Effect of El Nino Southern Oscillations on the incidence of enteric fever in Ahmedabad,India from 1985 to 2017

Objective:To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Nino Southern Oscillations and Indian Ocean Dipole over enteric fever incidence.Method:A total of 29808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed.El Nino,La Nina,neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever.Results:Population-normalized average monthly enteric fever case rates were the highest for El Nino years(25.5),lower for La Nina years(20.5)and lowest for neutral years(17.6).A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Nino Southern Oscillations categories.However,visual profile plot of estimated marginal monthly means showed two distinct characteristics:an early rise and peaking of cases in the El Nino and La Nina years,and a much more restrained rise without conspicuous peaks in neutral years.Further analysis based on monthly El Nino Southern Oscillations categories was conducted to detect differences in median monthly case rates.Median case rates in strong and moderate El Nino months and strong La Nina months were significantly dissimilar from that during neutral months(P<0.001).Conclusions:El Nino Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad,and further investigation from more cities and towns is required.

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.

Assessment of Clinical Presentation, Performance of Diagnostic Methods and Antibiotic Susceptibility Testing for Salmonella among Patients Attending Kangema Sub-County Hospital, Kenya

Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.028, diarrhoea p = 0.038, loose or watery stool p = 0.021 and mild general condition p = 0.02 remained independently associated with Salmonella infection. Conclusion: Typhoid Fever being endemic, laboratory diagnosis was a key for confirmation after clinical diagnosis. SAT can accurately be used to detect the disease where culture is unavailable. However, antibiotic sensitivity tests were crucial when determining the drug of choice as Salmonella isolates were multi-drug resistant. Establishment of prescribing antimicrobial policies and guidelines can periodically monitor the antibiogram patterns.