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Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India
Dipika Sur, Mohammad Ali, Lorenz von Seidlein, Byomkesh Manna, Jacqueline L Deen, Camilo J Acosta, John D Clemens, Sujit K Bhattacharya
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-289
Abstract: We conducted a large enteric fever surveillance study and analyzed factors which correlate with enteric fever on an individual level and factors associated with high and low risk areas with enteric fever incidence. Individual level data were linked to a population based geographic information systems. Individual and household level variables were fitted in Generalized Estimating Equations (GEE) with the logit link function to take into account the likelihood that household factors correlated within household members.Over a 12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were detected among 56,946 residents in two bustees (slums) of Kolkata, India. The incidence of paratyphoid fever was lower (0.8/1000/year), and the mean age of paratyphoid patients was older (17.1 years) than for typhoid fever (incidence 1.4/1000/year, mean age 14.7 years). Residents in areas with a high risk for typhoid fever had lower literacy rates and economic status, bigger household size, and resided closer to waterbodies and study treatment centers than residents in low risk areas.There was a close correlation between the characteristics detected based on individual cases and characteristics associated with high incidence areas. Because the comparison of risk factors of populations living in high versus low risk areas is statistically very powerful this methodology holds promise to detect risk factors associated with diseases using geographic information systems.Enteric fever is a systemic illness characterized by fever, abdominal pain, and non-specific symptoms including nausea, vomiting, headache, and anorexia. When enteric fever is caused by Salmonella enterica serovar Typhi, it is known as typhoid fever and when due to S. enterica serovar Paratyphi A, B, or C, it is called paratyphoid fever. The clinical differences in signs, symptoms and outcome between typhoid and paratyphoid fever are subtle [1]. Typhoid fever is traditionally believed to be more common, have a mo
Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination  [cached]
Escott S,Tarabishy AB,Davidorf FH
Clinical Ophthalmology , 2013,
Abstract: Sarah Escott, Ahmad B Tarabishy, Frederick H DavidorfHavener Eye Institute, The Ohio State University, Columbus, OH, USAAbstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.Keywords: multifocal choroiditis, vaccination, hepatitis A, typhoid, yellow fever
Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination
Escott S, Tarabishy AB, Davidorf FH
Clinical Ophthalmology , 2013, DOI: http://dx.doi.org/10.2147/OPTH.S37443
Abstract: ltifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination Case report (466) Total Article Views Authors: Escott S, Tarabishy AB, Davidorf FH Published Date February 2013 Volume 2013:7 Pages 363 - 365 DOI: http://dx.doi.org/10.2147/OPTH.S37443 Received: 28 August 2012 Accepted: 22 September 2012 Published: 18 February 2013 Sarah Escott, Ahmad B Tarabishy, Frederick H Davidorf Havener Eye Institute, The Ohio State University, Columbus, OH, USA Abstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.
Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics
A Ahmed, B Ahmed
Annals of African Medicine , 2010,
Abstract: Background: While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. Materials and Methods: This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Results: Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6 ± 9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38 – 165 umol/l with mean of 117 ± 14SD. Conjugated bilirubin ranged 31-150 umol/l with mean of 95 ± 8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Conclusion: Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.
Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics  [cached]
Ahmed A,Ahmed B
Annals of African Medicine , 2010,
Abstract: Background: While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. Materials and Methods: This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Results: Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6 ± 9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38 - 165 umol/l with mean of 117 ± 14SD. Conjugated bilirubin ranged 31-150 umol/l with mean of 95 ± 8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Conclusion: Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.
The Application of the Grey Disaster Model to Forecast Epidemic Peaks of Typhoid and Paratyphoid Fever in China  [PDF]
Xuejun Shen, Limin Ou, Xiaojun Chen, Xin Zhang, Xuerui Tan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060601
Abstract: Objective The objectives of this study were to forecast epidemic peaks of typhoid and paratyphoid fever in China using the grey disaster model, to evaluate its feasibility of predicting the epidemic tendency of notifiable diseases. Methods According to epidemiological features, the GM(1,1) model and DGM model were used to build the grey disaster model based on the incidence data of typhoid and paratyphoid fever collected from the China Health Statistical Yearbook. Model fitting accuracy test was used to evaluate the performance of these two models. Then, the next catastrophe date was predicted by the better model. Results The simulation results showed that DGM model was better than GM(1,1) model in our data set. Using the DGM model, we predicted the next epidemic peak time will occur between 2023 to 2025. Conclusion The grey disaster model can predict the typhoid and paratyphoid fever epidemic time precisely, which may provide valuable information for disease prevention and control.
Multidrug Resistant Gene(S) Harboring On A 20 Kb Plasmid In Salmonella typhi
That Causes Typhoid - Enteric Fever
 [PDF]

Md. Abdul Hye Khan,Asif Hasan Chowdhoury,M. Ashik Mosaddik,M. Shajahan
Pakistan Journal of Biological Sciences , 2000,
Abstract: Ten multidrug resistant Salmonella typhi were isolated from the blood and stool samples of clinically suspected patients suffering from typhoid fever. To see whether the drug resistance phenomenon was plasmid mediated, one of these resistant isolates was used for the plasmid analysis and a single 20 kb plasmid was found. This 20 kb plasmid was transferred to a sensitive E. coli LE 392 and after the plasmid transfer experiment E. coli LE 392 acquired resistance against those previously used antibiotics. Plasmid analysis of the transformed E. coli LE 392 further exhibited that it harbored a single 20 kb plasmid corresponding to that of the wild S. typhi which further confirmed that the 20 kb plasmid was carrying the gene(s) responsible for the multidrug resistance in Salmonella typhi.
Spatiotemporal Transmission and Determinants of Typhoid and Paratyphoid Fever in Hongta District, Yunnan Province, China  [PDF]
Jin-Feng Wang ,Yan Wang,Jing Zhang ,George Christakos,Jun-Ling Sun,Xin Liu,Lin Lu,Xiao-Qing Fu,Yu-Qiong Shi,Xue-Mei Li
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002112
Abstract: Background Typhoid and paratyphoid fever are endemic in Hongta District and their prevalence, at 113 per 100,000 individuals, remains the highest in China. However, the exact sources of the disease and its main epidemiological characteristics have not yet been clearly identified. Methods and Findings Numbers of typhoid and paratyphoid cases per day during the period 2006 to 2010 were obtained from the Chinese Center of Disease Control (CDC). A number of suspected disease determinants (or their proxies), were considered for use in spatiotemporal analysis: these included locations of discharge canals and food markets, as well as socio-economic and environmental factors. Results showed that disease prevalence was spatially clustered with clusters decreasing with increasing distance from markets and discharge canals. More than half of the spatial variance could be explained by a combination of economic conditions and availability of health facilities. Temporal prevalence fluctuations were positively associated with the monthly precipitation series. Polluted hospital and residential wastewater was being discharged into rainwater canals. Salmonella bacteria were found in canal water, on farmland and on vegetables sold in markets. Conclusion Disease transmission in Hongta district is driven principally by two spatiotemporally coupled cycles: one involving seasonal variations and the other the distribution of polluted farmland (where vegetables are grown and sold in markets). Disease transmission was exacerbated by the fact that rainwater canals were being used for disposal of polluted waste from hospitals and residential areas. Social factors and their interactions also played a significant role in disease transmission.
Combined Rapid (TUBEX) Test for Typhoid-Paratyphoid A Fever Based on Strong Anti-O12 Response: Design and Critical Assessment of Sensitivity  [PDF]
Meiying Yan, Frankie C. H. Tam, Biao Kan, Pak Leong Lim
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024743
Abstract: Rapid diagnostics can be accurate but, often, those based on antibody detection for infectious diseases are unwittingly underrated for various reasons. Herein, we described the development of a combined rapid test for two clinically-indistinguishable bacterial diseases, typhoid and paratyphoid A fever, the latter fast emerging as a global threat. By using monoclonal antibodies (mAbs) to bacterial antigens of known chemical structures as probes, we were able to dissect the antibody response in patients at the level of monosaccharides. Thus, a mAb specific for a common lipopolysaccharide antigen (O12) found in both the causative organisms was employed to semi-quantify the amounts of anti-O12 antibodies present in both types of patients in an epitope-inhibition particle-based (TUBEX) immunoassay. This colorimetric assay detected not only anti-O12 antibodies that were abundantly produced, but also, by steric hindrance, antibodies to an adjoining epitope (O9 or O2 in the typhoid or paratyphoid bacillus, respectively). Sensitivity and, particularly, reaction intensities, were significantly better than those obtained using an anti-O9 or anti-O2 mAb-probe in the examination of paired sera from 22 culture-confirmed typhoid patients (sensitivity, 81.8% vs 75.0%) or single sera from 36 culture-confirmed paratyphoid patients (52.8% vs 28.6), respectively. Importantly, sensitivity was better (97.1% for typhoid, 75.0% for paratyphoid) if allowance was made for the absence of relevant antibodies in certain specimens as determined by an independent, objective assay (ELISA) — such specimens might have been storage-denatured (especially the older paratyphoid samples) or procured from non-responders. Benchmarking against ELISA, which revealed high concordance between the two tests, was useful and more appropriate than comparing with culture methods as traditionally done, since antibody tests and culture target slightly different stages of these diseases. Paired sera analysis was insightful, revealing 64% of typhoid patients who had no change in antibody titer over 4–16 days, and 14% with no IgM-IgG class-switching.
Host response transcriptional profiling reveals extracellular components and ABC (ATP-binding cassette) transporters gene enrichment in typhoid fever-infected Nigerian children
Sok Khoo, David Petillo, Mrutyunjaya Parida, Aik Tan, James H Resau, Stephen K Obaro
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-241
Abstract: Global transcriptional profiles of S. Typhi-infected young Nigerian children were obtained from their peripheral blood and compared with that of other bacteremic infections using Agilent gene expression microarrays. The host-response profiles of the same patients in acute vs. convalescent phases were also determined. The top 96-100 differentially-expressed genes were identified and four genes were validated by quantitative real-time PCR. Gene clusters were obtained and functional pathways were predicted by DAVID (Database for Annotation, Visualization and Integrated Discovery).Transcriptional profiles from S. Typhi-infected children could be distinguished from those of other bacteremic infections. Enriched gene clusters included genes associated with extracellular peptides/components such as lipocalin (LCN2) and systemic immune response which is atypical in bacterial invasion. Distinct gene expression profiles can also be obtained from acute vs. convalescent phase during typhoid fever infection. We found novel down-regulation of ABC (ATP-binding cassette) transporters genes such as ABCA7, ABCC5, and ABCD4 and ATPase activity as the highest enriched pathway.We identified unique extracellular components and ABC transporters gene enrichments in typhoid fever-infected Nigerian children, which have never been reported. These enriched gene clusters may represent novel targeted pathways to improve diagnostic, prognostic, therapeutic and next-generation vaccine strategies for typhoid fever in Africa.Salmonella enterica serovar Typhi (S. Typhi) is a Gram-negative bacterium that causes typhoid fever. The World Health Organization (WHO) recognizes S. Typhi infection as a global health problem, with an estimated 21 million cases and between 200,000 and 600,000 deaths annually [1,2]. In Africa, typhoid fever affects mainly school-age children and younger adults [3]. In fact, in endemic and large outbreak areas, young children represent a subgroup with the highest burden of infec
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