Typhoid Research Articles

Trends in typhoid fever during the COVID-19 pandemic in Pakistan.

Pakistan has been experiencing an extensively drug-resistant (XDR) outbreak of typhoid for some years. We sought to evaluate how the COVID-19 pandemic impacted typhoid epidemiology in Pakistan, from the beginning of the pandemic in 2020 through the end of 2022, and the reduction of COVID-19 cases. We compared national public COVID-19 data with retrospectively obtained patient data of confirmed S. Typhi isolates between January 2019 and December 2022 from Shaukat Khanum Memorial Cancer Hospital and Research Centre and the hospital's extended network of laboratory collection centers across Pakistan. We observed that during the early onset of the COVID-19 pandemic and COVID-19 peaks, typhoid positivity generally decreased. This suggests that restrictions and non-pharmaceutical interventions that limited social interactions and promoted good sanitation and hygiene practices had a positive secondary effect on typhoid. This led to an overall yearly decrease in typhoid positivity between 2019 to 2021. However, the percentage of S. Typhi cases isolated that were ceftriaxone-resistant continued to increase, suggesting the continued dominance of XDR typhoid in Pakistan. In 2022, with the alleviation of pandemic restrictions, we observed increased typhoid positivity and COVID-19 and typhoid positivity started to follow similar trends. Given the continued presence of COVID-19 along with XDR typhoid in Pakistan, it will be imperative to use differential testing to ensure that the epidemiology of each reported is accurate, the spread of each it contained, and that antibiotics are not misused. The use of approved vaccinations will lessen the burden of both diseases.

Salmonella Bacteremia in Spanish Pediatric Emergency Departments: Uncommon But Not Mild.

Salmonella spp. is an uncommon microorganism in bloodstream infections among pediatric patients in our setting, although in developing countries it is the most common causative organism in blood cultures. We describe the children presenting to pediatric emergency departments and diagnosed with Salmonella bacteremia (SB) and identify clinical and laboratory predictors of poor outcome (ie, complications, sequelae and death) by bivariate analysis. We performed an observational study and subanalysis of a multicenter prospective registry, including patients <18 years of age with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered young age, chronic diseases, immunosuppressive treatment and intestinal flora disruption as risk factors for SB. Of the 55 patients with SB (3.2% of registered bacteremia), 32 (58.2%) had no risk factors for SB, 42 (76.3%) had a normal pediatric assessment triangle and 45 (81.8%) an associated gastrointestinal infection (acute gastroenteritis or enteric fever). Nine (16.4%) had a poor outcome, including 1 death (1.8%). A poor outcome was more common in patients with an abnormal pediatric assessment triangle [odds ratio (OR): 51.6; 95% confidence interval (CI): 9.2-289.5], an altered physical examination (OR: 15.2; 95% CI: 4.4-58.8) and elevated C-reactive protein (OR: 1.01; 95% CI: 1.005-1.03). Most SBs were related to a gastrointestinal infection. One in 6 children had a poor outcome; abnormal pediatric assessment triangle on arrival (25% of patients) was the main risk factor identified.

The Use of Azithromycin in Pediatric Typhoid Fever without Complication: A Case Report

Typhoid fever is an infection caused by the bacterium Salmonella typhi. The prevalence is still high among emerging countries, such as Indonesia. There are limited options for the treatment of typhoid fever in children and more so is complicated by the emergence of antimicrobial resistance. The use of azithromycin has evolved as an important drug in the treatment of typhoid. A male, aged 7 years and 2 months, was admitted to our hospital with remittent fever 4 days prior. The patient also presented with a period of cough since 2 days, and constipation, with full consciousness. The child had basic immunization completed for his age. He had a history of frequent consumption of street food. The diagnosis of typhoid fever was confirmed by serologic testing of positive 8 IgM Salmonella. Initially, the patient was treated with intravenous antibiotics of ceftriaxone for 8 days but shoed no clinical improvement, then the treatment was changed to intravenous azithromycin for 4 days and his condition improved greatly. The patient showed a better response with the use of azithromycin. The management of typhoid fever remains challenging up to this day with variations in treatment response. From this case, we can conclude that azithromycin in some patients may show better improvement in the management of typhoid fever in pediatric patients. Although, ceftriaxone and other third-generation cephalosporins are still highly effective against Salmonella typhi.

Infections associated with haemophagocytic syndrome: A case report of a rare coexistence with common infections

Infection-associated haemophagocytic syndrome (IAHS) is exceptional in typhoid and tuberculosis co-infections. We encountered a 50-year-old man with a history of pacemaker implantation who was previously treated for typhoid fever and currently presented with a chronic fever and shortness of breath. Initial laboratory tests revealed pancytopenia. A bone marrow aspiration was performed. However, due to cardiac problems, a bone marrow biopsy could not be performed. A bone marrow aspirate was submitted for cell block preparation. The cytology of the bone marrow aspirate revealed hemophagocytosis, which was initially presumed to be secondary to typhoid. Subsequently, cell block preparation of the bone marrow aspirate exhibited numerous granulomas with necrosis suggestive of tuberculosis. The patient was successfully treated with anti-tuberculosis drugs, steroids, and antibiotics. This case highlighted an association between IAHS and a common tropical illness. The usefulness of an aspirate cell block in the absence of biopsy and the potential existence of tuberculosis, especially in tuberculosis-endemic countries is to be noted.

Renal Tuberculosis: A Case History that makes or Breaks the Case, Nothing is more Deceptive

This manuscript presents a compelling case of renal tuberculosis in a 15-year-old male, elucidating the intricate diagnostic hurdles and strategic management approaches encountered. The patient initially presented with nonspecific symptoms, including intermittent low-grade fever, weight loss, fatigue, and diffuse skin rashes, which were initially managed as suspected enteric fever. However, as the patient’s condition deteriorated, a comprehensive diagnostic exploration revealed renal tuberculosis. The report meticulously outlines the clinical presentation, diagnostic evaluation, and therapeutic trajectory, emphasizing the enigmatic nature of symptoms and advocating for a multidimensional diagnostic paradigm integrating clinical, radiological, microbiological, and histopathological assessments. Furthermore, this case report provides a comprehensive review of urogenital tuberculosis, discussing its epidemiological underpinnings, clinical manifestations, diagnostic methodologies, and therapeutic tenets. It underscores the paramount significance of early recognition and prompt initiation of treatment in forestalling complications and optimizing patient outcomes. This case report enriches the medical discourse by shedding light on the diagnostic intricacies and therapeutic imperatives pertinent to renal tuberculosis, especially in the younger demographic. We believe that the findings will contribute significantly to the understanding and management of this disease.

Revealing the mechanism of Dahuang Huanglian Xiexin Decoction attenuates dysbiosis via IL-17 signaling pathway based on network pharmacology and experimental validation

Ethnopharmacological relevanceDahuang Huanglian Xiexin Decoction (XXD), derived from Zhang Zhongjing's Treatise on Typhoid Fever, has a long history of medicinal use and is widely used for digestive system diseases. It is mainly composed of three natural medicines, including Dahuang (Rheum palmatum L.), Huanglian (Coptis chinensis Franch.), and Huangqin (Scutellaria baicalensis Georgi). Modern pharmacological research shows that the active ingredients of XXD can have a positive effect on intestinal flora regulatory effect, but its mechanism of action is unclear. Aims of this studyClarify the effect of XXD on regulating dysbiosis, and elucidate the mechanism of XXD in alleviating dysbiosis based on network pharmacology, molecular docking and experimental verification. MethodsHistopathological observation and intestinal high-throughput sequencing were used to observe the effect. Preliminary prediction of the mechanism of action of XXD in treating dysbiosis through network pharmacology and molecular docking. Finally, the effect of XXD on the IL-17 signaling pathway was verified through in vivo experiments. ResultsHistopathology and high-throughput sequencing of intestinal flora indicated that XXD has a good regulatory effect on bacterial dysbiosis. At the same time, network pharmacology identified a total of 40 active compounds, 14 of which may be key compounds for XXD to treat dysbiosis. In addition, the study also revealed 14 potential key targets as well as the top 5 therapeutic targets: IL-6, TNF-α, IL-1β, TP53 and PTGS2. GO and KEGG predicted the key pathway for IL-17 signaling pathway to play a role in XXD. In the verification of the prediction results, it was found that the above targets and the IL-17 target showed strong activity in molecular docking. Furthermore, it was found that XXD can reduce the levels of IL-17, IL-6, TNF-α, IL-1β, p53 and COX-2 in serum, while inhibiting the expression of IL-17, IL-17RA, Act-1 and NF-κB protein and the mRNA expression of IL-17, IL-17RA and Act-1 in colon tissue. ConclusionsThis study found that XXD has a good regulatory effect on dysbiosis and its induced symptoms. Network pharmacology was used to predict the key compounds and therapeutic targets of XXD, and preliminary experiments confirmed that XXD may regulate bacterial dysbiosis by inhibiting the IL-17 signaling pathway.

Identification of Salmonella Enterica Serovar Typhi DNA by loop-mediated isothermal amplification with fluorescent detection

Introduction. Real-time PCR may be used along with loop isothermal amplification method (LAMP) allowing to conduct the study in 30–40 minutes to diagnose typhoid fever. Several LAMP assay variations for detecting Salmonella enterica serovar Typhi have been described. The studies report that relevant primers were tested on strains specific for Malaysia and China. We attempted to evaluate the LAMP primers described above for identifying S. Typhi strains specific for the Russian Federation and compare their sensitivity and specificity with each other. Materials and methods. A comparative in silico analysis of target sequences was carried out both in the open NCBI database and among the genetic sequences of collection strains at the St. Petersburg Pasteur Institute. Several sets of primers for LAMP amplification of various S. Typhi genome regions were tested. The tested primers amplify the following fragments: SalTyp1 — region of the STY1607 gene, SalTyp2 — region of the STY2879 gene, SalTyp3 — region of the STBHUCCB_38510 gene of the PapD chaperone. Results. In silico analysis of LAMP primers showed that only the SalTyp 3 set has strict specificity for Salmonella enterica serovar Typhi. For the SalTyp 1 and SalTyp 2 an opportunity of false-positive reactions with some E. coli strains was shown. A LAMP method for DNA fluorescent detection of the typhoid fever causative agent was chosen. Assay has been based on a marker gene termed STBHUCCB_38510 and amplification with six specific primers. The detection limit was 20 copies/reaction in reference plasmids and the reaction time lasted for 35 minutes. The specificity of the method was tested on DNA specimens of 20 S. Typhi isolates and 90 strains of other heterologous bacteria from 24 different species. No false positive or false negative results were identified. Conclusion. The developed method can be used in clinical practice for laboratory confirmation of typhoid fever diagnosis as a part of epidemiological monitoring of environmental objects as well as food products.

Typhoid fever in children in Goroka, Papua New Guinea.

Typhoid is endemic in many low-income countries, including in Papua New Guinea. This study aimed to describe the burden and clinical features of typhoid in children in a provincial hospital, to describe environmental conditions that lead to typhoid, and to document the antibiotic sensitivity of Salmonella spp. in the Eastern Highlands Province. A combined retrospective and prospective study of children admitted to with clinical features of typhoid to the Goroka Hospital throughout 2022. The study included 98 children, of which 54% were female. The median age was 8 (IQR 5-10.6) years. Over 60% of the patients were from Goroka District, the peri-urban area encompassing the town and surrounds. Ninety-four percent (92) of the patients used a pit latrine as a toilet and only 28% had access to treated water. Neuropsychiatric symptoms were common (60%), as was leukopenia (48%), thrombocytopenia (52%) and anaemia (42%). Thirty-seven patients had positive blood cultures for Salmonella typhi; all isolates were sensitive to third-generation cephalosporins, pefloxacin, ampicillin, trimethoprim and sulfamethoxazole, and only 54% sensitive to chloramphenicol. The median duration of hospitalisation was 6 days (IQR). There were no deaths. Prompt public health actions are needed to reduce the burden of typhoid infection in the Papua New Guinea. The conjugate typhoid vaccine should be considered in the highlands region, where typhoid is most endemic.

Association between clinical symptoms during the COVID-19 infection and SARS-CoV-2 immunoglobulin G titers in COVID-19 convalescent whole-blood donors in China.

Limited studies have explored the association between clinical symptoms and titers of SARS-CoV-2 antibodies. In this cross-sectional study, whole-blood donors who had experienced a confirmed or suspected COVID-19 infection completed questionnaires at the time of blood donation. Plasma SARS-CoV-2 immunoglobulin G (IgG) titers were measured using an enzyme-linked immunosorbent assay. Logistic regression models were used to calculate odds ratios (ORs) for high-titer COVID-19 convalescent plasma (CCP) for each variable. Among the total 386 donors, 120 (31%) donors with IgG titers ≥1:160 were classified as high-titer donors. The multivariable ORs (95% confidence intervals [CIs]) for high titers were 2.33 (1.45-3.75), 2.11 (1.29-3.43), 1.10 (1.01-1.21), 1.19 (1.00-1.43), and 1.97 (1.05-3.71) for sore throat, cough, symptom count, fever duration, and low fever (compared with non-fever), respectively. No significant association was observed between other symptoms and medical visits and the odds of high-titer CCP. The association between high-titer CCP and fever duration was restricted to confirmed COVID-19-infected donors, while associations with sore throat and cough remained significant in suspected infected donors. In addition, medical visit was positively associated with high-titer CCP in suspected donors, but not in confirmed donors. In bootstrapped logistic regression models, the associations remained significant and reproducible for medical visit in suspected donors and for sore throat and cough in both suspected donors and total donors. Experiencing a sore throat and cough were associated with high-titer CCP in overall donors. We also identified sore throat, cough, and medical visits as potential predictors of high-titer CCP for suspected donors during the pandemic.

Socio-Demographic Factors Affecting the Prevalence of Typhoid Fever Among Febrile Patients in Kebbi State, Nigeria

Typhoid fever is a life-threatening public health disease caused by the bacterium Salmonella Typhi. The disease is a significant health concern in underdeveloped and most developing countries, especially in Asia and Africa (including Nigeria). The study was aimed at determining the prevalence and sociodemographic factors associated with typhoid fever among febrile patients attending three selected hospitals in Kebbi State, Nigeria. A hospital based cross sectional study was carried out among 406 febrile patients suspected of typhoid fever aged 1-70 years (mean age 34 years) in three selected health facilities of Kebbi State, Nigeria from February2021 to October, 2021. Approximately 20 ml and 10 ml of venous blood was collected from adults and children respectively. Blood culture and biochemical tests were carried out. Patients were administered structured questionnaires to evaluate the level of knowledge and practice toward the disease. Data obtained from respondents was analysed by descriptive statistics. In this study, the culture identified Salmonella Typhi prevalence of typhoid fever among febrile study subjects in Kebbi State was 6.4%. A higher prevalence was recorded among males (7.5%) than in females (5.0%) participants. Patients within the age range of 11- 20 years had the highest prevalence (14.8%), those with informal education recorded 11.2%. It was observed that rural area dwellers had higher prevalence (9.4%). Out of 26 isolates, 25 were susceptible to cefotaxime, 11 isolates were resistant to cotrimoxazole and amoxicillin-clavulanate antibiotics. Salmonella enterica serovar Typhi is an important and common cause of febrile illness in our population. Lack of good quality drinking water in rural areas has a greater impact on the burden of typhoid fever among study participants. Cefotaxime and ciprofloxacin therapy are suitable treatments for typhoid fever. The identification of sociodemographic characteristics associated with the disease are of great importance in providing holistic preventive approach and control strategies of the disease.

Non-specific protection against severe COVID-19 associated to typhoid fever and DTP vaccination

Trained immunity (TRAIM) or the enhanced non-specific immune response after primary stimulation by infection or vaccination is a recent but well-recognized concept. To verify its predictions, our objective was to determine the effects of two bacterial vaccines, typhoid fever (TFV) and diphtheria-tetanus-pertussis (DTP) on the infection, hospitalization and death frequencies associated to COVID-19 in a retrospective study on subjects vaccinated or not with TFV and DTP in the 4 years prior to the start of COVID-19 pandemia in the Basque Country (Spain). The studied outcome records were split into two periods according to COVID-19 vaccination, the pre-vaccination (ACV) from March to December 2020 and the post-vaccination (PCV) from September 2021 to June 2022). In total, 13,673 subjects were vaccinated against TFV and 42,997 against DTP.A total of 2,005,084 individual records were studied in the ACV period and 1,436,693 in the PCV period. The proportion of infection, hospitalization and death associated to COVID-19 among controls in ACV was 4.97 %, 7.14 % and 3.54 %, respectively vs. 7.20 %, 2.24 % and 0.10 % among TFV subjects. Regarding DTP, the proportions were 4.97 %, 7.12 % and 3.58 % for controls and 5.79 %, 5.79 % and 0.80 % for vaccinees. In the PCV period, the proportion of infection, hospitalization and death among controls was 21.89 %, 2.62 % and 0.92 %, respectively vs. 31.19 %, 0.76 %, 0.00 % among TFV. For DTP, infection, hospitalization and death proportions were 21.89 %, 2.62 % and 0.92 %, respectively, among controls vs. 32.03 %, 1.85 % and 0.24 % among vaccinated subjects. The corresponding combined ACV and PCV odds ratios (OR) for SARS-CoV2 infection were 1.505 (95%CI 1.455–1.558; p < 0.0001; reduction −41.85 %) and 1.633 (95%CI 1.603–1.662; p < 0.0001; reduction −51.74 %), for TFV and DTP, respectively. Regarding COVID-19 associated hospitalization, the OR were 0.295 (95%CI 0.220–0.396; p = 0.0001; reduction 69.74 %) and 0.667 (95%CI 0.601–0.741; p = 0.0001; reduction 32.44 %), for TFV and DTP, respectively). COVID-19 associated death OR were 0.016 (95%CI 0.002–0.113, p < 0.0001; reduction 98.38 %) and 0.212 (95%CI 0.161–0.280; p = 0.0001; reduction 78.52 %), for TFV and DTP, respectively. We conclude that TRAIM effects by TFV and DTP vaccination in the four years prior to the pandemic SARS-CoV2 were supported by slightly increased infection rates, but strongly reduced COVID-19 associated hospitalization and death rates.

Effect of Enteric Fever on Hematological Cells Parameters

Background: Salmonella typhoid and paratyphoid are the agents that cause Enteric fever (Typhoid fever). It is primarily a disease of developing countries because of poor sanitation standards. Fever is a prominent and well-known feature of the illness that increases steadily to a maximum degree. The hematological criteria of an affected individual are changed by this infectious disease. To ascertain the different hematological cells parameters in our sample population, we conducted the investigation. Patients and Methodology: The study, which involved 100 Afghans, was carried out at the Nangarhar University Teaching Hospital between June and November of 2022. A case-control study design was used. Fifty individuals (Cases) who had a confirmed diagnosis of Enteric fever (Typhoid fever) based on typhoid (IgG and IgM) were included in the study. As a control group, fifty healthy individuals with negative typhoid (IgG and IgM) results and no other complaints were included in the study. For both the case and control groups, a complete blood count was performed. Hemoglobin (Hb), White Blood Cell Count (WBC), and Platelet Count (PLT) are regarded as hematological markers. Every patient was also interviewed, and a questionnaire was employed. Numerous demographic factors were questioned, including sex, age, economic status, level of education, and clinical symptoms. SPSS version 16 was then used to analyze the collected data. Results. In the current research, over all 100 patients were enrolled (50 were case, and 50 were control group). The mean age± SD of the patients under the study were 38.74±15.22 years. The most common hematological changes observed were; anemia (32%), thrombocytopenia (24%), leukocytosis (8%) &amp; leucopenia (22%). Fever was the most common presenting symptom (78%) and abdominal symptoms were about 38%. Most of the people were of lower socioeconomic state and were uneducated. Conclusion: This study shows that Enteric fever is bacterial infection and are acquired by enteral route. This disease commonly affects people of low socioeconomical states and those that are uneducated. Fever was the most commonly presenting symptom in these patients. Enteric fever causes changes in the hematological cells parameters which is probably due to bone marrow suppression, which is transient and shows response to therapy.

Phytochemistry and Evaluation of Acute Toxicity of Aqueous and Hydroethanolic Extracts of Pavetta corymbosa Leaves (Rubiaceae)

Pavetta corymbosa (Rubiaceae) is a plant widely known in sub-Saharan Africa in the field of traditional medicine. It is used empirically against certain pathologies such as malaria, diabetes, hemorrhages and typhoid fever. However, there is no scientific data on its phytochemical and biological profile, so this study was carried out to research the chemical groups contained in the leaves of this plant and determine the toxicological parameters which would justify its use in traditional medicine. Several standard characterization methods were used for phytochemical screening of aqueous and hydroethanolic extracts of Pavetta corymbosa leaves. The study of the acute toxicity of the two types of extracts from the leaves of this plant was carried out according to the OECD guideline 423 using Wistar rats. Phytochemical screening indicated the existence of polyphenols, saponosides, quinones, flavonoids, polyterpenes and sterols in the two types of extracts of this plant, which would justify its biological and pharmacological effects. The study of the acute toxicity of these two types of extracts, administered intraperitoneally to Wistar rats, showed no mortality of the rats. These toxicological results allow us to qualify the leaves of Pavetta corymbosa as being non-toxic, hence the interest in its use in traditional medicine against certain pathologies.

The increasing healthcare burden of enteric fever in a low-incidence setting

ObjectivesEnteric fever carries appreciable morbidity in non-endemic settings, particularly in returned travelers. This study aimed to characterize the healthcare burden of enteric fever in a low-incidence setting and to identify risk factors and opportunities for preventative interventions. MethodsAnalysis of a retrospective case series from a tertiary pediatric center (2015–2019), augmented by public health notification and microbiological laboratory data (2018–2019), from Western Sydney, Australia, a region with frequent travel links to South Asia. ResultsEighty-nine (89) patients were diagnosed with enteric fever, including 43 children with complete demographic and travel data. Enteric fever cases increased over time (by 4.9 % per year) and incidence was three times higher in the pediatric population (<15 years old) compared to adults. Travel to India and visiting friends and relatives (VFR) travel were risk factors. Few children received enteric fever vaccination prior to travel, as pre-travel advice most commonly was not sought. ConclusionsChildren visiting relatives in high-incidence countries are increasingly at risk for enteric fever, particularly when travelling to South Asia. Targeted health advice to travelers visiting friends and relatives is warranted to mitigate the healthcare burden of enteric fever in low-incidence settings.

A Reaction-diffusion System Modeling the Transmission of Typhoid Fever in a Periodic Environment

Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi, and it is still an important issue in developing countries. There are two infection routes of Typhoid fever, namely, the human-to-human transmission and the environment-to-human transmission. It is evident that people living near rivers may have a higher rate of typhoid infection, and temperature changes also have significant impacts on Typhoid transmission dynamics. In the model, the population of human will be divided into susceptible individuals, infected individuals, carrier individuals, individuals under treatment, and recovered individuals. Then a periodic dispersion-reaction system is used to describe the transport and the interactions between human and bacteria in the environment. The solution maps of the proposed periodic dispersion-reaction system lack the compactness since the population under treatment has no diffusion term, which makes analysis more difficult. After the feasible domain is chosen carefully, the eventually boundedness of the solutions can be established, and the loss of compactness is overcome if the initial data is chosen from the feasible domain. In order to introduce the reproduction number &amp;lt;I&amp;gt;R&amp;lt;sub&amp;gt;0&amp;lt;/sub&amp;gt;&amp;lt;/I&amp;gt;, the linearized system around the disease-free state is constructed, and the basic reproduction number is defined as the spectral radius of the next generation operator. Then the comparison principle and persistence theory can be utilized to establish that the index &amp;lt;I&amp;gt;R&amp;lt;sub&amp;gt;0&amp;lt;/sub&amp;gt;&amp;lt;/I&amp;gt; completely determines the threshold behavior of the typhoid spread. Brief mathematical and biological interpretations are also presented.

Predominance of multidrug-resistant Salmonella Typhi genotype 4.3.1 with low-level ciprofloxacin resistance in Zanzibar.

Typhoid fever is a common cause of febrile illness in low- and middle-income countries. While multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) has spread globally, fluoroquinolone resistance has mainly affected Asia. Consecutively, 1038 blood cultures were obtained from patients of all age groups with fever and/or suspicion of serious systemic infection admitted at Mnazi Mmoja Hospital, Zanzibar in 2015-2016. S. Typhi were analyzed with antimicrobial susceptibility testing and with short read (61 strains) and long read (9 strains) whole genome sequencing, including three S. Typhi strains isolated in a pilot study 2012-2013. Sixty-three S. Typhi isolates (98%) were MDR carrying blaTEM-1B, sul1 and sul2, dfrA7 and catA1 genes. Low-level ciprofloxacin resistance was detected in 69% (43/62), with a single gyrase mutation gyrA-D87G in 41 strains, and a single gyrA-S83F mutation in the non-MDR strain. All isolates were susceptible to ceftriaxone and azithromycin. All MDR isolates belonged to genotype 4.3.1 lineage I (4.3.1.1), with the antimicrobial resistance determinants located on a composite transposon integrated into the chromosome. Phylogenetically, the MDR subgroup with ciprofloxacin resistance clusters together with two external isolates. We report a high rate of MDR and low-level ciprofloxacin resistant S. Typhi circulating in Zanzibar, belonging to genotype 4.3.1.1, which is widespread in Southeast Asia and African countries and associated with low-level ciprofloxacin resistance. Few therapeutic options are available for treatment of typhoid fever in the study setting. Surveillance of the prevalence, spread and antimicrobial susceptibility of S. Typhi can guide treatment and control efforts.

SPECIFIC BIOCHEMICAL INDICATORS AND INFLAMMATORY MARKERS IN RHEUMATOID ARTHRITIS (RA)

It is acknown that Rheumatoid inflammation is a chronic systemic autoimmune disease developing on the background of infection. Damages mainly the heart, blood vessels, musculoskeletal system and other internal organs. Multiple joints may be affected, primarily the knee, ankle and elbow undergoing destruction leads to pain, mainly symmetrical. Damaged joints swollen and skin in these foci reddens; joint morning stiffness lasts for an hour or more, this sign is accompanied by low fever and fatigue. As a result of the rheumatic process, the heart is damaged, leading to cardiovascular manifestations. Analysis of blood parameters allows the severity of the disease to be determined based on a relatively new method using Das28. The obtained results for ESR and CRP are used to calculate DAS28, which also allows monitoring of RA treatment. Most patients with rheumatoid arthritis (RA) are seropositive—they have abnormally high levels of rheumatoid factor (RF) or anti-citrullinated peptide antibodies (anti-CPP) in the blood. The article examines aspects of synthetic, chemical and alternative medicine impact on treating patients with RA as well. The article discusses comparative aspects of pharmacological and herbal medicine in the therapeutics. According to the literature, patients who have not received the expected results after treatment with pharmacological preparations successfully use herbal remedies as a means of body restoring and healing. To date, the success of traditional medicine is ahead of those of conventional using synthetic drugs.

Erasmus syndrome: A rare case report

Erasmus syndrome is a rare clinical entity in which systemic sclerosis develops following exposure to silica with or without development of silicosis. There are very few cases reported in literature from India. Here we report a case of Erasmus syndrome in a 52 years male who is a stone crusher by occupation for last 22 years presented with dry cough, low grade irregular fever, progressive shortness of breath, slowly progressive sclerodactyly and features suggestive of Raynaud’s phenomenon. Radiological evaluations revealed multiple subpleural and centrilobular nodules in bilateral upper, lower lobes and right middle lobe, conglomerated nodular opacities (progressive massive fibrosis- PMF). There was pleural thickening and calcification, bronchial dilatation and fibrosis, calcified right hilar and mediastinal lymphadenopathy. Serological markers like Anti Scl-70 antibody came out to be positive (3+) Based on clinical features diagnosis of systemic sclerosis was made. Based on exposure history and radiology silicosis was diagnosed. Association of silicosis and systemic sclerosis establishes the diagnosis of Erasmus syndrome. Treatment was started with Prednisone, cyclophosphamide and Nifedipine. Strict avoidance to cold and regular follow-up was advised.

Antibacterial activity of Shallots (Allium xwakegi Araki.) cultivars in Palu Valley against Salmonella Typhi ATCC 27870 through in vitro and in silico evaluation

Background and Objectives: Shallots, recognized for their minimal toxicity, cost-effectiveness, and widespread avail- ability, are increasingly considered a viable source of biological activity. This study evaluates the antibacterial efficacy of a specific shallot cultivar from Palu Valley, Indonesia, against Salmonella typhi, the pathogen responsible for typhoid fever. Materials and Methods: Utilizing thin-layer chromatography (TLC-bioautography) and gas chromatography-mass spec- troscopy (GC-MS), the study identifies active compounds in shallot ethanol extract and employs molecular docking to assess interactions between receptors and ligands. Results: Findings indicate significant antibacterial activity, with a notable inhibition zone diameter of 31.5 mm at spot Rf 0.28 in TLC bioautography and an optimum concentration of 2% yielding an average clear zone diameter of 28.27 mm in the agar diffusion test. GC-MS analysis reveals 41 compounds, predominantly dodecanoic acid and 1,2,3-propanetriyl ester. Ad- ditionally, molecular docking reveals the lowest binding affinity (-7.3 kcal/mol) for Ergost-8-En-3-Ol, 14-Methyl-, (3.Beta,5. Alpha.) against DNA gyrase. Conclusion: This study confirms Palu Valley shallot extract's potent antibacterial effect against Salmonella typhi, highlight- ing its therapeutic potential.

Nuclear factor kappa B-dependent persistence of Salmonella Typhi and Paratyphi in human macrophages.

Salmonella enterica is a common cause of gastrointestinal infections worldwide. The serovars Salmonella Typhi and Salmonella Paratyphi A cause a distinctive systemic illness called enteric fever, whose pathogenesis is incompletely understood. Here, we show that enteric fever Salmonella serovars lack 12 specific virulence factors possessed by nontyphoidal Salmonella serovars, which allow the enteric fever serovars to persist within human macrophages. We propose that this fundamental difference in the interaction of Salmonella with human macrophages is responsible for the chronicity of typhoid and paratyphoid fever, suggesting that targeting the nuclear factor κB (NF-κB) complex responsible for macrophage survival could facilitate the clearance of persistent bacterial infections.