Cases Of Typhoid Fever Research Articles

A case of typhoid fever with deep vein thrombosis

Typhoid fever is a systemic infection caused by Salmonella typhi. It is a disease caused by food and water sources and is an important public health problem in developing countries. Fever, flu-like symptoms, headache, cough, malaise, nausea and myalgia are the most common symptoms. Venous thrombosis often occurs in the fourth week of the disease and was a common complication before the antibiotic era. In this article, we present a case who presented with high fever, headache, fatigue, diarrhea, had deep vein thrombosis as a result of the tests, Salmonella typhi produced in blood culture and healing with ceftriaxone treatment.

Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates.

BackgroundIn surveillance for typhoid fever, under-detection of cases occurs when patients with fever do not seek medical care, or seek medical care but do not receive a blood test. Missing data may result in incorrect estimates of disease incidence.MethodsWe used data from an ongoing randomised clinical trial of typhoid conjugate vaccine among children in Nepal to determine if eligible patients attending our fever clinics who did not have blood taken for culture had a lower risk of disease than those who had blood drawn. We assessed clinical and demographic predictors of having blood taken for culture, and predictors of culture-positive results. Missing blood culture data were imputed using multiple imputations.ResultsDuring the first year of surveillance, 2392 fever presentations were recorded and 1615 (68%) of these had blood cultures. Children were more likely to have blood taken for culture if they were older, had fever for longer, a current temperature ≥38 degrees, or if typhoid or a urinary tract infection were suspected. Based on imputation models, those with blood cultures were 1.87 times more likely to have blood culture-positive fever than those with missing data.ConclusionClinical opinion on the cause of the fever may play a large part in the decision to offer blood culture, regardless of study protocol. Crude typhoid incidence estimates should be adjusted for the proportion of cases that go undetected due to missing blood cultures while adjusting for the lower likelihood of culture-positivity in the group with missing data.

Epidemiology profil of fever typhoid in Meknes (Morocco) 2013-2016

Twenty million cases of typhoid and paratyphoid fever (TF) are observed annually worldwide with more than 200,000deaths. These fevers occur in areas where hygiene is precarious, mainly in developing countries. The objective of this study was to describe epidemiological patterns of TF in Meknes, Morocco in order to improve preventive measures. We conducted a case series study based on data from 2013 to 2016 in the Meknes TF surveillance system. Data collected included socio-demographic variables, place of residence, season, mode of water supply, and food consumed. Diagnosis of TF was confirmed with the Widal test. Data were analyzed with Epi-info version 7 and mapping was done with Qgis version 2.18.1. Three hundred and twenty-two cases were reported with a male/female sex ratio of 0.9. Average age was 26±20years. Incidence increased from 13 per 100.000inhabitants in 2013 to 8 per 100.000 inhabitants in 2016. Two hundred and seventy-nine (87%) cases occurred in urban areas and 174 (54%) cases developed in summer. One death was recorded. Public awareness campaigns on health education for hygiene are needed. Focus should be placed on transmission by food handlers.

Cost-effectiveness of using environmental surveillance to target the roll-out typhoid conjugate vaccine

Typhoid conjugate vaccine (TCV) has been shown to be costeffective in some settings, but to make the most of limited healthcare funds, the WHO recommends that decisions about when and where to introduce TCV should be based on local evidence of transmission. Further, Gavi, The Vaccine Alliance, recommends that countries request TCV funding based on epidemiological data from within-country. Since few countries have reliable case reporting, we considered environmental surveillance as a decision-support tool for vaccine introduction choices. Environmental surveillance methods are still in development and this analysis assesses its potential as a decision support tool. We combined a disease transmission simulation model with an economic model, to quantify the value of surveillance. The disease transmission model is fit to historical case reporting from Blantyre, Malawi. The economic model takes a social perspective and incorporates the cost of environmental surveillance, vaccination, and both direct and indirect cost of care for acute typhoid cases. We find that the use of time-limited environmental surveillance to differentiate low- from high-endemicity areas is low cost relative to potential savings, especially if it is paired with a locally targeted vaccination campaign. These findings are robust to the uncertainty of cost model parameters and underlying endemicity.

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

BackgroundAntimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.MethodsWe performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance.FindingsWe identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified.InterpretationDrug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice.Trial registrationPROSPERO CRD42018029432.

Strengthening District Health Teams Capacity in Surveillance Systems and Response to Public Health Threats in Western Uganda through Field Epidemiology Training Program (FETP)

Aim: To strengthen the District Capacity in surveillance for effective detection, Reporting and Response to Public Health threats. Background: The overall aim of a good surveillance system is to strengthen the capacity of a Health system through training of health personnel who can conduct effective surveillance activities. A good surveillance system is achieved through improved use of complete and timely health information to detect changes in time to institute a rapid response to the suspected outbreak of Public Health events. This assessment followed a 3-month Field Epidemiology Training program undertaken by the investigator who applied the acquired knowledge and skills in completion of the assessment. Study Design: It was a descriptive cross-sectional, institutional based epidemiological investigation conducted at district level and Health Centre 1V in Kabarole from 15th December 2019-March 2020. eReports were retrieved from DHIS-2 for epidemiological weeks 44 in 2019 to week 3 in 2020. Data analysis: Micro soft word excel program was used to determine the reporting rates, epidemic disease trends and construction of malaria channel. SWOT analysis was done to identify poor HMIS reporting as the lead surveillance quality challenge and route cause analysis done to determine underlying causes. Results: Weekly reports analyzed were from a total of 53 Health facilities and one Health Centre four for malaria channel construction. Of the 53 functional Health facilities assessed in the district, the average reporting Timeliness was 32% and Completeness at 63% from week 44 in 2019 to week 3 in 2020. This finding shows that the district was not achieving the 80% Timeliness and 80% Completeness national target. The poor reporting situation implies that the district may not detect an emerging Public Health Event and respond in time. Poor reporting rate was linked to knowledge gap among reporting staff in completion of the newly revised HMIS tools and lack of support supervision. The analyzed data revealed that the district had increased dysentery, measles and typhoid fever cases. The dysentery and typhoid fever cases had reached and surpassed the Alert and Action thresh hold levels however there was no reported death from these diseases. Further inquiry revealed that Typhoid fever was being diagnosed using WIDAL test as opposed to WHO recommendation of stool or blood culture. The noted typhoid fever outbreak in the district was therefore being based on wrong laboratory tests hence regarded by the researcher as speculative. Findings on malaria channel revealed a normal and expected trend of malaria in Kabarole district in 2020. Conclusion: knowledge and skills from FETP-training enabled the investigator to establish the fact that the district’s surveillance system was less sensitive in detecting Public Health events for a quick response. Intensified targeted support supervision and mentorships of all health workers on reporting could help improve the districts surveillance system.

An unusual case of XDR enteric fever with ARDS

An unusual case of XDR enteric fever with ARDS

Clinical and microbiological profile of enteric fever among pediatric patients in a tertiary care center in South India: A cross-sectional study

Introduction: Enteric fever, which is endemic in India, is a significant cause for morbidity, particularly among young children. Enteric fever is associated with high fever, abdominal pain, diarrhea, and splenomegaly. Recently, there have been increasing reports of enteric fever due to Salmonella enterica serovar Paratyphi A and multidrug resistance among Salmonella species. Objectives: The objective of this study was to know the relative occurrence of Salmonella Typhi and Salmonella Paratyphi A from blood cultures of enteric fever cases, to study the sensitivity pattern of Salmonella species isolated, to compare the clinical profiles in typhoid and paratyphoid fever, and to know their treatment outcome. Materials and Methods: It was a prospective hospital-based cross-sectional study. The demographic, clinical, and laboratory data were recorded for all cases included in the study. All clinically suspected cases of enteric fever were confirmed by blood culture and/or the Widal test. Antibiotic sensitivity was tested by the Kirby–Bauer disc diffusion method. Results were analyzed using SPSS version 21. Results: One hundred and nineteen cases were confirmed enteric fever. Their clinical profile is discussed. Out of 119 cases, 24 showed blood culture positivity. Salmonella Paratyphi A and Salmonella Typhi were isolated in the ratio of 3:1. The isolates were sensitive to ampicillin, co-trimoxazole, ceftriaxone, and azithromycin. Ceftriaxone was the most commonly used antibiotic for treatment. All patients recovered, and no mortality was encountered. Complications were seen in 33 children (27.7%), which included subclinical hepatitis, bronchitis, and pneumonia. Conclusion: Considering the blood culture results, enteric fever due to S. Paratyphi A was more common in our study. Multidrug resistance was not seen among Salmonella species. The duration of illness and complications were more with typhoid than paratyphoid cases.

Salmonella Newport Gastroenteritis in an Adult- A Rare Case Report

Salmonella Newport is a major cause of food-borne infection which occurs due to consumption of contaminated food items. Stool sample from a suspected case of enteric fever was received in the Central Microbiology Laboratory of a tertiary care teaching hospital in Southern India. The bacterial isolate was identified on the basis of Gram Staining, cultural characteristics and biochemical reactions as Salmonella species. Agglutination for serotyping was done and it was found to be agglutinable by only Polyvalent O antiserum. For further speciation, the isolate was sent to the National Institute of Cholera and Enteric Diseases (NICED), Kolkata, West Bengal, India and was identified as Salmonella enterica serotype Newport. The patient responded well to ciprofloxacin therapy. As the diagnosis of Non-Typhoidal Salmonellosis (NTS) is often challenging, patients with suspected Salmonella infections are usually given empirical antibiotic therapy which can cause an increase in drug resistant NTS.

Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report

Background: Dengue fever classically presents with fever, arthralgia, myalgia, leukopenia, and thrombocytopenia. A classical presentation with a positive serology test is usually enough to make the diagnosis in an endemic area. Case Presentation: A 30-year-old man presented with fever, leucopenia, thrombocytopenia, hepatitis, and delirium. Dengue Immunoglobulin M (IgM) serology was positive. Blood culture grew Salmonella typhi, his ferritin was raised, and bone marrow histology showed histiocytes and hemophagocytic activity. A 2-week course of ceftriaxone (60-75 mg/kg/day) and intravenous immunoglobulin (0.4 g/kg once a day) for 3 days resulted in complete resolution of his illness. Conclusion: We report a case of typhoid fever with hemophagocytic lymphohistiocytosis mimicking as dengue fever due to cytopenias and hepatitis, and dengue IgM serology was positive. Although rare, a high index of suspicion is required for early diagnosis and treatment.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.

Analisa Biaya Pengobatan Demam Tifoid Berdasarkan Clinical Pathway Di Rumah Sakit Harapan Bunda

Clinical pathways are used in quality and cost control with indicators of length of stay. Cases of typhoid fever at Harapan Bunda Hospital include the criteria for the first rank of High Volume in 2018 and Problem Prone in the cost of treatment. The purpose of the study is to analyze the cost of treatment based on the implementation of clinical pathways in antibiotic therapy. Observational research with comparative studies of the use of injection antibiotics based on clinical pathway implementation. Retrospective data collection with dependent outcome therapy variables (cost and length of stay) while the independent variable regimen of antibiotic use. The population of typhoid fever patients according to the criteria for the implementation of clinical pathway ICD code (A0.10) 571 patients. Samples using total sampling that fulfills the criteria of direct inclusion are made into samples divided by the antibiotic regimen of the payment system, the group with the least amount excluded. There were 4 observation groups: generic ceftriaxone (n = 52) branded ceftriaxone (n = 51), generic cefotaxime (n = 53) and branded cefotaxime (n = 57) totaling 213 patients. Satatistic test results of length of stay (p> 0.05) explained that they did not have a significant difference, the average value (5.1596). Medical expenses for generic cefotaxime (Rp 4,072,002,6792), generic cherryax (Rp 4,479,480,4808), branded cefotaxime (Rp 6,945,258,3333) and branded ceftriaxone (Rp 7,296,933,5686). Conclusions based on JKN (AMiB) antibiotic payment systems are cheaper than general and the cheapest cefotaxime cheapest generic antibiotics.

Spatial and spatiotemporal patterns of typhoid fever and investigation of their relationship with potential risk factors in Iran, 2012-2017.

Typhoid fever is a global infectious disease which remains a severe health problem in Asia and Africa. In subnational levels of Iran, environmental and socio-economic properties are often so divergent, that can have a major effect on the incidence of typhoid fever. We used the data of MOHME that has reported 2474 cases of typhoid fever from 20th Feb 2012 to 31st Dec 2017 in Iran. First, we ran a spatial autocorrelation analysis to see whether there is any spatial trend in incidence cases and find the high-high clusters of typhoid (at different confidence levels) using Local indicators of spatial association (LISAs). To explore the spatial and temporal patterns of typhoid fever and examine their relationship with climatic and socio-economic variables; we have employed a spatiotemporal zero-inflated Poisson (ZIP) model in a Bayesian framework. Our results show thirteen High-High clusters and windspeed (RR[95% CrI] =1.39 [1.15-1.69]), public sewerage system (RR[95% CrI] =0.76 [0.63-0.92]), years of schooling (RR[95% CrI] =0.78 [0.65-0.95]), wealth index (RR[95% CrI] =0.59 [0.55-0.63]) and urbanization (RR[95% CrI] =0.6 [0.48-0.76]) as variables that are importantly associated with typhoid fever incidence. Therefore, typhoid fever is spatially clustered with a high incidence in children and adolescents. Windy, poor, rural, and uneducated areas are high-risk regions that can be controlled by proliferating the standard sewerage networks, which eventually leads to safer water supplies.

Comparative Study Of Blood Culture with Rapid Diagnostic Tests for Diagnosis Of Enteric Fever In A Tertiary Centre Of NE-India.

Introduction: Enteric fever is a global health problem and is also endemic in India. The laboratory diagnosis of enteric fever is very important mainly because in post-antibiotic era most cases are treated empirically and investigated for various causes of PUO including enteric fever. A fast, reliable, and easy to perform serodiagnostic test with a higher sensitivity and specificity is required for rapid diagnosis and management of typhoid cases, thereby enabling clinicians to initiate an early therapy, reducing morbidity and its complications.
 Aim : The study was performed to evaluate the performance of Widal test and Typhidot, a lateral flow immunoassay test.
 Materials and Methods: This study was carried out in the Department of Microbiology in a tertiary care center for 1 year (August 2016– July2017). A total of 110 blood samples were collected from patients (cases) clinically suspected of enteric fever. Culture and Serological tests were done in all the 110 cases. Salmonella isolation was done by conventional methods of culture. Demonstration of presence of anitibodies were done by Widal tests using commercially available kits. Typhidot, a lateral flow immunoassay, was used to test and detect IgM and IgG antibodies against the outer membrane protein (OMP) of the Salmonella Typhi. The performances of the tests were compared, and diagnostic accuracy determined.
 Results : Out of 110 cases, highest percentage of positive cases were found by Typhidot test (29.09%) followed by Widal test (23.63%) . 18.18% cases were confirmed by blood culture. Taking blood culture as gold standard , it was found that Widal test had a sensitivity of 30% and specificity of 78% and Typhidot had a sensitivity of 75% and specificity of 81%.
 Conclusion : Though definitive diagnosis of enteric fever is isolation of the causative organism from the patient, Widal test and Typhidot test are important diagnostic tools in the medical set up. Typhidot is fast becoming a practical alternative to Widal test. Typhidot test had a fairly good sensitivity and specificity, whereas Widal test had good specificity but a lower sensitivity.

An Update on Isolation of Extensively Drug Resistant (XDR) Salmonella enterica from Blood Cultures in a Tertiary Care Centre

Introduction: Typhoid fever is a public health issue, burdening many regions of the world with poor socioeconomic background. Management of this disease faces the major hurdle of antimicrobial resistance. The present study reveals current pattern of antimicrobial susceptibility among Salmonella enterica (Salmonella typhi & Salmonella paratyphi A) blood culture isolates from typhoid fever cases. Regular data collection about Salmonella infections and their response to antimicrobial agents, coupled with a long term commitment to providing adequate health information systems, is the key to effective planning and policy formation against typhoid fever. Aims & Objectives: To evaluate the prevalence of ceftriaxone resistant Salmonella enterica isolates from blood cultures in Shaikh Zayed Medical Complex for updating nosocomial antimicrobial resistance data. Place and duration of study: This research study was conducted at Shaikh Zayed Medical Complex, Lahore from March 2018 to May 2019. Material & Methods: Blood cultures positive for Salmonella enterica were analyzed, taking into consideration the gender & age of patients with typhoid fever. Antimicrobial susceptibility testing was carried out through disc diffusion method. The recommended antimicrobial agents for S. typhi (Salmonella typhi) & S. paratyphi A (Salmonella Parathyphi A) (as per CLSI, USA 2018/2019 guidelines; described later), were tested and analyzed during this study with the main focus on 3rd generation cephalosporin resistance pattern. Among second line treatment options, meropenem and azithromycin were selected for study. Results: Out of 899 isolates of Salmonella enterica (from 13964 samples for blood culture), 849 (94.4%) were S. typhi and 50 (5.6%) were S. paratyphi A. Of these, 57.1% isolates were from males, 42.9% from females, 81.7% from children (age less than 12 years) and 18.3% were from adults (age more than 12 years). A continuously rising resistance percentage was observed for 3rd generation cephalosporins over the span of fifteen months. It was 43.4% for ceftriaxone (CRO). No case of meropenem and azithromycin resistance was observed during study period. Conclusion: Demographic information was provided by this study regarding high level of resistance among Salmonella enterica isolates particularly S. typhi .The first line antibiotic drugs were a complete failure in ongoing outbreak of typhoid fever. The novel results of this study are the high resistance percentages for 3rd generation cehalosporins, whether oral or parenteral. This result is worrisome as it will leave us with no option but to resort to second line drugs. However, an increasing trend of blood culturing was observed in this research. Extensively drug resistant (XDR) Salmonella infection has definitely highlighted the importance of blood culture and its use as a more preferred diagnostic tool. Key words: Typhoid fever, Extensively drug resistant (XDR) Salmonella enterica, (S. typhi & S. paratyphi A), Antimicrobial Resistance, CRO (Ceftriaxone) resistance.

A Study of Typhoid Fever in Bheri Zonal Hospital and Nepalgunj Medical College Teaching Hospital, Banke, Nepal

Typhoid fever remains an important public health issue in many developing countries and predominates in areas with poor sanitation, which aids its transmission and persistencein the human population. The prevalence of typhoid fever in different months of a year (2009/2010) and the distribution of cases of typhoid fever with respect to their age and gender among patients visiting Nepalgunj Medical College Teaching Hospital (NGMCTH) and Bheri Zonal Hospital (BZH), the two major health delivering institutions of Mid-western and Far-western regions of Nepal. During this period, 4657 and 5496 blood samples were collected in NGMCTH and BZH respectively. Of the 4657 tested in NGMCTH, agglutinins to Salmonella typhi was observed in 1092 samples (overall prevalence rate being 23.45%), that were most prevalent in months corresponding to wet season (June/ July-31%, July/August-29.65%).Similar trend was observed for BZH where of 5496 samples tested, Salmonella typhi was positive in 1814 samples with overall prevalence rate being 31.77%, cases being most prevalent in months corresponding to wet season (June/July–45.91%, July/August – 47.41%). In both hospitals, there was male predominance among cases (Male to Female Sex-ratio: 224:100 for NGMCTH and 247:100 for BZH). This male predominance was maintained in almost all age-groups. There was high proportion of cases of less than 30 years of age in both NGMCTH and BZH (77.84% and 73.98% respectively) indicating that most of the cases of typhoid fever are of younger age-group.On the average, typhoid cases aged 24.58 years ± 13.00 years for NGMCTH, while for BZH it was 25.81 years ± 13.41 years. Mean age of females was found to exceed to that of males in both NGMCTH (26.84 years ± 12.31 years against 23.58 years ± 13.16 years) and BZH (27.61 years ± 13.64years against 25.08 years ± 13.25 years).
 Key words: Salmonella typhi, widal test, incidence, Nepal.

A Multicenter Cost-of-Illness and Long-term Socioeconomic Follow-up Study in the Severe Typhoid Fever in Africa Program: Study Protocol.

BackgroundThere are limited data on typhoid fever cost of illness (COI) and economic impact from Africa. Health economic data are essential for measuring the cost-effectiveness of vaccination or other disease control interventions. Here, we describe the protocol and methods for conducting the health economic studies under the Severe Typhoid Fever in Africa (SETA) program.MethodsThe SETA health economic studies will rely on the platform for SETA typhoid surveillance in 4 African countries—Burkina Faso, Ethiopia, Ghana, and Madagascar. A COI and long-term socioeconomic study (LT-SES) will be its components. The COI will be assessed among blood culture–positive typhoid fever cases, blood culture–negative clinically suspected cases (clinical cases), and typhoid fever cases with pathognomonic gastrointestinal perforations (special cases). Repeated surveys using pretested questionnaires will be used to measure out-of-pocket expenses, quality of life, and the long-term socioeconomic impact. The cost of resources consumed for diagnosis and treatment will be collected at health facilities.ResultsResults from these studies will be published in peer-reviewed journals and presented at scientific conferences to make the data available to the wider health economics and public health research communities.ConclusionsThe health economic data will be analyzed to estimate the average cost per case, the quality of life at different stages of illness, financial stress due to illness, and the burden on the family due to caregiving during illness. The data generated are expected to be used in economic analysis and policy making on typhoid control interventions in sub-Saharan Africa.

RESOURCES REQUIRED IN CLINICAL PATHWAY FOR TYPHOID FEVER TREATMENT AT KALIWATES GENERAL HOSPITAL IN 2017

Background: A clinical pathway is a concept of an integrated service which describes the stages of healthcare services from the admission until the return of patients based on the medical service standards and evidence-based nursing care with measurable results. Kaliwates General Hospital is an accredited hospital with a clinical pathway. Typhoid case was the highest disease in 2017 at Kaliwates General Hospital.Aims: This study aims to describe the resources at Kaliwates General Hospital in the implementation of clinical pathways, especially typhoid fever treatment.Method: This study was a descriptive and qualitative study. Nine respondents were selected using purposive sampling, including one internist and the quality team at Kaliwates General Hospital. The variables studied include human resource factors, budget factors, method factors, and time factors.Results: The results suggested that the human resources at Kaliwates General Hospital had high commitment, motivation, and moderate knowledge in the implementation of clinical pathways. All equipment and documents were considered adequate. The communication among the implementers was good, but compliance and training for staffs were considered less prominent. The task division of each staff was fairly distributed even though the pharmacy unit perceived that the division was quite unfair.Conclusion: The implementation of the clinical pathway for typhoid fever treatment at Kaliwates General Hospital runs quite well. The hospital must identify and plan staff training regularly, prepare the job description appropriately, and perform performance appraisal based on the job description that has been developed.Keywords: clinical pathway, typhoid fever, resource.

Persistent circulation of a fluoroquinolone-resistant Salmonella enterica Typhi clone in the Indian subcontinent.

BackgroundThe molecular structure of circulating enteric fever pathogens was studied using hospital-based genomic surveillance in a tertiary care referral centre in South India as a first genomic surveillance study, to our knowledge, of blood culture-confirmed enteric fever in the region.MethodsBlood culture surveillance was conducted at St John’s Medical College Hospital, Bengaluru, between July 2016 and June 2017. The bacterial isolates collected were linked to demographic variables of patients and subjected to WGS. The resulting pathogen genomic data were also globally contextualized to gauge possible phylogeographical patterns.ResultsHospital-based genomic surveillance for enteric fever in Bengaluru, India, identified 101 Salmonella enterica Typhi and 14 S. Paratyphi A in a 1 year period. Ninety-six percent of isolates displayed non-susceptibility to fluoroquinolones. WGS showed the dominant pathogen was S. Typhi genotype 4.3.1.2 (H58 lineage II). A fluoroquinolone-resistant triple-mutant clone of S. Typhi 4.3.1.2 previously associated with gatifloxacin treatment failure in Nepal was implicated in 18% of enteric fever cases, indicating ongoing inter-regional circulation.ConclusionsEnteric fever in South India continues to be a major public health issue and is strongly associated with antimicrobial resistance. Robust microbiological surveillance is necessary to direct appropriate treatment and preventive strategies. Of particular concern is the emergence and expansion of the highly fluoroquinolone-resistant triple-mutant S. Typhi clone and its ongoing inter- and intra-country transmission in South Asia, which highlights the need for regional coordination of intervention strategies, including vaccination and longer-term strategies such as improvements to support hygiene and sanitation.

A retrospective study of patients with blood culture-confirmed typhoid fever in Fiji during 2014-2015: epidemiology, clinical features, treatment and outcome.

BackgroundTyphoid fever is endemic in Fiji. We sought to describe the epidemiology, clinical features and case fatality risk of blood culture-confirmed typhoid fever from January 2014 through December 2015.MethodsBlood culture-positive patients were identified from a typhoid surveillance line list. A standardised case investigation form was used to record data from patients’ medical records.ResultsOf 542 patients, 518 (95.6%) were indigenous Fijians (iTaukei) and 285 (52.6%) were male. The median (IQR) age was 25 (16–38) y. Mean (SD) time from the onset of illness to admission was 11.1 (6.9) d. Of 365 patients with clinical information, 346 (96.9%) had fever, 239 (66.9%) diarrhoea, 113 (33.5%) vomiting, and 72 (30.2%) abdominal pain. There were 40 (11.0%) patients with complications, including 17 (4.7%) with shock, and 11 (3.0%) with hepatitis. Nine patients died for a case fatality risk of 1.7%. Of the 544 Salmonella Typhi isolates tested, none were resistant to first line antimicrobials; 3(0.8%) were resistant to ciprofloxacin and 5(1.4%) to nalidixic acid.ConclusionsIn Fiji, most blood culture-confirmed typhoid fever cases were in young adults. Common clinical manifestations were fever and gastrointestinal symptoms. Further studies are required to elucidate the factors associated with complications and death.