A retrospective study of patients with blood culture-confirmed typhoid fever in Fiji during 2014–2015: epidemiology, clinical features, treatment and outcome

Abstract

Background Typhoid fever is endemic in Fiji. We sought to describe the epidemiology, clinical features and case fatality risk of blood culture-confirmed typhoid fever from January 2014 through December 2015. Methods Blood culture-positive patients were identified from a typhoid surveillance line list. A standardised case investigation form was used to record data from patients’ medical records. Results Of 542 patients, 518 (95.6%) were indigenous Fijians (iTaukei) and 285 (52.6%) were male. The median (IQR) age was 25 (16–38) y. Mean (SD) time from the onset of illness to admission was 11.1 (6.9) d. Of 365 patients with clinical information, 346 (96.9%) had fever, 239 (66.9%) diarrhoea, 113 (33.5%) vomiting, and 72 (30.2%) abdominal pain. There were 40 (11.0%) patients with complications, including 17 (4.7%) with shock, and 11 (3.0%) with hepatitis. Nine patients died for a case fatality risk of 1.7%. Of the 544 Salmonella Typhi isolates tested, none were resistant to first line antimicrobials; 3(0.8%) were resistant to ciprofloxacin and 5(1.4%) to nalidixic acid. Conclusions In Fiji, most blood culture-confirmed typhoid fever cases were in young adults. Common clinical manifestations were fever and gastrointestinal symptoms. Further studies are required to elucidate the factors associated with complications and death.

A Systematic Review on Antimicrobial Resistance among Salmonella Typhi Worldwide

“… 45 However, the H58 haplotype has so far not expanded in Fiji where most Salmonella Typhi isolates remain susceptible to traditional first-line antimicrobials. 48 , 49 We observed a decline in the median prevalence of resistance to each of the traditional first-line antimicrobials and in MDR across Asia, corroborating reports of increasing prevalence of chloramphenicol-susceptible strains in areas that previously documented a high prevalence of resistance to the drug. 50 – 53 …”

Complications and mortality of typhoid fever: A global systematic review and meta-analysis

“…Of 22 estimates, seven (31.8%) were from Africa, 30 , 37 , 59 , 66 , 81 , 122 12 (54.6%) from Asia, 36 , 38 , 41 , 72 , 84 , 96 , 98 , 102 , 105 , 109 , 131 and one each (4.5%) were from the Americas, 97 Europe, 101 and Oceania. 108 Among all 22 estimates, there was a statistically non-significant positive correlation of longer delay in care with increased CFR ( r = 0.11; p = 0.64). Among the 12 estimates from Asia, there was a significant positive correlation between delay in care and CFR ( r = 0.84; p <0.01) and a non-significant negative correlation between delay in care and CFR (−0.42; p = 0.35) among seven estimates from Africa.…”

“…Of 22 estimates, seven (31.8%) were from Africa, 30,37,59,66,81,122 12 (54.6%) from Asia, 36,38,41,72,84,96,98,102,105,109,131 and one each (4.5%) were from the Americas, 97 Europe, 101 and Oceania. 108…”

Genotype Diversity before and after the Introduction of a Rotavirus Vaccine into the National Immunisation Program in Fiji

“…In 2015, there was a marked increase in the number of negative samples tested. From 2010 to 2013, there was an increase in typhoid detection as the result of six typhoid outbreaks in Fiji, along with outbreaks of both Zika virus and Chikungunya virus, which were both initially detected in 2015, all which may have led to an increased number of negative samples being sent to MCRI for analysis during this time period [ 20 , 21 , 22 ]. Being negative samples only, this also would have had minimal impact on the rotavirus distribution observed in this study.…”