scholarly journals Diagnostic Value of Clinical Features to Distinguish Enteric Fever From Other Febrile Illnesses in Bangladesh, Nepal, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S257-S265 ◽  
Author(s):  
Kristen Aiemjoy ◽  
Dipesh Tamrakar ◽  
Shampa Saha ◽  
Shiva R Naga ◽  
Alexander T Yu ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Features ◽  
Diagnostic Performance ◽  
Enteric Fever ◽  
Random Effect ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Diagnostic Value ◽  
Case Definition ◽  
Mixed Effect

Abstract Background Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan. Methods Outpatients presenting with ≥3 consecutive days of reported fever and inpatients with clinically suspected enteric fever from all 6 SEAP study hospitals were eligible to participate. We evaluated the diagnostic performance of select clinical features against blood culture results among outpatients using mixed-effect regression models with a random effect for study site hospital. We also compared the clinical features of S. Typhi to S. Paratyphi A among both outpatients and inpatients. Results We enrolled 20 899 outpatients, of whom 2116 (10.1%) had positive blood cultures for S. Typhi and 297 (1.4%) had positive cultures for S. Paratyphi A. The sensitivity of absence of cough was the highest among all evaluated features, at 65.5% (95% confidence interval [CI], 55.0–74.7), followed by measured fever at presentation at 59.0% (95% CI, 51.6–65.9) and being unable to complete normal activities for 3 or more days at 51.0% (95% CI, 23.8–77.6). A combined case definition of 3 or more consecutive days of reported fever and 1 or more of the following (a) either the absence of cough, (b) fever at presentation, or (c) 3 or more consecutive days of being unable to conduct usual activity--yielded a sensitivity of 94.6% (95% CI, 93.4–95.5) and specificity of 13.6% (95% CI, 9.8–17.5). Conclusions Clinical features do not accurately distinguish blood culture–confirmed enteric fever from other febrile syndromes. Rapid, affordable, and accurate diagnostics are urgently needed, particularly in settings with limited or no blood culture capacity.

scholarly journals Antibiotic Use Prior to Hospital Presentation Among Individuals With Suspected Enteric Fever in Nepal, Bangladesh, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S285-S292
Author(s):  
Krista Vaidya ◽  
Kristen Aiemjoy ◽  
Farah N Qamar ◽  
Samir K Saha ◽  
Dipesh Tamrakar ◽  
...  
Keyword(s):  
Blood Culture ◽  
Disease Severity ◽  
Enteric Fever ◽  
Clinical Care ◽  
Prevalence Ratio ◽  
Antibiotic Use ◽  
Urine Samples ◽  
Mixed Effect ◽  
Culture Positivity ◽  
Blood Culture Positivity

Abstract Background Antibiotic use prior to seeking care at a hospital may reduce the sensitivity of blood culture for enteric fever, with implications for both clinical care and surveillance. The Surveillance for Enteric Fever in Asia Project (SEAP) is a prospective study of enteric fever incidence in Nepal, Bangladesh, and Pakistan. Nested within SEAP, we evaluated the accuracy of self-reported antibiotic use and investigated the association between antibiotic use and blood culture positivity. Methods Between November 2016 and April 2019, we collected urine samples among a subset of SEAP participants to test for antibiotic use prior to the hospital visit using an antibacterial activity assay. All participants were asked about recent antibiotic use and had a blood culture performed. We used mixed-effect logit models to evaluate the effect of antimicrobial use on blood culture positivity, adjusted for markers of disease severity. Results We enrolled 2939 patients with suspected enteric fever. Antibiotics were detected in 39% (1145/2939) of urine samples. The correlation between measured and reported antibiotic use was modest (κ = 0.72). After adjusting for disease severity, patients with antibiotics in their urine were slightly more likely to be blood culture positive for enteric fever; however, the effect was not statistically significant (prevalence ratio, 1.22 [95% confidence interval, .99–1.50]). Conclusions The reliability of self-reported prior antibiotic use was modest among individuals presenting with fever to tertiary hospitals. While antibiotics are likely to reduce the sensitivity of blood culture, our findings indicate that there is still considerable value in performing blood culture for individuals reporting antibiotic use.

scholarly journals Utilization of Blood Culture in South Asia for the Diagnosis and Treatment of Febrile Illness

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S266-S275
Author(s):  
Caitlin Hemlock ◽  
Stephen P Luby ◽  
Shampa Saha ◽  
Farah Qamar ◽  
Jason R Andrews ◽  
...  
Keyword(s):  
Blood Culture ◽  
Regression Models ◽  
Enteric Fever ◽  
Febrile Illness ◽  
Improve Patient Care ◽  
Initial Therapy ◽  
Linear Regression Models ◽  
Current Standard ◽  
Middle Income ◽  
Additive Regression

Abstract Background Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions. Methods We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the burden of febrile illness, stratified by hospital. We used logistic regression to analyze predictors for receiving antibiotics empirically. We descriptively reviewed changes in antibiotic therapy by susceptibility patterns and coverage, stratified by country. Results We screened 30 809 outpatients resulting in 1819 enteric fever cases; 1935 additional cases were enrolled from other hospital locations. Younger outpatients were less likely to receive a blood culture. The association between the number of febrile outpatients and the proportion prescribed blood culture varied by hospital. Antibiotics prescribed empirically were associated with severity and provisional diagnoses, but 31% (1147/3754) of enteric fever cases were not covered by initial therapy; this was highest in Pakistan (50%) as many isolates were resistant to cephalosporins, which were commonly prescribed empirically. Conclusions Understanding hospital-level communication between laboratories and physicians may improve patient care and timeliness of appropriate antibiotics, which is important considering the rise of antimicrobial resistance.

scholarly journals Antimicrobial Resistance in Typhoidal Salmonella: Surveillance for Enteric Fever in Asia Project, 2016–2019

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S276-S284 ◽  
Author(s):  
Farah N Qamar ◽  
Mohammad T Yousafzai ◽  
Irum F Dehraj ◽  
Sadia Shakoor ◽  
Seema Irfan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Enteric Fever ◽  
Treatment Options ◽  
Age Groups ◽  
Febrile Illness ◽  
Preventive Measure ◽  
Salmonella Typhi ◽  
Study Participants

Abstract Background Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. Methods From September 2016–September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. Results We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal. Conclusions Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine.

scholarly journals Healthcare Utilization Patterns for Acute Febrile Illness in Bangladesh, Nepal, and Pakistan: Results from the Surveillance for Enteric Fever in Asia Project

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S248-S256 ◽  
Author(s):  
Jason R Andrews ◽  
Krista Vaidya ◽  
Shampa Saha ◽  
Mohammad Tahir Yousafzai ◽  
Caitlin Hemlock ◽  
...  
Keyword(s):  
Disease Severity ◽  
Enteric Fever ◽  
Febrile Illness ◽  
Household Wealth ◽  
Acute Febrile Illness ◽  
Care Seeking ◽  
Mixed Effect ◽  
Healthcare Seeking ◽  
The Past ◽  
Catchment Areas

Abstract Background Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data. Methods We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with 1) fever for ≥3 consecutive days within the past 8 weeks; or 2) fever resulting in hospitalization within the past year. We also collected data about disease severity and household demographics and assets. We used mixed-effect multivariable logistic regression models to identify determinants of healthcare seeking at study hospitals and determinants of culture-confirmed enteric fever. Results We enrolled 31 841 households (53 926 children) in Bangladesh, 25 510 households (84 196 children and adults) in Nepal, and 21 310 households (108 031 children and adults) in Pakistan. Children <5 years were most likely to be taken to the study hospitals for febrile illness at all sites. Household wealth was positively correlated with healthcare seeking in 4 of 5 study sites, and at least one marker of disease severity was positively associated with healthcare seeking in 3 of 5 catchment areas. Wealth and disease severity were variably predictive of blood culture-confirmed enteric fever. Conclusions Age, household wealth, and disease severity are important determinants of healthcare seeking for acute febrile illness and enteric fever risk in these communities, and should be incorporated into estimation models for enteric fever incidence.

scholarly journals COMPARATIVE ASSESSMENT OF ICT,WIDAL WITH BLOOD CULTURE FOR THE DIAGNOSIS OF TYPHOID FEVER AMONG PUO CASES IN A TERTIARY CARE: A HOSPITAL BASED STUDY OF NORTH EAST.

2020 ◽  
pp. 19-20
Author(s):  
Banti Das ◽  
Niladri Sekhar Das
Keyword(s):  
Blood Culture ◽  
Disease Burden ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Comparative Assessment ◽  
Acute Febrile Illness ◽  
North East ◽  
Laboratory Confirmation ◽  
Tropical Areas

Background: Disease burden of acute febrile illness due to infectious etiologies is under reported in various parts of India including North east due to lack of laboratory confirmation. Undifferentiated febrile illnesses common in tropical areas of Asia and enteric fever is one of them Aims: This study was conducted to determine the best investigative procedures for the diagnosis of enteric fever . Setting and Design: This was a hospital based study among 205 patients including paediatric patients admitted with acute febrile illness were evaluated by ICT, Widal and Blood culture Materials and Methods: ICT , Widal and blood culture were performed according to manufactuter instruction Results: When ICT was compared to blood culture concordence rate was found to be 92% where as discrepacancy was just 8% and sensitivity and specificity was found to be 100 % and 90.24%.

Clinical symptoms cannot predict influenza infection during the 2013 influenza season in Bavaria, Germany

2015 ◽  
Vol 144 (5) ◽  
pp. 1045-1051 ◽  
Author(s):  
H. CAMPE ◽  
S. HEINZINGER ◽  
C. HARTBERGER ◽  
A. SING
Keyword(s):  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Influenza Season ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Laboratory Confirmation

SUMMARYFor influenza surveillance and diagnosis typical clinical symptoms are traditionally used to discriminate influenza virus infections from infections by other pathogens. During the 2013 influenza season we performed a multiplex assay for 16 different viruses in 665 swabs from patients with acute respiratory infections (ARIs) to display the variety of different pathogens causing ARI and to test the diagnostic value of both the commonly used case definitions [ARI, and influenza like illness (ILI)] as well as the clinical judgement of physicians, respectively, to achieve a laboratory-confirmed influenza diagnosis. Fourteen different viruses were identified as causing ARI/ILI. Influenza diagnosis based on clinical signs overestimated the number of laboratory-confirmed influenza cases and misclassified cases. Furthermore, ILI case definition and physicians agreed in only 287/651 (44%) cases with laboratory confirmation. Influenza case management has to be supported by laboratory confirmation to allow evidence-based decisions. Epidemiological syndromic surveillance data should be supported by laboratory confirmation for reasonable interpretation.

scholarly journals The diagnostic value of the widal test in the inoculated

1948 ◽  
Vol 46 (1) ◽  
pp. 98-100 ◽  
Author(s):  
R. H. Mole
Keyword(s):  
Blood Culture ◽  
Enteric Fever ◽  
Diagnostic Value ◽  
Widal Test ◽  
Diagnostic Aid

1. Evidence is given that in recently inoculated persons the Widal reaction, even when serial quantitative tests are done, has no practical value in the diagnosis of enteric fever. Conscription enlarges permanently the inoculated proportion of the whole population.2. The diagnostic value of any particular titre depends not only on the relative frequencies with which this titre occurs in normal and infected individuals but also on the incidence of enteric fever in the population and on the fashionableness of the Widal test as a diagnostic aid.3. It is emphasized that blood culture is a more reliable aid to diagnosis than the Widal test.

Comparative study between WIDAL and DOT ELISA in the diagnosis of Typhoid fever

2021 ◽  
Vol 12 (4) ◽  
pp. 81-85
Author(s):  
Sarah Hassan ◽  
Vineeta Khare ◽  
Shadma Yaqool ◽  
Syed Abid Asghar ◽  
Mastan Singh ◽  
...  
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Diagnostic Yield ◽  
Communicable Disease ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Widal Test ◽  
Serum Samples ◽  
Cross Sectional ◽  
Dot Elisa

Background: Typhoid fever, also known as enteric fever, is a communicable disease, found only in man and occurs due to systemic infection mainly by Salmonella typhi organisms. Blood culture is regarded as the gold standard for diagnosis and carry 70-75% diagnostic yield in the first week of illness. Aims and Objective: To compare the sensitivity and specificity of Widal test and dot ELISA with blood culture in the early diagnosis of Typhoid fever. Materials and Methods: A Cross-Sectional study was carried out in the Department of Microbiology, Era’s Lucknow Medical College and Hospital for a period of 18 months. Patients presenting with acute febrile illness suspicious of typhoid fever accompanied by clinical signs and symptoms of typhoid fever in the absence of any other known febrile illnesses, were included in the study. Widal and Dot ELISA was performed using serum samples and for blood culture aseptically collected blood was used. Results: Sensitivity, Specificity, PPV, NPV of DOT ELISA as compared to Blood culture for typhoid positivity was found to be 92.6%, 83.7%, 55.6% and 98.1% respectively. Diagnostic accuracy of DOT ELISA as compared to Blood culture was found to be 85.3%. Conclusion: For both early and late diagnosis of typhoid fever with high sensitivity as well as accuracy for identification of typhoid fever, the rapid diagnostic test (Dot Elisa) is better than the Widal test. However, it may be an increased burden to healthcare owing to a low positive predictive value in a low prevalence scenario.

scholarly journals PROKALSITONIN, CRP DAN PRESEPSIN SERUM DI SIRS

2016 ◽  
Vol 20 (3) ◽  
pp. 183
Author(s):  
Hendrianingtyas Hendrianingtyas ◽  
Banundari RH ◽  
Indranila KS ◽  
Imam Budiwiyono
Keyword(s):  
Blood Culture ◽  
Predictive Value ◽  
Gold Standard ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Higher Sensitivity ◽  
Septic Condition

Infection in ICU patients can lead to a septic condition with clinical signs similar to Systemic Inflammatory Response Syndrome (SIRS). The high risk of death and high cost of sepsis is the reason to find an early marker in diagnosing sepsis. Blood culture can givea result in 1-3 days, so C reactive protein, procalcitonin and presepsin which are fast and accurate are needed to find a septic condition in SIRS patients. The aim of this study is to determine the diagnostic value of CRP, PCT and presepsin of sepsis with blood culture as the gold standard., The samples were collected from 32 clinically SIRS patients in the Dr. Kariadi Hosiptal, Semarang. The PCT level was measured using ELFA method, CRP level by PET IA method, while presepsin level by CLEA method. The determined area was under curve (AUC) and the cut off level was determined by 2×2 table to find out the sensitivity, spesificity, positive predictive value, negative predictive value and likelihood ratio of CRP, PCT and presepsin as well. The AUC of PCT, CRP and presepsin was 0.78 (cut off 4.314 ng/mL); 0.673 (cut off 10.245 mg/L) and 0.814 (cut off 1134.5 pg/mL). The presepsin level had a higher sensitivity (90%) than PCT (80%) and CRP (70%). PCT specificity was 72.73%, presepsin and CRP specificity each was 68.18%. Based on this study, AUC and sensitivity of presepsin level were found higher than the PCT and CRP level.

scholarly journals A Clinical Study of the Association of Thrombocytopenia with Acute Febrile Illness

2022 ◽  
Vol 9 (3) ◽  
pp. 12-15
Author(s):  
Gangum Venkatreddy ◽  
Shireesha Gugloth
Keyword(s):  
Platelet Count ◽  
Enteric Fever ◽  
Viral Infections ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Platelet Counts ◽  
Chest X Ray ◽  
The Common ◽  
Time Of Admission

Abstract Background: Thrombocytopenia accompanying acute febrile illnesses is a matter of concern because lack of prompt treatment could result in significant mortality. We in this study tried to evaluate the clinical profile of cases with acute fever and thrombocytopenia and determine the cause of fever with thrombocytopenia and the outcome of treatment of such patients in our hospital. Methods: A total of n=50 successive cases of acute febrile illness with thrombocytopenia following inclusion and exclusion criteria were included in this study. Clinical signs such as rashes, signs of dehydration, petechiae, jaundice, lymphadenopathy, hepatomegaly, splenomegaly, anemia, abdominal tenderness, altered sensorium, were noted. Investigations included CBP, ESR, LFT, RFT, serum electrolytes, Chest X-ray, USG abdomen were done. Other investigations included Dengue serology, Malaria, Widal, IgM for leptospirosis, sputum for AFB. Results: Out of n=50 patients with acute fever with thrombocytopenia, all of them had a definitive diagnosis with malaria (40%) as the commonest cause, followed by enteric fever (24%), viral fever (14%), septicemia (6%), dengue (14%), and leptospirosis (2%). 50% of the patients had platelet count in the range of 50, 000 – 1,00, 000 and 30% had platelet counts above 100000-150000. 8% of cases had platelet counts below 25000 and 12% had platelet counts between 25000-50000 at the time of admission. 10% mortality was observed. Conclusion: infections as the commonest cause of thrombocytopenia. Malaria, dengue enteric fever, leptospirosis, and other viral infections formed the major diseases in this group of population. The diagnosis of malaria was the common cause because of seasonal and regional variations. A definitive increase in platelet count was noted after the underlying cause was treated. Severe cases of septicemia with associated co-morbidities resulted in mortality.

Sign in / Sign up

Export Citation Format

Share Document