Oh et al. and Laditan reported that, in their series, hepatomegaly was almost twice as frequently observed as splenomegaly (Laditan, 1981; Yaramis, 2001; Oh, 1997). Splenomegaly is found in 28.2 % of patientsin our study and most studies have reported it in 30-61% of young children (Mishra, 1991; Ahmet Yaramis, 2001; Mulligan, 1971; Kapoor et al., 1985; Duggan, 1975; Scagg, 1969). Rose spots were seen in 1% of blood culture negative patients. Rose spots are seen in minority of patients and are difficult to recognize in dark skinned individuals. Cutaneous involvement with S.typhi is common, including characteristic skin lesion associated with typhoid fever described as rose spots and is seen in 3% of patients in a study from Bangladesh (Ahmet Yaramis, 2001; Fig. 1. Distribution of clinical profile (Symptoms%) in blood culture positive typhoid fever patients
from acute illness. Overall, some 1-5% of typhoid fever patients become chronic carriers. The rate of carriage is slightly higher among female patients, patients older than 50 years, and patients with cholelithiasis or schistosomiasis. If cholelithiasis or schistosomiasis is present the patient probably requires cholecystectomy or antiparasitic medication in addition to antibiotics in order to achieve bacteriological cure. In order to eradicate S. typhi carriage, amoxicillin or ampicillin (100 mg per kg per day) plus probenecid (1 g orally or 25 mg per kg for children) or TMP-SMZ (160 to 800 mg twice daily) is administered for six weeks; about 60% of persons treated with either regimen can be expected to have negative cultures on follow-up. Clearance of up to 80% of chronic carriers can be achieved with the administration of 750 mg of ciprofloxacin twice daily for 28 days or 400 mg of norfloxacin. Other quinolone drugs may yield similar results. Carriers should be excluded from any activities involving food preparation and serving, as should convalescent patients and any persons with possible symptoms of typhoid fever. Although it would be difficult for typhoid carriers in developing countries to follow this recommendation, food handlers should not resume their duties until they have had three negative stool cultures at least one month apart.
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Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered.
Approximately 3–4 g of stool was collected by a sterile wide-mouthed plastic container from those who had clinical symptoms of typhoid fever and visited the laboratory for Widal test. Then a piece of stool was taken by using wire loop and streaked on xylose lysine deoxycholate (Oxoid Ltd, UK, code CM 0469) and MacConkey agar (Oxoid) and incubated at 37°C for 24 h. Then S. enterica serotype Typhi was identi- fied by biochemical tests used to identify Enterobacteriaceae according to the method described in Clinical and Laboratory Standards Institute. 21,22 Sterility of the prepared culture media
Patients. Children consecutively admitted to AHC with a documented fever of ³ 38 °C within 48 hours of admission who were < 16 years of age were eligible for entry to the study. There were two periods of prospective study recruitment. The first period was between April and May of 2009 (N = 125), and it was the subject of a previous report. 12 The second period of recruitment was between March and August of 2010 (N = 375), and it was part of a larger 1-year study of the causes of fever among children admitted to this hospital that is reported elsewhere. 16 The two periods of recruitment were chosen to be during the season in which typhoid fever is most common in Cambodia. Blood was collected from the patients on admission and discharge where possible. Five hundred children were included in this study of typhoid rapid diagnos- tic tests if sufficient admission whole-blood and serum blood samples were available for analysis.
ABSTRACT: In present study total 2352 samples were collected out of that 21.04% were positive for Typhoid fever while 78.95% were negative. The sex wise distribution results showed male are more effected (12.71%) as compare to female (8.33%). However, the age wise distribution showed that 10.45% in 6-10 years, 6.54% in 3-6 years and 4.03% in 1-3 years. Moreover, the Typhoid fever cases were significantly high (8.41%) in Pashtoon followed by (6.93%) in Baloch, (4.16%) in Punjabi and (1.53%) in Hazara. The 11.60 % Typhoid fever was observed in the patients with low socioeconomic status, 6.67% in middle socioeconomic status and 2.76% in the patients belonged to high socioeconomic status. The electrolytes imbalance results revealed that Sodium was low in 9.82% patients and Potassium was low in 7.21% patients while the calcium was low in 4.01% Typhoid patients. The significant Typhoid fever cases were reported in July (2.97%) August (3.13%) and September (3.92%) as compared to other months of the year .
After institution ethical committee approval , informed and written consent was obtained from parents/ guardians of the subjects. Detailed epidemiological history and clinical examination was done according to pre designed proforma. .Socio economic status was graded according to modified kuppusamy‟s scale.All subjects included in this study were undergone complete hemogram, Liver function test, USG abdomen, blood culture and sensitivity, Widal,and Typhidot–M test. All variables including socio economic details, clinical signs and symptoms and the results of laboratory tests was recorded. and analysed using IBM SSPS 22 version.The findings will be tabulated in percentage and mean standard deviation will be calculated wherever applicable..
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Prospective and retrospective hospital-, laboratory- and community-based studies were included, if they met the spe- cified inclusion criteria. Review articles were scanned for rele- vant references. Studies were screened at title, abstract and full-text stage by one author (CD) and reviewed by a second author (AB). Data were extracted into a predefined database by AB and reviewed by BKH and JL. Additionally, 20% of the extracted studies were checked by a third reviewer (CD). Disagreements were resolved by discussion. Susceptibility data for antimicrobials recommended for the treatment of enteric fever by WHO, i.e. ampicillin/amoxicillin, chloram- phenicol, trimethoprim-sulphamethoxazole (co-trimoxazole), fluoroquinolones (e.g. ciprofloxacin and ofloxacin), third- generation cephalosporins (e.g. ceftriaxone and cefixime) and azithromycin, were extracted . Furthermore, multidrug resistance (MDR; defined as resistance to ampicillin/amoxi- cillin, chloramphenicol and co-trimoxazole) and nalidixic acid resistance, as a proxy marker for reduced ciprofloxacin susceptibility, were recorded .
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efficacy data on Typbar-TCV from field trials. Although promis- ing, it is important to remember that human challenge studies are inherently small. In addition, the bacterial load and the timing of vaccination in relation to the challenge are highly controlled. These studies cannot replace large-scale real-life RCTs as sole evi- dence for approval of new vaccines but could be incorporated into a more efficient approval process. An RCT assessed Typbar-TCV versus ViPS for immunogenicity and safety in people aged 2 to 45 years old (Mohan 2015). Infants and children aged 6 to 23 months were observed in a non-controlled parallel trial. As there was no placebo control group, the trial could not assess adverse events from Typbar-TCV, but these were reported as similar with TCV and ViPs, fever being the most common, with a single serious adverse event deemed unrelated to the vaccine. In an observational group of children under two years in the same study, authors again described adverse events as uncommon, with fever being the most usual (Mohan 2015).
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infrastructure. The prosperity of the colony rested on the health of its people. Because of the failure of the government to recognise the value of strong public health legislation it was up to the medical profession and the community to be vigilant and take the challenge to the government. This study has found that throughout the second half of the nineteenth century the medical profession and the community with the support of various newspapers had to challenge the government on public health issues consistently in relation to typhoid fever. This political pressure was more successful in Toowoomba where William Groom’s leadership achieved some important engineering solutions whereas campaigns in the capital, Brisbane, were marked by diversity and divisions. Intransigent colonial government policy condemned both cities to inadequate sanitation infrastructure until the
group, whereas other reports show a more even distribution but confirm that typhoid is an uncommon but serious infection in patients over 20 (Butler et al., 1991, Lin et al., 2000). In industrialized countries the majority of S. typhi infections are acquired abroad. Infection is acquired by ingestion of contaminated food and water or contact with a patient or carrier of the disease. It is restricted in host range to human beings, and there is no known animal reservoir. The incidence of typhoid is falling worldwide due to improvements in public health, such as provision of clean water and good sewage systems, but it still remains a major threat to human health.
Durani and Rab 14 reported that classical pattern of step-ladder fever associated with relative bradycardia was not seen in most patients. Twenty-two percent cases had sudden onset of high grade fever and of them majority were clinically diagnosed as septicaemia. Diarrhoea, hepatomegaly and jaundice are not commonly encountered. Diagnoses of viral hepatitis, bronchitis, psychosis, meningitis, myocarditis, polyneuropathy and proximal myopathy were also made based on the presenting signs and symptoms. Neuropsychiatric manifestations were less frequent as compared to 45% cases reported from India 9,12 . In a study Dutta and associates 15 reported
compared with control, the ViPS vaccine provided significant pro- tection in children 2 to 5 years of age two years after vaccina- tion. However, contrary to these results, the cluster-RCT con- ducted in Pakistan (Khan 2012 PAK) did not show any protec- tion among children between two and five years of age compared with placebo. The reasons for the difference in effectiveness by age are unclear. The two trials differed in methodology, with the trial in India taking a mass vaccination approach (vaccinating the entire population) and the trial in Pakistan targeting only chil- dren. The trial conducted in India, which took a mass vaccina- tion approach, demonstrated indirect protection (herd immunity) within the population under study; this was not seen in the trial in Pakistan, in which only children were vaccinated. It may be that this indirect protection led to reduced overall transmission within the intervention clusters and a reduced incidence of typhoid fever among young children compared with control clusters observed within the Indian trial.
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emptying the night-buckets in the prison yard to be washed away into the drain was discontinued in 1887. A yard had been established for the placement of large tubs into which the night-buckets were emptied each morning to be emptied by the ‘city scavengers twice a week’. Unfortunately, this yard was also the area where the prisoners ‘had to take their food and exercise’. The earth closets in the yards were also emptied twice a week. 124 Prison regulations stated that prisoners were required to have a bath on arrival and ‘one every week thereafter’. The bathing regulation was not strictly enforced and some prisoners did not have a bath for months. The Board of Inquiry noted that there was ‘an epidemic of mild typhoid’, but the doctor alleged that the disease was brought into the gaol, and did not arise from any defects of sanitation. 125 However, the Board pointed out that there was a rule that ‘all prisoners shall, upon their admission, be inspected by the surgeon, and be thoroughly washed and cleaned previous to being placed with other prisoners’. The object of the rule was to prevent contagious or infectious disease being imported into the gaol, and the Board stated that the epidemic of typhoid must have occurred by ‘non-
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Among patients with positive malarial parasitemia, 5.3% were co-infected with iNTS serotypes isolated by stool culture. The incidence of iNTS among patients with positive malarial parasitemia was recorded elsewhere. In Ghana, Nelsen  found that 6% of P. falciparum parasitemic positive children were co- infected with iNTS while in Kenya, Berkley  found that 3,0% of children had iNTS and malaria co-infection. However, our findings are consistent with study by Chakrabart  that showed that iNTS is more likely to occur in children than in adult’s population. In response to the relative lack of sound epidemiological data for invasive Salmonellosis in sub-Saharan, in 2009, the Bill & Melinda Gates Foundation funded the International Vaccine Institute to conduct the Typhoid Surveillance in Africa Program (TSAP); a multicountry surveillance study aimed at bridging knowledge gaps on the population incidence of typhoid and iNTS infections in sub-Saharan Africa . INTS serotypes cause a self-limited gastroenteritis in immunocompetent individuals, while children with severe Plasmodium falciparum malaria can develop a life-threatening infection. Takem  had hypothesized that malaria increases the risk of iNTS bacteraemia in those who are already infected (carriers).
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Children aged 2 months to 14 years were screened for eli- gibility during study hours from 7am to 7pm, Monday to Sunday. Children with fever of 3 or more days prior to admission, or fever of less than 3 days but with at least one severity criteria (respiratory distress, deep breathing, respiratory distress in combination with severe pallor, prostration, capillary refill ≥ 3 seconds, temperature gra- dient, systolic blood pressure < 70 mm Hg, coma defined by Glasgow Coma Scale ≤ 10 or Blantyre Coma Scale ≤ 2, severe jaundice, history of 2 or more convulsions in the last 24 hours, blood glucose < 3 mmol associated with clinical signs, neck stiffness, bulging fontanel, or oxygen saturation < 90%) were recruited into the study. All clini- cal information was recorded on a standard case record form. Treatment was provided according to national guidelines. On admission we collected 3 to 5 milliliters (ml) of blood (depending on body weight) from each eli- gible child for the Widal test and a single blood culture. All clinical procedures were performed by trained study clinical officers and nurses under the supervision of study physicians.
Blood culture has limited and inconsistent use among the laboratories. Although, this is the second best method for the diagnosis of typhoid fever, because of duration of investigation, (usually between 5 and8 days) both the patient and the laboratory personnel are usually negatively disposed to this method. Patients will only appear for laboratory test when all self- medications have failed and at this point, they can no longer wait but needed a result to either confirm or not their self-diagnosis. Blood culture will equally provide information about the species being isolated and the susceptibility pattern of the isolates especially in view of multidrug resistance being reported among Salmonella sp [16-18]. This method in combination with stool culture is important for epidemiological studies . Molecular characterization is only possible if and when proper cultural techniques are put in place. This further reinforces the need for all clinical diagnostic laboratories in the study area to add cultural methods to serological method, if they must continue to be relevant in the diagnosis of typhoid fever. The higher number of cultures recorded among the government laboratories in stool and blood culture are likely due to government assistance which invariably reduces cost and increases patronage.
All the isolates of Salmonella typhi were found to be Gram-negative rods with polar flagellation and negative to indole and urease tests but positive to coagulase and catalase tests. A total of 125 students were tested for typhoid fever, of these 94 students tested positive to Salmonella typhi constituting 75.2% prevalence, using stool culture (Table 1) and 80 tested positive using Widal test, giving a prevalence of 69.6% of the study population. A low prevalence was obtained from the use of Widal test kits when compared to the stool culture technique (75.2% and 69.6%, respectively) and this could suggest that the typhoid infection in the studied subjects was recent and antibodies had not been generated enough to be detected using Widal test in some of the samples. Therefore, in this study stool culture method where the growth of Salmonella typhi was evidence of infection, was relied upon.
Besides being used as a correction factor in the meas- urement of disease burden estimates which play crucial role in policy making, the proportion of typhoid fever cases detected is important for clinicians. Even if the blood culture is negative for typhoid fever, the person still may be suffering from the disease and need treat- ment. Thus understanding how many typhoid fever cases are actually detected by blood culture has critical importance for clinicians who would treat the patients, epidemiologists who estimate the disease incidence and policy makers who would use the data for decisions on control measures. As we argued that the blood culture sensitivity measured against bone marrow culture is not the true measure of the proportion of typhoid fever cases detected, here we present a new method. This method will be helpful in measuring the precise propor- tion of typhoid fever cases detected when blood culture is deployed as a diagnostic test.
Majority of the studies were hospital based [9, 10-15, 16-24] and only two were done in community settings [10,16]. Most of the studies included patients who were clinically suspected as having typhoid fever. Blood culture was taken as GS test across all studies and a few studies had used a composite standard which included an extra test in addition to blood culture. Widal test was the most common second test to be included in the composite ‘standard’. Of the 16 studies reviewed, the possibility of reference standard misclassification was discussed explicitly in only two studies [14,15] and inferred implicitly in three studies [13,17,19] and the remaining studies did not mention it [9-12,16,18, 20-24]. The common strategies adopted in the articles that came closer to having adjusted/explained RSM were - using a composite standard [13, 17, 18], duration wise analysis (or restriction of analysis to patients presenting within a predefined week/day of illness) [10,13,14,16, 17,19], and agreement analysis . Even though some studies have not mentioned RSM, they have taken steps that could adjust for this [10,16,18]. Atleast four [13,15,17,19] of the studies after doing modified analysis were able to show that there was change in the validity of the index tests. As far the temporality part of the problem goes, none of the 16 articles mentioned it, however certain articles [10, 13, 14, 16, 19] have done analyses that would probably take care of this in a primitive manner. This review reveals that a large proportion of studies have ignored the possibility of reference standard misclassification and its implication in study interpretation, let alone taking cognizance of the temporality of this phenomenon.