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.

Paratyphoid fever- Emerging problem in South India

Objective:To review the clinical profile and drug susceptibilities of Salmonella paratyphi A in a tertiary care hospital.Methods:Retrospective analyses of 113 patients with paratyphoid fever and 101 culture proven Salmonella paratyphi A infection were included in the study.The study extended over a period of 3 years(2006-2008).Diagnosis of patients were based on clinical features,serology and blood culture.The drug susceptibility testing of the isolates were performed by the disc diffusion method.Clinical presentation,laboratory parameters,susceptibility patterns of isolates,treatment and clinical response were studied.Results:Of the 113 cases,77(68.4%) were males and 36 were females(32.8%),which included 2 pediatric patients.Fever was the most common symptom(100.0%) followed by loose stools(37.2%),headache(35.4%),myalgia(31.9%), pain abdomen(29.2%),dry cough(19.5%) and vomiting(13.3%).All patients were clinically cured. Majority of the isolates(46%) were resistant to cotrimoxazole in 2006,however they became 100% sensitive in 2007 and 2008.whereas the strains became 100% sensitive to ampicillin and chloramphenicol only in 2008.In 2006 the sensitivity of organisms to ciprofloxacin was 89% but in 2007 and 2008 there has been an increasing resistance to ciprofloxacin(46% and 86%) respectively.Surprisingly 3 isolates(8.1%) were resistant to ceftriaxone in 2006,showed 100% sensitivity in 2008.Common drugs used were ceftriaxone in 100 cases(88.4%) and ciprofloxacin in 13 cases(11.6%).One patient had relapse of paratyphoid fever after treatment with ciprofloxacin which responded to ceftriaxone.Conclusions:Paratyphoid fever A is one of the emerging infections and a significant problem in India.An increasing resistance to fluoroquinolones is noted.Continuous monitoring of drug susceptibilities is mandatory in instituting appropriate therapy.

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.

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.

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.

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.

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.

A Comparative Study of the Typhidot (Dot-EIA) versus Widal Test in Diagnosis of Typhoid Fever among Egyptian Patients

Background and Study Aim: Typhoid (Enteric) fever is a systemic infection caused by Salmonella Typhi and Salmonella Paratyphi. It is endemic in the developing countries including Egypt. Different diagnostic tools can achieve diagnosis and include cultures from the blood, stool, bone marrow, rarely urine for isolation of the organism. Antibody detection by Widal test and relatively recent typhoid are also used. The current study aimed at comparing the most commonly used antibody detection Widal test with the rapid antibody detection typhidot for diagnosis of typhoid fever among Egyptian adults. Patients and Methods: The study included 140 patients who are presented with picture suggestive of typhoid fever. Confirmed cases after the blood culture were included in the final analysis. Widal and typhidot tests were performed in all patients and were compared for sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Results: 45 patients out of 140 were diagnosed as typhoid fever by blood culture. Out of them, Widal test was positive in 39 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 86.7%, 89.5%, 79.5%, 93.4% and 88.5% respectively. Typhidot test was positive in 42 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 93.3%, 90.6%, 82.3%, 96.6%, and 91.4% respectively (P = 0.00). Conclusions: Typhidot test is reliable, simple highly sensitive and specific test in diagnosing typhoid fever when compared with Widal test.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through;vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sourcesof drinking water, good sanitation and hygiene, food safety and poverty alleviation.

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.

甲型和乙型副伤寒同时暴发流行事件中菌株分子分型、毒力及耐药特征分析

目的对一起甲型和乙型副伤寒同时暴发流行事件中菌株的分子分型、毒力及耐药特征进行分析,为不同型别副伤寒同时传播的防治提供参考依据。方法回顾分析2018年9月至11月新疆生产建设兵团医院就诊的副伤寒确诊病例31例。对分离菌株进行血清学分型及药物敏感试验,采用多重PCR、脉冲场凝胶电泳、多位点序列分析进行分子分型,并检测毒力基因及耐药基因。结果31例确诊病例共分离出32株副伤寒沙门菌,血清学分型分为甲型19株、乙型13株,所有菌株对环丙沙星中介率为100%。11株代表菌株的M-PCR分子分型与血清学分型结果一致;甲型与乙型副伤寒沙门菌的PFGE指纹图谱均一致;甲型副伤寒沙门菌MLST为ST85型,乙型副伤寒沙门菌MLST为ST86型;所有菌株均携带毒力岛SPI1~SPI5代表基因invA、sitC、sseL、sifA、mgtC、siiE、sopB和调节基因phoP,甲型副伤寒沙门菌还携带三聚体结构的伤寒毒素(cytolethal distending toxin,CDT)基因cdtB、pltA、pltB,毒力质粒基因pefA、prot6E、spvB检测均为阴性。结论甲型和乙型副伤寒沙门菌同时传播具有致病性强及环丙沙星药物敏感性差的特点,应引起临床及实验室的高度关注。

基于伤寒六经传变浅议荨麻疹的辨治

荨麻疹属中医学“瘾疹”范畴,以营卫不和为主要病机,与狭义的太阳病病机相符,通过研究太阳经与少阳经、阳明经、太阴经、少阴经、厥阴经等三阴三阳六经之间的传变规律,并将之运用到荨麻疹的辨治上。观察发现,六经传变能有效指导荨麻疹的临床方药选择,且可重复性较高,值得推广应用。

“中”“阳”视域下“红山医派”《伤寒论》解经与中医临床教育刍议

2023年6月至10月,北京中医药大学“红山医派”《伤寒论》解经研究课题组、北京扶阳国际中医科学研究院持续开展了“红山医派”《伤寒论》解经暨临床教育相关研讨。综合纳入院校与民间中医学者和北京中医药大学研究生、本科生群体,以求在瞄准临床的经典学习、解读中可集“庙堂之上”与“江湖之远”之长。选定《伤寒论》为主要学习研讨对象,以“红山医派”的重“阳”和重“中”的理念,为相对“中规中矩”的院校经典教育及基于教育的临床实践注入“一剂活水”。在传统院校教育基础上,提升了中医学习者在古今语境差异下从相对碎片化的行文论述中把握经典中心思想的能力。文章将“红山医派”《伤寒论》解经与中医临床教育研讨成果进行整理,以求对于临床经典教学有所借鉴及参考。

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。

《内经》“杂合以治”思想对仲景学术的影响探微

“杂合以治”出自《素问·异法方宜论篇》,原指医者采用砭石、毒药、灸焫、九针、导引按跷5种方法相杂合来治疗疾病。该文通过系统整理和分析张仲景《伤寒论》和《金匮要略》中有关“杂合以治”思想的具体内容,旨在探讨该思想对仲景学术的影响并挖掘其蕴含的现实指导价值,以期为中医综合治疗理论的创立和完善提供有益思路。