Diagnosis and Treatment of Human Salmonellosis in Addis Ababa City, Ethiopia

Abstract

Background Diagnosis using reliable tools and treatment following in vitro antimicrobial susceptibility tests are critical to proper addressing of antibiotic-resistant Salmonella infection. Methodology A cross-sectional study was conducted to assess the practice of diagnosis and treatment of salmonellosis in Addis Ababa. Tube Widal test (for blood samples only), culture, biochemical and carbohydrate fermentation, serotyping, and antimicrobial susceptibility tests were employed for both blood and stool samples. Results Of all the diseases listed in the diagnosis, nontyphoidal (n = 72, 13.71%) and typhoidal (n = 47, 8.95%) salmonellosis were the second and third common diseases. Among the 288 blood samples, almost half were positive for O, H, or both antigens. However, only 1 (0.68%) of the positive blood samples yielded Salmonella isolate during culture. The study demonstrated low specificity (0.68%) and positive predictive value (48.78%) of Widal test. Conversely, the test showed 100% sensitivity and negative predictive values. Salmonella isolates were identified from 7 (7.07%) of 99 stool samples. Two-thirds of salmonellosis suspected patients received antibiotic treatment. However, only half of the confirmed salmonellosis patients were treated with appropriate antibiotics. All of the isolates were susceptible to ciprofloxacin and ceftriaxone but resistant to ampicillin. Conclusions Majority of the patients who participated in this study were wrongly diagnosed using symptoms, clinical signs, and tube Widal test. Consequently, most of the patients received inappropriate treatment.

Prevalence of Schistosoma mansoni–Salmonella coinfection among patients in southern Ethiopia

“…All the Salmonella isolates showed resistance to ampicillin. This result is in line with earlier Ethiopian studies [ 38 , 39 ]. In addition, 66% Salmonella spp.…”

“…isolates exhibited resistance to both cotrimoxazole and tetracycline. This is in line with results documented in earlier studies performed in various regions of the country [ [38] , [39] , [40] , [41] ]. According to the WHO, MDR exhibited by species of Salmonella is currently a serious global concern.…”

Pathology and Public Health Significance of Salmonella

“…Youngsters under 5 yearsof age, the aged and immunocompromised patients are more susceptible to Salmonella contaminations than healthy individuals. Practically, all Salmonella strains are pathogenic, as they can attack human host cells, repeat and endure, prompting a conceivable sickness (Smith et al 2016;Dougnon et al 2017;Garedew et al 2018). Illness usually lasts for 4-7 days.…”

Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

“…The prevalence of typhoid fever confirmed by the detection of its biomarker using blood culture among febrile patients were estimated to be 5%, which is significantly lower than the conventional Widal test result ( Habte et al, 2018 ). Among a 288 collected blood samples, nearly half were positive in Widal test, and only 1 (0.7%) yielded Salmonella isolates during blood culture ( Garedew et al, 2018 ). In addition, a study conducted among febrile patients in Southern Ethiopia estimated the prevalence of typhoid fever through the detection of the pathogen using blood culture to be 1.6% ( Awol et al, 2021 ).…”

“…Infection with resistant microorganisms has severe health outcomes including longer illnesses, increased mortality and morbidity ( 9789241509763_eng.pdf ). Clinically determining which patients require antibacterial drugs and susceptible to empirical antibacterial have been identified as a challenge for clinicians in Ethiopia ( Garedew et al, 2018 ). The national typhoid fever surveillance system data is lacking on typhoid fever diagnosis uncertainties and associated morbidity that could inform policymakers for evidence-based decision making and impacting population practice for the prevention of typhoid fever and its antimicrobial susceptibility.…”