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Wang H, Zhao J, Xie N, Wang W, Qi R, Hao X, Liu Y, Sevalie S, Niu G, Zhang Y, Wu G, Lv X, Chen Y, Ye Y, Bi S, Moseray M, Cellessy S, Kalon K, Baika DI, Luo Q. A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone. Infect Dis Ther 2021; 10:1645-1664. [PMID: 34173960 PMCID: PMC8234757 DOI: 10.1007/s40121-021-00474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Sierra Leone has one of the highest burdens of febrile illnesses in the world. As the incidence of malaria diminishes, a better understanding of the spectrum of etiological agents was important for accurate diagnosis and empirical treatment of febrile illness. Methods Blood, nasopharyngeal, and fecal specimens were collected from febrile patients for serological, molecular detection, and microbiologic culture to identify potential pathogens. Results For this prospective study, 142 febrile patients were enrolled. The prevalence of malaria was higher in children aged 5–15 years old (P = 0.185) and adults (P = 0.018). Acute respiratory infection (ARI) presented more commonly in the under 5 years old group (P = 0.009). For diarrhea, all children groups (P = 0.024) were predominant. A total of 22.5% of the febrile patients had malaria infection, 19.7% had typhoid infection, and 2.8% were coinfected with malaria and typhoid. ARI was the most common causes of fever, accounting for 31.7% of patients, influenza A virus, Mycoplasma pneumoniae, and five other respiratory pathogens were found. Diarrhea accounted for 16.2%, and seven kinds of diarrhea bacteria were isolated. Hepatitis B accounted for 8.5%, including five cases of spontaneous bacterial peritonitis, and ascites smear staining were both Gram-negative bacteria. Tuberculous encephalitis, parasitic diseases (ascaris and filariasis), and skin infection caused by Staphylococcus aureus accounted for 0.7%, 2.1%, and 0.7%, respectively. Conclusions Evidence of a wide spectrum of febrile etiological agents other than malaria was identified. The spread of malaria rapid diagnostic tests (RDTs) out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. Antibiotics against Gram-negative bacteria are helpful for empirical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00474-y. Sierra Leone has one of the highest burdens of febrile illnesses in the world. Evidence of a wide spectrum of febrile pathogens other than malaria has been proven in this study. We considered that the etiology of febrile patients was closely related to local geography, heredity, immune features, economic industry, living habits, air pollution, medical and health conditions, and this was fully analyzed and discussed. The screening process used in this study can further simplify and identify the etiological agents of fever in more than 70% of the study population. This laid the foundation for the establishment of a more simplified and efficient diagnosis and treatment process in the local area. We also found the characteristics of age distribution of different febrile diseases. Children were an important susceptible population to fever. This study indicated the importance of reliable diagnostic tests for febrile pathogens and provided the necessary information for RDT requirements. The spread of malaria RDTs out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. For empirical treatment, antimalarial treatment was still targeted at falciparum malaria in Sierra Leone. Antibiotics against Gram-negative bacteria contributed to the empirical treatment of febrile diseases. For patients with acute respiratory tract infection, Gram-positive coccal antibiotics could be candidates for treatment. In addition, systematic and professional treatment of liver diseases should be promoted to reduce infection complications.
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Affiliation(s)
- Han Wang
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China.
| | - Jing Zhao
- Department of Clinical Diagnostic Centre, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, The People's Republic of China
| | - Na Xie
- Department of Inpatient and Medical Record Management, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Wanxue Wang
- Nursing Department, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Ruping Qi
- Department of Radiology, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, The People's Republic of China
| | - Xiaogang Hao
- Department of Inpatient and Medical Record Management, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yan Liu
- Department of Clinical Diagnostic Centre, North Hospital District, The Third Hospital of Peking University, Beijing, The People's Republic of China
| | - Stephen Sevalie
- Headquarters, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Guotao Niu
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yangli Zhang
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Ge Wu
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Xiaona Lv
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yuhao Chen
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yanfei Ye
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Sheng Bi
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Moses Moseray
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Saidu Cellessy
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Ksaidu Kalon
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Dawud Ibrahim Baika
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Qun Luo
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China.
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Mawazo A, Bwire GM, Matee MIN. Performance of Widal test and stool culture in the diagnosis of typhoid fever among suspected patients in Dar es Salaam, Tanzania. BMC Res Notes 2019; 12:316. [PMID: 31167646 PMCID: PMC6551910 DOI: 10.1186/s13104-019-4340-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
Objective We set an experiment to determine the diagnostic performance of the Widal test and stool culture in typhoid-suspected cases attending tertiary hospitals in Dar es Salaam, Tanzania using blood culture as a golden standard. We also evaluated the agreement between Widal, stool and blood culture. Results This was a cross-sectional study conducted between June and September 2018, in three Regional Referral Hospitals in Dar es Salaam, Tanzania. A total of 158 typhoid-suspected cases were enrolled, after obtaining an informed consent. Of the 158 patients participated in the study, 128 (81%) tested positive for the Widal test and 17 (11%) patients were stool culture positive. Widal test recorded 81.5% sensitivity, 18.3% specificity, 10.1% positive predictive value and 89.7% negative predictive value. Stool culture showed 31.3% sensitivity, 91.5% specificity, 29% positive predictive value and 91.5% negative predictive value. In conclusion, Widal test is not reliable for diagnosis of typhoid fever since false positive and negative results are common. In addition, Widal test recorded poor agreement with the blood culture (kappa = 0.014, p < 0.05) while stool culture had strong agreement with the blood culture (kappa = 0.22, p < 0.05).
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Affiliation(s)
- Akili Mawazo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - George M Bwire
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Mecky I N Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Paramasivam OR, Trivedi S, Sangith N, Sankaran K. Active sulfite oxidase domain of Salmonella enterica pathogenic protein small intestine invasive factor E (SiiE): a potential diagnostic target. Appl Microbiol Biotechnol 2019; 103:5679-5688. [PMID: 31104097 DOI: 10.1007/s00253-019-09894-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
Serovars of Salmonella enterica are common food-borne bacterial pathogens. Salmonella typhi, which causes typhoid, is the most dangerous of them. Though detailed molecular pathogenesis studies reveal many virulence factors, inability to identify their biochemical functions hampers the development of diagnostic methods and therapeutic leads. Lack of quicker diagnosis is an impediment in starting early antibiotic treatment to reduce the severe morbidity and mortality in typhoid. In this study, employing bioinformatic prediction, biochemical analysis, and recombinantly cloning the active region, we show that extracellularly secreted virulence-associated protein, small intestinal invasion factor E (SiiE), possesses a sulfite oxidase (SO) domain that catalyzes the conversion of sodium sulfite to sodium sulfate using tungsten as the cofactor. This activity common to Salmonella enterica serovars seems to be specific to them from bioinformatic analysis of available bacterial genomes. Along with the ability of this large non-fimbrial adhesin of 600 kDa binding to sialic acid on the host cells, this activity could aid in subverting the host defense mechanism by destroying sulfites released by the immune cells and colonize the host gastrointestinal epithelium. Being an extracellular enzyme, it could be an ideal candidate for developing diagnostics of S. enterica, particularly S. typhi.
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Affiliation(s)
| | - Swati Trivedi
- Centre for Biotechnology, Anna University, Chennai, 600020, India
| | - Nikhil Sangith
- Centre for Biotechnology, Anna University, Chennai, 600020, India.
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Development of Inhouse Immunoblot Method for Detection of Anti Salmonella Antibody and Comparison with Widal Test. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Storey HL, Huang Y, Crudder C, Golden A, de los Santos T, Hawkins K. A Meta-Analysis of Typhoid Diagnostic Accuracy Studies: A Recommendation to Adopt a Standardized Composite Reference. PLoS One 2015; 10:e0142364. [PMID: 26566275 PMCID: PMC4643909 DOI: 10.1371/journal.pone.0142364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/21/2015] [Indexed: 01/09/2023] Open
Abstract
Novel typhoid diagnostics currently under development have the potential to improve clinical care, surveillance, and the disease burden estimates that support vaccine introduction. Blood culture is most often used as the reference method to evaluate the accuracy of new typhoid tests; however, it is recognized to be an imperfect gold standard. If no single gold standard test exists, use of a composite reference standard (CRS) can improve estimation of diagnostic accuracy. Numerous studies have used a CRS to evaluate new typhoid diagnostics; however, there is no consensus on an appropriate CRS. In order to evaluate existing tests for use as a reference test or inclusion in a CRS, we performed a systematic review of the typhoid literature to include all index/reference test combinations observed. We described the landscape of comparisons performed, showed results of a meta-analysis on the accuracy of the more common combinations, and evaluated sources of variability based on study quality. This wide-ranging meta-analysis suggests that no single test has sufficiently good performance but some existing diagnostics may be useful as part of a CRS. Additionally, based on findings from the meta-analysis and a constructed numerical example demonstrating the use of CRS, we proposed necessary criteria and potential components of a typhoid CRS to guide future recommendations. Agreement and adoption by all investigators of a standardized CRS is requisite, and would improve comparison of new diagnostics across independent studies, leading to the identification of a better reference test and improved confidence in prevalence estimates.
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Affiliation(s)
- Helen L. Storey
- Diagnostics Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Ying Huang
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Chris Crudder
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Allison Golden
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Tala de los Santos
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Kenneth Hawkins
- Diagnostics Program, PATH, Seattle, Washington, United States of America
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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: 640] [Impact Index Per Article: 71.1] [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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7
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Waddington CS, Darton TC, Pollard AJ. The challenge of enteric fever. J Infect 2014; 68 Suppl 1:S38-50. [DOI: 10.1016/j.jinf.2013.09.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/27/2022]
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Saha SK, Ruhulamin M, Hanif M, Islam M, Khan WA. Interpretation of the Widal test in the diagnosis of typhoid fever in Bangladeshi children. ANNALS OF TROPICAL PAEDIATRICS 1996; 16:75-8. [PMID: 8787370 DOI: 10.1080/02724936.1996.11747807] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The value of a Widal test in diagnosing typhoid fever was assessed in children aged between 1 and 10 years in Bangladesh. The test was done on sera specimens from 300 healthy school children, 100 patients with non-typhoidal febrile illness and 150 bacteriologically proven cases of typhoid fever. Salmonella typhi O and H agglutinin titres > 1:80 and > 1:160 were considered to be significant with 88% sensitivity and 98% specificity, respectively. Among the bacteriologically proven cases, 11.3% showed no response to either agglutinin, and in another 17.3% of cases there was no response for TO agglutinin. This study suggests that in children in an endemic area a positive Widal test is of considerable importance in diagnosing typhoid fever. Furthermore, negative results should be interpreted with caution and both the agglutinins must be considered equally important. Reliance on somatic (TO) antigen only will result in missed diagnosis.
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Affiliation(s)
- S K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka, Bangladesh
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9
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Quiroga T, Goycoolea M, Tagle R, Gonzalez F, Rodriguez L, Villarroel L. Diagnosis of typhoid fever by two serologic methods. Enzyme-linked immunosorbent assay of antilipopolysaccharide of Salmonella typhi antibodies and Widal test. Diagn Microbiol Infect Dis 1992; 15:651-6. [PMID: 1478046 DOI: 10.1016/0732-8893(92)90066-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Serum samples from 85 patients with proven typhoid fever, 11 patients with p-typhoidal fever, 101 patients with febrile non-typhoidal, and 130 healthy subjects were tested for immunoglobulin G (IgG), IgA, and IgM antilipopolysaccharide (LPS) of Salmonella typhi antibodies by enzyme-linked immunosorbent assay (ELISA) and Widal test. The levels of all three classes of immunoglobulin anti-LPS of S. typhi were higher in typhoid patients than in healthy or febrile nontyphoidal groups; we selected various combinations between the three classes of immunoglobulin to obtain the best combination of sensitivity and specificity. The sum of the absorbance values obtained from the ELISA assay for IgG+IgA+IgM (sigma lgs) was the best choice for diagnostic utility for typhoid fever. We selected a positive test at a decision level of sigma lgs > or = 1.2 with a sensitivity of 94% and a specificity of 92% with a frequency of false negative of 5.9%. The frequency of false positives for healthy controls was 7.7% and, for the febrile nontyphoidal group, it was 7.9%. We also compared receiver (or relative) operating characteristic (ROC) curves for the diagnostic usefulness of the ELISA with that of the Widal test, whose merits and limitations, especially in endemic regions, are discussed. The ELISA assay was much more sensitive and specific than any combination of the Widal test, and hence it could be a useful tool for the serologic diagnosis of typhoidal fever with a single blood sample.
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Affiliation(s)
- T Quiroga
- Central Laboratory, UDA Clinical Laboratories Diagnostic Center, School of Medicine, Pontificia Catholic University of Chile, Santiago
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Koeleman JG, Regensburg DF, van Katwijk F, MacLaren DM. Retrospective study to determine the diagnostic value of the Widal test in a non-endemic country. Eur J Clin Microbiol Infect Dis 1992; 11:167-70. [PMID: 1396731 DOI: 10.1007/bf01967071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to determine the usefulness of the Widal test in the diagnosis of typhoid fever. Data were obtained by retrospective analysis of 311 Widal requests covering a six-year period. Nine cases of typhoid infection were diagnosed culturally. Of these, only three patients had samples for serological examination, all giving indicative titres. Of the 274 evaluated sera, 26 showed significant agglutinating titres; 23 of them were false positive. These results show that routine use of the Widal test is of limited value and should only be used for patients in whom repeated cultures remain negative.
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Affiliation(s)
- J G Koeleman
- Department of Clinical Microbiology and Hospital Hygiene, Free University Hospital, Amsterdam, The Netherlands
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Dance D, Richens JE, Ho M, Acharya G, Pokhrel B, Tuladhar NR. Blood and bone marrow cultures in enteric fever. J Clin Pathol 1991; 44:1038. [PMID: 1791210 PMCID: PMC494981 DOI: 10.1136/jcp.44.12.1038-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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O'Brien JP, Regan W, Cleary EG. Giant cell arteritis. J Clin Pathol 1991; 44:1037-8. [PMID: 1817493 PMCID: PMC494980 DOI: 10.1136/jcp.44.12.1037-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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