Typhoid Outbreak in Songkhla, Thailand 2009–2011: Clinical Outcomes, Susceptibility Patterns, and Reliability of Serology Tests

Limpitikul, Wannee; Henpraserttae, Narong; Saksawad, Rachanee; Laoprasopwattana, Kamolwish

doi:10.1371/journal.pone.0111768

Cited by 16 publications

(19 citation statements)

References 31 publications

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“…However, presentation as fever of unknown origin may pose a diagnostic dilemma. Enteric fever presenting as FUO is not uncommon in India due to endemicity in this part of the world 3,6,7. In our study out of 88 only 7 (8%) patients were found to fulfill criteria for FUO.…”

Section: Discussioncontrasting

confidence: 48%

“…The reason for bone marrow culture being considered superior is that prior antibiotic use does not interfere with isolation of S. Typhi from marrow unlike blood culture 3. The most common organism isolated in our study was S. Typhi (6 out of 7 cases, 86%).…”

Section: Discussionmentioning

confidence: 75%

“…Mortality due to enteric fever depends on time taken to diagnose and institute antibiotic treatment. Mortality is less than 1% if treatment is started before onset of complications, and increases to around 15% if treatment is started after onset of complications 3. Enteric fever is confirmed by blood culture.…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country.

Iqbal

Basheer

Mookkappan

et al. 2015

Mediterr J Hematol Infect Dis

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BackgroundEnteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries.MethodsWe aim to describe the clinical, laboratory and pathological features of patients hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.ResultsSeven of 88 (8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality while leucopenia was rare. Transaminase elevation was almost universal. S. Typhi and S. Paratyphi A were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi A and histiocytic hemophagocytosis was noted in two cases.ConclusionFUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia, and presence of thrombocytopenia, bicytopenia or pancytopenia. In addition, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 75%

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Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country.

Iqbal

Basheer

Mookkappan

et al. 2015

Mediterr J Hematol Infect Dis

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“…Three included studies evaluated SD Bioline (Kawano 2007; Limpitikul 2014; Maude 2015), and all three studies reported the preferred IgM test format. In Kawano 2007, SD Bioline IgM had an inferior performance to TUBEX when tested on the same participants.…”

Section: Resultsmentioning

confidence: 99%

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Wijedoru

Mallett

Parry

2017

Cochrane Database of Systematic Reviews

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Background Differentiating both typhoid ( Salmonella Typhi) and paratyphoid ( Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point‐of‐care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)‐recommended main diagnostic test for enteric fever. Objectives To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies. Selection criteria We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone). Data collection and analysis Two review authors independently extracted the test result data. We used a modified QUADAS‐2 extraction form to assess methodological quality. We performed a meta‐analysis when there were sufficient studies for the test and heterogeneity was reasonable. Main results Thirty‐seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence rates in the study populations ranged from 1% to 75% (median prevalence 24%, interquartile range (IQR) 11% to 46%). The included studies evaluated 16 different RDTs, and 16 studies compared two or more different RDTs. Only three studies used the Grade 1 reference standard, and only 11 studies recruited unselected febrile patients. Most included studies were from Asia, with five studies from sub‐Saharan Africa. All of the RDTs were designed to detect S. Typhi infection only. Most studies evaluated three RDTs and their variants: TUBEX in 14 studies; Typhidot (Typhidot, Typhidot‐M, and TyphiRapid‐Tr02) in 22 studies; and the Test‐It Typ...

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“…In 2013, subnational incidence estimates ranged from 0.9 to 83.6/100,000, highlighting the disparities between provinces. 1 Following mass vaccination campaigns in the late 1970s, typhoid fever declined considerably in certain areas and national rates of typhoid fever have remained lower than 10/100,000 people in recent years. Paratyphoid fever rates have consistently remained significantly lower than those of typhoid; however, large outbreaks still occur, making enteric fever a persistent public health concern.…”

Section: Introductionmentioning

confidence: 99%

Typhoidal Salmonella Trends in Thailand

Techasaensiri

Radhakrishnan

Als

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Typhoid and paratyphoid fever remain endemic diseases in Thailand with wide variation in subnational incidence trends. We examined these trends alongside contextual factors to study potential interactions and guide control strategies for this disease. Culture-confirmed typhoid and paratyphoid fever data from 2003 to 2014 were collected from the Ministry of Public Health website. Contextual factor data were collected from various sources including World Health Organization/United Nations Children’s Fund Joint Monitoring Program, United Education Statistical World Bank database, World Bank, Development Research group, and global child mortality estimates published in the Lancet. Typhoid fever exhibited a declining trend with peak incidence reported in 2003 at 8.6 cases per 100,000 persons per year. Incidence dropped to three cases per 100,000 persons in 2014. The trend in paratyphoid fever remained stable with the peak incidence of 0.77 cases per 100,000 persons observed in 2009. Subnational variations of typhoid were seen throughout the study period with the highest incidence observed in the northwestern region of Thailand. Increases in female literacy, and access to improved water and sanitation were observed with decreases in poverty head count ratio and diarrheal mortality rate per 1,000 live births. Case fatality remained consistently low at 0.4% or less in all years with reported deaths. At the national level, typhoid fever incidence has shown a notable decline; however, incidence appears to have plateaued since 2007 with access to improved water supply and sanitation above 80%. Eliminating this disease will require strong disease prevention measures in conjunction with effective treatment interventions.

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Typhoid Outbreak in Songkhla, Thailand 2009–2011: Clinical Outcomes, Susceptibility Patterns, and Reliability of Serology Tests

Cited by 16 publications

References 31 publications

Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country.

Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country.

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Typhoidal Salmonella Trends in Thailand

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