High Rates of Enteric Fever Diagnosis and Lower Burden of Culture-Confirmed Disease in Peri-urban and Rural Nepal

Andrews, Jason R.; Vaidya, Krista; Bern, Caryn; Tamrakar, Dipesh; Wen, Shi Wu; Madhup, Surendra Kumar; Shrestha, Rajeev; Karmacharya, Biraj; Amatya, Bibush; Koju, Rajendra; Adhikari, Shiva Raj; Hohmann, Elizabeth L.; Ryan, Edward T.; Bogoch, Isaac I.

doi:10.1093/infdis/jix221

Cited by 48 publications

(45 citation statements)

References 43 publications

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“…The age distribution we observed for all enteric fever cases is similar to results from other hospital-based studies in Asia [ 14 , 22 ]. This is in contrast to community-based surveillance in previous studies, which reported a shift toward a higher prevalence in younger populations [ 4–6 ].…”

Section: Discussionsupporting

confidence: 89%

A Retrospective Review of Hospital-Based Data on Enteric Fever in India, 2014–2015

Sur

Barkume

Mukhopadhyay

et al. 2018

The Journal of Infectious Diseases

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BackgroundEnteric fever remains a threat to many countries with minimal access to clean water and poor sanitation infrastructure. As part of a multisite surveillance study, we conducted a retrospective review of records in 5 hospitals across India to gather evidence on the burden of enteric fever.MethodsWe examined hospital records (laboratory and surgical registers) from 5 hospitals across India for laboratory-confirmed Salmonella Typhi or Salmonella Paratyphi cases and intestinal perforations from 2014–2015. Clinical data were obtained where available. For laboratory-confirmed infections, we compared differences in disease burden, age, sex, clinical presentation, and antimicrobial resistance.ResultsOf 267536 blood cultures, 1418 (0.53%) were positive for S. Typhi or S. Paratyphi. Clinical data were available for 429 cases (72%); a higher proportion of participants with S. Typhi infection were hospitalized, compared with those with S. Paratyphi infection (44% vs 35%). We observed resistance to quinolones among 82% of isolates, with cases of cephalosporin resistance (1%) and macrolide resistance (9%) detected. Of 94 participants with intestinal perforations, 16 (17%) had a provisional, final, or laboratory-confirmed diagnosis of enteric fever.DiscussionData show a moderate burden of enteric fever in India. Enteric fever data should be systematically collected to facilitate evidence-based decision-making by countries for typhoid conjugate vaccines.

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Section: Discussionsupporting

confidence: 89%

A Retrospective Review of Hospital-Based Data on Enteric Fever in India, 2014–2015

Sur

Barkume

Mukhopadhyay

et al. 2018

The Journal of Infectious Diseases

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“…However, we did not evaluate the prior antibiotic consumption by the patients before enrollment. In addition, our data is well supported by recent epidemiological studies in Nepal [ 26 , 27 ], where the great bulk of undifferentiated febrile illness was associated with other atypical organisms [ 27 ]. In addition, male patients (149, 12.5%) and patients in the 15–44 age group (178, 72.6%) showed higher incidence of enteric fever cases, corroborating the previous reports from Nepal [ 19 , 28 ].…”

Section: Discussionsupporting

confidence: 87%

Enteric Fever Caused bySalmonella entericaSerovars with Reduced Susceptibility of Fluoroquinolones at a Community Based Teaching Hospital of Nepal

Bhetwal

Maharjan

Khanal

et al. 2017

International Journal of Microbiology

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Enteric fever continues to be an important public health problem especially in developing countries of the tropical region including Nepal. In this study, we aimed to investigate the incidence of enteric fever associated with Salmonella enterica and determine its antimicrobial susceptibilities to therapeutic antimicrobials in a community based teaching hospital of Nepal. A total of 2,304 blood samples from suspected enteric fever patients attending Manmohan Memorial Teaching Hospital were processed with standard microbiological methods for the isolation and identification of bacterial pathogens. The Salmonella enterica clinical strains were subjected to antimicrobial susceptibility testing by Kirby–Bauer disk diffusion method, and the results were interpreted according to the criteria suggested by the Clinical and Laboratory Standards Institute (CLSI). A total of 245 (10.6%) cases of enteric fever associated with Salmonella enterica were confirmed by blood culture. Out of them, 162 (66.1%) were caused by Salmonella Typhi and 83 (33.9%) by Salmonella Paratyphi. On Kirby–Bauer disk diffusion antimicrobial susceptibility testing, Salmonella isolates were highly susceptible to cefixime (100%), ceftriaxone (100%), ampicillin (97.9%), cotrimoxazole (94.6%), azithromycin (96.7%), tetracycline (95.5%), and chloramphenicol (97.5%), respectively. Two hundred twenty-six (92.2%) of Salmonella isolates were nalidixic acid resistant with reduced susceptibility to ciprofloxacin (36.7%) and ofloxacin (54.8%), respectively. Although the rate of MDR Salmonella strains was very low (<5%), their reduced susceptibility to fluoroquinolones has restricted their routine empirical use. Third generation cephalosporins are the safest choice for empirical use but ampicillin, cotrimoxazole, azithromycin, and chloramphenicol can be effective alternatives.

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“…Most of the local guidelines for febrile illness are based upon the epidemiological data and endemic disease. The most common differentials of undifferentiated fever in Nepal is enteric fever [5]. This could be the reason for the use of trial of azithromycin, cefixime, and quinolones among generalized fever cases at primary consultation.…”

Section: Resultsmentioning

confidence: 99%

The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal

Kattel¹,

Agrawal²,

Pandey³

et al. 2019

J Trop Dis

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Introduction: Acute Febrile Illness (AFI) is a common clinical syndrome presenting at tropical health centers. The challenges in resource-limited set up are an undifferentiated clinical manifestation with wide differentials and inadequate laboratory diagnostic support. With this background, we conducted a study to look at the outcome of AFI spectrum presented at BP Koirala Institute of Health Sciences (BPKIHS), a referral medical school hospital in eastern Nepal. Objective: To determine the etiological diagnosis and hospital-based outcome of AFI. Methods:It was a prospective observational study of the AFI inpatient cases in the . Considering a 15% prevalence of acute febrile in patients with a 95% confidence interval and 95% power of study a sample size of 196 was calculated. Assuming 25% as a sampling error 245 patients were enrolled. The patient was diagnosed and treated as per the hospital protocol developed by Tropical and Infectious Disease Unit. Case record form was used to record and tabulated in an excel sheet. Descriptive and analytic statistics were used. Results: The incidence of AFI was 12% (557) among the 4669 inpatient cases. Among 245 enrolled cases, 61%presented as localized fever. The most common clinical diagnosis was pneumonia (29%), urinary tract infection (18%), meningitis (11%) and tropical disease (14%) that includes malaria, dengue, rickettsia, and leptospirosis. The etiological diagnosis was established among 26% (64). Among AFI cases sepsis, acute renal injury and septic shock was present in 18%, 11%, and 6% respectively. The putative diagnosis could not be made in 18% (44) of the cases and they were treated empirically with dual antibiotics (injectable 3 rd generation cephalosporin with macrolides or fluoroquinolones or aminoglycosides). Favorable outcomes in term of clinical cure were seen in 76% (186) of the cases. Conclusion: Establishment of etiological diagnosis is logistically not feasible in developing the world. Contextual guidelines for undifferentiated fever may be a possible option for improving the outcome of undifferentiated fever in Nepal.

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High Rates of Enteric Fever Diagnosis and Lower Burden of Culture-Confirmed Disease in Peri-urban and Rural Nepal

Cited by 48 publications

References 43 publications

A Retrospective Review of Hospital-Based Data on Enteric Fever in India, 2014–2015

A Retrospective Review of Hospital-Based Data on Enteric Fever in India, 2014–2015

Enteric Fever Caused bySalmonella entericaSerovars with Reduced Susceptibility of Fluoroquinolones at a Community Based Teaching Hospital of Nepal

The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal

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