitivity should be accounted for in incidence and next-generation diagnostic studies.
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Affiliation(s)
- Marina Antillon
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Center for Health Economics Research and Modeling of Infectious Diseases, University of Antwerp, Belgium
| | - Neil J Saad
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Stephen Baker
- Oxford University Clinical Research Unit Vietnam, Ho Chi Minh City, Vietnam
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford , Oxford, United Kingdom
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Rossi O, Dybowski R, Maskell DJ, Grant AJ, Restif O, Mastroeni P. Within-host spatiotemporal dynamics of systemic Salmonella infection during and after antimicrobial treatment. J Antimicrob Chemother 2018; 72:3390-3397. [PMID: 28962012 PMCID: PMC5890750 DOI: 10.1093/jac/dkx294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/20/2017] [Indexed: 01/23/2023] Open
Abstract
Objectives We determined the interactions between efficacy of antibiotic treatment, pathogen growth rates and between-organ spread during systemic Salmonella infections. Methods We infected mice with isogenic molecularly tagged subpopulations of either a fast-growing WT or a slow-growing ΔaroC Salmonella strain. We monitored viable bacterial numbers and fluctuations in the proportions of each bacterial subpopulation in spleen, liver, blood and mesenteric lymph nodes (MLNs) before, during and after the cessation of treatment with ampicillin and ciprofloxacin. Results Both antimicrobials induced a reduction in viable bacterial numbers in the spleen, liver and blood. This reduction was biphasic in infections with fast-growing bacteria, with a rapid initial reduction followed by a phase of lower effect. Conversely, a slow and gradual reduction of the bacterial load was seen in infections with the slow-growing strain, indicating a positive correlation between bacterial net growth rates and the efficacy of ampicillin and ciprofloxacin. The viable numbers of either bacterial strain remained constant in MLNs throughout the treatment with a relapse of the infection with WT bacteria occurring after cessation of the treatment. The frequency of each tagged bacterial subpopulation was similar in the spleen and liver, but different from that of the MLNs before, during and after treatment. Conclusions In Salmonella infections, bacterial growth rates correlate with treatment efficacy. MLNs are a site with a bacterial population structure different to those of the spleen and liver and where the total viable bacterial load remains largely unaffected by antimicrobials, but can resume growth after cessation of treatment.
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Affiliation(s)
- O Rossi
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - R Dybowski
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - D J Maskell
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - A J Grant
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - O Restif
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - P Mastroeni
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
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20
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An SJ, Scaria PV, Chen B, Barnafo E, Muratova O, Anderson C, Lambert L, Chae MH, Yang JS, Duffy PE. Development of a bivalent conjugate vaccine candidate against malaria transmission and typhoid fever. Vaccine 2018; 36:2978-2984. [PMID: 29681410 DOI: 10.1016/j.vaccine.2018.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 01/24/2023]
Abstract
Immune responses to poorly immunogenic antigens, such as polysaccharides, can be enhanced by conjugation to carriers. Our previous studies indicate that conjugation to Vi polysaccharide of Salmonella Typhi may also enhance immunogenicity of some protein carriers. We therefore explored the possibility of generating a bivalent vaccine against Plasmodium falciparum malaria and typhoid fever, which are co-endemic in many parts of the world, by conjugating Vi polysaccharide, an approved antigen in typhoid vaccine, to Pfs25, a malaria transmission blocking vaccine antigen in clinical trials. Vi-Pfs25 conjugates induced strong immune responses against both Vi and Pfs25 in mice, whereas the unconjugated antigens are poorly immunogenic. Functional assays of immune sera revealed potent transmission blocking activity mediated by anti-Pfs25 antibody and serum bactericidal activity due to anti-Vi antibody. Pfs25 conjugation to Vi modified the IgG isotype distribution of antisera, inducing a Th2 polarized immune response against Vi antigen. This conjugate may be further developed as a bivalent vaccine to concurrently target malaria and typhoid fever.
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Affiliation(s)
- So Jung An
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA; International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, 151-742 Seoul, Republic of Korea
| | - Puthupparampil V Scaria
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Beth Chen
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Emma Barnafo
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Olga Muratova
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Charles Anderson
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Lynn Lambert
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Myung Hwa Chae
- International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, 151-742 Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, 151-742 Seoul, Republic of Korea
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA.
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A diagnostic and epidemiologic investigation of acute febrile illness (AFI) in Kilombero, Tanzania. PLoS One 2017; 12:e0189712. [PMID: 29287070 PMCID: PMC5747442 DOI: 10.1371/journal.pone.0189712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction In low-resource settings, empiric case management of febrile illness is routine as a result of limited access to laboratory diagnostics. The use of comprehensive fever syndromic surveillance, with enhanced clinical microbiology, advanced diagnostics and more robust epidemiologic investigation, could enable healthcare providers to offer a differential diagnosis of fever syndrome and more appropriate care and treatment. Methods We conducted a year-long exploratory study of fever syndrome among patients ≥ 1 year if age, presenting to clinical settings with an axillary temperature of ≥37.5°C and symptomatic onset of ≤5 days. Blood and naso-pharyngeal/oral-pharyngeal (NP/OP) specimens were collected and analyzed, respectively, using AFI and respiratory TaqMan Array Cards (TAC) for multi-pathogen detection of 57 potential causative agents. Furthermore, we examined numerous epidemiologic correlates of febrile illness, and conducted demographic, clinical, and behavioral domain-specific multivariate regression to statistically establish associations with agent detection. Results From 15 September 2014–13 September 2015, 1007 febrile patients were enrolled, and 997 contributed an epidemiologic survey, including: 14% (n = 139) 1<5yrs, 19% (n = 186) 5-14yrs, and 67% (n = 672) ≥15yrs. AFI TAC and respiratory TAC were performed on 842 whole blood specimens and 385 NP/OP specimens, respectively. Of the 57 agents surveyed, Plasmodium was the most common agent detected. AFI TAC detected nucleic acid for one or more of seven microbial agents in 49% of AFI blood samples, including: Plasmodium (47%), Leptospira (3%), Bartonella (1%), Salmonella enterica (1%), Coxiella burnetii (1%), Rickettsia (1%), and West Nile virus (1%). Respiratory TAC detected nucleic acid for 24 different microbial agents, including 12 viruses and 12 bacteria. The most common agents detected among our surveyed population were: Haemophilus influenzae (67%), Streptococcus pneumoniae (55%), Moraxella catarrhalis (39%), Staphylococcus aureus (37%), Pseudomonas aeruginosa (36%), Human Rhinovirus (25%), influenza A (24%), Klebsiella pneumoniae (14%), Enterovirus (15%) and group A Streptococcus (12%). Our epidemiologic investigation demonstrated both age and symptomatic presentation to be associated with a number of detected agents, including, but not limited to, influenza A and Plasmodium. Linear regression of fully-adjusted mean cycle threshold (Ct) values for Plasmodium also identified statistically significant lower mean Ct values for older children (20.8), patients presenting with severe fever (21.1) and headache (21.5), as well as patients admitted for in-patient care and treatment (22.4). Conclusions This study is the first to employ two syndromic TaqMan Array Cards for the simultaneous survey of 57 different organisms to better characterize the type and prevalence of detected agents among febrile patients. Additionally, we provide an analysis of the association between adjusted mean Ct values for Plasmodium and key clinical and demographic variables, which may further inform clinical decision-making based upon intensity of infection, as observed across endemic settings of sub-Saharan Africa.
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22
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Hercik C, Cosmas L, Mogeni OD, Wamola N, Kohi W, Houpt E, Liu J, Ochieng C, Onyango C, Fields B, Mfinanga S, Montgomery JM. A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania. Am J Trop Med Hyg 2017; 98:625-632. [PMID: 29280432 PMCID: PMC5929188 DOI: 10.4269/ajtmh.17-0421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents. We collected both blood and naso/oro-pharyngeal (NP/OP) swabs from consecutive consenting patients ≥ 1 year of age, with an axillary temperature ≥ 37.5°C, and symptom onset of ≤ 5 days. Specimens were analyzed using both acute febrile illness (AFI) and respiratory TaqMan array cards (Resp TAC) for multiagent detection of 56 different bloodstream and respiratory agents. In addition, we collected epidemiologic data to further characterize our patient population. We enrolled 205 febrile patients, including 70 children (1 < 15 years of age; 34%) and 135 adults (≥ 15 years of age; 66%). AFI TAC and Resp TAC were performed on 191 whole blood specimens and 115 NP/OP specimens, respectively. We detected nucleic acid for Plasmodium (57%), Leptospira (2%), and dengue virus (1%) among blood specimens. In addition, we detected 17 different respiratory agents, most notably, Haemophilus influenzae (64%), Streptococcus pneumonia (56%), Moraxella catarrhalis (39%), and respiratory syncytial virus (11%) among NP/OP specimens. Overall median cycle threshold was measured at 26.5. This study provides a proof-of-concept for the use of a multiagent diagnostic approach for exploratory research on febrile illness and underscores the utility of quantitative molecular diagnostics in complex epidemiologic settings of sub-Saharan Africa.
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Affiliation(s)
| | - Leonard Cosmas
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ondari D Mogeni
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Newton Wamola
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Wanze Kohi
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Caroline Ochieng
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Clayton Onyango
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Barry Fields
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Sayoki Mfinanga
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Joel M Montgomery
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Antillón M, Warren JL, Crawford FW, Weinberger DM, Kürüm E, Pak GD, Marks F, Pitzer VE. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis 2017; 11:e0005376. [PMID: 28241011 PMCID: PMC5344533 DOI: 10.1371/journal.pntd.0005376] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/09/2017] [Accepted: 01/31/2017] [Indexed: 11/26/2022] Open
Abstract
Background Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs), so model-based estimates offer insights for decision-makers in the absence of readily available data. Methods We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model. Results We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9–48.4 million). Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2–4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models. Conclusions Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases. Typhoid fever is a bacterial enteric infection that continues to pose a considerable burden to the 5.5 billion people living in low- and middle-income countries (LMICs). We developed and validated a model incorporating widely available indicators of economic and social development and the environment to estimate the burden of typhoid fever across LMICs. Our analysis uses all available data to estimate the incidence of typhoid in key age groups, which is important for the design and implementation of optimal vaccination strategies, and it identifies regions of the world that have the most uncertainty in typhoid incidence. Across all LMICs, we estimated that the expected number of typhoid fever cases per year is 17.8 million (95% CI: 6.9–48.4 million). We also present the probability that incidence surpasses the criteria for low, medium, high, and very high incidence in each country, which could help guide policy in the face of uncertainty.
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Affiliation(s)
- Marina Antillón
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Forrest W. Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Esra Kürüm
- Department of Statistics, University of California Riverside, Riverside, California, United States of America
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Germeraad EA, Hogerwerf L, Faye-Joof T, Goossens B, van der Hoek W, Jeng M, Lamin M, Manneh IL, Nwakanma D, Roest HIJ, Secka A, Stegeman A, Wegmüller R, van der Sande MAB, Secka O. Low Seroprevalence of Brucellosis in Humans and Small Ruminants in the Gambia. PLoS One 2016; 11:e0166035. [PMID: 27824952 PMCID: PMC5100947 DOI: 10.1371/journal.pone.0166035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 10/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background Brucellosis is a worldwide zoonosis with significant impact on rural livelihoods and a potentially underestimated contributor to febrile illnesses. The aim of this study was to estimate the seroprevalence of brucellosis in humans and small ruminants in The Gambia. Methods The study was carried out in rural and urban areas. In 12 rural villages in Kiang West district, sera were collected from humans (n = 599) and small ruminants (n = 623) from the same compounds. From lactating small ruminants, milk samples and vaginal swabs were obtained. At the urban study sites, sera were collected from small ruminants (n = 500) from slaughterhouses and livestock markets. Information on possible risk factors for seropositivity was collected through questionnaires. Sera were screened for antibodies against Brucella spp. with the Rose Bengal Test, ELISA and Micro Agglutination Test (human sera only). PCR was performed on 10 percent of the milk samples and vaginal swabs from small ruminants. Results One human and 14 sheep sera were positive by the Rose Bengal Test. The rest were negative in all serological tests used. The PCR results were all negative. Conclusions The results suggest that brucellosis is currently not a generalized problem in humans or small ruminants in The Gambia.
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Affiliation(s)
- Eveline A. Germeraad
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Lenny Hogerwerf
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- * E-mail:
| | - Tisbeh Faye-Joof
- Department of Vaccinology, Medical Research Council Unit The Gambia, Banjul, Fajara, The Gambia
| | | | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Momodou Jeng
- International Trypanotolerance Centre, Banjul, The Gambia
| | - Modou Lamin
- Department of Disease Control and Elimination, Medical Research Council Unit, The Gambia, Banjul, Fajara, The Gambia
| | - Ismaila L. Manneh
- Department of Vaccinology, Medical Research Council Unit The Gambia, Banjul, Fajara, The Gambia
| | - Davis Nwakanma
- Department of Disease Control and Elimination, Medical Research Council Unit, The Gambia, Banjul, Fajara, The Gambia
| | - Hendrik I. J. Roest
- Department of Bacteriology and Epidemiology, Central Veterinary Institute, part of Wageningen UR, Lelystad, The Netherlands
| | - Arss Secka
- International Trypanotolerance Centre, Banjul, The Gambia
| | - Arjan Stegeman
- Department of Farm Animal Health, Utrecht University, Utrecht, The Netherlands
| | - Rita Wegmüller
- Medical Research Council (MRC) International Nutrition Group, MRC Unit The Gambia, Keneba, The Gambia
| | - Marianne A. B. van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ousman Secka
- Department of Disease Control and Elimination, Medical Research Council Unit, The Gambia, Banjul, Fajara, The Gambia
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Achonduh-Atijegbe OA, Mfuh KO, Mbange AHE, Chedjou JP, Taylor DW, Nerurkar VR, Mbacham WF, Leke R. Prevalence of malaria, typhoid, toxoplasmosis and rubella among febrile children in Cameroon. BMC Infect Dis 2016; 16:658. [PMID: 27825318 PMCID: PMC5101675 DOI: 10.1186/s12879-016-1996-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/28/2016] [Indexed: 01/21/2023] Open
Abstract
Background The current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses. However, lack of knowledge of the prevalence of other febrile illnesses and affordable diagnostic tests means that febrile patients are not managed optimally. This study assessed the prevalence of commonly treatable or preventable febrile illnesses in children between 6 months and 15 years using rapid diagnostic tests at the point-of-care. Methods Febrile children were enrolled between February-April 2014 at a health facility after obtaining informed consent from parent. Eligible participants were aged 6 months-15 years with a history of fever in the last 24 h or axillary temperature ≥38 °C at consultation. All participants were tested using RDTs for malaria, typhoid, toxoplasmosis and rubella. Malaria parasites were further identified by microscopy and PCR. Clinical and household characteristics were recorded and association with pathogens determined. Results Of the 315 children enrolled, the mean age was 5.8 ± 3.8 years. Stomach pain (41.2 %) was the most reported symptom. Prior to attending the health facility, 70.8 % had taken antipyretics, 27.9 % antimalarials, 11.4 % antibiotics and 13.3 % antifungal drugs. Among 315 children with fever, based on RDTs, 56.8 % were infected with malaria, 4.4 % with typhoid, 3.2 % with acute toxoplasmosis, and 1.3 % with rubella (all positive for rubella were in the same family and not vaccinated). All non-malarial infections were co-infections and approximately 30 % of the fever cases went un-diagnosed. Malaria prevalence by microscopy and PCR was 43.4 and 70.2 % respectively. The sensitivity and specificity of RDTs for the diagnosis of malaria were 75.98 and 100 % respectively, with 0.73 measurement agreement between RDTs and microscopy while that of RDT and PCR were 81 and 100 % respectively with a K value of 0.72. The use of Insecticide Treated Bednets was 44 %. There was a significant association between ITN non-usage and malaria (p = 0. 029) as well as drinking water and presence of typhoid (p = 0.047). No association was observed between type of housing and malaria, or toxoplasmosis and raising cats. Conclusion Though malaria still remains the major cause of fever in children, using RDTs for other treatable febrile illnesses like typhoid and toxoplasmosis could facilitate the optimal management of febrile illnesses in children especially when these occur as co-infections with malaria Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1996-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olivia A Achonduh-Atijegbe
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon. .,North Pacific Global Health Program, University of Hawaii, Hawaii, USA.
| | - Kenji O Mfuh
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Hawaii, USA
| | | | - Jean P Chedjou
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Diane W Taylor
- North Pacific Global Health Program, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Hawaii, USA
| | - Vivek R Nerurkar
- North Pacific Global Health Program, University of Hawaii, Hawaii, USA.,Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Hawaii, USA
| | - Wilfred F Mbacham
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Rose Leke
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.,North Pacific Global Health Program, University of Hawaii, Hawaii, USA
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Wells KM, Lee YJ, Erdene S, Erdene S, Sanchin U, Sergelen O, Zhang C, Rodriguez BP, deVries CR, Price RR. Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy. Surgery 2016; 160:509-17. [DOI: 10.1016/j.surg.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 01/11/2023]
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Franco-Paredes C, Khan MI, Gonzalez-Diaz E, Santos-Preciado JI, Rodriguez-Morales AJ, Gotuzzo E. Enteric Fever: A Slow Response to an Old Plague. PLoS Negl Trop Dis 2016; 10:e0004597. [PMID: 27171237 PMCID: PMC4865160 DOI: 10.1371/journal.pntd.0004597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México D.F., México
- Phoebe Putney Memorial Hospital, Albany, Georgia, United States of America
- * E-mail:
| | - M. Imran Khan
- Precision Developmental Research and Advocacy Consultants, Karachi, Pakistan
| | | | - Jose I. Santos-Preciado
- Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital General de México, México, D.F., México
| | - Alfonso J. Rodriguez-Morales
- Public Health and Infectious Disease Research Group, Facultad de Ciencias Médicas, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical, Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Development of a Simple, Peripheral-Blood-Based Lateral-Flow Dipstick Assay for Accurate Detection of Patients with Enteric Fever. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:403-409. [PMID: 26961857 DOI: 10.1128/cvi.00690-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/29/2016] [Indexed: 11/20/2022]
Abstract
Enteric fever is a systemic infection caused by typhoidal strains of Salmonella enterica and is a significant cause of mortality and morbidity in many parts of the world, especially in resource-limited areas. Unfortunately, currently available diagnostic tests for enteric fever lack sensitivity and/or specificity. No true clinically practical gold standard for diagnosing patients with enteric fever exists. Unfortunately, microbiologic culturing of blood is only 30 to 70% sensitive although 100% specific. Here, we report the development of a lateral-flow immunochromatographic dipstick assay based on the detection of Salmonella enterica serovar Typhi (S Typhi) lipopolysaccharide (LPS)-specific IgG in lymphocyte culture secretion. We tested the assay using samples from 142 clinically suspected enteric fever patients, 28 healthy individuals residing in a zone where enteric fever is endemic, and 35 patients with other febrile illnesses. In our analysis, the dipstick detected all blood culture-confirmed S Typhi cases (48/48) and 5 of 6 Salmonella enterica serovar Paratyphi A blood cultured-confirmed cases. The test was negative in all 35 individuals febrile with other illnesses and all 28 healthy controls from the zone of endemicity. The test was positive in 19 of 88 individuals with suspected enteric fever but with negative blood cultures. Thus, the dipstick had a sensitivity of 98% compared to blood culture results and a specificity that ranged from 78 to 100% (95% confidence interval [CI], 70 to 100%), depending on the definition of a true negative. These results suggest that this dipstick assay can be very useful for the detection of enteric fever patients especially in regions of endemicity.
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Ao TT, Feasey NA, Gordon MA, Keddy KH, Angulo FJ, Crump JA. Global burden of invasive nontyphoidal Salmonella disease, 2010(1). Emerg Infect Dis 2015; 21. [PMID: 25860298 PMCID: PMC4451910 DOI: 10.3201/eid2106.140999] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nontyphoidal Salmonella is a major cause of bloodstream infections worldwide, and HIV-infected persons and malaria-infected children are at increased risk for the disease. We conducted a systematic literature review to obtain age group-specific, population-based invasive nontyphoidal Salmonella (iNTS) incidence data. Data were categorized by HIV and malaria prevalence and then extrapolated by using 2010 population data. The case-fatality ratio (CFR) was determined by expert opinion consensus. We estimated that 3.4 (range 2.1-6.5) million cases of iNTS disease occur annually (overall incidence 49 cases [range 30-94] per 100,000 population). Africa, where infants, young children, and young adults are most affected, has the highest incidence (227 cases [range 152-341] per 100,000 population) and number of cases (1.9 [range 1.3-2.9] million cases). An iNTS CFR of 20% yielded 681,316 (range 415,164-1,301,520) deaths annually. iNTS disease is a major cause of illness and death globally, particularly in Africa. Improved understanding of the epidemiology of iNTS is needed.
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Halliday JEB, Allan KJ, Ekwem D, Cleaveland S, Kazwala RR, Crump JA. Endemic zoonoses in the tropics: a public health problem hiding in plain sight. Vet Rec 2015; 176:220-5. [PMID: 25722334 PMCID: PMC4350138 DOI: 10.1136/vr.h798] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Zoonotic diseases are a significant burden on animal and human health, particularly in developing countries. Despite recognition of this fact, endemic zoonoses often remain undiagnosed in people, instead being mistaken for febrile diseases such as malaria. Here, as part of Veterinary Record's ongoing series of articles on One Health, a multidisciplinary team of researchers from Scotland, Tanzania and New Zealand argues that a One Health approach is needed to effectively combat these diseases
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Affiliation(s)
- Jo E B Halliday
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Kathryn J Allan
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Divine Ekwem
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Sarah Cleaveland
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Rudovick R Kazwala
- Faculty of Veterinary Medicine, Sokoine University of Agriculture, P. O. Box 3015, Chuo Kikuu, Morogoro, Tanzania
| | - John A Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Ong EBB, Ignatius J, Anthony AA, Aziah I, Ismail A, Lim TS. Multi-isotype antibody responses against the multimeric Salmonella Typhi recombinant hemolysin E antigen. Microbiol Immunol 2015; 59:43-7. [PMID: 25399538 DOI: 10.1111/1348-0421.12211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/16/2014] [Accepted: 11/11/2014] [Indexed: 11/27/2022]
Abstract
The detection and measurement of different antibody isotypes in the serum provide valuable indicators of the different stages of typhoid infection. Here, the ability of S. Typhi recombinant hemolysin E (HlyE) to detect multi-isotype antibody responses in sera of patients with typhoid and paratyphoid A was investigated using an indirect antibody immunoassay. Nanogram amounts of HlyE were found to be sufficient for detection of IgG and IgA isotypes and, in a study of individuals' sera (n = 100), the immunoassay was able to distinguish between typhoid and non-typhoid sera. The overall sensitivity, specificity and efficiency of the ELISA were 70% (39/56), 100% (44/44) and 83% respectively.
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Affiliation(s)
- Eugene Boon Beng Ong
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, 11800, Minden, Malaysia
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Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clin Microbiol Rev 2015; 28:901-37. [PMID: 26180063 PMCID: PMC4503790 DOI: 10.1128/cmr.00002-15] [Citation(s) in RCA: 651] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica, initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, Otago, New Zealand Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Sjölund-Karlsson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melita A Gordon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Penno EC, Crump JA, Baird SJ. Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings. Am J Trop Med Hyg 2015. [PMID: 26195467 DOI: 10.4269/ajtmh.15-0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bacterial sepsis is an important cause of mortality in low- and middle-income countries, yet distinguishing patients with sepsis from those with other illnesses remains a challenge. Currently, management decisions are based on clinical assessment using algorithms such as Integrated Management of Adolescent and Adult Illness. Efforts to develop and evaluate point-of-care tests (POCTs) for sepsis to guide decisions on the use of antimicrobials are underway. To establish the minimum performance characteristics of such a test, we varied the characteristics of a hypothetical POCT for sepsis required for it to be cost-effective and applied a decision tree model to a population of febrile patients presenting at the district hospital level in a low-resource setting. We used a case fatality probability of 20% for appropriately treated sepsis and of 50% for inappropriately treated sepsis. On the basis of clinical assessment for sepsis with established sensitivity of 0.83 and specificity of 0.62, we found that a POCT for sepsis with a sensitivity of 0.83 and a specificity of 0.94 was cost-effective, resulting in parity in survival but costing $1.14 less per live saved. A POCT with accuracy equivalent to the best malaria rapid diagnostic test was cheaper and more effective than clinical assessment.
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Affiliation(s)
- Erin C Penno
- Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - John A Crump
- Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sarah J Baird
- Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
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Prasad N, Murdoch DR, Reyburn H, Crump JA. Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review. PLoS One 2015; 10:e0127962. [PMID: 26126200 PMCID: PMC4488327 DOI: 10.1371/journal.pone.0127962] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/22/2015] [Indexed: 02/04/2023] Open
Abstract
Background With apparent declines in malaria worldwide during the last decade and more widespread use of malaria rapid diagnostic tests, healthcare workers in low-resource areas face a growing proportion of febrile patients without malaria. We sought to describe current knowledge and identify information gaps of the etiology severe febrile illness in low-and middle-income countries. Methods and Findings We conducted a systematic review of studies conducted in low-and-middle income countries 1980–2013 that prospectively assessed consecutive febrile patients admitted to hospital using rigorous laboratory-based case definitions. We found 45 eligible studies describing 54,578 patients; 9,771 (17.9%) had a positive result for ≥1 pathogen meeting diagnostic criteria. There were no eligible studies identified from Southern and Middle Africa, Eastern Asia, Oceania, Latin American and Caribbean regions, and the European region. The median (range) number of diagnostic tests meeting our confirmed laboratory case definitions was 2 (1 to 11) per study. Of diagnostic tests, 5,052 (10.3%) of 49,143 had confirmed bacterial or fungal bloodstream infection; 709 (3.8%) of 18,142 had bacterial zoonosis; 3,488 (28.5%) of 12,245 had malaria; and 1,804 (17.4%) of 10,389 had a viral infection. Conclusions We demonstrate a wide range of pathogens associated with severe febrile illness and highlight the substantial information gaps regarding the geographic distribution and role of common pathogens. High quality severe febrile illness etiology research that is comprehensive with respect to pathogens and geographically representative is needed.
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Affiliation(s)
- Namrata Prasad
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - David R. Murdoch
- Department of Pathology, University of Otago Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8011, New Zealand
| | - Hugh Reyburn
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - John A. Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
- * E-mail:
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McCullagh D, Dobinson HC, Darton T, Campbell D, Jones C, Snape M, Stevens Z, Plested E, Voysey M, Kerridge S, Martin LB, Angus B, Pollard AJ. Understanding paratyphoid infection: study protocol for the development of a human model of Salmonella enterica serovar Paratyphi A challenge in healthy adult volunteers. BMJ Open 2015; 5:e007481. [PMID: 26082464 PMCID: PMC4480031 DOI: 10.1136/bmjopen-2014-007481] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION This study will develop the first human challenge model of paratyphoid infection which may then be taken forward to evaluate paratyphoid vaccine candidates. Salmonella Paratyphi A is believed to cause a quarter of the estimated 20 million cases of enteric fever annually. Epidemiological evidence also suggests that an increasing proportion of the enteric fever burden is attributable to S. Paratyphi infection meriting further attention and interest in vaccine development. Assessment of paratyphoid vaccine efficacy in preclinical studies is complicated by the lack of a small animal model and the human-restricted nature of the infection. The use of experimental human infection in healthy volunteers provides an opportunity to address these problems in a cost-effective manner. METHODS AND ANALYSIS Volunteers will ingest virulent S. Paratyphi A bacteria (NVGH308 strain) with a bicarbonate buffer solution to establish the infectious dose resulting in an 'attack rate' of 60-75%. Using an a priori decision-making algorithm, the challenge dose will be escalated or de-escalated to achieve the target attack rate, with the aim of reaching the study end point while exposing as few individuals as possible to infection. The attack rate will be determined by the proportion of paratyphoid infection in groups of 20 healthy adult volunteers, with infection being defined by one or more positive blood cultures (microbiological end point) and/or fever, defined as an oral temperature exceeding 38 °C sustained for at least 12 h (clinical end point); 20-80 participants will be required. Challenge participants will start a 2-week course of an oral antibiotic on diagnosis of infection, or after 14 days follow-up. ETHICS AND DISSEMINATION The strict eligibility criterion aims to minimise risk to participants and their close contacts. Ethical approval has been obtained. The results will be disseminated in a peer-reviewed journal and presented at international congresses. TRIAL REGISTRATION NUMBER NCT02100397.
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Affiliation(s)
- David McCullagh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Hazel C Dobinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Thomas Darton
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Danielle Campbell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Claire Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Matthew Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Zoe Stevens
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Laura B Martin
- Novartis Vaccines Institute for Global Health, Siena, Italy
| | - Brian Angus
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Boyd MA, Tennant SM, Melendez JH, Toema D, Galen JE, Geddes CD, Levine MM. Adaptation of red blood cell lysis represents a fundamental breakthrough that improves the sensitivity of Salmonella detection in blood. J Appl Microbiol 2015; 118:1199-209. [PMID: 25630831 PMCID: PMC4418380 DOI: 10.1111/jam.12769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
AIMS Isolation of Salmonella Typhi from blood culture is the standard diagnostic for confirming typhoid fever but it is unavailable in many developing countries. We previously described a Microwave Accelerated Metal Enhanced Fluorescence (MAMEF)-based assay to detect Salmonella in medium. Attempts to detect Salmonella in blood were unsuccessful, presumably due to the interference of erythrocytes. The objective of this study was to evaluate various blood treatment methods that could be used prior to PCR, real-time PCR or MAMEF to increase sensitivity of detection of Salmonella. METHODS AND RESULTS We tested ammonium chloride and erythrocyte lysis buffer, water, Lymphocyte Separation Medium, BD Vacutainer(®) CPT(™) Tubes and dextran. Erythrocyte lysis buffer was the best isolation method as it is fast, inexpensive and works with either fresh or stored blood. The sensitivity of PCR- and real-time PCR detection of Salmonella in spiked blood was improved when whole blood was first lysed using erythrocyte lysis buffer prior to DNA extraction. Removal of erythrocytes and clotting factors also enabled reproducible lysis of Salmonella and fragmentation of DNA, which are necessary for MAMEF sensing. CONCLUSIONS Use of the erythrocyte lysis procedure prior to DNA extraction has enabled improved sensitivity of Salmonella detection by PCR and real-time PCR and has allowed lysis and fragmentation of Salmonella using microwave radiation (for future detection by MAMEF). SIGNIFICANCE AND IMPACT OF THE STUDY Adaptation of the blood lysis method represents a fundamental breakthrough that improves the sensitivity of DNA-based detection of Salmonella in blood.
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Affiliation(s)
- M A Boyd
- Center for Vaccine Development, University of Maryland Baltimore, Baltimore, MD, USA; Department of Pediatrics, University of Maryland Baltimore, Baltimore, MD, USA
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Blum LS, Dentz H, Chingoli F, Chilima B, Warne T, Lee C, Hyde T, Gindler J, Sejvar J, Mintz ED. Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi. Am J Trop Med Hyg 2014; 91:729-37. [PMID: 25002303 PMCID: PMC4183395 DOI: 10.4269/ajtmh.14-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022] Open
Abstract
Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak.
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Affiliation(s)
- Lauren S Blum
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Holly Dentz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Felix Chingoli
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Benson Chilima
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Thomas Warne
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Carla Lee
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Terri Hyde
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Jacqueline Gindler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - James Sejvar
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Eric D Mintz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
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Serum bactericidal assays to evaluate typhoidal and nontyphoidal Salmonella vaccines. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:712-21. [PMID: 24623629 DOI: 10.1128/cvi.00115-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Invasive Salmonella infections for which improved or new vaccines are being developed include enteric fever caused by Salmonella enterica serovars Typhi, Paratyphi A, and Paratyphi B and sepsis and meningitis in young children in sub-Saharan Africa caused by nontyphoidal Salmonella (NTS) serovars, particularly S. enterica serovars Typhimurium and Enteritidis. Assays are needed to measure functional antibodies elicited by the new vaccines to assess their immunogenicities and potential protective capacities. We developed in vitro assays to quantify serum bactericidal antibody (SBA) activity induced by S. Typhi, S. Paratyphi A, S. Typhimurium, and S. Enteritidis vaccines in preclinical studies. Complement from various sources was tested in assays designed to measure antibody-dependent complement-mediated killing. Serum from rabbits 3 to 4 weeks of age provided the best complement source compared to serum from pigs, goats, horses, bovine calves, or rabbits 8 to 12 weeks of age. For S. Enteritidis, S. Typhimurium, and S. Typhi SBA assays to be effective, bacteria had to be harvested at log phase. In contrast, S. Paratyphi A was equally susceptible to killing whether it was grown to the stationary or log phase. The typhoidal serovars were more susceptible to complement-mediated killing than were the nontyphoidal serovars. Lastly, the SBA endpoint titers correlated with serum IgG anti-lipopolysaccharide (LPS) titers in mice immunized with mucosally administered S. Typhimurium, S. Enteritidis, and S. Paratyphi A but not S. Typhi live attenuated vaccines. The SBA assay described here is a useful tool for measuring functional antibodies elicited by Salmonella vaccine candidates.
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Abstract
PURPOSE OF REVIEW Infection caused by ingestion of human-restricted Salmonella enterica serovars Typhi and Paratyphi predominantly affects the most impoverished sections of society. In this review, we describe recent advances made in estimating the burden of illness and the important role improved diagnostic tests may have in controlling infection and report the development of a new human challenge model of typhoid infection. RECENT FINDINGS Typhoid continues to be a major cause of morbidity, particularly in children and young adults in south east Asia, although accurate assessments are still hindered by the lack of reliable surveillance data. Recent reports of high rates of infection in Africa and the dominance of paratyphoid in several geographic areas are of particular concern. Diagnosis of enteric fever remains frustrated by the nonspecific clinical presentation of cases and the lack of test sensitivity. Methods to improve diagnostic accuracy are hindered by the incomplete understanding of immunobiological mechanisms of infection and lack of a suitable animal infection model. SUMMARY Enteric fever is a major global problem, the burden of which has only partially been recognized. Control strategies utilizing cheap accurate diagnostics and effective vaccines are urgently required, and their development should be accelerated by the use of a human challenge model.
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Thriemer K, Ley B, Menten J, Jacobs J, van den Ende J. A systematic review and meta-analysis of the performance of two point of care typhoid fever tests, Tubex TF and Typhidot, in endemic countries. PLoS One 2013; 8:e81263. [PMID: 24358109 PMCID: PMC3864786 DOI: 10.1371/journal.pone.0081263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/10/2013] [Indexed: 11/26/2022] Open
Abstract
Background In the absence of well-equipped laboratory infrastructure in many developing countries the accurate diagnosis of typhoid fever is challenging. Rapid diagnostic tests (RDT) with good performance indicators would be helpful to improve clinical management of suspected cases. We performed a systematic literature review and meta- analysis to determine the performance of TUBEX TF and Typhidot for the diagnosis of typhoid fever using PRISMA guidelines. Methods Titles and abstracts were reviewed for relevance. Articles were screened for language, reference method and completeness. Studies were categorized according to control groups used. Meta-analysis was performed only for categories where enough data was available to combine sensitivity and specificity estimates. Sub-analysis was performed for the Typhidot test to determine the influence of indeterminate results on test performance. Results A total of seven studies per test were included. The sensitivity of TUBEX TF ranged between 56% and 95%, Specificity between 72% and 95%. Meta-analysis showed an average sensitivity of 69% (95%CI: 45–85) and an average specificity of 88% (CI95%:83–91). A formal meta-analysis for Typhidot was not possible due to limited data available. Across the extracted studies, sensitivity and specificity estimates ranged from 56% to 84% and 31% to 97% respectively. Conclusion The observed performance does not support the use of either rapid diagnostic test exclusively as the basis for diagnosis and treatment. There is a need to develop an RDT for typhoid fever that has a performance level comparable to malaria RDTs.
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Affiliation(s)
- Kamala Thriemer
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Benedikt Ley
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Menten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jef van den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Akinwusi PO, Komolafe AO, Olayemi OO, Adeomi AA. Communicable disease-related sudden death in the 21st century in Nigeria. Infect Drug Resist 2013; 6:125-32. [PMID: 24124382 PMCID: PMC3794985 DOI: 10.2147/idr.s47959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some cases of sudden death (SD) have been attributed to communicable diseases (CD) in middle- and low-income countries of the world even in this 21st century. CDs produce clinical symptoms and signs over several days before culminating in death. They are also amenable to treatment with antimicrobials if affected persons present early. We sought to find out the incidence of CD-related SD at the Ladoke Akintola University of Technology Teaching Hospital (Osogbo, Osun State, Nigeria) - a tertiary health facility in southwest Nigeria - and the prevailing associated factors. METHODS We conducted a retrospective study of CD-related SD in adult patients aged 18 years and older that occurred from January 2003 to December 2011. The Statistical Package for the Social Sciences version 16 was used for analysis of the generated data. Percentages and frequencies were calculated. RESULTS There were 17 (39.6%) CD-related SDs out of the 48 cases of SD studied. CD-related SD also accounted for 2.4% of all adult medical admissions. The mean age of the patients was 37.6 ± 11.6 years, age range of 25-62 years, mode of 25 years, and median 34 years. The male-to-female ratio was 1.8:1. Typhoid sepsis was responsible for SD in 47.1% of patients, pulmonary tuberculosis in 17.7% of patients, and lobar pneumonia in 17.7% of patients. The most affected age group was the 20-29-year-old group (41.2%), while the unskilled occupational group was the most affected occupational group with 35.3% of them having SD. Most of the patients with acute bacterial infection died of multiple organ failure. CONCLUSION There is an urgent need to step up public health strategies to curtail infections in this environment, encourage better use of the existing health facilities by the people, and the government should strive hard to make health a top priority.
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Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria
- Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Akinwumi Oluwole Komolafe
- Department of Morbid Anatomy, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olanrewaju Olayinka Olayemi
- Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Adeleye Abiodun Adeomi
- Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
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Chappuis F, Alirol E, d’Acremont V, Bottieau E, Yansouni C. Rapid diagnostic tests for non-malarial febrile illness in the tropics. Clin Microbiol Infect 2013; 19:422-31. [DOI: 10.1111/1469-0691.12154] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/21/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
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Thriemer K, Ley B, Ame SS, Deen JL, Pak GD, Chang NY, Hashim R, Schmied WH, Busch CJL, Nixon S, Morrissey A, Puri MK, Ochiai RL, Wierzba T, Clemens JD, Ali M, Jiddawi MS, von Seidlein L, Ali SM. Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions. PLoS One 2012; 7:e51823. [PMID: 23284780 PMCID: PMC3527440 DOI: 10.1371/journal.pone.0051823] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The gold standard for diagnosis of typhoid fever is blood culture (BC). Because blood culture is often not available in impoverished settings it would be helpful to have alternative diagnostic approaches. We therefore investigated the usefulness of clinical signs, WHO case definition and Widal test for the diagnosis of typhoid fever. METHODOLOGY/PRINCIPAL FINDINGS Participants with a body temperature ≥37.5°C or a history of fever were enrolled over 17 to 22 months in three hospitals on Pemba Island, Tanzania. Clinical signs and symptoms of participants upon presentation as well as blood and serum for BC and Widal testing were collected. Clinical signs and symptoms of typhoid fever cases were compared to other cases of invasive bacterial diseases and BC negative participants. The relationship of typhoid fever cases with rainfall, temperature, and religious festivals was explored. The performance of the WHO case definitions for suspected and probable typhoid fever and a local cut off titre for the Widal test was assessed. 79 of 2209 participants had invasive bacterial disease. 46 isolates were identified as typhoid fever. Apart from a longer duration of fever prior to admission clinical signs and symptoms were not significantly different among patients with typhoid fever than from other febrile patients. We did not detect any significant seasonal patterns nor correlation with rainfall or festivals. The sensitivity and specificity of the WHO case definition for suspected and probable typhoid fever were 82.6% and 41.3% and 36.3 and 99.7% respectively. Sensitivity and specificity of the Widal test was 47.8% and 99.4 both forfor O-agglutinin and H- agglutinin at a cut-off titre of 1:80. CONCLUSIONS/SIGNIFICANCE Typhoid fever prevalence rates on Pemba are high and its clinical signs and symptoms are non-specific. The sensitivity of the Widal test is low and the WHO case definition performed better than the Widal test.
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Abstract
PURPOSE OF REVIEW This review summarizes the recent advances in vaccination against Salmonella enterica serovar Typhi and highlights the data supporting the development of next generation vaccines to address paratyphoid fever and invasive nontyphoidal Salmonella (iNTS) disease. RECENT FINDINGS There has been increasing awareness of the disease burden caused by S. Typhi particularly in Africa and greater recognition of S. Paratyphi A's contribution to enteric fever episodes throughout Asia. Groups have been working to improve the existing typhoid vaccines and provide comprehensive data on the feasibility of their implementation in endemic settings. These data have resulted in modifications to the recommendations for typhoid vaccination in traveller markets and endemic settings, and has also led to the development of S. Paratyphi A vaccine components that can be combined with existing typhoid vaccines to generate bivalent formulations against enteric fever. The epidemiology of iNTS serovars as cause of appreciable morbidity and mortality in Africa, and the need for vaccines, has also become more widely appreciated. SUMMARY Current typhoid vaccines, although moderately effective for short periods of time, cannot be used in all age groups and only target one of the clinically relevant Salmonella serovars. Greater effort must be placed on the development and implementation of improved vaccines for the disease burden resulting from Typhi, Paratyphi A or iNTS infections.
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Salmonella typhi in the democratic republic of the congo: fluoroquinolone decreased susceptibility on the rise. PLoS Negl Trop Dis 2012; 6:e1921. [PMID: 23166855 PMCID: PMC3499407 DOI: 10.1371/journal.pntd.0001921] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/10/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Drug resistance of Salmonella enterica serovar Typhi (Salmonella Typhi) to first-line antibiotics is emerging in Central Africa. Although increased use of fluoroquinolones is associated with spread of resistance, Salmonella Typhi with decreased ciprofloxacin susceptibility (DCS) has rarely been reported in Central Africa. METHODOLOGY/PRINCIPAL FINDINGS As part of a microbiological surveillance study in the Democratic Republic of the Congo (DR Congo), Salmonella Typhi isolates from bloodstream infections were collected prospectively between 2007 and 2011. The genetic relationship of the Salmonella Typhi isolates was assessed by pulsed-field gel electrophoresis (PFGE). The antimicrobial resistance profile of the isolates was determined and mutations associated with DCS were studied. In total, 201 Salmonella Typhi isolates were collected. More than half of the Salmonella Typhi isolates originated from children and young adults aged 5-19. Thirty different PFGE profiles were identified, with 72% of the isolates showing a single profile. Multidrug resistance, DCS and azithromycin resistance were 30.3%, 15.4% and 1.0%, respectively. DCS was associated with point mutations in the gyrA gene at codons 83 and 87. CONCLUSIONS/SIGNIFICANCE Our study describes the first report of widespread multidrug resistance and DCS among Salmonella Typhi isolates from DR Congo. Our findings highlight the need for increased microbiological diagnosis and surveillance in DR Congo, being a prerequisite for rational use of antimicrobials and the development of standard treatment guidelines.
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Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1833-7. [PMID: 22993409 DOI: 10.1128/cvi.00380-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Typhoid fever remains a major global health problem. A major impediment to improving outcomes is the lack of appropriate diagnostic tools, which have not significantly improved in low-income settings for 100 years. We evaluated two commercially available rapid diagnostic tests (Tubex and TyphiDot), a prototype (TyphiRapid TR-02), and the commonly used single-serum Widal test in a previously reported high-burden area of Papua New Guinea. Samples were collected from 530 outpatients with axillary temperatures of ≥37.5°C, and analysis was conducted on all malaria-negative samples (n = 500). A composite reference standard of blood culture and PCR was used, by which 47 participants (9.4%) were considered typhoid fever positive. The sensitivity and specificity of the Tubex (51.1% and 88.3%, respectively) and TyphiDot (70.0% and 80.1%, respectively) tests were not high enough to warrant their ongoing use in this setting; however, the sensitivity and specificity for the TR-02 prototype were promising (89.4% and 85.0%, respectively). An axillary temperature of ≥38.5°C correlated with typhoid fever (P = 0.014). With an appropriate diagnostic test, conducting typhoid fever diagnosis only on patients with high-grade fever could dramatically decrease the costs associated with diagnosis while having no detrimental impact on the ability to accurately diagnose the illness.
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Crump JA. Reply to Yansouni et al. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yansouni CP, Bottieau E, Chappuis F, Phoba MF, Lunguya O, Ifeka BB, Jacobs J. Rapid diagnostic tests for a coordinated approach to fever syndromes in low-resource settings. Clin Infect Dis 2012; 55:610-1; author reply 611-2. [PMID: 22563019 DOI: 10.1093/cid/cis466] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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