Bacteremic Typhoid Fever in Children in an Urban Slum, Bangladesh

Brooks, W. Abdullah; Hossain, Ahmed; Goswami, Doli; Sharmeen, Amina Tahia; Nahar, Kamrun; Alam, Khorshed; Ahmed, Noor Zaheer; Naheed, Aliya; Nair, G. Balakrish; Luby, Stephen P.; Breiman, Robert F.

doi:10.3201/eid1102.040422

Cited by 209 publications

(178 citation statements)

References 11 publications

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“…In our study, 15.2% of all patients with typhoid fever were under 5 years, which is close to the figure in other studies. 9,10,18 Blood culture was positive in 46% of cases which was comparable to other studies by Bhutta et al 11 , Dheer et al 13 and Sanjeev et al 15 Krishna et aL showed 64%blood culture positivity in their trials. 16 Hemoglobin is normal in the initial stages but drops with progressing illness.…”

Section: Discussionsupporting

confidence: 79%

To study haematological profile of Enteric fever patients.

2017

Int. J. Curr. Res. Med. Sci.

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Introduction: Typhoid fever is a major health problem in developing countries. It is caused by Salmonella typhi and S. paratyphi .In India annual incidence is nearly 1%.Blood culture for Salmonella is the gold standard to diagnose typhoid fever. Hematological profile of these patients is affected by this infection. We took this study to establish the significance of hematological profile in blood culture proven Typhoid fever patients. Material and Methods : We did a cross sectional study on 100 patients attending OPD and IPD of Department of Pediatrics ,with history of fever of >38 0 Cfor 3 days aged 1-14 years. Previously antibiotic treated patients and patients with proven localised infection were excluded .Panel of tests including blood culture and haematological profile (Hemoglobin , TLC ,DLC, Platelet count, ESR) were done on these patients . Results: In our study 46% of our patients were blood culture proven typhoid fever patients. Male children of school going age group were most commonly affected by typhoid fever. We found anemia, leucopenia, thrombocytopenia in 47.8%,6.5%and 21.5% of patients. Lymphocytosis was seen in 10.9 % of patients.ESR was high in 52.2% of patients. Results were comparable to studies done in past but we found that out of all these parameters only ESR was significantly associated with blood culture positivity. Conclusion : Anemia in typhoid fever patients is not because of the salmonella infection .It can be because of other reasons for which detailed blood indices are required to be investigated .Total leucocyte count, eosinophil count and platelet count are also not contributory to diagnosis of enteric fever. High ESR is associated with typhoid fever. Further studies are needed to study the blood indices in detail in patients with typhoid fever in India.

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Section: Discussionsupporting

confidence: 79%

To study haematological profile of Enteric fever patients.

2017

Int. J. Curr. Res. Med. Sci.

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“…Microbiologic culturing of blood is approximately 30 to 70% sensitive, with the highest sensitivity being associated with an absence of prior use of antibiotics and the culturing of larger volumes of blood, features that complicate this mode of diagnosis in young children (5,6,8,36). Microbiologic culturing of bone marrow aspirates is more sensitive than blood but often clinically impractical (1,11,12).…”

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confidence: 99%

“…Diagnostic tests for typhoid fever often lack sensitivity and/or specificity, especially in areas of the world that are endemic for typhoid fever, where clinically distinguishing typhoid fever from other febrile illnesses is difficult (5,17,39). Microbiologic culturing of blood is approximately 30 to 70% sensitive, with the highest sensitivity being associated with an absence of prior use of antibiotics and the culturing of larger volumes of blood, features that complicate this mode of diagnosis in young children (5,6,8,36).…”

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confidence: 99%

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Salmonella enterica Serovar Typhi-Specific Immunoglobulin A Antibody Responses in Plasma and Antibody in Lymphocyte Supernatant Specimens in Bangladeshi Patients with Suspected Typhoid Fever

Sheikh

Bhuiyan

Khanam

et al. 2009

Clin Vaccine Immunol

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Many currently available diagnostic tests for typhoid fever lack sensitivity and/or specificity, especially in areas of the world where the disease is endemic. In order to identify a diagnostic test that better correlates with typhoid fever, we evaluated immune responses to Salmonella enterica serovar Typhi (serovar Typhi) in individuals with suspected typhoid fever in Dhaka, Bangladesh. We enrolled 112 individuals with suspected typhoid fever, cultured day 0 blood for serovar Typhi organisms, and performed Widal assays on days 0, 5, and 20. We harvested peripheral blood lymphocytes and analyzed antibody levels in supernatants collected on days 0, 5, and 20 (using an antibody-in-lymphocyte-supernatant [ALS] assay), as well as in plasma on these days. We measured ALS reactivity to a serovar Typhi membrane preparation (MP), a formalin-inactivated whole-cell preparation, and serovar Typhi lipopolysaccharide. We measured responses in healthy Bangladeshi, as well as in Bangladeshi febrile patients with confirmed dengue fever or leptospirosis. We categorized suspected typhoid fever individuals into different groups (groups I to V) based on blood culture results, Widal titer, and clinical features. Responses to MP antigen in the immunoglobulin A isotype were detectable at the time of presentation in the plasma of 81% of patients. The ALS assay, however, tested positive in all patients with documented or highly suspicious typhoid, suggesting that such a response could be the basis of improved diagnostic pointof-care-assay for serovar Typhi infection. It can be important for use in epidemiological studies, as well as in difficult cases involving fevers of unknown origin.Salmonella enterica serovar Typhi (serovar Typhi) is the cause of typhoid fever, an illness that affects over 20,000,000 individuals worldwide each year, killing over 200, 000 (5, 8, 16). The largest burden of typhoid fever is borne by impoverished individuals in resource-poor areas of the world. Serovar Typhi is a human-restricted invasive enteric pathogen which, after ingestion, crosses the intestinal mucosa, is taken up by gutassociated lymphoreticular tissues, and enters the systemic circulation. Both mucosal and systemic host immune responses are stimulated after infection. Serovar Typhi is an intracellular pathogen, and antibody and cell-mediated immune responses occur after infection or immunization with live oral attenuated typhoid vaccines (10,25,34).Diagnostic tests for typhoid fever often lack sensitivity and/or specificity, especially in areas of the world that are endemic for typhoid fever, where clinically distinguishing typhoid fever from other febrile illnesses is difficult (5, 17, 39). Microbiologic culturing of blood is approximately 30 to 70% sensitive, with the highest sensitivity being associated with an absence of prior use of antibiotics and the culturing of larger volumes of blood, features that complicate this mode of diagnosis in young children (5,6,8,36). Microbiologic culturing of bone marrow aspirates is more sensitive than bl...

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“…Low positivity rates of blood culture, which was also reported in a previous study, may as well be results from prior antibiotic use. [17][18] This study showed that IgM anti S. typhi serologic test had a poor AUC when cut-off value ≥4 was used, while highest AUC was demonstrated on cut-off value >8. Sensitivity was found to be good as reported in previous studies in all age groups6 and children group, 10,11 reflecting the high number of positive result when the disease is actually present.…”

Section: Discussionmentioning

confidence: 99%

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Marsela¹,

Setiabudi²,

Indrati³

2017

amj

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Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1-14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test. Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%. Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..

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Bacteremic Typhoid Fever in Children in an Urban Slum, Bangladesh

Cited by 209 publications

References 11 publications

To study haematological profile of Enteric fever patients.

To study haematological profile of Enteric fever patients.

Salmonella enterica Serovar Typhi-Specific Immunoglobulin A Antibody Responses in Plasma and Antibody in Lymphocyte Supernatant Specimens in Bangladeshi Patients with Suspected Typhoid Fever

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

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