A Dynamical Study of Modeling the Transmission of Typhoid Fever throughDelayed Strategies

This study analyzes the transmission of typhoid fever caused by Salmonella typhi using a mathematical model thathighlights the significance of delay in its effectiveness.Time delays can affect the nature of patterns and slow downthe emergence of patterns in infected population density.The analyzed model is expanded with the equilibriumanalysis,reproduction number,and stability analysis.This study aims to establish and explore the non-standardfinite difference(NSFD)scheme for the typhoid fever virus transmission model with a time delay.In addition,the forward Euler method and Runge-Kutta method of order 4(RK-4)are also applied in the present research.Some significant properties,such as convergence,positivity,boundedness,and consistency,are explored,and theproposed scheme preserves all the mentioned properties.The theoretical validation is conducted on how NSFDoutperforms other methods in emulating key aspects of the continuous model,such as positive solution,stability,and equilibrium about delay.Hence,the above analysis also shows some of the limitations of the conventional finitedifference methods,such as forward Euler and RK-4 in simulating such critical behaviors.This becomes moreapparent when using larger steps.This indicated that NSFD is beneficial in identifying the essential characteristicsof the continuous model with higher accuracy than the traditional approaches.

Typhoid fever presenting as neuropsychiatric oddities:A case report

Rationale:Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent.Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country.Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor.Patient concerns:A 19-year-old male,presented with a 10-day history of altered mental status,high-grade fever and violent behaviour.2 Days prior to admission,he developed decreased responsiveness and a muttering delirium with self-talking.Diagnosis:Coma vigil secondary to salmonellosis.Interventions:Intravenous ceftriaxone and dexamethasone.Outcomes:The resolution of the coma vigil and the associated Salmonella infection were observed;however,the patient developed residual mutism.Lessons:The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide.Additionally,the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.

“Typhoidal Cells”Appear in a Woman with Hemophagocytic Syndrome Secondary To Brucellosis:A Case Report

We report a case of hemophagocytic syndrome(HPS)secondary to brucellosis,in which typhoidal cells were found in bone marrow,suggesting typhoidal cells present not only in Salmonella typhi infections but also in other bacterial infections.Typhoidal cells in bone marrow can be used to quickly identify the presence of bacterial infection pending the results of bone marrow and/or blood cultures.

Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.

Typhoid with pancytopenia:Revisiting a forgotten foe:Two case reports

BACKGROUND Typhoid fever is a public health problem in Asia and Africa.Pancytopenia has been rarely reported during the 20th century.Reports during the last 20 years are scarce.CASE SUMMARY Our first patient was a young adult male presenting with febrile neutropenia whose blood and bone marrow cultures grew Salmonella typhi.He recovered before discharge from the hospital.The second was a primigravida who had an abortion following a febrile illness and was found to have pancytopenia.The Widal test showed high initial titers,and she was presumptively treated for typhoid.Convalescence showed a doubling of Widal titers.CONCLUSION Typhoid fever continued to show up as a fever with cytopenia demanding significant effort and time in working up such patients.In developing countries,the liaison with typhoid continues.

A Reliable Stochastic Numerical Analysis for Typhoid Fever Incorporating With Protection Against Infection

In this paper,a reliable stochastic numerical analysis for typhoid fever incorporating with protection against infection has been considered.We have compared the solutions of stochastic and deterministic typhoid fever model.It has been shown that the stochastic typhoid fever model is more realistic as compared to the deterministic typhoid fever model.The effect of threshold number T*hold in stochastic typhoid fever model.The proposed framework of the stochastic non-standard finite difference scheme(SNSFD)preserves all dynamical properties like positivity,bounded-ness and dynamical consistency defined by Mickens,R.E.The stochastic numerical simulation of the model showed that increase in protection leads to low disease prevalence in a population.

Prevalence and antimicrobial resistance of non-typhoid Solmonella in military personnel,1988-2013

Objective:To describe the spanning 25 years data for the occurrence, magnitude, and trends regarding antimicrobial resistance of non-typhoidalSalmonella (NTS) isolated from non-immune travelers to Thailand participating in joint military operations.Methods:A total of 355 NTS isolates, obtained from 2052 fecal samples from US soldiers deployed for military maneuvers in Thailand during 1988-2013, were examined for NTS serogroup/serotypes and tested for antimicrobial susceptibility by disk diffusion to these 10 antibiotics:ampicillin, azithromycin (AZM), ciprofloxacin, colistin, gentamicin, kanamycin, nalidixic acid, streptomycin (STR), tetracycline (TET), and trimethoprim/sulfamethoxazole. Identified AZM-resistant NTS isolates were further evaluated for their minimal inhibitory concentration by the E-test method.Results:NTS infections accounted for 17.3％ (355/2052), including 11 serogroups and 50 different serotypes. The most prevalent serogroup wasSalmonella group C2-C3 (35.8％, 127/355) followed by groups B (21.1％, 75/355) and C1 (18.6％, 66/355). Identified serotypes includedSalmonellahadar (n=60),Salmonellarissen (n=45), andSalmonella blockley (n=34). Among the predominate serogroups, antimicrobial resistance was consistently high against TET (76.9％, 273/355) followed by STR (40.8％, 145/355). OneSalmonella senftenberg isolate demonstrated decreased ciprofloxacin susceptibility. Most isolates (94.6％) were resistant to one or more antimicrobials, and the most common multidrug resistance was TET-STR-nalidixic acid (11.5％, 41/355).Conclusions:The prevalence of NTS serotypes and the growing magnitude of antibiotic resistant bacteria isolated from deployed US military in Thailand are documented from 1988-2013. This study demonstrates the antibiotic resistance profiles, highlighting the effectiveness of AZM that is a first-line treatment for travelers to Southeast Asia. AZM-resistant NTS isolates are periodically observed over a 25-year period. Hence, the ongoing surveillance and prevalence efforts are required to monitor NTS resistant strains causing further treatment failure.

Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Outcome of surgical treatment of intestinal perforation in typhoid fever

AIM:To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever.METHODS:The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively.RESULTS:There were 18 males and 4 females,mean age 37 years(range,8-64 years).Presenting symptoms were fever,abdominal pain,diarrhea or constipation.Sixteen cases were subjected to segmental resection and end-to-end anastomosis,while 3 cases received 2-layered primary repair following debridement,one case with multiple perforations received 2-layered primary repair and end ileostomy,one case received segmental resection and end-to-end anastomosis followed by an end ileostomy,and one case received segmental resection and end ileostomy with mucous fistula operation.Postoperative morbidity was seen in 5 cases and mortality was found in one case.CONCLUSION:Intestinal perforation resulting from Salmonella typhi is an important health problem in Eastern and Southeastern Turkey.In management of this illness,early and appropriate surgical intervention is vital.

Salmonella Berta myocarditis:Case report and systematic review of non-typhoid Salmonella myocarditis

AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.

Molecular characterization of antimicrobial multi-drug resistance in non-typhoidal Salmonellae from chicken and clam in Mangalore, India

Salmonella enterica has been documented as one of the leading causes of salmonellosis throughout the world and is most commonly associated with the consumption of contaminated food products. Thus, this research was aimed at studying the antimicrobial susceptibility pattern and detection of quinolone resistance in Salmonella spp isolated from food of animal origin. Thirty-six Salmonella isolates comprising 8 from poultry and 28 from seafood（clams） were identified, serotyped and characterized for their antimicrobial susceptibility against 10 different antibiotics. Plasmid DNA was isolated from all the isolates by alkaline lysis, quinolone resistant non-typhoidal S. Weltevreden were examined for mutation in the DNA gyrase coding gene. Among the 36 Salmonella isolates, 20 were S. weltevreden（8 from poultry and 12 from seafood） and 16 were S. Typhimurium（from seafood）. All the isolates showed multiple resistance to nalidixic acid, tetracycline, co-trimoxazole and nitrofurantoin, but, interestingly, the isolates were 100% susceptible to ampicillin, chloramphenicol and gentamicin. Resistant isolates from the study carried the genes responsible for resistance to respective antibiotics. The strain S130 isolated in the study showed single point mutation,Asp87Gly, at position 87 in quinolone resistance determining region. It revealed mutation in quinolone resistance determining region as a cause for quinolone resistance in non-typhoidal Salmonellae. The occurrence of genes accountable for plasmid mediated resistance to quinolones（viz., qnrA, qnrB and qnrS） in plasmid of non-typhoidal Salmonellae isolates provides evidence for plasmid mediated quinolone resistance.

Refractory hypocalcemia precipitated by dual infection with typhoid fever and hepatitis A in a patient with congenital hypoparathyroidism

We present this rare occurrence of a 17 yr old boy,a known case of congenital hypoparathyroidism, who presented with fever and jaundice for 8 days and 2 episodes of generalised tonic-clonic seizures.Premorbidly patient was on regular oral calcium supplementations with normal serum calcium levels.Investigations revealed severe hypocalcaemia(3.2 mg/dL),low 25 hydroxyvitamin D levels and hypomagnesacmia.The marked elevation of serum bilirubin was accompanied by derangement of liver enzymes.Microbiological investigations were confirmatory for both hepatitis A and typhoid fever.In spite of the aggressive management with intravenous calcium gluconate infusion,refractory hypocalcaemia persisted with recovery only after gradual decline in the bilirubin levels.We inferred that the cholestatic process produced by both acute viral hepatitis A and typhoid fever precipitated this state of refractory hypocalcaemia in the previously well preserved patient.

Splenic abscess in typhoid fever - Surgical management

Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100%if left untreated.Splenic abscess is also rarely encountered as a complication of typhoid fever.We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive therapies.Another case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and appropriate antibiotics.Being a rare entity in clinical practice,splenic abscess has been poorly studied.Haemalogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries.In multiple or multiloeulated abscesses aspiration usually does not succeed,which happened in our case.Splenectomy remains the definitive choice of treatment.However,Ultra sonography(USG) or CT-guided aspiration may be tried in selective cases.

Screening,phylogenetic analysis and antibiotic sensitivity pattern of Salmonella enterica serovar Typhi isolates from typhoid asymptomatic carriers

Objective:To isolate the Salmonella enterica serovar Typhi(S.typhi) from asymptomatic typhoid carriers in the local population.To assess the antibiotic sensitivity and resistant pattern of S.typhi isolates against viable antibiotics and phylogenetic analysis of S.typhi isolates on the basis of 16S rDNA gene.Methods:S.typhi was isolated and identified based on the cultural characteristics on BSA(Bismuth Sulphite Agar),MacConkey agar,agglutination test with specific antiserum and phylogenetic analysis.5.typhi isolates were tested for sensitivity and resistant pattern with a number of viable antibiotics by disc diffusion method.Result:A total of 15 bile samples were collected from the food handlers to screen the typhoid asymptomatic carriers.Positive result was yielded for 3 out of 15 samples.S.typhi isolates showed resistant to amphicillin(100%), tetracyclin(100%),rifampicin(66.5%),ofloxacin(33.5%),cloxacillin(33.5%) and susceptibility to gentamycin(100%),amikacin(100%),chloramphenicol(100%),streptomycin(100%),kanamycin (100%),cprofloxacin(100%),amoxycillin(66.5%) and ofloxacin(66.5%).Conclusions:This study demonstrates the outbreak of typhoid fever occurs through asymptomatic carrier.In addition,this study also reveals the occurrence of considerable drug resistant among the S.typhi isolates.

Relapse typhoid fever in North-eastern state in Malaysia

Objective:To discuss the prevalence,clinical and laboratory presentations of relapse typhoid fever.Methods:All relapse cases were reviewed to identify the clinical and laboratory presentation of the relapse typhoid fever.Results:Two hundred and forty six patients were admitted to a teaching tertiary hospital in North-eastern state of Malaysia and fourteen(5.69%) relapse cases were identified.The duration of relapse after the patient was discharged was(25.0±9.9) d.The patients presented with fever,diarrhoea,headache,abdominal pain and constipation. The duration of fever before admission in the initial episode[(8.6±4.2) d]was significantly longer than the relapse episode[(5.0±2.5) d](P=0.019).Four patients have hepatomegaly in initial episode and ten in relapse episode(P=0.852).The defervescence days of initial episodes was (3.2±2.2) d,comparing to relapse episode[(2.0±1.8) d]which was statistically not significant (P=0.124).Conclusion:Assumption of the relapse typhoid fever is milder comparing to original episodes based on observation and is not supported by statistical analysis.

Survey of food handlers in bukas (a type of local restaurant) in Lagos, Nigeria about typhoid fever

Purpose: The study was conducted to survey the knowledge and behavioural practices of food handlers in bukas (a type of local restaurant) in Nigeria with the aim of assessing the hygiene practices of food handlers and whether they were knowledgeable about typhoid fever and its mode of transmission. Methods: One hundred and seventy four (174) Respondents were ad- ministered questionnaires on their sociode- mographic characteristics, behavioural practices and knowledge of typhoid fever. Results: Ma- jority of the food handlers drank pure water (32.1%), borehole water (32.6%) and public tap water (31.1%) at the about the same frequecy. More than half (62.2%) washed their hands with water only before eating while 27.7% did not wash their hands always before preparing food. After using toilets, 71.9% washed their hands with soap and water while 28.1% washed their hands with only water. When asked if they had heard about typhoid fever 90% said they had heard, out of which15.6% did not know how it was contracted while the others had partial knowledge. Conclusion: Food handlers play a prominent role in the transmission of typhoid fever and so it is important that the food handlers are well informed about their hygiene status and the causes of typhoid fever trans- mission and ways by which typhoid fever spread is prevented. This will go a long way to help reduce the incidence of typhoid fever in the country.

The Relative Prevalence of Typhoid and Malaria in Febrile Patients in Freetown, Sierra Leone

Malaria and typhoid fever are debilitating diseases responsible for the deaths of thousands of lives annually. Over the last decade both diseases have received increasing attention with particular focus on malaria. However, recent reports indicate an increasing co-infection rate between mala- ria and typhoid fever. Familiar signs and symptoms of both diseases have led to the belief in some communities that it’s a new disease. In this study, we investigated the relationship between mala- ria and typhi O and H antigens among patients reporting with fever. Patients reporting with fever from April 2013-March 2014 were recruited for the study. Our results showed that there was no association between having malaria and typhoid fever infection. However, having fever was asso- ciated with having both diseases. Also, fever among patients was more likely to be caused by Sal- monella typhi O and H antigens than plasmodium parasites. Infections of both diseases were higher in wet season than in dry season. The study recommends that malaria and typhoid fever intervention programs are increased in endemic areas. Also attention should be paid to typhoid fever infection rates in the country.

Detection of non-typhoid Salmonella infection by citrus and citrus extracts in Lao PDR

Objective:To know the current state of non-typhoid Salmonella infection in Laos.To examine the usefulness of new screening methods for Salmonella using citrus.Methods:Non-typhoid Salmonella infection of person in Lao PDR was studied in this research(2004-2009).The site was Vientiane capital city in 2004.Research from rural villages locating suburb of Vientiane during 2005-2008 was carried out.Rural villages in Attapu province where ethnic minorities were living was searched for this study in 2009.During this research,to detect Salmonella strain, a new method using citrus and citrus extract named MY phenomenon that observing black ring (MIDO ring) on DHL agar was tried.The slice lemon and lime were used for this trial in 2004. After 2005,disk of ascorbic acid and citric acid were used for the device instead of citrus fruits itself.Results:During this research,65 of 272 human samples(23.9%) were infected with non- typhoid Salmonella.Conclusions:During this study,the method using citrus and citrus extracts was accepted for the detection of Salmonella.This study shows that with citrus and citrus extract, detection of Salmonella is possible using only DHL media.Results suggest that infectious rate of non-typhoid Salmonella was high.

A Single Blind Comparative Randomized Non-Inferior Multicenter Study for Efficacy and Safety of Levofloxacin versus Ciprofloxacin in the Treatment of Uncomplicated Typhoid Fever

Ciprofloxacin is currently the drug of choice for typhoid fever, but Salmonella typhi resistance to ciprofloxacin is increasing, while levofloxacin has been shown to be very effective in a few open studies. This study aimed to compare the efficacy, and safety of levofloxacin and ciprofloxacin for typhoid fever. From 110 patients with confirmed typhoid fever, 54 patients received oral levofloxacin 500 mg once daily with one drop out, while 56 received ciprofloxacin 500 mg twice daily for 7 days with two drop outs. Defervescence of fever was achieved on an average of 3 days after initiating levofloxacin and 5 days after starting ciprofloxacin and one microbiologically non confirmed typhoid fever relapse occurred in the levofloxacin group while two relapses with positive Salmonella microorganism occurred in the ciprofloxacin group. No carrier of Salmonella typhi was found in both groups at day 30. Adverse reactions were more pronounced in the ciprofloxacin group compared to the levofloxacin group. In conclusion, oral levofloxacin 500 mg once daily for one week showed faster fever clearance compared to ciprofloxacin 500 mg twice daily in typhoid fever in Indonesia, and less adverse reactions occurred with levofloxacin compared to ciprofloxacin. This electronic document is a “live” template. The various components of your paper (title, text, heads, etc.) are already defined on the style sheet, as illustrated by the portions given in this document.

Acute Cerebellar Ataxia—Uncommon Manifestation of Typhoid Fever

Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.