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.

Socio-demographic, host and clinical characteristics of people with typhoidal and non-typhiodal<i>Salmonella</i>gastroenteritis in urban Bangladesh

Typhoidal (Salmonella enterica serover Typhi and Para-typhi A and B) (TS) and non-typhiodal Salmonella (NTS) gastroenteritis are less reported in Bangladesh. There is also a lack of report on socio-demographic and clinical characteristics of Bangladeshi people with typhoid fever and those with non-typhoidal Salmonella (NTS) gastroenteritis. Thus, the present study aimed to compare the socio-demographic, host and clinical characteristics, and seasonal variations between TS and NTS infections among patients attending at a large diarrheal disease hospital in urban Bangladesh. Information were extracted from the database of icddr,b in two different age stratums (0-14 years, and 15 years and above) as 54 with TS and 199 with NTS;and 65 with TS and 239 with NTS respectively after excluding all other pathogens. Randomly selected individuals with diarrhea but without any pathogen in stool constituted the control group (n = 253 and n = 304 respectively). Among 0-14 years, fever [aOR-4.35 (95% CI-1.45-13.06)] and drink unboiled water [aOR-0.22 (95% CI-0.06-0.83)] significantly differed between TS and NTS. Significant associations were observed with lower socio-economic context [aOR-10.02 (95% CI-3.79-26.45)], unbolied drinking water [aOR-2.16 (95% CI-1.05-4.43)], fever [aOR-4.54 (95% CI-1.71-12.03)], pneumonia [aOR-21.57 (95% CI-1.90-245.01)], wasting [aOR-2.60 (95% CI-1.21-5.57)], presence of RBC [aOR-0.09 (95% CI-0.02-0.33], leucocytes [aOR-3.97 (95% CI-1.76-8.99)] and macrophage [aOR-10.71 (95% CI-2.80-41.06)] in stool and alkaline pH [aOR-2.07 (95% CI-1.08-3.97)] when compared with control group. Among ≥15 years, TS was more frequently isolated from individuals with poor socio-economic background [aOR-2.09 (95% CI-1.0-4.33)] and use non-tap drinking water [aOR-0.29 (95% CI-0.13-0.66] compared to their NTS counterparts. Reported lack of formal schooling [aOR-0.65 (95% CI-0.44-0.96)], fever [aOR-2.10 (95% CI-1.03-4.31)], hospital stay (>24 hours) [aOR-1.66 (95% CI-1.05-2.62)], use of intravenous saline [aOR-0.50 (95% CI-0.34-0.76)] and RBC [aOR-2.34 (95% CI-1.23-4.45)] were associated with TS and NTS compared to control group. Socio-demographic, host and clinical characteristics between TS and NTS gastroenteritis were identical;however, findings significantly differed when compared with individuals presented with diarrhea but without any common enteric pathogen in stool.

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.

Molecular Detection of Mutations within the Quinolone Resistance-Determining Regions in Non Typhoidal Salmonella Isolates from Malaysia

Introduction: The efficacy of chemotherapy in bacteraemia caused by non-typhoidal Salmonella (NTS) is compromised by antibiotic resistance. Objective: This study was undertaken to describe the mechanism of resistance among clinical NTS isolates. Materials & Methodology: Thirty of NTS were isolated from blood (n = 19), stool (n = 10) and bronchioalveolar lavage (BAL;n = 1) respectively. These isolates were tested for susceptibility testing by disc diffusion method against ampicillin, gentamicin, tetracycline, co-trimoxazole, nalidixic acid, ciprofloxacin and ceftriaxone. Epsilometer tests (E-test) for nalidixic acid and ciprofloxacin were performed for nalidixic acid resistant isolates by disc diffusion method. DNA sequencing was carried out on six of the nalidixic acid resistant Salmonella Enteritidis isolates to identify mutations within quinolones resistance determining regions (QRDR) of gyrA, gyrB, parC and parE genes. Results: Resistance rates of NTS isolates from blood, stool, and BAL were respectively 37%, 20% and 0% for ampicillin, 79%, 40% and 0% for tetracycline, 32%, 40% and 0% for co-trimoxazole, 37%, 10% and 100% for nalidixic acid. Eight isolates were resistant to nalidixic acid and had exhibited reduced susceptibility towards ciprofloxacin by E-test. Mutation within QRDR was detected in gyrA gene (n = 6;Asp 47 → His [3], Asp 51 → Asn [1], Asp 73 → Gly [1], and Gly 48 → Asp [1]) and double mutation was detected in parE gene (n = 3;Gly 48 → Asp [3], Glu 82 → Ser [3]). Out of six isolates, three isolates were found to have both gyrA and parE gene mutations. Conclusions: There was no mutation observed in gyrB and parC gene. Mutation in gyrA gene was sufficient to induce decreased susceptibility to ciprofloxacin. Variation in amino acid sequences are novel, while detection of other gene mutation was uncommon.

Association of Phenotypic and Genotypic Fluoroquinolone Susceptibility among Non-Typhoidal Salmonella Isolates from Jeddah, KSA

Non-typhoid Salmonella (NTS) infects 250 to 3200 per 100,000 individuals from all over the world. NTS infection is relatively high in Jeddah (ranges between 44-132/100,000 population) as compared to other cities of Saudi Arabia. NTS isolates have also shown increasing resistance to conventional antibiotics. Therefore, fluoroquinolone (FQ) is considered drug of choice for the treatment of invasive NTS infections. A rapid detection of FQ resistance may greatly assist in appropriate therapy and containment of resistant NTS strains. Thus, molecular detection of mutations in FQ resistance genes (gyrA and parC) may play a promising role. Since limited data were available about FQ resistance among NTS isolates, therefore, this study primarily explored the occurrence of phenotypic and genotypic FQ resistance among NTS isolates from Jeddah, Saudi Arabia. Study also explored any correlation between phenotypic and genotypic FQ resistance. Fifty NTS isolates were collected from a public sector hospital of Jeddah from January to December, 2014. FQ susceptibility was determined for 48 NTS isolates using Kirby-bauer disk diffusion method and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) methodology. Genotypic resistance to FQ was determined by exploring mutations in gyrA and parC genes using PCR- based gene-sequencing method. Results were statistically analyzed using Social Package of Statistical Science (SPSS) version 22. Phenotypic antibiogram revealed that 38% (18/48) NTS isolates were FQ resistant, that 23% (11/48) were intermediately susceptible and that 39% (19/48) were susceptible. Genotypic resistance revealed mutations in only four codons of gyrA and parC genes among 39% (7/18) of FQ resistant isolates. 43% (3/7) of FQ resistant isolates showed mutations at two codons 83 (S83F, S83Y) and 87, (D87G, D87Y, D87W) of gyrA gene. Two resistant isolates showed triple mutations i.e. at codons 83 and 87 of gyrA and codon 80 (S80I and S80W) of parC gene, while one resistant isolate revealed mutation at codon 87 of gyrA and 57 (S57T) of parC gene. Moreover, 55% (6/11) intermediately susceptible isolates for FQ also revealed mutation at codon 83 of gyrA gene whereas;one intermediately susceptible isolate (1/6) also revealed additional mutation at codon 57 of parC gene. None of the FQ susceptible NTS isolates showed any mutations in gyrA or parC genes. Occurrence of mutations at only four codons in gyrA and parC genes among FQ resistant isolates may assist in development of rapid molecular method for FQ resistance detection. Presence of mutations among more than fifty percent of intermediately susceptible FQ isolates is alarming and may serve as a predictor for pre-resistant isolates for FQ. Moreover, absence of mutation in about sixty percent of phenotypically FQ resistant NTS isolates shows existence of an alternate resistance mechanism requiring further investigations.

儿童非伤寒沙门菌胃肠炎抗感染治疗研究进展

目的为儿童非伤寒沙门菌(NTS)胃肠炎抗感染治疗提供参考。方法采用计算机检索PubMed,Web of Science,The Cochrane Library和中国知网数据库中自建库起至2023年12月的儿童NTS胃肠炎抗感染治疗相关文献,从NTS的微生物学特点、流行病学、耐药性及抗感染治疗方案进行总结。结果儿童是NTS感染的高危人群;在非免疫缺陷情况下,儿童NTS胃肠炎感染程度通常较轻,具有自限性,无须治疗;重度感染、新生儿和低于3月龄、先天性或医源性免疫缺陷患儿需抗感染治疗。目前,第3代头孢菌素、喹诺酮类和大环内酯类抗菌药物为主要治疗药物,具体用法用量应遵循相关指南,疗程以7~10 d为宜。结论应严格把握儿童NTS胃肠炎抗感染治疗指征,制订合理的抗感染治疗方案,以规范抗菌药物的合理使用,遏制细菌耐药。

1990—2019年中国三种肠道传染病发病和死亡趋势分析及预测研究

背景肠道传染病是常见的传染性疾病之一,分析和预测其流行现状能够为肠道传染病的防治提供一定的参考。目的了解1990—2019年中国腹泻病、伤寒与副伤寒和侵袭性非伤寒沙门菌肠道感染3种肠道传染病的发病和死亡情况,并预测2020—2030年其发病率和死亡率,为肠道传染病的防控提供参考。方法基于2019全球疾病负担研究数据库(GBD),收集1990—2019年中国腹泻病、伤寒与副伤寒和侵袭性非伤寒沙门菌肠道感染3种肠道传染病的发病和死亡数据,根据变化率(%)和年估计百分比(EAPC)分析以上3种肠道感染疾病的变化趋势。利用自回归移动平均模型(ARIMA)预测2020—2030年中国以上3种肠道传染病的发病率和死亡率。结果1990—2019年腹泻病的发病率变化无统计学意义(EAPC=0.09,P>0.05),而伤寒与副伤寒和侵袭性非伤寒沙门菌肠道感染的发病率均呈下降趋势(EAPC分别为-4.0%、-0.64%,P<0.05)。1990—2019年腹泻病、伤寒与副伤寒和侵袭性非伤寒沙门菌肠道感染的死亡率均呈下降趋势(EAPC分别为-8.39%、-3.38%、-1.87%,P<0.05)。在各年龄组中,2019年≥70岁人群腹泻病的发病率在各年龄组中最高,且呈上升趋势(EAPC=0.27,P<0.05)。1990—2019年所有年龄组以上3种肠道传染病的死亡率均呈下降趋势(P<0.05)。ARIMA模型预测结果显示,2020—2030年我国腹泻病发病率呈上升趋势,伤寒与副伤寒和侵袭性非伤寒沙门菌的发病率呈下降趋势,预计以上3种疾病的发病率分别为58793.04/10万、5.26/10万、0.447/10万。此外,2020—2030年我国腹泻病、伤寒与副伤寒和侵袭性非伤寒沙门菌的死亡率均呈下降趋势,预计2030年以上3种疾病的死亡率分别为0.214/10万、0.039/10万、0.026/10万。结论2030年我国腹泻病、伤寒与副伤寒和侵袭性非伤寒沙门菌肠道感染的死亡率呈下降趋势;除腹泻病的发病率呈上升趋势外,其余两种疾病的发病率呈下降趋势,提示政府及相关卫生部门应当重视关注腹泻病,并针对不同人群采取不同防控措施。

儿童非伤寒沙门菌肠炎的耐药性及无症状带菌情况分析

目的:分析儿童非伤寒沙门菌肠炎的临床特征、耐药性及恢复期无症状带菌情况,为合理使用抗菌药物提供参考。方法:回顾性收集粪培养结果为非伤寒沙门菌的患儿病例资料,按出院时粪培养是否检出非伤寒沙门菌将入组患儿分为转阴组和未转阴组,分析两组患儿的临床特征、血清型分布、耐药性及恢复期带菌情况。结果:120株非伤寒沙门菌中,鼠伤寒血清型(76株,63.3%)最多。转阴组和未转阴组对抗菌药物的耐药率比较差异无统计学意义(P>0.05)。120例患儿中,76例(63.3%)感染多重耐药非伤寒沙门菌,经抗感染治疗临床症状治愈但粪培养未转阴者占62.5%。结论:本地区儿童非伤寒沙门菌多重耐药菌株比例较高,应加强监测并规范抗菌药物使用。恢复期无症状带菌是非伤寒沙门菌感染的常见后遗症,应规范抗菌药物使用疗程,以免延长带菌周期或诱导细菌耐药。

Prevalence and Characterization of Pathogens Responsible for Enteric Fever and Assessment of Their Antibiotic Susceptibility Pattern in Bangladesh

In Bangladesh, Enteric fever is a persistent health issue throughout the year, occasionally reaching epidemic levels. The growing antibiotic resistance makes treatment increasingly challenging. Therefore, studying the antibiotic resistance patterns within the population is crucial to ensure a more effective treatment strategy. This study was designed to determine the prevalence, antimicrobial susceptibility profile, and factors associated with Salmonella spp. infections among clinically suspected Enteric fever patients in Bangladesh. This study also aimed to investigate whether there has been a re-emergence in the susceptibility of bacterial strains to conventional drugs. Data were collected from February 2024 to July 2024, from patients suspected Enteric fever (fever less than seven days duration) in a Private Diagnostic Center of Bangladesh. A total of 195 blood samples were cultured, where 53.85% came out positive, among which 79.05% Salmonella typhi and 20.95% Salmonella paratyphi A were found. Prevalence of Typhoid fever was observed high among the school-going age group (0 - 15 years) patients. Both these organisms were susceptible to ceftazidime, cefixime, ceftriaxone and cefepime but resistant to nalidixic acid, ciprofloxacin and levofloxacin. Nalidixic Acid is resistant to all S. paratyphi A and sensitive to few S. typhi. Ciprofloxacin and levofloxacin showed delayed response (36.14% and 22.72% sensitive to S. typhi and S. paratyphi A, respectively) and resistance (63.85% and 77.27% resistant to S. typhi and S. paratyphi A, respectively). In case of S. typhi, the resistance was found against ampicillin (32.53%), chloramphenicol (27.71%), cotrimoxazole (24.09%) and the resistance of S. paratyphi A found against ampicillin (4.54%), chloramphenicol (0%) and cotrimoxazole (0%). This study will provide clinicians with alternative drug options and facilitate the effective treatment of Enteric fever.

湖南和云南地区禽蛋、禽畜肉沙门氏菌污染的情况分析

对随机抽取的湖南、云南地区的禽蛋、禽畜肉样品中沙门氏菌污染的情况进行调查分析。将所选取的样品先经过增菌、选择性平板分离培养,再经过生化鉴定、微生物全自动鉴定仪鉴定,荧光定量PCR鉴定和血清分型鉴定,基质辅助激光解析电离飞行时间质谱鉴定。检测分析鉴定结果发现,所选取的101批次禽蛋、禽畜肉样品总体受肠炎沙门氏菌、鼠伤寒沙门氏菌污染比例分别为35.64%,8.91%;其中禽蛋受肠炎沙门氏菌污染的比例为25.00%,受鼠伤寒沙门氏菌污染的比例为33.33%;禽畜肉受肠炎沙门氏菌污染的比例为37.08%,受鼠伤寒沙门氏菌污染的比例为5.62%。禽蛋总体受肠炎沙门氏菌和鼠伤寒沙门氏菌污染率为58.33%,高于禽畜肉总体的污染率42.70%。调查结果显示,禽蛋和禽畜肉受沙门氏菌污染情况不容乐观,在屠宰、生产加工、包装储运、食用过程中仍需要引起注意。

Salmonella typhimurium myopericarditis: A case report and review of literature

BACKGROUND Non-typhoidal salmonella(NTS)is a rare,but well-established cause of myopericarditis.Presenting symptoms may be varied,however often revolve around the dual presentation of both myopericarditis and infectious diarrhoea.Given the rarity of NTS related myopericarditis,we conducted a systematic review of the literature,identifying 41 previously reported cases.CASE SUMMARY We present the case of an otherwise healthy 39-year old male,presenting with chest pain in the setting of documented Salmonella typhimurium infection.After further investigation with echocardiogram and laboratory blood tests,a diagnosis of NTS associated myopericarditis was made,and the patient received antibiotic treatment with an excellent clinical outcome.Overall,myopericarditis is rare in NTS.Although treatment for myopericarditis has not been well established,there are guidelines for the treatment of NTS infection.In our review,we found that the majority of NTS cases has been pericarditis(27/42,64.3%),with an average age of 48.3 years,and 71.4%being male.The average mortality across all cases was 31%.CONCLUSION Myopericarditis is a rare,but potentially serious complication of NTS infection,associated with an increased morbidity and mortality.

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.

In vivo anti-salmonella activity of aqueous extract of Euphorbia prostrata Aiton(Euphorbiaceae) and its toxicological evaluation

Objective: To investigate the in vivo anti-salmonella activity and the safety of aqueous extract of Euphorbia prostratra(E. prostratra), a plant commonly used in Cameroon by traditional healers.Methods: A Salmonella typhimurium-infected rat model was used for the study. The physiological, biochemical and histopathological markers of possible side effects of this extract were studied using standard methods.Results: The extract had a significant effect on the number of viable Salmonella typhimurium recovered from faeces, and could stop salmonellosis after 8 and 10 days of treatment for male and female rats, respectively, with non-toxic doses. However, the biochemical and histopathological analyses revealed that at relatively high doses(≥ 73.48 mg/kg for female and ≥ 122.71 mg/kg for male) the extract could induce liver damage, as illustrated by a rise of serum transaminases' levels and significant inflammation of the parenchyma and portal vein.Side effects were also observed on the kidneys, as shown by both serum and urinary creatinine,and urinary proteins.Conclusions: The overall results indicate that the aqueous extract of E. prostrata has the potential to provide an effective treatment for salmonellosis, including typhoid fever. However,it is necessary to extrapolate these results in large animals, in further studies.

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.

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.

National outbreak of <i>Salmonella typhimurium</i>with preference for infants

Purpose: During a large outbreak of Salmonella typhimurium (S. typhimurium) inDenmarkin 2008, a remarkable high incidence was observed among children below the age of 1 year. Therefore we performed this retrospective study to describe the epidemiology, severity and outcome among a subset of children in this age-group. Methods: Cases were identified for the years 2000-2009 through a register at the Department of Clinical Microbiology atHvidovreHospital, in theCopenhagenarea,Denmark. For hospitalized patients below 1 year with S. typhimurium, the medical record was reviewed. Results: The highest incidence for S. typhimurium was observed in 2008 with 315 cases per 100,000 among children below 1 year. In 2008 significantly more children age During the S. typhimurium outbreak in 2008, the incidence was especially high among infants age under 1 year. The infants in 2008 might have been slightly more affected than other years 2000-2009.

儿童非伤寒沙门菌胃肠炎抗感染策略

非伤寒沙门菌(nontyphoidal Salmonella,NTS)属于沙门菌属的肠道沙门菌种,感染人类后主要引起急性胃肠炎的表现,5岁以下儿童易感,夏季多见,腹泻与发热是最常见症状,大便性状多样。最常见的血清型有肠炎沙门菌、鼠伤寒沙门菌和纽波特沙门菌,多数患者仅需补液及纠正电解质紊乱等对症治疗,存在侵袭性感染风险的人群、明确鼠伤寒沙门菌感染应考虑抗菌药物治疗,儿童首选抗生素为三代头孢菌素。近年国内NTS耐药率有增加趋势,疑似感染者尽可能在开始抗感染治疗前完善病原学检测。非伤寒沙门菌感染的临床诊疗仍存在许多争议,提高临床病例病原学确诊率、推广快速病原诊断方法、开展高循证质量临床试验,有助于规范非伤寒沙门菌胃肠炎的诊治。

腹泻儿童非伤寒沙门菌感染的病原学及耐药性分析

目的探究苏州地区腹泻儿童非伤寒沙门菌(NTS)感染的病原学特征及耐药性变迁。方法回顾性收集2016年至2021年苏州大学附属儿童医院收治的1265例NTS感染相关腹泻患儿的临床数据并进行统计分析。结果本研究共分离得到1265株NTS,平均检出率为11.79%,主要以5岁以下低龄儿童为主,夏季为高发流行季节(20.00%),优势血清群为B群(63.95%)和D群(17.00%),其中以鼠伤寒沙门菌(54.47%)和肠炎沙门菌(15.18%)为主;药敏结果显示,苏州地区腹泻患儿分离得到的NTS对广谱合成类青霉素敏感性较低(耐药率均>70%),而对含酶抑制剂的青霉素复合制剂较为敏感(耐药率均<10%),对三代头孢菌素及其复合制剂、碳青霉烯类抗生素敏感性也较好;不同血清型沙门菌的耐药性也存在差异,D群沙门菌环丙沙星和复方新诺明总体耐药率均低于其他血清群(χ^(2)值分别为20.71、147.24,P<0.05);2020—2021年分离的NTS对三代头孢菌素和氟喹诺酮类药物的耐药率较往年明显下降(χ^(2)值分别为29.02、11.55,P<0.05)。结论NTS是导致苏州地区儿童感染性腹泻的主要病原菌,临床医生应认识到NTS的病原学特征及耐药性改变,帮助早期诊断和合理使用抗菌药物,延缓耐药菌株的产生。

儿童非伤寒沙门菌败血症13例病例系列报告

背景非伤寒沙门菌(NTS)发生侵袭性血流感染可引起败血症,诊治不及时会引起严重并发症甚至死亡。目的 总结分析儿童NTS败血症的临床特征及治疗经验。设计病例系列报告。方法 纳入2017年11月至2022年10月在四川大学华西第二医院经血培养明确诊断为NTS败血症的患儿。通过医院电子病历系统收集患儿的一般资料、临床表现、辅助检查、治疗及转归。主要结局指标好转出院或死亡。结果 13例NTS败血症患儿纳入本文分析,发病中位年龄为1(0.9,6)岁,<5岁10例,男5例,7例存在基础疾病。除1例有不洁饮食史外,余无明确感染来源。发病时间7~9月份占76.9%。均有高热,10例(76.9%)以发热为首发症状,腹泻、咳嗽各6例,其余症状还包括气促、精神萎靡、抽搐、呕吐、血便、皮疹、骨关节痛、喘息、发绀和黄疸。合并胃肠炎6例,肺炎5例,脑膜炎和骨髓炎各1例。WBC和PLT升高各3例,CRP显著升高8例,PCT显著升高、Hb降低、ALT/AST升高各6例。血培养肠炎沙门菌和鼠伤寒沙门菌各3例,德比沙门菌、都柏林沙门菌和纽兰沙门菌各1例,未分型4例;血培养转阴时间为5(4.5,13.5)d。12例菌株存在不同程度耐药,7例为多重耐药。对阿米卡星(92.3%)、妥布霉素(92.3%)、庆大霉素(92.3%)耐药率较高,其次为氨苄西林(69.2%)、磺胺甲噁唑/甲氧苄啶(30.8%),无碳青霉烯类耐药,多数对第三、四代头孢菌素和氨曲南敏感。抗生素中位疗程为17(14,21.5)d。13例均好转出院。结论 NTS败血症多发生于5岁以下儿童,以高热为主要临床表现,伴或不伴胃肠道症状,明确诊断依据病原学检测。经验性用药推荐第三代头孢菌素,多数患儿可获得较好的临床效果,对于一线治疗效果不佳、严重感染者建议使用碳青霉烯类药物。