A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

Abstract

BackgroundFever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.MethodsAdults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.ResultsWe enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.ConclusionEnteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

Enteric Fever Cases in the Two Largest Pediatric Hospitals of Bangladesh: 2013–2014

“…In general, our study finds that a large percentage of infectious diseases in Dhaka can be attributed to enteric fever, consistent with single-center studies previously conducted in Bangladesh [ 14 , 17 ]. For instance, one study collected blood specimens from 103679 hospitalized and nonhospitalized patients attending the hospital attached to icddrb, between January 2005 and December 2014, and found that 13.6% of cultured blood samples were positive, with Salmonella Typhi being the most frequently isolated microorganism (36.9% of positive blood samples) [ 14 ].…”

Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance

“…Based on bacteriological evidence, the prevalence of typhoid fever in this study was 14.1%. Previous studies have reported comparable prevalence data of 11.3% to 18.7% among febrile patients26–28. In one previous study, Maude et al26 reported that 11.3% of a group of 300 febrile adults/children in Bangladesh were positive for typhoid, as determined by blood culture and polymerase chain reaction (PCR) for S. typhi.…”

Profile of the 2016 dengue outbreak in Nepal

“…Similar epidemiologic trends, in which ADE associated with multiple circulating serotypes has been considered a significant factor, have been observed in other regions such as in Indonesia and Brazil [ 22 , 23 ]. Circulation of DENV-1 was also documented during 2014–2016 in several countries neighboring Nepal including India, China, Pakistan, Bangladesh and Sri Lanka [ 24 – 28 ].…”