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Date K, LeBoa C, Hoffman SA, Haldar P, Harvey P, An Q, Zhang C, Yewale VN, Daruwalla S, Dharmapalan D, Gavhane J, Joshi S, Rai R, Rathod V, Shetty K, Warrier DS, Yadav S, Shimpi R, Jayaprasad N, Horng L, Fagerli K, Borhade P, Chakraborty D, Katkar A, Kunwar A, Andrews JR, Bahl S, Bhatnagar P, Dutta S, Luby SP. Field Effectiveness of a Typhoid Conjugate Vaccine: The 2018 Navi Mumbai Pediatric TCV Campaign. Am J Trop Med Hyg 2024; 111:848-852. [PMID: 39137766 PMCID: PMC11448546 DOI: 10.4269/ajtmh.24-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/12/2024] [Indexed: 08/15/2024] Open
Abstract
Typbar-TCV®, a typhoid conjugate vaccine (TCV), was prequalified by the World Health Organization in 2017. We evaluated its effectiveness in a mass vaccination program targeting children 9 months to 14 years in Navi Mumbai, India, from September 2018 to July 2020. We compared laboratory-confirmed typhoid cases from six clinical sites with age-matched community controls. Of 38 cases, three (8.6%) received TCV through the campaign, compared with 53 (37%) of 140 controls. The adjusted odds ratio of typhoid fever among vaccinated children was 0.16 (95% CI: 0.05-0.55), equivalent to a vaccine effectiveness of 83.7% (95% CI: 45.0-95.3). Vaccine effectiveness of Typbar-TCV in this large public sector vaccine introduction was similar to prior randomized controlled trials, providing reassurance to policymakers that TCV effectiveness is robust in a large-scale implementation.
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Affiliation(s)
- Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher LeBoa
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pauline Harvey
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Qian An
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chenhua Zhang
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vijay N Yewale
- Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India
| | - Savita Daruwalla
- Department of Pediatrics, NMMC General Hospital, Navi Mumbai, India
| | | | - Jeetendra Gavhane
- Department of Pediatrics, MGM New Bombay Hospital, MGM Medical College, Navi Mumbai, India
| | - Shrikrishna Joshi
- Dr. Joshi's Central Clinical Microbiology Laboratory, Navi Mumbai, India
| | - Rajesh Rai
- Department of Pediatrics & Neonatology, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Varsha Rathod
- Rajmata Jijau Hospital, Airoli (NMMC), Navi Mumbai, India
| | - Keertana Shetty
- Department of Microbiology, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, India
| | | | - Shalini Yadav
- Department of Microbiology, MGM New Bombay Hospital, Navi Mumbai, India
| | - Rahul Shimpi
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Niniya Jayaprasad
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Lily Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kirsten Fagerli
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Priyanka Borhade
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Debjit Chakraborty
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Arun Katkar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Abhishek Kunwar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sunil Bahl
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Pankaj Bhatnagar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Aprile F, Vangeli M, Allocca M, Zilli A, Argollo MC, D’amico F, Parigi TL, Danese S, Furfaro F. Gastrointestinal Ultrasound in Infectious Diseases: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1402. [PMID: 39336443 PMCID: PMC11434242 DOI: 10.3390/medicina60091402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/16/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Infectious diseases affecting the gastrointestinal tract often present diagnostic challenges due to the variability in clinical manifestations and overlapping symptoms. Ultrasound imaging has emerged as a valuable tool in the assessment of gastrointestinal pathologies, offering non-invasive and real-time visualization of anatomical structures. This review aims to explore the role of ultrasound in the diagnosis and management of infectious diseases involving the gastrointestinal tract. We discuss the imaging features of various infectious etiologies, such as bacterial, viral, and parasitic infections, highlighting characteristic findings on ultrasound scans. Additionally, we provide insights into the utility of ultrasound for the assessment of treatment response. Through a comprehensive analysis of existing literature and clinical case studies, this review underscores the significance of ultrasound imaging as a frontline modality in the diagnosis and management of infectious diseases affecting the gastrointestinal tract.
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Affiliation(s)
- Francesca Aprile
- Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.A.); (M.V.)
| | - Marcello Vangeli
- Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.A.); (M.V.)
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Marjorie Costa Argollo
- Gastroenterology Department, Federal University of São Paulo, São Paulo 04021-001, Brazil;
| | - Ferdinando D’amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
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3
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Martin LB, Tack B, Marchello CS, Sikorski MJ, Owusu-Dabo E, Nyirenda T, Mogasale V, Crump JA. Vaccine value profile for invasive non-typhoidal Salmonella disease. Vaccine 2024; 42:S101-S124. [PMID: 39003017 DOI: 10.1016/j.vaccine.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 07/15/2024]
Abstract
Invasive non-typhoidal Salmonella (iNTS) disease is an under-recognized high-burden disease causing major health and socioeconomic issues in sub-Saharan Africa (sSA), predominantly among immune-naïve infants and young children, including those with recognized comorbidities such as HIV infection. iNTS disease is primarily caused by Salmonella enterica serovar Typhimurium sequence type (ST) 313 and 'African-restricted clades' of Salmonella Enteritidis ST11 that have emerged across the African continent as a series of epidemics associated with acquisition of new antimicrobial resistance. Due to genotypes with a high prevalence of antimicrobial resistance and scarcity of therapeutic options, these NTS serovars are designated by the World Health Organization as a priority pathogen for research and development of interventions, including vaccines, to address and reduce NTS associated bacteremia and meningitis in sSA. Novel and traditional vaccine technologies are being applied to develop vaccines against iNTS disease, and the results of the first clinical trials in the infant target population should become available in the near future. The "Vaccine Value Profile" (VVP) addresses information related predominantly to invasive disease caused by Salmonella Enteritidis and Salmonella Typhimurium prevalent in sSA. Information is included on stand-alone iNTS disease candidate vaccines and candidate vaccines targeting iNTS disease combined with another invasive serotype, Salmonella Typhi, that is also common across sSA. Out of scope for the first version of this VVP is a wider discussion on either diarrheagenic NTS disease (dNTS) also associated with Salmonella Enteritidis and Salmonella Typhimurium or the development of a multivalent Salmonella vaccines targeting key serovars for use globally. This VVP for vaccines to prevent iNTS disease is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic, and societal value of pipeline vaccines and vaccine-like products. Future versions of this VVP will be updated to reflect ongoing activities such as vaccine development strategies and a "Full Vaccine Value Assessment" that will inform the value proposition of an iNTS disease vaccine. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the World Health Organization African Region. All contributors have extensive expertise on various elements of the iNTS disease VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
| | - Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
| | | | - Michael J Sikorski
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | | - John A Crump
- Centre for International Health, University of Otago, New Zealand.
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Okeke IN, de Kraker MEA, Van Boeckel TP, Kumar CK, Schmitt H, Gales AC, Bertagnolio S, Sharland M, Laxminarayan R. The scope of the antimicrobial resistance challenge. Lancet 2024; 403:2426-2438. [PMID: 38797176 DOI: 10.1016/s0140-6736(24)00876-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Each year, an estimated 7·7 million deaths are attributed to bacterial infections, of which 4.95 million are associated with drug-resistant pathogens, and 1·27 million are caused by bacterial pathogens resistant to the antibiotics available. Access to effective antibiotics when indicated prolongs life, reduces disability, reduces health-care expenses, and enables access to other life-saving medical innovations. Antimicrobial resistance undoes these benefits and is a major barrier to attainment of the Sustainable Development Goals, including targets for newborn survival, progress on healthy ageing, and alleviation of poverty. Adverse consequences from antimicrobial resistance are seen across the human life course in both health-care-associated and community-associated infections, as well as in animals and the food chain. The small set of effective antibiotics has narrowed, especially in resource-poor settings, and people who are very young, very old, and severely ill are particularly susceptible to resistant infections. This paper, the first in a Series on the challenge of antimicrobial resistance, considers the global scope of the problem and how it should be measured. Robust and actionable data are needed to drive changes and inform effective interventions to contain resistance. Surveillance must cover all geographical regions, minimise biases towards hospital-derived data, and include non-human niches.
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Affiliation(s)
- Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on AMR, Geneva, Switzerland
| | - Thomas P Van Boeckel
- Health Geography and Policy Group, Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland; One Health Trust, Bengaluru, India
| | | | - Heike Schmitt
- Centre for Zoonoses and Environmental Microbiology, Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Environmental Biotechnology, Faculty of Applied Sciences, Delft University of Technology, Delft, Netherlands
| | - Ana C Gales
- Division of Infectious Diseases, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Silvia Bertagnolio
- Department of Surveillance, Control, and Prevention of Antimicrobial Resistance, WHO, Geneva, Switzerland
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, St George's, University London, London, UK
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Aralar A, Goshia T, Ramchandar N, Lawrence SM, Karmakar A, Sharma A, Sinha M, Pride DT, Kuo P, Lecrone K, Chiu M, Mestan KK, Sajti E, Vanderpool M, Lazar S, Crabtree M, Tesfai Y, Fraley SI. Universal Digital High-Resolution Melt Analysis for the Diagnosis of Bacteremia. J Mol Diagn 2024; 26:349-363. [PMID: 38395408 PMCID: PMC11090205 DOI: 10.1016/j.jmoldx.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Fast and accurate diagnosis of bloodstream infection is necessary to inform treatment decisions for septic patients, who face hourly increases in mortality risk. Blood culture remains the gold standard test but typically requires approximately 15 hours to detect the presence of a pathogen. We, therefore, assessed the potential for universal digital high-resolution melt (U-dHRM) analysis to accomplish faster broad-based bacterial detection, load quantification, and species-level identification directly from whole blood. Analytical validation studies demonstrated strong agreement between U-dHRM load measurement and quantitative blood culture, indicating that U-dHRM detection is highly specific to intact organisms. In a pilot clinical study of 17 whole blood samples from pediatric patients undergoing simultaneous blood culture testing, U-dHRM achieved 100% concordance when compared with blood culture and 88% concordance when compared with clinical adjudication. Moreover, U-dHRM identified the causative pathogen to the species level in all cases where the organism was represented in the melt curve database. These results were achieved with a 1-mL sample input and sample-to-answer time of 6 hours. Overall, this pilot study suggests that U-dHRM may be a promising method to address the challenges of quickly and accurately diagnosing a bloodstream infection.
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Affiliation(s)
- April Aralar
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Tyler Goshia
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Nanda Ramchandar
- Department of Pediatrics, Naval Medical Center San Diego, San Diego, California; Division of Infectious Diseases, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Shelley M Lawrence
- Division of Neonatology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | | | | | | | - David T Pride
- Department of Pathology, University of California, San Diego, La Jolla, California
| | - Peiting Kuo
- Department of Pathology, University of California, San Diego, La Jolla, California
| | - Khrissa Lecrone
- Department of Pathology, University of California, San Diego, La Jolla, California
| | - Megan Chiu
- Department of Pathology, University of California, San Diego, La Jolla, California
| | - Karen K Mestan
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Eniko Sajti
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Michelle Vanderpool
- Department of Pathology and Laboratory Medicine, Rady Children's Hospital-San Diego, San Diego, California
| | - Sarah Lazar
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Melanie Crabtree
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Yordanos Tesfai
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Stephanie I Fraley
- Department of Bioengineering, University of California, San Diego, La Jolla, California.
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Batool R, Qamar ZH, Salam RA, Yousafzai MT, Ashorn P, Qamar FN. Efficacy of typhoid vaccines against culture-confirmed Salmonella Typhi in typhoid endemic countries: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e589-e598. [PMID: 38485426 DOI: 10.1016/s2214-109x(23)00606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Typhoid is a serious public health threat in many low-income and middle-income countries. Several vaccines for typhoid have been recommended by WHO for typhoid prevention in endemic countries. This study aimed to review the efficacy of typhoid vaccines against culture-confirmed Salmonella enterica serovar Typhi. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for studies published in English between Jan 1, 1986 and Nov 2, 2023. We included randomised controlled trials (RCTs) comparing typhoid vaccines with a placebo or another vaccine. This meta-analysis evaluated the efficacy and safety of several typhoid vaccines, including live attenuated oral Ty21a vaccine, Vi capsular polysaccharide (Vi-PS), Vi polysaccharide conjugated to recombinant Pseudomonas aeruginosa exotoxin A vaccine (Vi-rEPA), and Vi-tetanus toxoid conjugate vaccine (TCV). The certainty of evidence for key outcomes was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. The outcome of interest was typhoid fever confirmed by the isolation of Salmonella enterica serovar Typhi in blood and adverse events following immunisation. This study is registered with PROSPERO (CRD42021241043). FINDINGS We included 14 RCTs assessing four different vaccines (Ty21a: four trials; Vi-PS: five trials; Vi-rEPA: one trial; TCV: four trials) involving 585 253 participants. All trials were conducted in typhoid endemic countries and the age of participants ranged from 6 months to 50 years. The pooled efficacy against typhoid fever was 45% (95% CI 33-55%; four trials; 247 649 participants; I2 59%; moderate certainty) for Ty21a and 58% (44-69%; five trials; 214 456 participants; I2 34%; moderate certainty) for polysaccharide Vi-PS. The cumulative efficacy of two doses of Vi-rEPA vaccine at 2 years was 91% (88-96%; one trial; 12 008 participants; moderate certainty). The pooled efficacy of a single shot of TCV at 2 years post-immunisation was 83% (77-87%; four trials; 111 130 participants; I2 0%; moderate certainty). All vaccines were safe, with no serious adverse effects reported in the trials. INTERPRETATION The existing data from included trials provide promising results regarding the efficacy and safety of the four recommended typhoid vaccines. TCV and Vi-rEPA were found to have the highest efficacy at 2 years post-immunisation. However, follow-up data for Vi-rEPA are scarce and only TCV is pre-qualified by WHO. Therefore, roll-out of TCV into routine immunisation programmes in typhoid endemic settings is highly recommended. FUNDING There was no funding source for this study.
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Affiliation(s)
- Rabab Batool
- Department of Epidemiology and Biostatistics, Aga Khan University Hospital, Karachi, Pakistan; Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Zoya Haq Qamar
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Per Ashorn
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
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Kasiano P, Kavai S, Kiiru S, Nyerere A, Kariuki S. Typhoidal salmonella disease in Mukuru informal settlement, Nairobi Kenya; carriage, diversity, and antimicrobial resistant genes. PLoS One 2024; 19:e0298635. [PMID: 38394140 PMCID: PMC10889635 DOI: 10.1371/journal.pone.0298635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/27/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Multiple studies have shown that typhoid fever is endemic in developing countries characterized by poor hygiene. A unique way of Salmonella Typhi (S.Typhi) pathogenicity is establishing a persistent, usually asymptomatic carrier state in some infected individuals who excrete large numbers of bacteria in faeces. This study aimed to determine the isolation rate of S.Typhi from blood and stool samples among cases and asymptomatic individuals in the Mukuru informal settlement and identify antibiotic resistance patterns within the same population. MATERIALS AND METHODS We recruited 1014 outpatient participants presenting with typhoid-like symptoms in selected health centres in Nairobi, Kenya. Bacterial isolation was done on Xylose Lysine Deoxycholate agar (XLD) and Mac Conkey agar (Oxoid), followed by standard biochemical tests. Identification was done using API20E, and S.Typhi was confirmed by serotyping using polyvalent antisera 0-9 and monovalent antisera d. The Kirby-Bauer disc diffusion method was used to test the antimicrobial susceptibility of S.Typhi isolates, while Multi-Drug Resistant (MDR) strains were characterized using conventional PCR. RESULTS Of 1014 participants, 54 (5%) tested positive for S.Typhi. Thirty-eight (70%) of the S.Typhi isolated were from stool samples, while sixteen (30%) were from blood. Three (0.2%) of the isolates were from asymptomatic carriers. Of the 54 S.Typhi isolates, 20 (37%) were MDR. Resistance to ciprofloxacin and nalidixic acid was 43% and 52%, respectively. Resistance to amoxicillin-clavulanic acid (a beta-lactam inhibitor) was 2%. The BlaTEM-1 gene was present in 19/20 (95%) MDR isolates. CONCLUSION MDR S.Typhi is prevalent in Mukuru Informal settlement. The sharp increase in nalidixic acid resistance is an indication of reduced susceptibility to fluoroquinolones, which are currently the recommended drugs for the treatment of typhoid fever. This study highlights the need for effective antimicrobial stewardship and routine surveillance of antimicrobial resistance (AMR) to inform policy on the prevention and control of MDR Typhoid disease.
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Affiliation(s)
- Purity Kasiano
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, JKUAT, Nairobi, Kenya
| | - Susan Kavai
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Susan Kiiru
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, JKUAT, Nairobi, Kenya
| | - Andrew Nyerere
- Jomo Kenyatta University of Agriculture and Technology, JKUAT, Nairobi, Kenya
| | - Samuel Kariuki
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
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Tewoldemedhin B, Pati S, Atiyat R, Fedida A, Suleiman A, Abu Ruman Y, Muhanna A, Iheagwara C, Szabela M, Slim J, Boghossian J. Salmonella Group B Ileitis Mimicking Crohn's Disease: A Case Report. Cureus 2024; 16:e52495. [PMID: 38371045 PMCID: PMC10874196 DOI: 10.7759/cureus.52495] [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: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Salmonellae, considered among the enteric-fever-causing pathogens, is associated with a range of human infections, including gastroenteritis, bacteremia, and osteomyelitis. Salmonella-induced mesenteric adenitis and terminal ileitis resembling acute appendicitis have been reported in the literature. Here, we present a rare case of a patient presenting with severe acute active ileitis and colitis mimicking Crohn's disease with no prior history of inflammatory bowel disease and found to have Salmonella group B bacteremia.
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Affiliation(s)
- Bereket Tewoldemedhin
- Internal Medicine, Suburban Community Hospital (Lower Bucks Hospital), Bristol, USA
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | - Shefali Pati
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Raed Atiyat
- Gastroenterology, Saint Michael's Medical Center, Newark, USA
| | - Andre Fedida
- Gastroenterology, Saint Michael's Medical Center, Newark, USA
| | - Addi Suleiman
- Cardiology, Saint Michael's Medical Center, Newark, USA
| | | | - Ala Muhanna
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | | | - Maria Szabela
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | - Jihad Slim
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | - Jack Boghossian
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
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9
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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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Martin LB, Khanam F, Qadri F, Khalil I, Sikorski MJ, Baker S. Vaccine value profile for Salmonella enterica serovar Paratyphi A. Vaccine 2023; 41 Suppl 2:S114-S133. [PMID: 37951691 DOI: 10.1016/j.vaccine.2023.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 11/14/2023]
Abstract
In Asia, there are an estimated 12 million annual cases of enteric fever, a potentially fatal systemic bacterial infection caused by Salmonella enterica serovars Typhi (STy) and Paratyphi A (SPA). The recent availability of typhoid conjugate vaccines (TCV), an increasing incidence of disease caused by SPA and growing antimicrobial resistance (AMR) across the genus Salmonella makes a bivalent STy/SPA vaccine a useful public health proposition. The uptake of a stand-alone paratyphoid vaccine is likely low thus, there is a pipeline of bivalent STy/SPA candidate vaccines. Several candidates are close to entering clinical trials, which if successful should facilitate a more comprehensive approach for enteric fever control. Additionally, the World Health Organization (WHO) has made advancing the development of vaccines that protect young children and working aged adults against both agents of enteric fever a priority objective. This "Vaccine Value Profile" (VVP) addresses information related predominantly to invasive disease caused by SPA prevalent in Asia. Information is included on stand-alone SPA candidate vaccines and candidate vaccines targeting SPA combined with STy. Out of scope for the first version of this VVP is a wider discussion on the development of a universal Salmonella combination candidate vaccine, addressing both enteric fever and invasive non-typhoidal Salmonella disease, for use globally. This VVP is a detailed, high-level assessment of existing, publicly available information to inform and contextualize the public health, economic, and societal potential of pipeline vaccines and vaccine-like products for SPA. Future versions of this VVP will be updated to reflect ongoing activities such as vaccine development strategies and "Full Vaccine Value Assessment" that will inform the value proposition of an SPA vaccine. This VVP was developed by an expert working group from academia, non-profit organizations, public-private partnerships, and multi-lateral organizations as well as in collaboration with stakeholders from the WHO South-East Asian Region. All contributors have extensive expertise on various elements of the VVP for SPA and collectively aimed to identify current research and knowledge gaps.
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Affiliation(s)
- Laura B Martin
- Independent Consultant (current affiliation US Pharmacopeia Convention), USA.
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | | | | | - Stephen Baker
- University of Cambridge School of Clinical Medicine, UK.
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Nakisuyi J, Bernis M, Ndamira A, Kayini V, Mulumba R, Theophilus P, Agwu E, Lule H. Prevalence and factors associated with malaria, typhoid, and co-infection among febrile children aged six months to twelve years at kampala international university teaching hospital in western Uganda. Heliyon 2023; 9:e19588. [PMID: 37809597 PMCID: PMC10558847 DOI: 10.1016/j.heliyon.2023.e19588] [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] [Received: 01/01/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background Paediatric febrile illnesses pose diagnostic challenges in low-income countries. Western Uganda is endemic for both malaria and typhoid but the true prevalence of each individual disease, their co-infections and associated factors are poorly quantified. Objective To determine the prevalence of malaria, typhoid, their co-infection, and associated factors amongst febrile children attending the paediatrics and child health department of Kampala International University Teaching Hospital (KIU-TH) in Western Uganda. Methods Cross-sectional study used a survey questionnaire covering demographics, clinical and behavioural variables. We obtained blood for peripheral films for malaria and cultures for typhoid respectively; from 108 consecutively consented participants. Ethical approval was obtained from KIU-TH research and ethics committee (No. UG-REC-023/201,834). Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p < 0.05 as statistically significant. Results Majority of participants were males 62% (n = 67), cared for by their mothers 86.1% (n = 93). The prevalence of malaria was 25% (n = 27). The prevalence of typhoid was 3.7% (n = 4), whereas the prevalence of malaria-typhoid co-infection was 2.8% (n = 3). Using treated water from protected public taps was associated with low malaria-typhoid co-infection [p = 0.04; aOR = 0.05, 95%CI [0.003-0.87], whereas drinking unboiled water from open wells increased the risk for the co-infection [p = 0.037, cOR = 17, 95%CI (1.19-243.25)]. Conclusions The prevalence of blood culture confirmed malaria-typhoid co-infection in children was lower than previously reported in serological studies. These findings emphasize the need to use gold standard diagnostic investigations in epidemiological studies. Educational campaigns should focus on the use of safe water, hygienic hand washing, and proper waste disposal; and should target mothers who mainly take care of these children.
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Affiliation(s)
- Joanitor Nakisuyi
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Melvis Bernis
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Andrew Ndamira
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Vicent Kayini
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Richard Mulumba
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Pius Theophilus
- Medical Laboratory Science Department, Kampala International University Western Campus, Bushenyi, Uganda
| | - Ezera Agwu
- Departments of Medical Microbiology and Clinical Immunology, Faculty of Medicine, Kabale University, Uganda
| | - Herman Lule
- Faculty of Medicine, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, FI-20014, Turku, Finland
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Veronese P, Pappalardo M, Maffini V, Rubini M, Giacometti A, Ruozi MB, Cella S, Dodi I. Severe Typhoid Fever Complicated by Superior Mesenteric and Splenic Vein Thrombosis. Infect Dis Rep 2023; 15:377-385. [PMID: 37489392 PMCID: PMC10366850 DOI: 10.3390/idr15040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
Typhoid fever (Typhoid or enteric fever) is still the most common bacterial bloodstream infection worldwide, caused by Salmonella typhi. The transmission route is indirect through passive vehicles such as contaminated water or food. Main clinical findings are a fever lasting more than three days, abdominal symptoms, leukocytosis, and anemia. Typhoid can cause a wide range of multi-organ complications. We report a particularly severe form of this infection complicated by superior mesenteric vein and splenic vein thrombosis, an extremely uncommon manifestation.
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Affiliation(s)
- Piero Veronese
- Pediatric Infectious Disease, Children's Hospital of Parma, 43126 Parma, Italy
| | - Marco Pappalardo
- Pediatric Infectious Disease, Children's Hospital of Parma, 43126 Parma, Italy
| | - Valentina Maffini
- Pediatric Infectious Disease, Children's Hospital of Parma, 43126 Parma, Italy
| | - Monica Rubini
- Pediatric Infectious Disease, Children's Hospital of Parma, 43126 Parma, Italy
| | | | | | - Simone Cella
- Pediatric Radiology, Institute of Radiology, University of Parma, 43126 Parma, Italy
| | - Icilio Dodi
- Pediatric Infectious Disease, Children's Hospital of Parma, 43126 Parma, Italy
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Parry CM, Qamar FN, Rijal S, McCann N, Baker S, Basnyat B. What Should We Be Recommending for the Treatment of Enteric Fever? Open Forum Infect Dis 2023; 10:S26-S31. [PMID: 37274536 PMCID: PMC10236504 DOI: 10.1093/ofid/ofad179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patients with suspected enteric (typhoid and paratyphoid) fever are predominantly managed as outpatients in endemic regions. Nonspecific clinical presentation, lack of accurate diagnostic tools, and widespread antimicrobial resistance makes management challenging. Resistance has been described for all antimicrobials including chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone, and azithromycin. No significant differences have been demonstrated between these antimicrobials in their ability to treat enteric fever in systematic reviews of randomized controlled trials (RCTs). Antimicrobial choice should be guided by local resistance patterns and national guidance. Extensively drug-resistant typhoid isolates require treatment with azithromycin and/or meropenem. Combining antimicrobials that target intracellular and extracellular typhoid bacteria is a strategy being explored in the Azithromycin and Cefixime in Typhoid Fever (ACT-SA) RCT, in progress in South Asia. Alternative antimicrobials, such as the oral carbapenem, tebipenem, need clinical evaluation. There is a paucity of evidence to guide the antimicrobial management of chronic fecal carriers.
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Affiliation(s)
- Christopher M Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Medical Microbiology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Farah N Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samita Rijal
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
| | - Naina McCann
- Hospital for Tropical Diseases, UCL, London, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
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Kumar P, Kumar M. Pancolitis in Enteric Fever: A Rare Occurrence. J Glob Infect Dis 2023; 15:86-87. [PMID: 37469463 PMCID: PMC10353637 DOI: 10.4103/jgid.jgid_229_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
- Prabhat Kumar
- Department of Internal Medicine, Kailash Hospital and Neuro Institute, Noida, Uttar Pradesh, India
| | - Manish Kumar
- Department of Gastroenterology, Kailash Hospital and Neuro Institute, Noida, Uttar Pradesh, India
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15
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Zhang B, Li M, Liu Y, Zhang B, Liu Z, Chen X, Huo J, Han Y. The diagnostic value of blood sample NGS in patients with early periprosthetic joint infection after total hip arthroplasty. Int Wound J 2023; 20:961-970. [PMID: 36054590 PMCID: PMC10030938 DOI: 10.1111/iwj.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022] Open
Abstract
The diagnostic value of next-generation sequencing (NGS) of blood samples from patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) was evaluated by comparing it with drainage fluid NGS and bacterial culture. The study was designed as a retrospective diagnostic test. Thirty-six infected patients were diagnosed with PJI according to the Musculoskeletal Infection Society (MSIS) criteria and 57 volunteers were included in our study. NGS and bacterial culture were chosen to detect PJI after THA. Blood samples and drainage fluid were collected for NGS, and the drainage fluid, which was collected at the same time as the NGS drainage fluid sample, was used for bacterial culture. The primary outcomes of interest were sensitivity, specificity, and accuracy. In the infection group, 31 patients showed positive results by blood sample NGS, 33 patients showed positive results by drainage fluid NGS, and 17 patients showed positive bacterial culture results. In the control group, the results of 2 blood sample NGS, 16 drainage fluid NGS, and 3 bacterial cultures were positive. The sensitivity, specificity, and accuracy of the blood sample were 0.86, 0.96, and 0.92, respectively. The sensitivity, specificity, and accuracy of the drainage fluid samples were 0.92, 0.72, and 0.80, respectively. The sensitivity, specificity, and accuracy of bacterial culture were 0.47, 0.95, and 0.79, respectively. The study demonstrated that both the sensitivity and specificity of NGS were higher than those of bacterial culture, regardless of the kind of sample. Compared with drainage fluid NGS, the sensitivity of blood sample NGS was slightly lower (0.86 vs 0.92), but blood sample NGS showed higher specificity (0.96 vs 0.72). In total, the diagnostic value of blood sample NGS was superior to that of drainage fluid NGS and bacterial culture. The majority of infected patients could be identified by blood sample NGS. Moreover, because of its high specificity, blood sample NGS can not only detect infectious bacteria but also distinguish infectious from non-infectious bacteria, which is dramatically different from using drainage fluid NGS.
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Affiliation(s)
- Bingshi Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Mengnan Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yawei Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Binquan Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Zeming Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Jia Huo
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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Intestinal and Extra-intestinal Complications of Typhoid Fever: an Update. CURRENT TROPICAL MEDICINE REPORTS 2023. [DOI: 10.1007/s40475-023-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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17
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Posen HJ, Wong W, Farrar DS, Campigotto A, Chan T, Barker KR, Hagmann SHF, Ryan ET, LaRocque RC, Earl AM, Worby CJ, Castelli F, Fumadó VP, Britton PN, Libman M, Hamer DH, Morris SK. Travel-associated extensively drug-resistant typhoid fever: a case series to inform management in non-endemic regions. J Travel Med 2023; 30:6651791. [PMID: 35904457 DOI: 10.1093/jtm/taac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Extensively drug-resistant (XDR) typhoid fever is a threat to travelers to Pakistan. We describe a multicontinental case series of travel-acquired XDR typhoid fever to demonstrate the global spread of the problem and encourage preventive interventions as well as appropriate empiric antimicrobial use. METHODS Cases were extracted from the GeoSentinel database, microbiologic laboratory records of two large hospitals in Toronto, Canada, and by invitation to TropNet sites. All isolates were confirmed XDR Salmonella enterica serovar Typhi (Salmonella typhi), with resistance to ampicillin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole. RESULTS Seventeen cases were identified in Canada (10), USA (2), Spain (2), Italy (1), Australia (1) and Norway (1). Patients under 18 years represented 71% (12/17) of cases, and all patients travelled to Pakistan to visit friends or relatives. Only one patient is known to have been vaccinated. Predominant symptoms were fever, abdominal pain, vomiting and diarrhoea. Antimicrobial therapy was started on Day 1 of presentation in 75% (12/16) of patients, and transition to a carbapenem or azithromycin occurred a median of 2 days after blood culture was drawn. Antimicrobial susceptibilities were consistent with the XDR S. typhi phenotype, and whole genome sequencing on three isolates confirmed their belonging to the XDR variant of the H58 clade. CONCLUSIONS XDR typhoid fever is a particular risk for travelers to Pakistan, and empiric use of a carbapenem or azithromycin should be considered. Pre-travel typhoid vaccination and counseling are necessary and urgent interventions, especially for visiting friends and relatives travelers. Ongoing sentinel surveillance of XDR typhoid fever is needed to understand changing epidemiology.
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Affiliation(s)
- H Joshua Posen
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Waison Wong
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel S Farrar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Tiffany Chan
- Division of Infectious Diseases, Trillium Health Partners, Mississauga, ON, Canada
| | - Kevin R Barker
- Division of Microbiology, Department of Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY, USA
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine/Hofstra Northwell, New Hempstead, NY, USA
| | - Edward T Ryan
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina C LaRocque
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Colin J Worby
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- ASST Spedali Civili, Brescia, Italy
| | - Victoria Pérez Fumadó
- Infectious Diseases Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Shaun K Morris
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada
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Igiri BE, Okoduwa SIR, Munirat SA, Otu-Bassey IB, Bashir A, Onyiyioza OM, Enang IA, Okoduwa UJ. Diversity in Enteric Fever Diagnostic Protocols and Recommendation for Composite Reference Standard. IRANIAN JOURNAL OF MEDICAL MICROBIOLOGY 2023; 17:22-38. [DOI: 10.30699/ijmm.17.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Liang Y, Driscoll AJ, Patel PD, Datta S, Voysey M, French N, Jamka LP, Henrion MYR, Ndeketa L, Laurens MB, Heyderman RS, Gordon MA, Neuzil KM. Typhoid conjugate vaccine effectiveness in Malawi: evaluation of a test-negative design using randomised, controlled clinical trial data. Lancet Glob Health 2023; 11:e136-e144. [PMID: 36442498 PMCID: PMC9748309 DOI: 10.1016/s2214-109x(22)00466-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Typhoid conjugate vaccines are being introduced in low-income and middle-income countries to prevent typhoid illness in children. Vaccine effectiveness studies assess vaccine performance after introduction. The test-negative design is a commonly used method to estimate vaccine effectiveness that has not been applied to typhoid vaccines because of concerns over blood culture insensitivity. The overall aim of the study was to evaluate the appropriateness of using a test-negative design to assess typhoid Vi polysaccharide-tetanus toxoid conjugate vaccine (Vi-TT) effectiveness using a gold standard randomised controlled trial database. METHODS Using blood culture data from a randomised controlled trial of Vi-TT in Malawi, we simulated a test-negative design to derive vaccine effectiveness estimates using three different approaches and compared these to randomised trial efficacy results. In the randomised trial, 27 882 children aged 9 months to 12 years were randomly assigned (1:1) to receive a single dose of Vi-TT or meningococcal capsular group A conjugate vaccine between Feb 21 and Sept 27, 2018, and were followed up for blood culture-confirmed typhoid fever until Sept 30, 2021. FINDINGS For all three test-negative design approaches, vaccine effectiveness estimates (test-negative design A, 80·3% [95% CI 66·2 to 88·5] vs test-negative design B, 80·5% [66·5 to 88·6] vs test-negative design C, 80·4% [66·9 to 88·4]) were almost identical to the randomised trial results (80·4% [95% CI 66·4 to 88·5]). Receipt of Vi-TT did not affect the risk of non-typhoid fever (vaccine efficacy against non-typhoid fever -0·4% [95% CI -4·9 to 3·9] vs -1% [-5·6 to 3·3] vs -2·5% [-6·4 to 1·3] for test-negative design A, test-negative design B, and test-negative design C, respectively). INTERPRETATION This study validates the test-negative design core assumption for typhoid vaccine effectiveness estimation and shows the accuracy and precision of the estimates compared with the randomised controlled trial. These results show that the test-negative design is suitable for assessing typhoid conjugate vaccine effectiveness in post-introduction studies using blood culture surveillance. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Priyanka D Patel
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Latif Ndeketa
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, UK
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Vij S, Thakur R, Rishi P. Reverse engineering approach: a step towards a new era of vaccinology with special reference to Salmonella. Expert Rev Vaccines 2022; 21:1763-1785. [PMID: 36408592 DOI: 10.1080/14760584.2022.2148661] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Salmonella is responsible for causing enteric fever, septicemia, and gastroenteritis in humans. Due to high disease burden and emergence of multi- and extensively drug-resistant Salmonella strains, it is becoming difficult to treat the infection with existing battery of antibiotics as we are not able to discover newer antibiotics at the same pace at which the pathogens are acquiring resistance. Though vaccines against Salmonella are available commercially, they have limited efficacy. Advancements in genome sequencing technologies and immunoinformatics approaches have solved the problem significantly by giving rise to a new era of vaccine designing, i.e. 'Reverse engineering.' Reverse engineering/vaccinology has expedited the vaccine identification process. Using this approach, multiple potential proteins/epitopes can be identified and constructed as a single entity to tackle enteric fever. AREAS COVERED This review provides details of reverse engineering approach and discusses various protein and epitope-based vaccine candidates identified using this approach against typhoidal Salmonella. EXPERT OPINION Reverse engineering approach holds great promise for developing strategies to tackle the pathogen(s) by overcoming the limitations posed by existing vaccines. Progressive advancements in the arena of reverse vaccinology, structural biology, and systems biology combined with an improved understanding of host-pathogen interactions are essential components to design new-generation vaccines.
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Affiliation(s)
- Shania Vij
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Reena Thakur
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Praveen Rishi
- Department of Microbiology, Panjab University, Chandigarh, India
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21
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Khan M, Shamim S. Understanding the Mechanism of Antimicrobial Resistance and Pathogenesis of Salmonella enterica Serovar Typhi. Microorganisms 2022; 10:2006. [PMID: 36296282 PMCID: PMC9606911 DOI: 10.3390/microorganisms10102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Salmonella enterica serovar Typhi (S. Typhi) is a Gram-negative pathogen that causes typhoid fever in humans. Though many serotypes of Salmonella spp. are capable of causing disease in both humans and animals alike, S. Typhi and S. Paratyphi are common in human hosts only. The global burden of typhoid fever is attributable to more than 27 million cases each year and approximately 200,000 deaths worldwide, with many regions such as Africa, South and Southeast Asia being the most affected in the world. The pathogen is able to cause disease in hosts by evading defense systems, adhesion to epithelial cells, and survival in host cells in the presence of several virulence factors, mediated by virulence plasmids and genes clustered in distinct regions known as Salmonella pathogenicity islands (SPIs). These factors, coupled with plasmid-mediated antimicrobial resistance genes, enable the bacterium to become resistant to various broad-spectrum antibiotics used in the treatment of typhoid fever and other infections caused by Salmonella spp. The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains in many countries of the world has raised great concern over the rise of antibiotic resistance in pathogens such as S. Typhi. In order to identify the key virulence factors involved in S. Typhi pathogenesis and infection, this review delves into various mechanisms of virulence, pathogenicity, and antimicrobial resistance to reinforce efficacious disease management.
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Affiliation(s)
| | - Saba Shamim
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Defence Road Campus, Lahore 54000, Pakistan
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22
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Muacevic A, Adler JR. Clinical and Laboratory Features of Enteric Fever in Children and Antibiotic Sensitivity Pattern in a Tertiary Care Hospital of a Low- and Middle-Income Country. Cureus 2022; 14:e30784. [PMID: 36320797 PMCID: PMC9614183 DOI: 10.7759/cureus.30784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Globally, enteric fever (EF) significantly gives rise to an appalling death toll. It is an endemic illness in Bangladesh and South Asia. The condition manifests in a wide range of clinical features in children. Nowadays, antibiotic resistance is an international stumbling block that hampers the appropriate treatment and outcome of EF. OBJECTIVE The study evaluated the clinical and laboratory characteristics and antibiotic sensitivity pattern of Salmonella enterica in children. METHODS This prospective research was conducted at Delta Medical College and Hospital, Dhaka, Bangladesh, from January 2017 to December 2019. A total of 200 pediatric cases of EF were included in this study who were either culture positive or had significantly raised Widal test titer for Salmonella with suggestive clinical features. RESULTS All the patients had a fever, and most had coated tongue, vomiting, abdominal pain, organomegaly, and diarrhea. Among the selected 200 cases of EF, 43.5% were Salmonella typhi culture-positive. A high erythrocyte sedimentation rate (ESR) was observed in a substantial number (53%) of patients. Ceftriaxone was the most sensitive (100%) antibiotic through laboratory analysis, followed by cefotaxime (95.1%). Among the oral antibiotics used, cefixime (92.8%) was the most sensitive. CONCLUSION EF in children can present with varied clinical manifestations. Selective antibiotic treatment according to sensitivity patterns is crucial for effective illness management and will reduce morbidity and mortality in the pediatric population.
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23
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Soedarmono P, Diana A, Tauran P, Lokida D, Aman AT, Alisjahbana B, Arlinda D, Tjitra E, Kosasih H, Merati KTP, Arif M, Gasem MH, Susanto NH, Lukman N, Sugiyono RI, Hadi U, Lisdawati V, Tchos KGF, Neal A, Karyana M. The characteristics of bacteremia among patients with acute febrile illness requiring hospitalization in Indonesia. PLoS One 2022; 17:e0273414. [PMID: 36074783 PMCID: PMC9455855 DOI: 10.1371/journal.pone.0273414] [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: 03/14/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
Blood culturing remains the "gold standard" for bloodstream infection (BSI) diagnosis, but the method is inaccessible to many developing countries due to high costs and insufficient resources. To better understand the utility of blood cultures among patients in Indonesia, a country where blood cultures are not routinely performed, we evaluated data from a previous cohort study that included blood cultures for all participants. An acute febrile illness study was conducted from July 2013 to June 2016 at eight major hospitals in seven provincial capitals in Indonesia. All participants presented with a fever, and two-sided aerobic blood cultures were performed within 48 hours of hospital admission. Positive cultures were further assessed for antimicrobial resistance (AMR) patterns. Specimens from participants with negative culture results were screened by advanced molecular and serological methods for evidence of causal pathogens. Blood cultures were performed for 1,459 of 1,464 participants, and the 70.6% (1,030) participants that were negative by dengue NS1 antigen test were included in further analysis. Bacteremia was observed in 8.9% (92) participants, with the most frequent pathogens being Salmonella enterica serovar Typhi (41) and Paratyphi A (10), Escherichia coli (14), and Staphylococcus aureus (10). Two S. Paratyphi A cases had evidence of AMR, and several E. coli cases were multidrug resistant (42.9%, 6/14) or monoresistant (14.3%, 2/14). Culture contamination was observed in 3.6% (37) cases. Molecular and serological assays identified etiological agents in participants having negative cultures, with 23.1% to 90% of cases being missed by blood cultures. Blood cultures are a valuable diagnostic tool for hospitalized patients presenting with fever. In Indonesia, pre-screening patients for the most common viral infections, such as dengue, influenza, and chikungunya viruses, would maximize the benefit to the patient while also conserving resources. Blood cultures should also be supplemented with advanced laboratory tests when available.
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Affiliation(s)
- Pratiwi Soedarmono
- Faculty of Medicine, Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Patricia Tauran
- Faculty of Medicine, Universitas Hasanuddin/ Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Dewi Lokida
- Tangerang District Hospital, Tangerang, Banten, Indonesia
| | - Abu Tholib Aman
- Faculty of Medicine, Public Heath, and Nursing, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Bachti Alisjahbana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dona Arlinda
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Emiliana Tjitra
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | | | - Mansyur Arif
- Faculty of Medicine, Universitas Hasanuddin/ Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | | | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Usman Hadi
- Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Vivi Lisdawati
- Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
| | - Karine G. Fouth Tchos
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Aaron Neal
- National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
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24
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Garrett DO, Longley AT, Aiemjoy K, Yousafzai MT, Hemlock C, Yu AT, Vaidya K, Tamrakar D, Saha S, Bogoch II, Date K, Saha S, Islam MS, Sayeed KMI, Bern C, Shakoor S, Dehraj IF, Mehmood J, Sajib MSI, Islam M, Thobani RS, Hotwani A, Rahman N, Irfan S, Naga SR, Memon AM, Pradhan S, Iqbal K, Shrestha R, Rahman H, Hasan MM, Qazi SH, Kazi AM, Saddal NS, Jamal R, Hunzai MJ, Hossain T, Marks F, Carter AS, Seidman JC, Qamar FN, Saha SK, Andrews JR, Luby SP. Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project. Lancet Glob Health 2022; 10:e978-e988. [PMID: 35714648 PMCID: PMC9210262 DOI: 10.1016/s2214-109x(22)00119-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Precise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform these strategies. METHODS From September, 2016, to September, 2019, we conducted prospective clinical surveillance for Salmonella enterica serotype Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C at health facilities in predetermined catchment areas in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients eligible for inclusion were outpatients with 3 or more consecutive days of fever in the last 7 days; inpatients with suspected or confirmed enteric fever; patients with blood culture-confirmed enteric fever from the hospital laboratories not captured by inpatient or outpatient enrolment and cases from the laboratory network; and patients with non-traumatic ileal perforation under surgical care. We used a hybrid surveillance model, pairing facility-based blood culture surveillance with community surveys of health-care use. Blood cultures were performed for enrolled patients. We calculated overall and age-specific typhoid and paratyphoid incidence estimates for each study site. Adjusted estimates accounted for the sensitivity of blood culture, the proportion of eligible individuals who consented and provided blood, the probability of care-seeking at a study facility, and the influence of wealth and education on care-seeking. We additionally calculated incidence of hospitalisation due to typhoid and paratyphoid. FINDINGS A total of 34 747 patients were enrolled across 23 facilitates (six tertiary hospitals, surgical wards of two additional hospitals, and 15 laboratory network sites) during the study period. Of the 34 303 blood cultures performed on enrolled patients, 8705 (26%) were positive for typhoidal Salmonella. Adjusted incidence rates of enteric fever considered patients in the six tertiary hospitals. Adjusted incidence of S Typhi, expressed per 100 000 person-years, was 913 (95% CI 765-1095) in Dhaka. In Nepal, the adjusted typhoid incidence rates were 330 (230-480) in Kathmandu and 268 (202-362) in Kavrepalanchok. In Pakistan, the adjusted incidence rates per hospital site were 176 (144-216) and 103 (85-126). The adjusted incidence rates of paratyphoid (of which all included cases were due to S Paratyphi A) were 128 (107-154) in Bangladesh, 46 (34-62) and 81 (56-118) in the Nepal sites, and 23 (19-29) and 1 (1-1) in the Pakistan sites. Adjusted incidence of hospitalisation was high across sites, and overall, 2804 (32%) of 8705 patients with blood culture-confirmed enteric fever were hospitalised. INTERPRETATION Across diverse communities in three south Asian countries, adjusted incidence exceeded the threshold for "high burden" of enteric fever (100 per 100 000 person-years). Incidence was highest among children, although age patterns differed across sites. The substantial disease burden identified highlights the need for control measures, including improvements to water and sanitation infrastructure and the implementation of typhoid vaccines. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- 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, GA, USA; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Aiemjoy
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Shampa Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sadia Shakoor
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- 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
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Shiva R Naga
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | - Sailesh Pradhan
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | | | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | | | - Saqib H Qazi
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Raza Jamal
- National Institute of Child Health, Karachi, Pakistan
| | - Mohammed J Hunzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tanvir Hossain
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK; University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Alice S Carter
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | | | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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25
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Paediatric enteric fever in Brussels: a case series over 16 years. Eur J Pediatr 2022; 181:1151-1158. [PMID: 34766200 DOI: 10.1007/s00431-021-04309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Enteric fever (EF) is a major public health problem and a witness of the global health disparities. It is caused by Salmonella enterica serovar Typhi (Salmonella ser. Typhi) and Salmonella enterica serovar Paratyphi A, B, C (Salmonella ser. Paratyphi) and is estimated to infect 12-26 million persons yearly. Paediatric data on enteric fever in Europe are scarce. A case series of EF was analysed to describe the clinical presentation, laboratory characteristics and diagnostic challenges identified in a paediatric population in Brussels. We performed a retrospective study of all lab-confirmed cases of enteric fever in children aged 0-15 years at two Brussels teaching hospitals, between January 2005 and December 2020. We reviewed age, gender, travel history, consultations before diagnosis, hospitalisation duration, clinical symptoms and laboratory findings. There were 34 positive isolates of S. typhi and S. paratyphi: 31 patients had positive blood culture, 1 patient had positive bone aspirate and 2 patients had positive stool culture (one was excluded for missing data). There were 20 girls (60%). Median age was 3.5 years (range 5 months to 14 years). Travel to EF endemic areas was present in 55% of patients. Diagnosis was delayed in 80% of children. Eosinopenia was present in 93% of the cohort. The patients had not received any preventive travel education or vaccination. Conlusion: Enteric fever poses diagnostic challenges to clinicians. Eosinopenia in a febrile patient coming from the tropics should raise suspicion of EF. Travellers to endemic areas should be better educated about EF risks, and typhoid fever vaccination must be promoted. What is Known: • Enteric fever is a global public health problem and includes typhoid and paratyphoid fever. • Typhoid fever is vaccine preventable disease. Paratyphoid fever is not vaccine preventable. What is New: • Enteric fever diagnosis is very challenging in non-endemic settings, and a large proportion of patients may develop serious complications if they receive delayed management. Occurrence of small family clusters is possible and mandates education and monitoring of the families of enteric fever affected children. • We report that the widest majority of our enteric fever affected patients (69%) had aneosinophilia (zero eosinophil count), and almost all patients (93%) had eosinopaenia (less than 50 eosinophil count) during their bacteriaemic phase.
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26
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Kim CL, Cruz Espinoza LM, Vannice KS, Tadesse BT, Owusu-Dabo E, Rakotozandrindrainy R, Jani IV, Teferi M, Bassiahi Soura A, Lunguya O, Steele AD, Marks F. The Burden of Typhoid Fever in Sub-Saharan Africa: A Perspective. Res Rep Trop Med 2022; 13:1-9. [PMID: 35308424 PMCID: PMC8932916 DOI: 10.2147/rrtm.s282461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/12/2022] [Indexed: 11/23/2022] Open
Abstract
While typhoid fever has largely been eliminated in high-income regions which have developed modern water, sanitation, and hygiene facilities, it remains a significant public health burden resulting in morbidity and mortality among millions of individuals in resource-constrained settings. Prevention and control efforts are needed that integrate several high-impact interventions targeting facilities and infrastructure, including those addressing improvements in sanitation, access to safe water, and planned urbanization, together with parallel efforts directed at effective strategies for use of typhoid conjugate vaccines (TCV). The use of TCVs is a critical tool with the potential of having a rapid impact on typhoid fever disease burden; their introduction will also serve as an important strategy to combat evolving antimicrobial resistance to currently available typhoid fever treatments. Well-designed epidemiological surveillance studies play a critical role in establishing the need for, and monitoring the impact of, typhoid fever control and prevention strategies implemented by public health authorities. Here, we present a perspective based on a narrative review of the impact of typhoid fever on morbidity and mortality in sub-Saharan Africa and discuss ongoing surveillance activities and the role of vaccination in prevention and control efforts.
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Affiliation(s)
- Cara Lynn Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kirsten S Vannice
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ilesh V Jani
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- University of Antananarivo, Antananarivo, Madagascar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Correspondence: Florian Marks, Tel +82-2-881-1133, Email
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27
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Kim SH, Bansal J. A Rare Case of Typhoid Fever in the United States Associated With Travel to Mexico. Cureus 2022; 14:e22316. [PMID: 35350527 PMCID: PMC8933273 DOI: 10.7759/cureus.22316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/03/2022] Open
Abstract
Typhoid fever is an infectious febrile illness caused by Salmonella typhi that is rare in the United States but is endemic in regions of South Asia and Africa. Typhoid fever initially presents with nonspecific symptoms such as fever, malaise, and abdominal pain. We describe a case of typhoid fever in an adult in the United States with recent travel to Mexico. After a nonspecific presentation, the patient developed Faget sign and computed tomography (CT) of the abdomen revealed mesenteric adenitis, which prompted additional workup. Diagnosis of typhoid fever was established by blood culture and the patient was treated with ciprofloxacin.
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28
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Nabarro LE, McCann N, Herdman MT, Dugan C, Ladhani S, Patel D, Morris-Jones S, Balasegaram S, Heyderman RS, Brown M, Parry CM, Godbole G. British Infection Association Guidelines for the Diagnosis and Management of Enteric Fever in England. J Infect 2022; 84:469-489. [PMID: 35038438 DOI: 10.1016/j.jinf.2022.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
Enteric fever (EF) is an infection caused by the bacteria called Salmonella Typhi or Paratyphi. Infection is acquired through swallowing contaminated food or water. Most EF in England occurs in people returning from South Asia and other places where EF is common; catching EF in England is rare. The main symptom is fever, but stomach pain, diarrhoea, muscle aches, rash and other symptoms may occur. EF is diagnosed by culturing the bacteria from blood and/or stool in a microbiology laboratory. EF usually responds well to antibiotic treatment. Depending on how unwell the individual is, antibiotics may be administered by mouth or by injection. Over the past several years, there has been an overall increase in resistance to antibiotics used to treat enteric fever, in all endemic areas. Additionally, since 2016, there has been an ongoing outbreak of drug-resistant EF in Pakistan. This infection is called extensively drug-resistant, or XDR, EF and only responds to a limited number of antibiotics. Occasionally individuals develop complications of EF including confusion, bleeding, a hole in the gut or an infection of the bones or elsewhere. Some people may continue to carry the bacteria in their stool for a longtime following treatment for the initial illness. These people may need treatment with a longer course of antibiotics to eradicate infection. Travellers can reduce their risk of acquiring EF by following safe food and water practices and by receiving the vaccine at least a few weeks before travel. These guidelines aim to help doctors do the correct tests and treat patients for enteric fever in England but may also be useful to doctors and public health professionals in other similar countries.
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Affiliation(s)
- L E Nabarro
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; St George's University Hospitals NHS Foundation Trust, London, UK; British Infection Association, UK
| | - N McCann
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - C Dugan
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Ladhani
- United Kingdom Health Security Agency, UK; Paediatric Infectious Diseases Research Group, St George's University, London, UK
| | - D Patel
- National Travel Health Network and Centre (NaTHNaC), UK
| | - S Morris-Jones
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - R S Heyderman
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - M Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - C M Parry
- Liverpool School of Tropical Medicine, Liverpool, UK; Alder Hey Hospital and Liverpool University Hospitals, Liverpool, UK; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - G Godbole
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; British Infection Association, UK.
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Van Be Bay P, Wain J, Phuong LT, Ho VA, Hien TT, Parry CM. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:736-744. [PMID: 35092688 PMCID: PMC9356000 DOI: 10.1093/trstmh/trac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Le Thi Phuong
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Vo Anh Ho
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Tran Tinh Hien
- Well come Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
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30
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Srinivasan M, Sindhu KN, Ramanujam K, Ramasamy RK, Subramaniam S, Ganesan SK, Vajja S, David AS, Lankala P, Rose W, Moses PD, Grassly NC, Kang G, John J. Factors Predicting Blood Culture Positivity in Children With Enteric Fever. J Infect Dis 2021; 224:S484-S493. [PMID: 35238358 PMCID: PMC8892536 DOI: 10.1093/infdis/jiab357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. METHODS A cohort of 6760 children aged 0.5-15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models. RESULTS Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39-2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71-4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89-4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11-11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness. CONCLUSIONS Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.
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Affiliation(s)
- Manikandan Srinivasan
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | | | - Karthikeyan Ramanujam
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Ranjith Kumar Ramasamy
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Sathyapriya Subramaniam
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Santhosh Kumar Ganesan
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Swathi Vajja
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Anita Shirley David
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Pramitha Lankala
- Department of Community Health, Christian Medical College, Vellore, India
| | - Winsley Rose
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Prabhakar D Moses
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, India
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31
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Advancement in Salmonella Detection Methods: From Conventional to Electrochemical-Based Sensing Detection. BIOSENSORS-BASEL 2021; 11:bios11090346. [PMID: 34562936 PMCID: PMC8468554 DOI: 10.3390/bios11090346] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023]
Abstract
Large-scale food-borne outbreaks caused by Salmonella are rarely seen nowadays, thanks to the advanced nature of the medical system. However, small, localised outbreaks in certain regions still exist and could possess a huge threat to the public health if eradication measure is not initiated. This review discusses the progress of Salmonella detection approaches covering their basic principles, characteristics, applications, and performances. Conventional Salmonella detection is usually performed using a culture-based method, which is time-consuming, labour intensive, and unsuitable for on-site testing and high-throughput analysis. To date, there are many detection methods with a unique detection system available for Salmonella detection utilising immunological-based techniques, molecular-based techniques, mass spectrometry, spectroscopy, optical phenotyping, and biosensor methods. The electrochemical biosensor has growing interest in Salmonella detection mainly due to its excellent sensitivity, rapidity, and portability. The use of a highly specific bioreceptor, such as aptamers, and the application of nanomaterials are contributing factors to these excellent characteristics. Furthermore, insight on the types of biorecognition elements, the principles of electrochemical transduction elements, and the miniaturisation potential of electrochemical biosensors are discussed.
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Khaliq A, Yousafzai MT, Haq S, Yaseen R, Qureshi S, Rind F, Padhani ZA, Khan A, Kazi AM, Qamar FN. A review of toolkits and case definitions for detecting enteric fever outbreaks in Asian and African countries from 1965-2019. J Glob Health 2021; 11:04031. [PMID: 34131486 PMCID: PMC8183158 DOI: 10.7189/jogh.11.04031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This review assessed the case definitions, diagnostic criteria, antimicrobial resistance, and methods used for enteric fever outbreaks and utilization of any unified outbreak score or checklist for early identification and response in Asia and Africa from 1965-2019. Methods We searched enteric fever outbreaks using PubMed, Google Scholar, and the Cochrane library. Studies describing a single outbreak event of enteric fever in Asia and Africa from 1965-2019 were reviewed. We excluded case reports, letter to editors, studies reporting typhoid in conjunction with other diseases, the Centers for Disease Control and Prevention (CDC) trip reports, the World Health Organization (WHO) bulletins report, data from mathematical modeling and simulation studies, reviews and ProMed alert. Also, non-typhoidal salmonella outbreaks were excluded. Results A total of 5063 articles were identified using the key terms and 68 studies were selected for data extraction. Most (48, 71%) outbreaks were from Asian countries, 20 (29%) were reported from Africa. Only 15 studies reported the case definition used for case identification during an outbreak and 8 of those were from Asia. A third (20, 29%) of the studies described antibiotic resistance pattern. 43 (63%) studies contained information regarding the source of the outbreak. Outcomes (hospitalization and deaths) were reported in a quarter of studies. Only 23 (29%) of the studies reported outbreak control strategies while none reported any unified outbreak score or a checklist to identify the outbreak. Conclusion This review highlights the variability in detection and reporting methods for enteric fever outbreaks in Asia and Africa. No standardized case definitions or laboratory methods were reported. Only a few studies reported strategies for outbreak control. There is a need for the development of a unified outbreak score or a checklist to identify and report enteric fever outbreaks globally.
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Affiliation(s)
- Asif Khaliq
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,Kirby Institute, University of New South Wales, Australia
| | - Salman Haq
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Rahima Yaseen
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Fahad Rind
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University Hospital, Karachi
| | - Ayub Khan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Abdul Momin Kazi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
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Chirambo AC, Nyirenda TS, Jambo N, Msefula C, Kamng'ona A, Molina S, Mandala WL, Heyderman RS, Iturizza-Gomara M, Henrion MYR, Gordon MA. Performance of molecular methods for the detection of Salmonella in human stool specimens. Wellcome Open Res 2021; 5:237. [PMID: 34017923 PMCID: PMC8108707 DOI: 10.12688/wellcomeopenres.16305.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The relationship between asymptomatic
Salmonella exposure within the gastrointestinal tract and
Salmonella bacteraemia is poorly understood, in part due to the low sensitivity of stool culture and the lack of validated molecular diagnostic tests for the detection of
Salmonella in the stool. The study aimed to determine a reliable molecular diagnostic test for
Salmonella in stool specimens. Methods: We optimised an in-house monoplex real-time polymerase chain reaction (PCR) for the detection of
Salmonellattr and
InvA genes in stool by including a selenite broth pre-culture step for
Salmonella before DNA extraction and validated their specificity against other local common pathogens. Then we assessed their performance against a well-validated multiplex PCR targeting the same
ttr and
InvA genes and against stool culture using clinical stool specimens collected from a cohort of 50 asymptomatic healthy Malawian children that were sampled at 1-month intervals over 12 months. We employed a latent Markov model to estimate the specificities and sensitivities of PCR methods. Results:
Ttr and
InvA primers were both able to detect all the different
Salmonella serovars tested and had superior limits of detection when DNA was extracted after selenite pre-culture. T
tr sensitivity and specificity for monoplex-PCR were (99.53%, 95.46%) and for multiplex-PCR (90.30%, 99.30%) respectively.
InvA specificity and specificity for using monoplex-PCR was (95.06%, 90.31%) and multiplex-PCRs (89.41%, 98.00%) respectively. Sensitivity and specificity for standard stool culture were 62.88% and 99.99%, respectively. Culture showed the highest PPV (99.73%), and monoplex-
ttr had the highest NPV (99.67%). Conclusion: Test methods demonstrated high concordance, although stool culture and monoplexed
ttr primers had superior specificity and sensitivity, respectively. The use of selenite pre-enrichment step increased
Salmonella detection rate. Taken together, molecular detection methods used here could be used to reveal the true extent of both asymptomatic and symptomatic
Salmonella exposure events.
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Affiliation(s)
- Angeziwa Chunga Chirambo
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Pathology Department, College of Medicine, Malawi, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Tonney S Nyirenda
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Pathology Department, College of Medicine, Malawi, Blantyre, Malawi
| | - Ndaru Jambo
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Pathology Department, College of Medicine, Malawi, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Chisomo Msefula
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Pathology Department, College of Medicine, Malawi, Blantyre, Malawi
| | - Arox Kamng'ona
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Biomedical Sciences Department, College of Medicine, Malawi, Blantyre, Malawi
| | - Sandra Molina
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Wilson L Mandala
- Malawi University of Science and Technology, Thyolo, +265, Malawi
| | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College London, London, WC1E 6EJ, UK
| | - Miren Iturizza-Gomara
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome (MLW) Programme, Blantyre, +265, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
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Sosa T, Kinnear B, Choe AY, Geha R, Haslam DB, Weiss PF, Parker MW. Caught in the Hotbox. J Hosp Med 2021; 16:304-307. [PMID: 33929950 DOI: 10.12788/jhm.3493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Tina Sosa
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kinnear
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Y Choe
- Division of Hospital Medicine, Children's Hospital of Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rabih Geha
- Department of Medicine, University of California, San Francisco, California
- Medical Service, San Francisco VA Medical Center, San Francisco, California
| | - David B Haslam
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Pamela F Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle W Parker
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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35
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Carey ME, MacWright WR, Im J, Meiring JE, Gibani MM, Park SE, Longley A, Jeon HJ, Hemlock C, Yu AT, Soura A, Aiemjoy K, Owusu-Dabo E, Terferi M, Islam S, Lunguya O, Jacobs J, Gordon M, Dolecek C, Baker S, Pitzer VE, Yousafzai MT, Tonks S, Clemens JD, Date K, Qadri F, Heyderman RS, Saha SK, Basnyat B, Okeke IN, Qamar FN, Voysey M, Luby S, Kang G, Andrews J, Pollard AJ, John J, Garrett D, Marks F. The Surveillance for Enteric Fever in Asia Project (SEAP), Severe Typhoid Fever Surveillance in Africa (SETA), Surveillance of Enteric Fever in India (SEFI), and Strategic Typhoid Alliance Across Africa and Asia (STRATAA) Population-based Enteric Fever Studies: A Review of Methodological Similarities and Differences. Clin Infect Dis 2021; 71:S102-S110. [PMID: 32725221 PMCID: PMC7388711 DOI: 10.1093/cid/ciaa367] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Building on previous multicountry surveillance studies of typhoid and others salmonelloses such as the Diseases of the Most Impoverished program and the Typhoid Surveillance in Africa Project, several ongoing blood culture surveillance studies are generating important data about incidence, severity, transmission, and clinical features of invasive Salmonella infections in sub-Saharan Africa and South Asia. These studies are also characterizing drug resistance patterns in their respective study sites. Each study answers a different set of research questions and employs slightly different methodologies, and the geographies under surveillance differ in size, population density, physician practices, access to healthcare facilities, and access to microbiologically safe water and improved sanitation. These differences in part reflect the heterogeneity of the epidemiology of invasive salmonellosis globally, and thus enable generation of data that are useful to policymakers in decision-making for the introduction of typhoid conjugate vaccines (TCVs). Moreover, each study is evaluating the large-scale deployment of TCVs, and may ultimately be used to assess post-introduction vaccine impact. The data generated by these studies will also be used to refine global disease burden estimates. It is important to ensure that lessons learned from these studies not only inform vaccination policy, but also are incorporated into sustainable, low-cost, integrated vaccine-preventable disease surveillance systems.
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Affiliation(s)
- Megan E Carey
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Justin Im
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - James E Meiring
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Malick M Gibani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Se Eun Park
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Ashley Longley
- Global Immunization Division, Centers for Disease Control Foundation, Atlanta, Georgia, USA
| | - Hyon Jin Jeon
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ellis Owusu-Dabo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sahidul Islam
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Melita Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | - Susan Tonks
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control Foundation, Atlanta, Georgia, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Idaban, Nigeria
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Merryn Voysey
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Jason Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Jacob John
- Christian Medical College, Vellore, India
| | - Denise Garrett
- Sabin Vaccine Institute, Washington, District of Columbia, USA
| | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
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36
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Manesh A, Meltzer E, Jin C, Britto C, Deodhar D, Radha S, Schwartz E, Rupali P. Typhoid and paratyphoid fever: a clinical seminar. J Travel Med 2021; 28:6129661. [PMID: 33550411 DOI: 10.1093/jtm/taab012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/07/2021] [Indexed: 01/06/2023]
Abstract
Rationale for review: Enteric fever (EF) caused by Salmonella enterica subspecies enterica serovar Typhi (Salmonella Typhi) and S. Paratyphi (Salmonella Paratyphi) remains an important cause of infectious morbidity and mortality in many low-income countries and, therefore, still poses a major infectious risk for travellers to endemic countries. Main findings: Although the global burden of EF has decreased over the past two decades, prevalence of EF remains high in Asia and Africa, with the highest prevalence reported from the Indian subcontinent. These statistics are mirrored by data on travel-related EF. Widespread and increasing antimicrobial resistance has narrowed treatment options for travel-related EF. Ceftriaxone- and azithromycin-based therapies are commonly used, even with the emergence of extremely drug-resistant typhoid in Pakistan. Preventive measures among locals and travellers include provision of safe food and water and vaccination. Food and water precautions offer limited protection, and the efficacy of Salmonella Typhi vaccines is only moderate signifying the need for travellers to be extra cautious. Recommendations: Improvement in the diagnosis of typhoid with high degree of clinical suspicion, better diagnostic assays, early and accurate detection of resistance, therapy with appropriate drugs, improvements in hygiene and sanitation with provision of safe drinking water in endemic areas and vaccination among travellers as well as in the endemic population are keys to controlling typhoid. While typhoid vaccines are recommended for travellers to high-risk areas, moderate efficacy and inability to protect against Salmonella Paratyphi are limitations to bear in mind. Improved Salmonella Typhi vaccines and vaccines against Salmonella Paratyphi A are required.
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Affiliation(s)
- Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Eyal Meltzer
- Department of Medicine `C', Center for Geographic Medicine, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Celina Jin
- Oxford Vaccine Group, Department of Pediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Carl Britto
- Oxford Vaccine Group, Department of Pediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Divya Deodhar
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Sneha Radha
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Eli Schwartz
- Department of Medicine `C', Center for Geographic Medicine, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
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37
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Manandhar R, Raghubanshi BR, Neupane S, Lama R. Prevalence of Enteric Fever Pathogens Isolated from Blood Culture at a Tertiary Care Centre. JNMA J Nepal Med Assoc 2021; 59:256-262. [PMID: 34506445 PMCID: PMC8369545 DOI: 10.31729/jnma.5748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Typhoid fever and paratyphoid fever commonly called as enteric fever is a life-threatening illness caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively. It is a major public health issue in underdeveloped and developing countries. The aim of the study is to find out the prevalence of enteric fever pathogens in blood culture of patients attending a tertiary care centre. METHODS A descriptive cross-sectional study was conducted in 3483 blood samples of patients attending a tertiary care centre, with the history and symptoms suspicious of enteric fever during one year period from mid-September 2019 to mid-September 2020 after ethical approval from the institutional review committee. Isolates were identified by standard microbiological methods and tested for in vitro antibiotic susceptibility by modified kirby-bauer disc diffusion method. The obtained data was entered and analyzed in WHONET 5.6 program, point estimate at 95% was calculated along with frequency and proportion for binary data. RESULTS In our study, enteric fever pathogens were isolated from 18 (0.51%) blood samples. Out of which, Salmonella Paratyphi A was isolated from 10 (8.19%) and Salmonella Typhi was isolated from 8 (6.55%) blood samples. Other serotypes were not isolated. Antimicrobial susceptibility test showed that salmonella species that was isolated were sensitive to most of the drugs. CONCLUSIONS Prevalence of enteric fever pathogens was lesser compared to other studies. Varying degrees of antibiotic resistance among isolated enteric fever pathogens necessitates continuous surveillance of the susceptibility patterns. Prudent use of antimicrobials, active infection control practices and stringent antibiotic policy should be implemented to prevent emergence of antibiotic resistance and future outbreaks.
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Affiliation(s)
- Ruchee Manandhar
- Department of Microbiology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | | | - Sweekrity Neupane
- Department of Microbiology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Rajni Lama
- Department of Microbiology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
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Affiliation(s)
- Buddha Basnyat
- Oxford University Clinical Research Unit-Patan Academy of Health Science Kathmandu, Nepal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | | | - Christopher M Parry
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Alder Hey Children' Hospital and Liverpool University Hospitals. Liverpool, UK
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A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract. Gastroenterol Res Pract 2021; 2021:8167149. [PMID: 33628227 PMCID: PMC7886506 DOI: 10.1155/2021/8167149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list of causalities may prove challenging for gastroenterologists and pathologists to formulate a list of clearly defined differentials. This is true when distinguishing these etiologies based on various clinical presentations and endoscopic and histological findings. We aim to provide a comprehensive review of some of the frequent and rare infectious granulomatous diseases of the gastrointestinal tract documented in the literature to date. We provide an overview of each infectious pathology with an emphasis on epidemiology, clinical presentation, and endoscopic and histologic findings, in addition to treatment.
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Extensively drug-resistant Salmonella Typhi in a patient returning from Pakistan, complicated by relapse with meropenem monotherapy. IDCases 2021; 23:e01048. [PMID: 33520658 PMCID: PMC7820545 DOI: 10.1016/j.idcr.2021.e01048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
In developing countries, typhoid fever is a common cause of febrile illness accompanied by abdominal pain and weakness. It is caused by Salmonella enterica serovar Typhi. Humans are the only known reservoir of infection, and typhoid fever is common in regions where access to clean water and sanitation is limited. The antimicrobials of choice for a case of typhoid fever acquired outside Pakistan are third generation cephalosporins. Lately, cases of extensively drug-resistant (XDR) Salmonella Typhi have been reported in people with a travel history to Pakistan. We present a case of XDR typhoid fever which relapsed after treatment with meropenem.
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Failure of CD4 T Cell-Deficient Hosts To Control Chronic Nontyphoidal Salmonella Infection Leads to Exacerbated Inflammation, Chronic Anemia, and Altered Myelopoiesis. Infect Immun 2020; 89:IAI.00417-20. [PMID: 33046510 DOI: 10.1128/iai.00417-20] [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: 07/06/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022] Open
Abstract
Immunocompromised patients are more susceptible to recurrent nontyphoidal Salmonella (NTS) bacteremia. A key manifestation of HIV infection is the loss of CD4 T cells, which are crucial for immunity to Salmonella infection. We characterized the consequences of CD4 T cell depletion in mice where virulent Salmonella establish chronic infection, similar to chronic NTS disease in humans. Salmonella-infected, CD4-depleted 129X1/SvJ mice remained chronically colonized for at least 5 weeks, displaying increased splenomegaly and more severe splenitis than infected mice with CD4 T cells. Mature erythrocytes, immature erythroid cells, and phagocytes accounted for the largest increase in splenic cellularity. Anemia, which is associated with increased mortality in Salmonella-infected humans, was exacerbated by CD4 depletion in infected mice and was accompanied by increased splenic sequestration of erythrocytes and fewer erythropoietic elements in the bone marrow, despite significantly elevated levels of circulating erythropoietin. Splenic sequestration of red blood cells, the appearance of circulating poikilocytes, and elevated proinflammatory cytokines suggest inflammation-induced damage to erythrocytes contributes to anemia and splenic retention of damaged cells in infected animals. Depleting CD4 T cells led to increased myeloid cells in peripheral blood, spleen, and bone marrow, as well as expansion of CD8 T cells, which has been observed in CD4-depleted humans. This work describes a mouse model of Salmonella infection that recapitulates several aspects of human disease and will allow us to investigate the interplay of innate and adaptive immune functions with chronic inflammation, anemia, and susceptibility to Salmonella infection.
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Hemlock C, Luby SP, Saha S, Qamar F, Andrews JR, Saha SK, Tamrakar D, Date K, Longley AT, Garrett DO, Bogoch II. Utilization of Blood Culture in South Asia for the Diagnosis and Treatment of Febrile Illness. Clin Infect Dis 2020; 71:S266-S275. [PMID: 33258939 PMCID: PMC7705874 DOI: 10.1093/cid/ciaa1322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions. METHODS We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the burden of febrile illness, stratified by hospital. We used logistic regression to analyze predictors for receiving antibiotics empirically. We descriptively reviewed changes in antibiotic therapy by susceptibility patterns and coverage, stratified by country. RESULTS We screened 30 809 outpatients resulting in 1819 enteric fever cases; 1935 additional cases were enrolled from other hospital locations. Younger outpatients were less likely to receive a blood culture. The association between the number of febrile outpatients and the proportion prescribed blood culture varied by hospital. Antibiotics prescribed empirically were associated with severity and provisional diagnoses, but 31% (1147/3754) of enteric fever cases were not covered by initial therapy; this was highest in Pakistan (50%) as many isolates were resistant to cephalosporins, which were commonly prescribed empirically. CONCLUSIONS Understanding hospital-level communication between laboratories and physicians may improve patient care and timeliness of appropriate antibiotics, which is important considering the rise of antimicrobial resistance.
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Affiliation(s)
- Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | | | - Shampa Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | | | | | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
- Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Kashmira Date
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley T Longley
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Isaac I Bogoch
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
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43
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Chirambo AC, Nyirenda TS, Jambo N, Msefula C, Kamng'ona A, Molina S, Mandala WL, Heyderman RS, Iturizza-Gomara M, Henrion MY, Gordon MA. Performance of molecular methods for the detection of Salmonella in human stool specimens. Wellcome Open Res 2020; 5:237. [DOI: 10.12688/wellcomeopenres.16305.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The relationship between asymptomatic Salmonella exposure within the gastrointestinal tract and Salmonella bacteraemia is poorly understood, in part due to the low sensitivity of stool culture, and the lack of validated molecular diagnostic tests for the detection of Salmonella in stool. The study aimed to determine a reliable molecular diagnostic test for Salmonella in stool specimens. Methods: We optimized an in-house monoplex real time polymerase chain reaction (PCR) for the detection of Salmonella TTR and InvA genes in stool by including a selenite broth pre-culture step for Salmonella before DNA extraction, and validated their specificity against other local common pathogens. Then we assessed their performance against a well-validated multiplex PCR targeting the same TTR and InvA genes, and against stool culture using clinical stool specimens collected from a cohort of 50 asymptomatic healthy Malawian children that were sampled at 1-month intervals over a period of 12 months. We employed a latent Markov model to estimate the specificities and sensitivities of PCR methods. Results: TTR and InvA primers were both able to detect all the different Salmonella serovars tested, and had superior limits of detection if DNA was extracted after selenite pre-culture. TTR sensitivity and specificity for monoplex-PCR were (99.53%, 95.46%) and for multiplex-PCR (90.30%, 99.30%) respectively. InvA specificity and specificity for using monoplex-PCR was (95.06%, 90.31%) and multiplex-PCRs (89.41%, 98.00%) respectively. Sensitivity and specificity for standard stool culture were 62.88% and 99.99% respectively. Culture showed the highest PPV (99.73%) and mono-TTR had the highest NPV (99.67%). Conclusion: Test methods demonstrated high concordance although stool culture and monoplexed TTR primers had superior specificity and sensitivity respectively. The use of selenite pre-enrichment step increased Salmonella detection rate. Taken together, molecular detection methods used here could be used to reveal the true extent of both asymptomatic and symptomatic Salmonella exposure events.
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44
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Kim S, Lee KS, Pak GD, Excler JL, Sahastrabuddhe S, Marks F, Kim JH, Mogasale V. Spatial and Temporal Patterns of Typhoid and Paratyphoid Fever Outbreaks: A Worldwide Review, 1990-2018. Clin Infect Dis 2020; 69:S499-S509. [PMID: 31665782 PMCID: PMC6821269 DOI: 10.1093/cid/ciz705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Analyses of the global spatial and temporal distribution of enteric fever outbreaks worldwide are important factors to consider in estimating the disease burden of enteric fever disease burden. METHODS We conducted a global literature review of enteric fever outbreak data by systematically using multiple databases from 1 January 1990 to 31 December 2018 and classified them by time, place, diagnostic methods, and drug susceptibility, to illustrate outbreak characteristics including spatial and temporal patterns. RESULTS There were 180 940 cases in 303 identified outbreaks caused by infection with Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi A or B (S. Paratyphi). The size of outbreak ranged from 1 to 42 564. Fifty-one percent of outbreaks occurred in Asia, 15% in Africa, 14% in Oceania, and the rest in other regions. Forty-six percent of outbreaks specified confirmation by blood culture, and 82 outbreaks reported drug susceptibility, of which 54% had multidrug-resistant pathogens. Paratyphoid outbreaks were less common compared to typhoid (22 vs 281) and more prevalent in Asia than Africa. Risk factors were multifactorial, with contaminated water being the main factor. CONCLUSIONS Enteric fever outbreak burden remains high in endemic low- and middle-income countries and, despite its limitations, outbreak data provide valuable contemporary evidence in prioritizing resources, public health policies, and actions. This review highlights geographical locations where urgent attention is needed for enteric fever control and calls for global action to prevent and contain outbreaks.
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Affiliation(s)
- Samuel Kim
- International Vaccine Institute, Seoul, Republic of Korea.,Imperial College London, United Kingdom
| | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
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45
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Abstract
In 1993, the International Task Force on Disease Eradication classified the political will for typhoid eradication as "none." Here we revisit the Task Force's assessment in light of developments in typhoid vaccines and increasing antimicrobial resistance in Salmonella Typhi that have served to increase interest in typhoid elimination. Considering the requisite biological and technical factors for elimination, effective interventions exist for typhoid, and humans are the organism's only known reservoir. Improvements in water supply, sanitation, hygiene, and food safety are critical for robust long-term typhoid control, and the recent Strategic Advisory Group of Experts on Immunization recommendation and World Health Organization prequalification should make typhoid conjugate vaccine more accessible and affordable in low-income countries, which will allow the vaccine to offer a critical bridge to quickly reduce burden. While these developments are encouraging, all current typhoid diagnostics are inadequate, having either poor performance characteristics, limited scalability, or both. No clear solution exists, and this should be viewed as a critical challenge to any elimination effort. Moreover, asymptomatic carriers and limited data and surveillance remain major challenges, and countries considering elimination campaigns will need to develop strategies to identify high-risk populations and to monitor progress over time. Finally, policymakers must be realistic in planning, learn from the planning failures of previous elimination and eradication efforts, and expect unforeseeable shocks and setbacks. In the end, if we assume neither unanticipated breakthroughs in typhoid control nor any chaotic shocks, history suggests that we should expect typhoid elimination to take decades.
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Affiliation(s)
- Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Phionah L Atuhebwe
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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46
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Abstract
Patients returning from travel to a foreign country often present with atypical infections that can present as diagnostic challenges. Although rarely seen in the United States, Salmonella infections are commonly seen in Sub-Saharan Africa. The common clinical manifestations of Salmonella infection include fever and diarrhea; however, about 5% of cases of non-typhi Salmonella progress to bacteremia. Here, we present a case of a unique presentation of Salmonella infection manifesting as a prostatic abscess in an immunocompetent patient.
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Affiliation(s)
- Christina Lin
- Internal Medicine, University of California Los Angeles, Los Angeles, USA
| | - Satya Patel
- Internal Medicine, University of California Los Angeles, Los Angeles, USA
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47
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Alhaj-Qasem DM, Al-Hatamleh MAI, Irekeola AA, Khalid MF, Mohamud R, Ismail A, Mustafa FH. Laboratory Diagnosis of Paratyphoid Fever: Opportunity of Surface Plasmon Resonance. Diagnostics (Basel) 2020; 10:diagnostics10070438. [PMID: 32605310 PMCID: PMC7400347 DOI: 10.3390/diagnostics10070438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022] Open
Abstract
Paratyphoid fever is caused by the bacterium Salmonellaenterica serovar Paratyphi (A, B and C), and contributes significantly to global disease burden. One of the major challenges in the diagnosis of paratyphoid fever is the lack of a proper gold standard. Given the absence of a licensed vaccine against S. Paratyphi, this diagnostic gap leads to inappropriate antibiotics use, thus, enhancing antimicrobial resistance. In addition, the symptoms of paratyphoid overlap with other infections, including the closely related typhoid fever. Since the development and utilization of a standard, sensitive, and accurate diagnostic method is essential in controlling any disease, this review discusses a new promising approach to aid the diagnosis of paratyphoid fever. This advocated approach is based on the use of surface plasmon resonance (SPR) biosensor and DNA probes to detect specific nucleic acid sequences of S. Paratyphi. We believe that this SPR-based genoassay can be a potent alternative to the current conventional diagnostic methods, and could become a rapid diagnostic tool for paratyphoid fever.
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Affiliation(s)
| | - Mohammad A. I. Al-Hatamleh
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; (M.A.I.A.-H.); (R.M.)
| | - Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia;
- Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa PMB 4412, Kwara State, Nigeria
| | - Muhammad Fazli Khalid
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; (M.F.K.); (A.I.)
| | - Rohimah Mohamud
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; (M.A.I.A.-H.); (R.M.)
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia
| | - Aziah Ismail
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; (M.F.K.); (A.I.)
| | - Fatin Hamimi Mustafa
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia; (M.F.K.); (A.I.)
- Correspondence: ; Tel.: +60-9767-2432
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48
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Chanthavilay P, Mayxay M, Xongmixay P, Roberts T, Rattanavong S, Vongsouvath M, Newton PN, Crump JA. Estimation of Incidence of Typhoid and Paratyphoid Fever in Vientiane, Lao People's Democratic Republic. Am J Trop Med Hyg 2020; 102:744-748. [PMID: 32124730 PMCID: PMC7124915 DOI: 10.4269/ajtmh.19-0634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Typhoid conjugate vaccines represent a new tool for typhoid control. However, incidence data are needed to inform decisions about introduction. We sought to estimate typhoid and paratyphoid fever incidence in Vientiane, the capital and largest city of the Lao People's Democratic Republic (Lao PDR). We did a representative cluster survey of health-seeking behavior for fever in Vientiane from January 15, 2019 through January 26, 2019. Multipliers derived from the survey were applied to data from Salmonella Typhi and Salmonella Paratyphi A bloodstream infection surveillance from Mahosot Hospital, Vientiane, for the period of January 1, 2015 through December 31, 2017, to estimate enteric fever incidence. A total of 336 households representing 1,740 persons were enrolled in the healthcare utilization survey, and multipliers were derived based on responses to questions about healthcare seeking in the event of febrile illness. Of 7,997 Vientiane residents receiving blood cultures over the 2-year surveillance period at Mahosot Hospital, we identified 16 (0.2%) with Salmonella Typhi and six (< 0.1%) with Salmonella Paratyphi A bloodstream infection. After applying multipliers, we estimated that the annual incidence of typhoid was 4.7 per 100,000 persons and paratyphoid was 0.5 per 100,000 persons. During the study period, the incidence of typhoid and paratyphoid fever was low in Vientiane. Ongoing surveillance is warranted to identify increases in future years. Similar studies elsewhere in the Lao PDR would be useful to understand the wider enteric fever situation in the country.
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Affiliation(s)
- Phetsavanh Chanthavilay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Mayfong Mayxay
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Phouthapanya Xongmixay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic
| | - Paul N Newton
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Islam MT, Im J, Ahmmed F, Kim DR, Khan AI, Zaman K, Ali M, Marks F, Qadri F, Kim JH, Clemens JD. Use of Typhoid Vi-Polysaccharide Vaccine as a Vaccine Probe to Delineate Clinical Criteria for Typhoid Fever. Am J Trop Med Hyg 2020; 103:665-671. [PMID: 32588803 PMCID: PMC7410438 DOI: 10.4269/ajtmh.19-0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Blood cultures (BCs) detect an estimated 50% of typhoid fever cases. There is need for validated clinical criteria to define cases that are BC negative, both to help direct empiric antibiotic treatment and to better evaluate the magnitude of protection conferred by typhoid vaccines. To derive and validate a clinical rule for defining BC-negative typhoid fever, we assessed, in a cluster-randomized effectiveness trial of Vi-polysaccharide (ViPS) typhoid vaccine in Kolkata, India, 14,797 episodes of fever lasting at least 3 days during 4 years of comprehensive, BC-based surveillance of 70,865 persons. A recursive partitioning algorithm was used to develop a decision rule to predict BC-proven typhoid cases with a diagnostic specificity of 97–98%. To validate this rule as a definition for BC-negative typhoid fever, we assessed whether the rule defined culture-negative syndromes prevented by ViPS vaccine. In a training subset of individuals, we identified the following two rules: rule 1: patients aged < 15 years with prolonged fever accompanied by a measured body temperature ≥ 100°F, headache, and nausea; rule 2: patients aged ≥ 15 years with prolonged fever accompanied by nausea and palpable liver but without constipation. The adjusted protective efficacy of ViPS against clinical typhoid defined by these rules in persons aged ≥ 2 years in a separate validation subset was 33% (95% CI: 4–53%). We have defined and validated a clinical rule for predicting BC-negative typhoid fever using a novel vaccine probe approach. If validated in other settings, this rule may be useful to guide clinical care and to enhance typhoid vaccine evaluations.
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Affiliation(s)
- Md Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- Korea University College of Medicine, Seoul, South Korea.,UCLA Fielding School of Public Health, Los Angeles, California.,International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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50
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Kumar S, Nodoushani A, Khanam F, DeCruz AT, Lambotte P, Scott R, Bogoch II, Vaidya K, Calderwood SB, Bhuiyan TR, Esfandiari J, Ryan ET, Qadri F, Andrews JR, Charles RC. Evaluation of a Rapid Point-of-Care Multiplex Immunochromatographic Assay for the Diagnosis of Enteric Fever. mSphere 2020; 5:e00253-20. [PMID: 32522777 PMCID: PMC7289704 DOI: 10.1128/msphere.00253-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
There is a critical need for an improved rapid diagnostic for enteric fever. We have previously demonstrated that serum IgA responses targeting Salmonella enterica serovar Typhi hemolysin E (HlyE) and lipopolysaccharide (LPS) are able to discriminate patients with acute typhoid from healthy controls in areas where enteric fever is endemic (healthy endemic controls) and from patients with other bacterial infections. We now have data demonstrating that IgA antibody responses against these antigens also work well for identifying patients with acute S. Paratyphi A infection. To develop a test for acute enteric fever detection, we have adapted a point-of-care immunochromatographic dual-path platform technology (DPP), which improves on the traditional lateral flow technology by using separate sample and conjugate paths and a compact, portable reader, resulting in diagnostics with higher sensitivity and multiplexing abilities. In this analysis, we have compared our standard enzyme-linked immunosorbent assay (ELISA) method to the DPP method in detecting acute phase plasma/serum anti-HlyE and anti-LPS IgA antibodies in a cohort of patients with culture-confirmed S. Typhi (n = 30) and Paratyphi A infection (n = 20), healthy endemic controls (n = 25), and febrile endemic controls (n = 25). We found that the DPP measurements highly correlated with ELISA results, and both antigens had an area under the curve (AUC) of 0.98 (sensitivity of 92%, specificity of 94%) with all controls and an AUC of 0.98 (sensitivity of 90%, specificity of 96%) with febrile endemic controls. Our results suggest that the point-of-care DPP Typhoid System has high diagnostic accuracy for the rapid detection of enteric fever and warrants further evaluation.IMPORTANCE Enteric fever remains a significant global problem, and control programs are significantly limited by the lack of an optimal assay for identifying individuals with acute infection. This is especially critical considering the recently released World Health Organization (WHO) position paper endorsing the role of the typhoid conjugate vaccine in communities where enteric fever is endemic. A reliable diagnostic test is needed to assess and evaluate typhoid intervention strategies and determine which high-burden areas may benefit most from a vaccine intervention. Our collaborative team has developed and evaluated a point-of-care serodiagnostic assay based on detection of anti-HlyE and LPS IgA. Our finding of the high diagnostic accuracy of the DPP Typhoid System for the rapid detection of enteric fever has the potential to have significant public health impact by allowing for improved surveillance and for control and prevention programs in areas with limited laboratory capacity.
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Affiliation(s)
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Paul Lambotte
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Robert Scott
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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