The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study

Petersiel, Neta; Shresta, Sudeep; Tamrakar, Rajendra; Koju, Rajendra; Madhup, Surendra Kumar; Shresta, Ashish; Bedi, Trs; Zmora, Niv; Paran, Yael; Schwartz, Eli; Neuberger, Ami

doi:10.1371/journal.pone.0204479

Cited by 20 publications

(19 citation statements)

References 21 publications

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“…Based on studies that overlap in place but not time [44,45,51] and also studies not included in our incidence review [10,[67][68][69], it is plausible that areas with high typhoid incidence also observe a high proportion of Salmonella Typhi among pathogens isolated from blood cultures. It should be noted that in the only two locations we were able to directly compare the place and time of prevalence to population-based incidence of Salmonella Typhi, there was an inverse association, 64.8% prevalence with 110 cases per 100 000 incidence [50] vs. 13.3% with a 249 per 100 000 incidence [47].…”

Section: Discussionmentioning

confidence: 99%

Using hospital‐based studies of community‐onset bloodstream infections to make inferences about typhoid fever incidence

Marchello

Dale

Pisharody

et al. 2019

Tropical Med Int Health

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objectives Hospital-based studies of community-onset bloodstream infections (CO-BSI) are less resource-intensive to carry out than population-based incidence studies. We examined several metrics capturing the potential role of Salmonella Typhi as a cause of CO-BSI for making inferences about incidence.methods We systematically reviewed three databases for hospital-based studies of CO-BSI. We determined, by study, the prevalence and rank order of Salmonella among pathogenic bloodstream isolates, and the prevalence ratio of Salmonella Typhi to Escherichia coli (S:E ratio). We then describe these hospital-based study metrics in relation to population-based typhoid fever incidence data from a separate systematic review.results Forty-four studies met the inclusion criteria, of which 23 (52.3%) isolated Salmonella Typhi at least once. Among studies isolating Salmonella Typhi, the median (interquartile range) prevalence and rank order of Salmonella Typhi compared to other pathogens isolated in BSI was 8.3% (3.2-37.9%) and 3 (1-6), respectively. The median (interquartile range) S:E ratio was 1.0 (0.4-3.0). With respect to incidence, in Pemba Island, Tanzania, prevalence, rank order, S:E ratio, and incidence was 64.8%, 1, 9.2 and 110 cases per 100 000, respectively, and in Boulkiemd e, Burkina Faso, was 13.3%, 3, 2.3 and 249 cases per 100 000.conclusions We describe considerable variation in place and time for Salmonella Typhi prevalence, rank order, and S:E ratio among hospital-based studies of CO-BSI. Data from simultaneous typhoid prevalence and incidence studies are limited. We propose that hospital-based study metrics warrant evaluation for making inference about typhoid incidence and as covariates in typhoid incidence models.

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Section: Discussionmentioning

confidence: 99%

Using hospital‐based studies of community‐onset bloodstream infections to make inferences about typhoid fever incidence

Marchello

Dale

Pisharody

et al. 2019

Tropical Med Int Health

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“…Among studies examining Salmonella spp. (S. Typhi and S. Paratyphi) resistance rates in bacteremia isolates between 2012 and 2017, the rate of ciprofloxacin non-susceptibility ranged from 25% to 94% (126)(127)(128)(129)(130)(131)(132)(133)(134)(135). A limited number of studies examined the resistance rates of other organisms isolated from blood cultures (132)(133)(134)(135)(136).…”

Section: Nepalmentioning

confidence: 99%

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

Alvarez-Uria²,

et al. 2020

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SUMMARY Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization’s Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.

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“…In most hospitals of Nepal, enteric fever or typhoid is one of the leading diagnosis of febrile illness; series of enteric fever outbreaks with changing antimicrobial resistance trend have been reported(10) (11)(12). The incidence in children (age categories up to 14 years) has been scarcely reported from Nepal; however, a pocket endemic region (13). In these perspectives, estimation of the disease burden and its etiologies along with antimicrobial susceptibilities are obligatory in an effective prevention and control interventions.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibility pattern of Salmonella enterica, blood-stream isolates, among febrile children: a prospective study from Nepal

Khadka¹,

Thapaliya²,

Thapa³

2019

Preprint

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Background Still, in developing the children are being treated empirically and irrationally with accessible antibiotic without susceptibility testing and minimal lethal dose calculations, defying the probable MDR (multi-drug resistance) isolates. This study was undertaken in the febrile children to determine the antimicrobial susceptibility pattern of Salmonella enterica against commonly prescribed antibiotics. Method All isolates were identified by biotyping and serotyping standard protocols then tested against antibiotics by modified Kirby disk-diffusion method. Minimum Inhibitory Concentration (MIC) of isolates were determined by agar dilution method and compared with disk diffusion results and on nalidixic-acid sensitive/resistant strains. Result Among 1815 enteric-fever-suspects, 90(4.9%) isolates of Salmonella enterica [serovar: 62(68.8%) Salmonella Typhi and 28 (31.1%) Salmonella Paratyphi A] were recovered. The incidence of infection was higher among male, age group 5 to 9, and patient from the out-patient department (OPD). On disk-diffusion test most isolates, were sensitive against first-line drugs, cephalosporins, and macrolides. However, against quinolone, a huge percentile i.e. 93.3%, of isolates were resistant [including 58 Typhi and 26 Paratyphi serovar], and nearly 14% against fluoroquinolones. When MIC breakpoint was adjusted 4µg/ml for azithromycin, ≥1 µg/ml for ciprofloxacin, 2µg/ml for ofloxacin, 8µg/ml for nalidixic acid, 1µg/ml for cefixime, higher sensitivity and specificity achieved while screening decreased susceptibility. Among tested antibiotics, low rate of resistant strain observed on MIC of azithromycin. Also, higher resistance against fluoroquinolones observed on NARS strain. Conclusion Higher susceptibility of Salmonella enterica to first-line drugs (the conventional antityphoidal drugs), third-generation cephalosporins, and azithromycin; advocates for its reconsideration in the implicated therapy. However, lower susceptibility against fluoroquinolones among nalidixic-acid resistant Salmonella (NARS) strain negates its empirical use in children. Keywords Enteric fever, Nepal, children, Salmonella enterica

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The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study

Cited by 20 publications

References 21 publications

Using hospital‐based studies of community‐onset bloodstream infections to make inferences about typhoid fever incidence

Using hospital‐based studies of community‐onset bloodstream infections to make inferences about typhoid fever incidence

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

Antimicrobial susceptibility pattern of Salmonella enterica, blood-stream isolates, among febrile children: a prospective study from Nepal

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