Diagnosis Of Typhoid Fever Research Articles

Early diagnosis of enteric fever in resource limited countries

Background: Streptococci detected in various regions of the body as normal flora are Gram positive diplococci, non-spore forming and non-motile bacteria. Streptococci can be classified according to biochemical and antigenic properties and the ability to produce hemolysis on blood agar. The diameter of beta hemolitic streptococci colonies are generally greater than 0.5mm and these are called pyogen; on the other hand bacteria whose colonies are smaller than 0.5mm (pin-point) are called Streptococcus milleri group in Europe and Streptococcus anginosus group in America. Streptococcus milleri group are classified into three species; Streptococcus anginosus, Streptococcus intermedius, Streptococcus constellatus. S. milleri group bacteria are genetically related to non-hemolitic streptococci. Methods & Materials: 100 streptococci strains were isolated from throat samples and also from other body sites such as abcess, blood and pustules. VP, CAMP tests, esculin and urease hydrolisis, sugar fermatation tests and Niven’s arginin hydrolysis test were carried out for pin-point colonies and species identification was carried by API 20 Strep kit and by PCR (table). Antibiotic susceptibility testing was carried out according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: All isolates were VP positive, PYR negative and did not hydrolyse hippurat; two strains were urease positive. All strains was found to be susceptible to vancomycin, ceftriaxone, cefepime, cefotaxime, levofloxacin, linezolid antibiotics. 16% of strains (10 S.anginosus, 4 S.constellatus)were found to be resistant to erythromycin. 6% of the strains (5 S.anginosus, 3 S.constellatus) were resistant to clindamycin and 5% (3 S.constellatusve 2 S.anginosus) of the strains were found to be resistant to tetracycline. According to PCR results of 100 isolates, 56 were identified as S.anginosus and 8 were identified as S.intermedius. Conclusion: It was determined that biochemical identification scheme is not satisfactory forStreptococcus milleri group. No emergence antibiotic resistance was determined. However, MIC should be investigated for strains isolated from sterile body parts. Commercially available biochemical kits are inadequent and identification should besupported with molecular methods. This study is thought to be a backbone for other studies in the future.

An Outpatient, Ambulant-Design, Controlled Human Infection Model Using Escalating Doses of Salmonella Typhi Challenge Delivered in Sodium Bicarbonate Solution

Typhoid fever is a major global health problem, the control of which is hindered by lack of a suitable animal model in which to study Salmonella Typhi infection. Until 1974, a human challenge model advanced understanding of typhoid and was used in vaccine development. We set out to establish a new human challenge model and ascertain the S. Typhi (Quailes strain) inoculum required for an attack rate of 60%-75% in typhoid-naive volunteers when ingested with sodium bicarbonate solution. Groups of healthy consenting adults ingested escalating dose levels of S. Typhi and were closely monitored in an outpatient setting for 2 weeks. Antibiotic treatment was initiated if typhoid diagnosis occurred (temperature ≥38°C sustained ≥12 hours or bacteremia) or at day 14 in those remaining untreated. Two dose levels (10(3) or 10(4) colony-forming units) were required to achieve the primary objective, resulting in attack rates of 55% (11/20) or 65% (13/20), respectively. Challenge was well tolerated; 4 of 40 participants fulfilled prespecified criteria for severe infection. Most diagnoses (87.5%) were confirmed by blood culture, and asymptomatic bacteremia and stool shedding of S. Typhi was also observed. Participants who developed typhoid infection demonstrated serological responses to flagellin and lipopolysaccharide antigens by day 14; however, no anti-Vi antibody responses were detected. Human challenge with a small inoculum of virulent S. Typhi administered in bicarbonate solution can be performed safely using an ambulant-model design to advance understanding of host-pathogen interactions and immunity. This model should expedite development of diagnostics, vaccines, and therapeutics for typhoid control.

Time for a comprehensive approach to the syndrome of fever in the tropics

Time for a comprehensive approach to the syndrome of fever in the tropics

Diagnostic efficacy of Widal slide agglutination test against Widal tube agglutination test in enteric fever

Introduction: Enteric fever is an endemic disease in India and warrants rapid and affordable diagnosis. The Widal slide agglutination test is a commonly used rapid screening test for this purpose. The literature available on its diagnostic ability in comparison to the tube agglutination test is however scanty. Hence, this study aims to evaluate the efficacy of the Widal slide agglutination test and the tube agglutination test for the diagnosis of enteric fever. Materials and Methods: A total of 1470 sera were collected during the study period of one year from patients having pyrexia of unknown origin. All the samples were tested for the presence of anti O and anti H agglutinins against S. typhi and S. paratyphi A by semi quantitative slide and quantitative tube agglutination tests as per standard protocols. The titers of 1:80 (O agglutinins) and 1:160 (H agglutinins) were taken as the significant titer for the diagnosis of enteric fever. The results of the slide agglutination test were compared with the tube agglutination test and analyzed using Fisher's exact test. The sensitivity, specificity, positive and negative predictive values of slide agglutination were calculated using the tube agglutination method as a standard for comparison. Results: Of the 294 slide positive samples, 209 (71.1%) samples tested negative by the tube agglutination test. The sensitivity, specificity, positive and negative predictive values for the slide agglutination test were observed to be 100 % (CI 95.75-100%), 84.91% (CI 82.93-86.73%), 28.91% (CI 23.84-34.45%) and 100% (CI 99.69-100%) respectively. Conclusion: Serological diagnosis of enteric fever should always be confirmed by the tube agglutination test rather than depending solely upon the rapid slide agglutination test results.

A comparative clinical study of efficacy of microimmuno assay with WIDAL-test in enteric fever in children

The diagnosis of typhoid fever in young children is also a dilemma because of its manifestations and typical presentation may not be seen in all cases. Antibodies to Salmonella typhi antigen are developed in the human body, which can be detected as a diagnostic test for the enteric fever. Objective: This study was undertaken to compare the efficacy of WIDAL-test with micro-immunoassay (dot enzyme immunosorbent assay). Method: 40 cases of clinically suspected enteric fever cases were included in this study. Result: In the present study, nearly 92% were positive for micro immunoassay (dot-enzyme immunosorbent assay) by Enterocheck-WB kit, 80% were positive for WIDAL and only 15% were culture positive. Immunoassay positive, but WIDAL negative cases were 20%, whereas WIDAL positive and immunoassay negative cases were only 7.5%. The positive predictivity of micro-immunoassay in diagnosing enteric fever is better than WIDAL both in 1st and 2nd week of illness. Micro-immunoassay done in the study was rapid in diagnosing the case. Conclusion: It is concluded from the present study that the micro-immunoassay (Enterocheck-WB) is better than WIDAL-test in the diagnosis of enteric fever in children.

Typhoid epidemiology, diagnostics and the human challenge model

Infection caused by ingestion of human-restricted Salmonella enterica serovars Typhi and Paratyphi predominantly affects the most impoverished sections of society. In this review, we describe recent advances made in estimating the burden of illness and the important role improved diagnostic tests may have in controlling infection and report the development of a new human challenge model of typhoid infection. Typhoid continues to be a major cause of morbidity, particularly in children and young adults in south east Asia, although accurate assessments are still hindered by the lack of reliable surveillance data. Recent reports of high rates of infection in Africa and the dominance of paratyphoid in several geographic areas are of particular concern. Diagnosis of enteric fever remains frustrated by the nonspecific clinical presentation of cases and the lack of test sensitivity. Methods to improve diagnostic accuracy are hindered by the incomplete understanding of immunobiological mechanisms of infection and lack of a suitable animal infection model. Enteric fever is a major global problem, the burden of which has only partially been recognized. Control strategies utilizing cheap accurate diagnostics and effective vaccines are urgently required, and their development should be accelerated by the use of a human challenge model.

Retrospective audit of the widal test for diagnosis of typhoid Fever in pediatric patients in an endemic region.

Although typhoid fever is confirmed by culture of Salmonella Typhi, Widal test is widely used in India but little information exists about its reliability. We examined the performance of Widal test in our hospital for diagnosis of typhoid fever in children. Hundred consecutive pediatric in-patients for whom, the Widal test was requested were grouped into four categories: widal positive and clinically consistent with typhoid fever (Group 1; n=42), widal negative but clinically consistent (Group 2, n=12), widal positive but not clinically consistent (Group 3, n=12) and widal negative and also not clinically consistent (Group 4, n=34). The results were analyzed by the test performance criteria, namely, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using culture-confirmed typhoid fever cases as the "true positives". We found that 7/100 patients had culture-proven typhoid fever. Using a cut off ≥ 50 for O agglutinins or ≥100 for H agglutinins, the Widal test gave a sensitivity of 71.43%, specificity of 47.31%, and a positive predictive value of 09.25% and a negative predictive value of 95.65%. The Widal test is an easy, inexpensive and relatively non-invasive but is not reliable in our set up because of a low PPV. There is a need for a more efficient rapid diagnostic test for typhoid fever.

Current Pattern in Antimicrobial Susceptibility in Enteric Fever In A Private Medical College

Background and objectives: Enteric fever continues to be an important health problem in Bangladesh. Emerging drug resistance adds magnitude to this problem. Only surveillance studies can help form guidelines for therapy under such a situation. The present study was undertaken to determine the current pattern in antimicrobial susceptibility of enteric fever cases in a private medical college and to find out the incidence of multidrug resistant (MDR) cases. Study design: Hospital based observational study. Study setting and period: Medicine units of Ibn Sina Medical College hospital from october’11 to august’12. Source of materials/participants: Fever cases with clinical diagnosis of enteric fever and positive blood culture, attending the outpatient and admitted at hospital were included in the study. Susceptibility of the isolates to commonly available antibiotics were recorded. Treatment and responses were followed up. Results: 100 adult patients with fever had positive blood cultures were included in the study. Majority of patients were 19 – 30 yr olds (63%). Susceptibility of the isolates were tested against 14 available antibiotics. Ceftriaxone was sensitive in 99% cases followed by ciprofloxacin (96%), Gentamycin ( 96%) and cefixime (91%). Adeclining trend in sensitivity to Azithromycin ( 61%) was observed. Resurgence of chloramphenicol (81%) and cotrimoxazole (75%) sensitivity was noted. In 98 cases sensitivity to all three (amoxicillin, co-trimoxazole and chloramphenicol) were tested. 13 cases were found resistant to all the three drugs (13/98=13.2%). These MDR cases were sensitive to ceftriaxone (100%), cefixime (100%), azithromycin (100%), gentamycin(94%)and ciprofloxacin (88%). Conclusion: Antibiotic sensitivity pattern showed a trend with onset of emerging resistance to azithromycin (ceftriaxone vs azithromycin z value = 7.63; P value =0.001 (Significant) and azithromycin vs ciprofloxacin Z value = 6.66; P value =0.001 (Significant). Multidrug resistant cases present showed reduced susceptibility to gentamycin. Sensitivity of these drugs must be preserved through constant surveillance and use only under a protocol. DOI: http://dx.doi.org/10.3329/bjms.v13i1.17440 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 67-69

A Systematic Review and Meta-Analysis of the Performance of Two Point of Care Typhoid Fever Tests, Tubex TF and Typhidot, in Endemic Countries

BackgroundIn the absence of well-equipped laboratory infrastructure in many developing countries the accurate diagnosis of typhoid fever is challenging. Rapid diagnostic tests (RDT) with good performance indicators would be helpful to improve clinical management of suspected cases. We performed a systematic literature review and meta- analysis to determine the performance of TUBEX TF and Typhidot for the diagnosis of typhoid fever using PRISMA guidelines.MethodsTitles and abstracts were reviewed for relevance. Articles were screened for language, reference method and completeness. Studies were categorized according to control groups used. Meta-analysis was performed only for categories where enough data was available to combine sensitivity and specificity estimates. Sub-analysis was performed for the Typhidot test to determine the influence of indeterminate results on test performance.ResultsA total of seven studies per test were included. The sensitivity of TUBEX TF ranged between 56% and 95%, Specificity between 72% and 95%. Meta-analysis showed an average sensitivity of 69% (95%CI: 45–85) and an average specificity of 88% (CI95%:83–91). A formal meta-analysis for Typhidot was not possible due to limited data available. Across the extracted studies, sensitivity and specificity estimates ranged from 56% to 84% and 31% to 97% respectively.ConclusionThe observed performance does not support the use of either rapid diagnostic test exclusively as the basis for diagnosis and treatment. There is a need to develop an RDT for typhoid fever that has a performance level comparable to malaria RDTs.

Atypical Presentation of Typhoid Fever

The classical presentation of typhoid has changed over the years. Atypical presentation of typhoid is now seen in clinical practice. Entericfever can present with atypical manifestations like abdominal lymphadenopathy, acute acalculous cholecystitis, osteomyelitis, splenic abscess and Pneumonia. Jaundice splenic abscess and thrombocytopenia in a febrile patient in the tropics is commonly due to Malaria, Leptospirosis and Dengue. We report a case of typhoid fever presenting with jaundice and thrombocytopenia. A 17 year old male presented to us with history of fever and jaundice. Investigations revealed thrombocytopenia and conjugated hyperbilirubinemia. Blood culture grew Salmonella Typhi. He was treated with ceftriaxone and he improved. A diagnosis of typhoid fever must be considered in a febrile patient with jaundice and thrombocytopenia in the tropics. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8584 Asian Journal of Medical Science, Volume-5(2) 2014: 140-142

English

The public health burden of typhoid fever can be substantially reduced by early diagnosis and appropriate antibiotic therapy. This study was conducted in an attempt to assess the reliability of immunochromatographic test (ICT) for the early diagnosis of typhoid fever. Immunochromatographic test to detect IgM, IgG or combined IgM/IgG in serum in 1st week of fever was done for the diagnosis of typhoid fever. Blood samples were taken for culture and Widal test of 100 clinically suspected cases of typhoid fever in 1st week of illness of patients at Outpatient Department of Rajshahi Medical College Hospital (RMCH), Bangladesh. Forty (40) controls of comparable age and sex were also taken including 20 febrile (non-typhoidal) and 20 healthy persons. Blood culture positive cases (16) and Widal test positive cases (15) were considered as typhoid fever patients and the total number was 31. ICT was performed for 31 typhoid fever patients and 40 controls. In this study, out of 31 cases, ICT was found positive in 28 (90.32%) typhoid fever patient, while 03 (15.00%) of the controls also showed ICT positivity indicating its specificity of 92.50%. It is evident from this study that ICT as a reliable diagnostic tool for early diagnosis of typhoid fever was found highly sensitive, rapid and easy to perform. It can be a versatile test for the screening of clinically suspected case of typhoid fever. therefore, ICT have been found to be encouraging in this study. Key words: Anti-salmonella antibodies, immunochromatographic assay, diagnostic tool, early diagnosis of typhoid fever.

Evaluation of the diagnostic accuracy of a typhoid IgM flow assay for the diagnosis of typhoid fever in Cambodian children using a Bayesian latent class model assuming an imperfect gold standard.

Rapid diagnostic tests are needed for typhoid fever (TF) diagnosis in febrile children in endemic areas. Five hundred children admitted to the hospital in Cambodia between 2009 and 2010 with documented fever (≥ 38°C) were investigated using blood cultures (BCs), Salmonella Typhi/Paratyphi A real-time polymerase chain reactions (PCRs), and a Typhoid immunoglobulin M flow assay (IgMFA). Test performance was determined by conventional methods and Bayesian latent class modeling. There were 32 cases of TF (10 BC- and PCR-positive cases, 14 BC-positive and PCR-negative cases, and 8 BC-negative and PCR-positive cases). IgMFA sensitivity was 59.4% (95% confidence interval = 41–76), and specificity was 97.8% (95% confidence interval = 96–99). The model estimate sensitivity for BC was 81.0% (95% credible interval = 54–99). The model estimate sensitivity for PCR was 37.8% (95% credible interval = 26–55), with a specificity of 98.2% (95% credible interval = 97–99). The model estimate sensitivity for IgMFA (≥ 2+) was 77.9% (95% credible interval = 58–90), with a specificity of 97.5% (95% credible interval = 95–100). The model estimates of IgMFA sensitivity and specificity were comparable with BCs and better than estimates using conventional analysis.

The role of abdominal ultrasound in the diagnosis of typhoid fever: An observational study

To study the usefulness of abdominal ultrasound in the diagnosis of typhoid fever and to determine the common ultrasound findings early in the course of the disease. Abdominal ultrasound examination was performed within the first week of initiation of symptoms in 350 cases with clinical diagnosis of typhoid fever. Subsequent ultrasound follow-up examination was done 15 days later (beginning of the third week). All the patients proved to have positive Widal test and Sallmonella culture. The study was performed in Erbil-Iraq from the period January 1993 to October 2010. The following ultrasound findings were reported: hepatomegaly (31.4%), prominent intrahepatic bile ducts (64.85%), splenomegaly (100%), mesenteric lymphadenopathy (42.85%), bowel wall thickening (35.71%), acalculous cholecystitis (16.28%), perforations (1.14%), and ascites in (3.4%). The current study showed that the findings are typical enough to justify initiation of treatment for typhoid fever when serology is equivocal and culture is negative, and is fairly safe to say that normal ultrasound examination early in the course of febrile illness rules out typhoid fever.

Baseline antibody titres against Salmonella typhi in apparently asymptomatic HIV positive individuals in a tertiary care hospital

Enteric fever is common in tropical regions and is caused by Salmonella enterica serotype typhi (S typhi ). For diagnosis of enteric fever, the Widal test is the most widely used test after blood culture. In HIV infected individuals false positive and false negative Widal reactions are common. The result is variable titres and baseline titres that are unusual in this patient population. This study was done to determine the baseline antibody titres for S typhi among HIV infected individuals. Average baseline antibody titres against O and H antigens of S typhi were measured by standard Widal test in 200 HIV positive asymptomatic individuals, as well as 200 age and sex-matched controls. The results were compiled and statistically analysed. A total of 84 (42%) of the cases had an H antibody titre of >1:20 and 105 (52.5%) had a titre of >1:20 against O antigen. This implies that positive titre of H and O antigen is significantly associated with HIV positive cases with P<0.001. Correlation of CD4 count with antibody titres shows that there is no significant association between CD4 counts and antibody titres against either H (P=0.634) or O antigen (P=0.765). This study shows that HIV infected individuals had increased titres of antibodies against S typhi from the baseline. This indicates a need for evaluation of current cut-off values of diagnostic titres for this group. We also suggest that it is best to perform baseline titres against S t yphi for each patient at the time of diagnosis of HIV status, and to use this for future reference.

Evaluation of an Electricity-free, Culture-based Approach for Detecting Typhoidal Salmonella Bacteremia during Enteric Fever in a High Burden, Resource-limited Setting

BackgroundIn many rural areas at risk for enteric fever, there are few data on Salmonella enterica serotypes Typhi (S. Typhi) and Paratyphi (S. Paratyphi) incidence, due to limited laboratory capacity for microbiologic culture. Here, we describe an approach that permits recovery of the causative agents of enteric fever in such settings. This approach involves the use of an electricity-free incubator based upon use of phase-change materials. We compared this against conventional blood culture for detection of typhoidal Salmonella.Methodology/Principal FindingsThree hundred and four patients with undifferentiated fever attending the outpatient and emergency departments of a public hospital in the Kathmandu Valley of Nepal were recruited. Conventional blood culture was compared against an electricity-free culture approach. Blood from 66 (21.7%) patients tested positive for a Gram-negative bacterium by at least one of the two methods. Sixty-five (21.4%) patients tested blood culture positive for S. Typhi (30; 9.9%) or S. Paratyphi A (35; 11.5%). From the 65 individuals with culture-confirmed enteric fever, 55 (84.6%) were identified by the conventional blood culture and 60 (92.3%) were identified by the experimental method. Median time-to-positivity was 2 days for both procedures. The experimental approach was falsely positive due to probable skin contaminants in 2 of 239 individuals (0.8%). The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% (95% CI: 80.0%–97.0%) and 96.0% (92.7%–98.1%), respectively. After initial incubation, Salmonella isolates could be readily recovered from blood culture bottles maintained at room temperature for six months.Conclusions/SignificanceA simple culture approach based upon a phase-change incubator can be used to isolate agents of enteric fever. This approach could be used as a surveillance tool to assess incidence and drug resistance of the etiologic agents of enteric fever in settings without reliable local access to electricity or local diagnostic microbiology laboratories.

Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan.

To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta (CHQ) from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot® tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever.

English

AIM AND OBJECTIVES: Purpose of the study is to compare the sensitivity and specificity of Widal test and Typhi dot with the blood culture, in the diagnosis of Typhoid fever. Material and methods:- Blood samples from 200 clinically diagnosed typhoid cases, were subjected to blood culture and the isolates were identified by biochemical reactions and samples were subjected to serological tests, Widal test and Typhi dot test. RESULTS: Out of 200 clinically diagnosed typhoid cases, 28 (14%) were blood culture positive for Salmonella typhi, 43 (21.5%) were Widal positive and 55 (27.5%) were Typhi dot positive. CONCLUSION : Blood culture and Widal test are used as conventional methods in the diagnosis of the typhoid fever. Typhi dot test is a new rapid serological test introduced commercially for the diagnosis typhoid fever. Typhi dot test has been designed to detect the IgM and IgG antibodies against the outer membrane protein (OMP) of Salmonella typhi. It offers the advantage of rapid & early diagnosis, with a sensitivity & specificity of 92% & 83% respectively in culture proven cases.

Graphene oxide-chitosan nanocomposite based electrochemical DNA biosensor for detection of typhoid

Graphene oxide (GO)-Chitosan (CHI) nano-composite is employed for the development of DNA based electrochemical biosensor for diagnosis of typhoid. Biosensor has been prepared by covalent immobilization of Salmonella typhi specific 5′-amine labeled single stranded (ss) DNA probe on GO-CHI/ITO via glutaraldehyde. Differential pulse voltammetry (DPV) studies revealed good specificity and ability of ssDNA/GO-CHI/ITO biosensor to distinguish complementary, non-complementary and one base mismatch sequences. The ssDNA/GO-CHI/ITO biosensor showed detection range of 10fM to 50nM and LOD 10fM within 60s hybridization times for complementary sequence. Further, ssDNA/GO-CHI/ITO bioelectrode is able to detect complementary target present in serum samples with LOD of 100fM at 25°C. The excellent performance of biosensor is attributed to large surface-to-volume ratio and good electrochemical activity of graphene oxide, and good biocompatibility of chitosan, which enhances the DNA immobilization and facilitate electron transfer between DNA and electrode surface (ITO).

Salmonella enterica serotype Typhi infections in a Canadian pediatric hospital: a retrospective case series.

In developed countries, typhoid fever generally occurs in travellers or recent immigrants from endemic areas. Our aim was to describe the epidemiology of Salmonella enterica serotype Typhi infections among children presenting to a pediatric teaching hospital in Montréal, Quebec. We included all patients less than 18 years of age who presented to the Montreal Children's Hospital between 1991 and 2011 with a laboratory-confirmed diagnosis of typhoid fever (Salmonella enterica ser. Typhi isolated from blood or stool) in a retrospective case series. During the study period, we identified 39 cases of typhoid fever (mean age of patient 7.5yr). Four (10.3%) of these cases occurred in newly arrived immigrants shortly after their arrival in Canada (median 15.5 d). Most cases (76.9%) occurred in children who had visited friends and relatives in their home country. None of the travellers had received a vaccination against typhoid fever before their departure. All cases presented with high fever (mean temperature 40.4°C) that lasted for a mean of 15.8 days. Common accompanying symptoms included anorexia, abdominal pain, vomiting and diarrhea. All 39 isolates of S. enterica ser. Typhi were susceptible to third-generation cephalosporins, and 7 were resistant to ciprofloxacin. Ampicillin resistance occurred in 10 (25.6%) of the isolates. No deaths occurred among the study participants. Most cases of typhoid fever occurred in children who had travelled to endemic areas to visit friends and relatives. Thus, there is a role for increased awareness on the part of family physicians and pediatricians caring for these children to discuss travel-related infections during regularly scheduled appointments, because parents might not consult travel clinics or discuss their travel plans before travelling back to their home country.

Raoultella planticola bacteraemia secondary to gastroenteritis

We present the first case of Raoultella planticola bacteria in human infections with a direct relationship between fish intake and enteric infection. The patient was treated with antibiotherapy (cefotaxime). It is important to consider this organism in the differential diagnosis of enteric fever and even more with previous ingestion of fish.