Typhoid Patients Research Articles

Comparison of Clinical Symptoms and Laboratory Findings in Typhoid Fever and Dengue Fever Patients

Abstract: Background: Typhoid fever and dengue hemorrhagic fever (DHF) are two infections that often occur in tropical and subtropical areas, including Indonesia, with similar clinical symptoms but different pathogens. Accurate diagnosis is essential for proper management. Objective: This study aims to analyze the differences in clinical symptoms and laboratory findings in typhoid fever and dengue fever patients at Aek Kanopan Regional Hospital, North Labuhan Batu Regency, North Sumatra. Method: This research is an observational comparative study involving 100 patients diagnosed with typhoid fever and dengue fever during the period December 2023 to February 2024. Data on clinical symptoms and laboratory examination results were collected and analyzed using descriptive and inferential statistics. Results: Results show that symptoms of stomach ache and headache are more common in typhoid fever patients, while rash and muscle pain are more prevalent in dengue fever patients. From a laboratory perspective, typhoid fever patients have an increased number of leukocytes (12,000 ± 3,500 cells/µL) compared to dengue fever (9,000 ± 2,000 cells/µL), while platelets in dengue fever patients are on average lower (45,000 ± 15,000 cells/µL) compared to typhoid fever (75,000 ± 20,000 cells/µL). Conclusion: This study confirms the importance of understanding the clinical and laboratory differences between typhoid fever and dengue fever to improve the accuracy of diagnosis and patient management. These results contribute to the development of better clinical guidelines for managing febrile infections in areas with high prevalence.

Salmonella Typhi Haplotype 58 biofilm formation and genetic variation in isolates from typhoid fever patients with gallstones in an endemic setting in Kenya.

Although typhoid fever has largely been eliminated in high-income countries, it remains a major global public health concern especially among low- and middle-income countries. The causative agent, Salmonella enterica serovar Typhi (S. Typhi), is a human restricted pathogen with a limited capacity to replicate outside the human host. Human carriers, 90% of whom have gallstones in their gallbladder, continue to shed the pathogen for an ill-defined period of time after treatment. The genetic mechanisms involved in establishing the carrier state are poorly understood, but S. Typhi is thought to undergo specific genetic changes within the gallbladder as an adaptive mechanism. In the current study, we aimed to identify the genetic differences in longitudinal clinical S. Typhi isolates from asymptomatic carriers with gallstones in a typhoid endemic setting in Nairobi, Kenya. Whole-genome sequences were analyzed from 22 S. Typhi isolates, 20 from stool samples, and 2 from blood samples, all genotype 4.3.1 (H58). Out of this, 19 strains were from four patients also diagnosed with gallstones, of whom three had typhoid symptoms and continued to shed S. Typhi after treatment. All isolates had point mutations in the quinolone resistance-determining region (QRDR), and only sub-lineage 4.3.1.2.EA3 encoded multidrug resistance genes. There was no variation in antimicrobial resistance patterns among strains from the same patient/household. Non-multidrug resistant (MDR) isolates formed significantly stronger biofilms in vitro than the MDR isolates, p<0.001. A point mutation within the treB gene (treB A383T) was observed in strains isolated after clinical resolution from patients living in 75% of the households. For missense mutations in Vi capsular polysaccharide genes, tviE P263S was also observed in 18% of the isolates. This study provides insights into the role of typhoid carriage, biofilm formation, AMR genes, and genetic variations in S. Typhi during asymptomatic carriage.

RpoS activates formation of Salmonella Typhi biofilms and drives persistence in the gall bladder.

The development of strategies for targeting the asymptomatic carriage of Salmonella Typhi in chronic typhoid patients has suffered owing to our basic lack of understanding of the molecular mechanisms that enable the formation of S. Typhi biofilms. Traditionally, studies have relied on cholesterol-attached biofilms formed by a closely related serovar, Typhimurium, to mimic multicellular Typhi communities formed on human gallstones. In long-term infections, S. Typhi adopts the biofilm lifestyle to persist in vivo and survive in the carrier state, ultimately leading to the spread of infections via the fecal-oral route of transmission. In the present work, we studied S. Typhi biofilms directly, applied targeted as well as genome-wide genetic approaches to uncover unique biofilm components that do not conform to the CsgD-dependent pathway established in S. Typhimurium. We undertook a genome-wide Tn5 mutation screen in H58, a clinically relevant multidrug resistance strain of S. Typhi, in gallstone-mimicking conditions. We generated New Generation Sequencing libraries based on the ClickSeq technology to identify the key regulators, IraP and RpoS, and the matrix components Sth fimbriae, Vi capsule and lipopolysaccharide. We discovered that the starvation sigma factor, RpoS, was required for the transcriptional activation of matrix-encoding genes in vitro, and for S. Typhi colonization in persistent infections in vivo, using a heterologous fish larval model. An rpoS null mutant failed to colonize the gall bladder in chronic zebrafish infections. Overall, our work uncovered a novel RpoS-driven, CsgD-independent paradigm for the formation of cholesterol-attached Typhi biofilms, and emphasized the role(s) of stress signaling pathways for adaptation in chronic infections. Our identification of the biofilm regulators in S. Typhi paves the way for the development of drugs against typhoid carriage, which will ultimately control the increased incidence of gall bladder cancer in typhoid carriers.

Nested PCR Targeting the Flagellin Gene (fliC) in Urine Sample for Diagnosis of Typhoid Fever – An Internal Pilot Study

Abstract Introduction Typhoid fever remains a significant public health challenge, especially in developing countries. Diagnostic complexities arise from the disease’s non-specific clinical manifestations that overlap with other febrile illnesses. Hence, reliable laboratory testing is crucial. Nested polymerase chain reaction (PCR) stands out for its diagnostic performance, especially when utilizing urine due to its minimal PCR inhibitors and ease of collection. Aim The study aimed to test the performance of Salmonella enterica serotype Typhi (Salmonella Typhi) fliC gene specific nested PCR in urine for laboratory diagnosis of typhoid fever. Subjects and Methods This observational, cross-sectional study was conducted as an internal pilot study during the period from August 2021 to October 2022. It included 25 clinically diagnosed enteric fever patients, recruited from Al-Abasseya Fever Hospital, Cairo, Egypt, and 25 healthy individuals as controls, matched for age and sex. Nested PCR was performed to detect the fliC gene of Salmonella Typhi in urine samples from both patients and controls. Urine culture was conducted for subjects in both groups, while blood and stool cultures were exclusively performed for the patients' group. Results The sensitivity of the nested PCR test targeting the fliC gene in urine was 44%, with a specificity of 88%. The positive predictive value was 78.57%, the negative predictive value was 61.11%, the positive likelihood ratio was 3.7, and the negative likelihood ratio was 0.63. Blood culture isolation exhibited a very low positivity rate of 4%. Conclusion Nested PCR targeting the fliC gene in urine samples holds promise as a diagnostic tool for typhoid fever. Despite its moderate sensitivity, the relatively higher specificity suggests its potential utility in confirming typhoid fever cases. The test offers a valuable adjunctive tool alongside conventional diagnostic method. However, further research and validation may be necessary before widespread clinical application. The performance of the test needs to be evaluated in clinically diagnosed and laboratory confirmed cases of typhoid fever.

The PARK2_e01(-697) Polymorphism does not Associate with Susceptibil-ity to Typhoid in Punjabi Population, Pakistan: A Case Control Study.

SNP based association studies have revolutionized the field of biomed-icines. Enteric fever is a systemic disease with etiologic agents Salmonella enterica serovar typhi and paratyphi. It is a serious health issue worldwide and presents wide variations in incidence, rates, and severity. Previous investigations have revealed that genetic variations may lead to sus-ceptibility to typhoid fever. A current study was performed to investigate the potential association of PARK2_e01(-697) polymorphism with the susceptibility to typhoid in the Punjabi population. For this case-control study, blood samples obtained from typhoid patients with positive Typhidot or blood culture test (n=72) and healthy controls (n=73) were processed for DNA ex-traction. The polymorphism PARK2_e01(-697) analysis was carried out by using PCR and RFLP. No allelic association was found between PARK2_e01(-697) and susceptibility to ty-phoid fever in the understudy population. This case control study is the demonstration of the non-association of PARK2_e01(-697) with typhoid in the Pakistani population. Future research, using a larger population size, will help to elucidate the role of PARK2_e01(-697) polymorphism in typhoid pathogenesis.

Asuhan Keperawatan Pada An. D dengan Demam Thypoid di Ruang Anggrek 1 RSUD dr. Soeselo Kabupaten Tegal

Typhoid fever is an acute infection of the small intestine caused by Salmonella typhi, commonly occurring in developing countries with poor sanitation, including tropical regions such as Indonesia, where the climate supports the proliferation of this bacterium (Yustati &amp; Dinata, 2023). The primary symptoms include high fever, nausea, abdominal pain, and gastrointestinal disturbances. This study employs a descriptive method with a case approach to identify and address nursing issues such as hyperthermia, knowledge deficit, and risk of nutritional deficit. The aim of this writing is to provide and describe comprehensive nursing care for typhoid fever patients at RSUD Dr. Soeselo, Tegal Regency, in accordance with established nursing standards, to ensure effective care and improved patient outcomes.

CLINICAL EFFICACY OF ORAL AZITHROMYCIN VERSUS OTHER ANTIMICROBIAL DRUGS IN THE TREATMENT OF TYPHOID PATIENTS ACROSS ALL AGE GROUPS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS.

Typhoid is a major health concern. Drug-resistant cases of typhoid have given rise to new debates. Azithromycin has shown adequate results. The study is designed to determine the clinical efficacy of oral azithromycin versus other antimicrobial drugs in typhoid patients. The studies included in the systematic review are randomized controlled trials, comparing the clinical efficacy of azithromycin to other antimicrobial drugs on typhoid patients. We searched 1180 articles from Google Scholar, PubMed Central, Cochrane Library, PLOS ONE, and JSTOR on 16th October, 2023. The risk of bias was analyzed by visualizing the funnel plot, Begg's and Egger's test, and plotting risk of bias graphs. Forest plots are created to display the findings. We identified 14 research articles (1556 participants). Odds ratios of the treatment outcomes were extracted. In a forest plot, the overall effect of the treatment outcome (CI=95%) of azithromycin, in comparison to fluoroquinolones appeared to be favourable (Random Effect Model (REM)=2.15, heterogeneity: I2=37%, τ2= 0.1729, p=0.15, the overall pooled effect was towards right side). Compared to chloramphenicol, azithromycin showed a high odds ratio (1.23). However, there was no difference in outcome among ceftriaxone and azithromycin groups (REM=0.67, heterogeneity: I2=0%, τ2=0%, p=0.78, the overall pooled effect touched the no-effect line). Azithromycin is more clinically efficacious than fluoroquinolones and chloramphenicol. The drug has fewer documented relapses in comparison with other antimicrobial drugs. Fever clearance time of azithromycin is greater than ceftriaxone and chloramphenicol.

Antibiogram and Salmonella typhi detection in suspected patients using advanced PCR technique, serology, and conventional blood culture

Background &amp; Objectives: Salmonella enterica serovar Typhi is a diverse gram-negative bacillus that causes life-threatening invasive bloodstream infection and remains a public health burden in developing countries. The antimicrobial resistance in Salmonella typhi has led to widespread multidrug resistance strains making complication in the treatment and demanding alternative therapies. Various diagnostics test such as blood culture, serological assay, and molecular assay are available. PCR is a newer gold standard method, but blood culture is still considered a definitive diagnosis of typhoid fever. Materials and Methods: A cross-sectional study was conducted. Venous blood was collected, and a widal test was performed to detect antibodies against O and H antigens in serum. Blood culture, isolation, and identification were performed using the standard techniques. The antibiogram of isolates was performed by the Kirby Bauer method. Amplification of the hilA gene through PCR was used for the molecular diagnosis. Results: Out of 141 suspected typhoid patients, 78 were males, and 63 were females. PCR detected maximum positivity rate (70%) followed by Widal test (43.26%) and blood culture (16.25%). PCR positive cases were highly prevalent in the male in less than 15 years of age group (14.8%), followed by 15-30 (12.7%) and 30-45 (9.1%). The isolated organism was found to be 100% sensitive to most antibiotics studied, except ofloxacin, which showed 71.4% sensitivity. In contrast, all the isolates were 100% resistant to nalidixic acid. None of the isolates showed multi-drug resistance. Conclusion: PCR is a sensitive, rapid, and better alternative than conventional methods that can be used in clinical diagnosis for early detection of the Salmonella typhi.

Genetic diversity, virulence profiles, and antimicrobial resistance of Salmonella enterica serovar Typhi isolated from typhoid fever patients in Baghdad, Iraq

Typhoid fever is an important health issue in developing countries, and the pathogenicity of Salmonella enterica serovar Typhi (S. ser. Typhi) depends on the presence of different virulence factors. Therefore, this study aimed to investigate the spread of virulence genes among S. Typhi isolates from patients with typhoid fever in Baghdad, Iraq. Sixty S. Typhi isolates were collected from several hospitals in Baghdad and identified using VITEK-II and confirmed by polymerase chain reaction (PCR) to detect the 16S rRNA gene. After testing their susceptibility to different antimicrobials (via the disk diffusion method), we found the highest resistance rates (100 %) were to ampicillin, piperacillin, cefotaxime, and ceftriaxone. The highest sensitivity rates (100 %) were to ertapenem, imipenem, meropenem, and sulfamethoxazole/trimethoprim. The presence of genes encoding for virulence in S. Typhi isolates was tested by conventional PCR. The results showed that out of 60 isolates, 59 (98.3 %), 59 (98.3 %), 58 (96.7 %), and 60 (100 %) were positive for viaB, staA, cdtB, and orfL genes, respectively. The sequencing of PCR products (viaB, staA, cdtB, and orfL genes) was carried out at the Macrogen Company (Seoul, Korea). The sequences were compared with nucleotide sequences in the BLAST GenBank database, and data obtained from the sequencing of these virulence genes were submitted to GenBank under different accession numbers. A phylogenetic analysis of the 16S rRNA gene sequence found a high similarity between local sequences and the closely related sequences of genes in GenBank. The presence of the viaB, staA, cdtB, and orfL virulence genes in nearly all of the isolates under examination suggests that they play an important role in the pathogenicity of local isolates.

Hubungan Kelengkapan Rekam Medis Dengan Keakuratan Kode Typhoid Fever Rawat Inap Rumah Sakit Santa Elisabeth Medan

The accuracy of the code is the accuracy in providing codes that are in accordance with the diagnosis of the disease and in accordance with the classification in ICD-10, which is useful to support the services and medical actions provided to patients. Completeness of medical records is the complete filling of medical records properly and correctly for medical services. The purpose of the study was to identify the relationship between the completeness of medical records and the accuracy of the typhoid fever code in hospitalization at Santa Elisabeth Hospital Medan in 2023. Analytic research design using a cross sectional approach. The population in the study were medical records of typhoid fever patients hospitalized at Santa Elisabeth Hospital Medan in 2023 as many as 214 medical records, the sample in the study was 66 medical records, the sampling technique was systematic random sampling. The instrument used was a checklist sheet. Data analysis using the Chi-square test. The results of this study obtained completeness of medical records with a complete category of 57 medical records (86.4%), the accuracy of the code with an accurate category of 51 codes (77.3%). Chi-square test results obtained p-value 0.023 (p0.05) indicates that there is a significant relationship between the completeness of medical records and the accuracy of the typhoid fever code inpatient Santa Elisabeth Hospital Medan.

Linking epidemiological and genomic data in cases of enteric fever in England to inform clinical management and public health action.

To explore the feasibility of linking data from enhanced surveillance patient questionnaires from each enteric fever case in England with genome sequencing data, including antimicrobial resistance (AMR) profiles, from the corresponding isolate of typhoidal salmonellae. After linking data we interrogated the merged dataset and assessed the utility of passive surveillance data to match and monitor antimicrobial treatment regimens in enteric fever patients with the AMR profiles of the infectious agent. A high proportion of cases were given antibiotics (n = 1230/1415; 86.9%); half of the cases stated the class of antibiotic they were given (n = 630/1239) and half were prescribed cephalosporins (n = 316/630). Reported treatment with a combination of antibiotics increased with symptom severity. Nearly half of isolates (n = 644/1415; 45.5%) had mutations conferring resistance to ciprofloxacin. Based on genome-derived AMR profiles, typhoidal salmonellae isolates inferred to be susceptible to the recommended first-line antimicrobials were twice as likely to be isolated from individuals residing in the least deprived areas compared with the most deprived (n = 26/169; 15.4% versus n = 32/442; 7.2%). Due to the high proportion of missing data obtained from patient interviews, we recommend a more transparent and systematic approach to recording the antibiotic prescription details by healthcare professionals in primary and secondary care. A more robust approach to data capture at this point in the care pathway would enable us to audit inconsistencies in the prescribing algorithms across England and ensure equitable treatment across all sections of society. Integrating prescribing data with the genome-derived AMR profiles of the causative agent at the individual patient level provides an opportunity to monitor the impact of treatment on clinical outcomes, and to promote best practice in real time.

EFEKTIVITAS OBAT ANTIBIOTIK UNTUK DEMAM TIFOID TERHADAP PASIEN ANAK DI RUMAH SAKIT UMUM DAERAH dr. AGOESDJAM KABUPATEN KETAPANG KALIMANTAN BARAT PERIODE 2019

Typhoid fever is the third of the 10 main diseases in patients treated in hospitals in Indonesia, while at RSUD dr. Agoesdjam West Kalimantan is ranked fourth. The aim of the research is to determine patterns of drug use and evaluate the effectiveness of antibiotic drugs for patients with thiophid fever at RSUD dr. Agoesdjam. This research is an observational study with retrospective data collection in May-July 2019, with a total of 103 patients. The inclusion criteria taken were medical record data from patients aged 5 to 10 years, who were diagnosed with typhoid fever at the inpatient installation of the Regional General Hospital ( RSUD) Dr. Agoesdjam Ketapang, West Kalimantan. Exclusion criteria are; Medical records for typhoid fever patients have other comorbidities such as kidney failure, psychiatric disorders, and so on.The parameters for the effectiveness of the drugs used are LoS, LoSAR, reduction in body temperature and reduction in the number of leukocytes. The results obtained were the use of antibiotics including chloramphenicol, ampicillin, ceftriaxone and cefixime. Based on LoS parameters, ceftriaxone was the most effective (2.77 days), LoSAR ceftriaxone (5 days), decreased body temperature ampislin (4.2 °C) and decreased leukocytes ampislin (6075 cells per micro liter). The most antibiotic used was chloramphenicol (41 patients). The most effective drugs were ceftriaxone (according to LoS and LoSAR parameters) and ampicillin (according to body temperature and leukocyte reduction parameters).

Fighting XDR Typhoid: A Hospital Based Study on Clinical Aspects and Treatment Outcome in Tertiary Care Hospital

Objective: The main aim of this study is to find Clinical Aspects and Treatment Outcome in drug resistant Typhoid. Methodology: Total 120 patients participated in this study. Individuals who received a diagnosis of XDR S.Typhi through a blood culture test were identified from the registry of both healthcare facilities. The medical data of patients suffering from typhoid fever who received treatment as either a hospital inpatient or outpatient between April 1, 2022, and June 30, 2022, were examined for the purpose of screening for inclusion in this investigation. Only typhoid patients who tested positive for S.Typhi in a test to culture blood and the manifestation of insusceptibility to the five classifications of antimicrobials (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolone, and 3rd generation cephalosporin (ceftriaxone or cefixime) were examined for potential incorporation in this inquiry. Results: Among the 120 cases of XDR Typhoid, n= 35 (29.16%) were managed exclusively with azithromycin, while 40 (33.33%) were solely administered meropenem. The remaining 45(37.5%) received a combination of both azithromycin and meropenem. Two patients could not recover after receiving Azithromycin. Full recovery seen in Meropenem. Four patients couldn’t recover from combination therapy. Conclusion: Escalating antibiotic resistance in Salmonella enterica has rendered it a complex ailment to address. Measures ought to be implemented to enhance antibiotic prescription protocols and establish consistent recommendations for the management of highly resistant strains of Salmonella enterica.

Gallbladder Perforation as a Complication of Enteric Fever: An Intriguing Case of Acute Abdomen

If not identified and treated right once, gallbladder perforation—a uncommon but dangerousconsequence of acute cholecystitis—can result in significant morbidity and mortality. We describe theexample of a female patient, having 19 years of age, who had a history of constipation. The patient was diagnosed with typhoid fever and underwent imaging studies that revealed gallbladder wall perforation along its postero-inferior aspect with adjacent contained right subhepatic collection. The patient underwent diagnostic laparoscopy and subtotal cholecystectomy. This instance emphasizes how crucial it is to rule out gallbladder perforation while diagnosing acute abdomen in typhoid fever patients. Prompt surgical intervention and early diagnosis can avert major problems and enhance results.

Cool Pack Management to Reduce Pain Levels During Infusion Installation in Typhoid Pediatric Patients in the Emergency Room

Background: Typhoid fever is an acute infectious disease that attacks the digestive tract and is caused by Salmonella typhi bacteria with symptoms of increased body temperature. Hyperthermia will also increase the risk of fluid volume deficiency (dehydration). One action to overcome this is by inserting fluids through an IV. However, nurses must respect the child's concerns about pain reactions. Therefore, efforts are needed to reduce pain due to the procedure provided by installing a Cool Pack. The Cool Pack, which is previously placed on the hand where the infusion will be installed, is able to reduce the level of pain because this therapy produces an analgesic effect by slowing down the speed at which pain impulses reach the brain. Objective: Management of Cool Pack in two patients to reduce the level of pain during infusion in pediatric typhoid patients in the Emergency Room of Muhammadiyah Hospital Palembang. Method: This method uses observation, interviews and assessment instruments with primary and secondary data collection techniques for 2 days from 06 May 2023 to 07 May 2023. Results: After administering the Cool Pack, the results obtained were that there was an effect from giving Cool Pack before installing the infusion. The first patient had a pain scale result: 5, and the second patient had a pain scale result: 5. Conclusion: Cool Pack management was good for reducing the level of pain during infusion in both patients. Suggestion: Cool Pack management is expected to be one of the treatment interventions to reduce the level of pain during infusion and not only in pediatric typhoid patients, but also in other pediatric patients who will undergo infusion. Keywords: Typhoid, Hyperthermia, Dehydration, Cool Pack, Infusion, Pain

The frequency and associated factors of typhoid carriage in patients undergoing cholecystectomy for gallbladder disease in Pakistan: A cross-sectional study.

Enteric fever is caused by Salmonella enterica serovars Typhi (S. Typhi) and Paratyphi A, B, and C. It continues to be a significant cause of morbidity and mortality worldwide. In highly endemic areas, children are disproportionately affected, and antimicrobial resistance reduces therapeutic options. It is estimated that 2-5% of enteric fever patients develop chronic asymptomatic infection. These carriers may act as reservoirs of infection; therefore, the prospective identification and treatment of carriers are critical for long-term disease control. We aimed to find the frequency of Salmonella Typhi carriers in patients undergoing cholecystectomy. We also compared the detection limit of culturing versus qPCR in detecting S. Typhi, performed a geospatial analysis of the carriers identified using this study, and evaluated the accuracy of anti-Vi and anti-YncE in identifying chronic typhoid carriage. We performed a cross-sectional study in two centers in Pakistan. Gallbladder specimens were subjected to quantitative PCR (qPCR) and serum samples were analyzed for IgG against YncE and Vi by ELISA. We also mapped the residential location of those with a positive qPCR result. Out of 988 participants, 3.4% had qPCR-positive gallbladder samples (23 S. Typhi and 11 S. Paratyphi). Gallstones were more likely to be qPCR positive than bile and gallbladder tissue. Anti-Vi and YncE were significantly correlated (r = 0.78 p<0.0001) and elevated among carriers as compared to qPCR negative controls, except for anti-Vi response in Paratyphi A. But the discriminatory values of these antigens in identifying carriers from qPCR negative controls were low. The high prevalence of typhoid carriers observed in this study suggests that further studies are required to gain information that will help in controlling future typhoid outbreaks in a superior manner than they are currently being managed.

Salmonella Typhi Haplotype 58 (H58) Biofilm Formation and Genetic Variation in Typhoid Fever Patients with Gallstones in an Endemic Setting in Kenya.

The causative agent of typhoid fever, Salmonella enterica serovar Typhi, is a human restricted pathogen. Human carriers, 90% of whom have gallstones in their gallbladder, continue to shed the pathogen after treatment. The genetic mechanisms involved in establishing the carrier state are poorly understood, but S. Typhi is thought to undergo specific genetic changes within the gallbladder as an adaptive mechanism. In the current study, we aimed to identify biofilm forming ability and the genetic differences in longitudinal clinical S. Typhi isolates from asymptomatic carriers with gallstones in Nairobi, Kenya. Whole genome sequences were analyzed from 22 S. Typhi isolates, 20 from stool and 2 from blood samples, all genotype 4.3.1 (H58). Nineteen strains were from four patients also diagnosed with gallstones, of whom, three had typhoid symptoms and continued to shed S. Typhi after treatment. All isolates had point mutations in the quinolone resistance determining region (QRDR) and only sub-lineage 4.3.1.2EA3 encoded multidrug resistance genes. There was no variation in antimicrobial resistance patterns among strains from the same patient/household. Non-multidrug resistant (MDR), isolates formed significantly stronger biofilms in vitro than the MDR isolates, p<0.001. A point mutation within the treB gene (treB A383T) was observed in strains isolated after clinical resolution from patients living in 75% of the households. Missense mutations in Vi capsular polysaccharide genes, tviE P263S was also observed in 18% of the isolates. This study provides insights into the role of typhoid carriage, biofilm formation, AMR genes and genetic variations in S. Typhi from asymptomatic carriers.

#862 Prevalence and surrogate predictors of acute kidney injury in tropical infections in eastern India

Abstract Background and Aims Acute kidney injury (AKI) in tropical countries is strikingly different from the other countries with a temperate climate. The epidemiology of AKI is largely influenced by environmental factors and climatic conditions and differ significantly its outcome and the surrogate predictors are not much studied. 1. To observe the spectrum and estimate the prevalence of AKI in tropical infections. 2. To evaluate the outcome and surrogate predictor of tropical AKI. Method This was a tertiary level single centre prospective observational study. All patients admitted with tropical infections associated AKI (KDIGO) were enrolled in two years and underwent complete history taking, clinical examinations and necessary laboratory investigations according to situations.. All patients were followed up more than 6 month. All data recorded were analysed in suitable statistical tool. Univariate analysis is followed by multivariate analysis was done for predictors followed by hazards ratio and Neglekers test. Results Out of 132 patients with Tropical AKI M:F was 1.5:1. Mean age was 42.3 ± 14.4 year, About 35.6% had Malaria,31.1% Dengue, 17% Scrub typhus, 10.4% Leptospira, and 5.9% patients had Typhoid fever. Malaria was the most common causative factor followed by Dengue. study reflecting the high dengue incidence occurring in the months of August, September, October &amp; November. Among Malaria AKI (MAKI) 43.75% (21) had Falciparum malaria, 50% (24) had Vivax malaria and 6.25% (3) had dual infection. Out of 132 patients with Tropical AKI about 60% totally recovered at the time of discharge. 40% patients had Shock. Among them 60% Dengue AKI, 33.3% Malarial AKI 5 (21.7%) Scrub typhus, 4 (28.6%) Leptospira AKI &amp; 3 (37%) Typhoid AKI patients had Shock. About 23% patients required RRT. Among them 8 (25%) patients died, 5 (15.6%) patients had CKD progression compared to non-RRT group where only 3 (2.9%) patients died, and 2 (1.94%) patients had progression to CKD. Total 11 (8.1%) patients died during hospital stay and only 7 (6.2%) patients had progressed to CKD. The mean Hospital stay was 5.51 ± 3.8 days. S hock at presentation, requirement of ICU support ( in form of ionotropic and ventilatory support), Need of RRT, prolong hospital stay, late referral was the bad prognostic predictor in terms of death. Though not statistically significant, presence of anaemia, hyponatraemia, deranged liver function &amp; hypoalbuminemia were more in patients who died compared to survival group. Limitations: Small enrolments. non inclusion of all cause including snake bite, less biopsy in this study. Conclusion There are wide spectrum of tropical AKI with high mortality and morbidity. A greater awareness and early intervention is necessary for prompt diagnosis, treatment and favourable outcome.

Prevalence of salmonella infection among the suspected enteric fever patients conducted at secondary hospital, Kathmandu, Nepal

Prevalence of salmonella infection among the suspected enteric fever patients conducted at secondary hospital, Kathmandu, Nepal

CHANGING SYMPTOMATOLOGY IN TYPHOID FEVER: A CROSS SECTIONAL STUDY AT KHYBER TEACHING HOSPITAL, PESHAWAR.

Objectives: To determine the frequency of shivering, intensity of fever, continuity of fever and duration of fever in culture positive patients of typhoid fever admitted to the department of child health, Khyber Teaching Hospital. Materials and Methods: It was a retrospective chart review of 296 patients who were admitted to the department fulfi lling our inclusion criteria. The data included was dated 15th may 2021 to 14 may 2023. The data was collected from HMIS.Results: In Majority (68.2%) of the patients the fever was of shorter duration and high-grade (80%). Only 41 had intermittent fever. Similarly, only 80 (27%) had shivering and chills. Cough was present in 92 (31%) patients. Among these, 72 (78.2%) patients had high-grade fever whereas 20 (21.7%) had low-grade fever, 68 (74%) had fever for a duration of less than 3 weeks, 12(13%) had 3-4 weeks and 12(13%) had a duration of more than 4 weeks. Out of 41 (13.9%) patients with intermittent fever, 9(22%) had a duration of more than 4 weeks.Conclusion: Although, cough, low-grade fever, fever of duration more than 4 weeks, intermittent fever and shivering was present in lesser frequency in patients with typhoid fever, these are still some of the presenting characteristics of fever which should be considered by the treating physician while considering a diagnosis.