scholarly journals Redefining typhoid diagnosis: what would an improved test need to look like?

2019 ◽  
Author(s):  
Richard Mather ◽  
Heidi Hopkins ◽  
Christopher M. Parry ◽  
Sabine Dittrich
Keyword(s):  
Typhoid Fever ◽  
Diagnostic Test ◽  
Clinical Medicine ◽  
Point Of Care ◽  
Treatment Algorithm ◽  
Febrile Illness ◽  
Diagnosis And Treatment ◽  
Acute Febrile Illness ◽  
Next Generation ◽  
Antibiotic Overuse

IntroductionTyphoid fever is one of the most common bacterial causes of acute febrile illness in the developing world, with an estimated 10.9 million new cases and 116.8 thousand deaths in 2017. Typhoid point-of-care (POC) diagnostic tests are widely used but have poor sensitivity and specificity, resulting in antibiotic overuse that has led to the emergence and spread of multidrug resistant strains. With recent advances in typhoid surveillance and detection, this is the ideal time to produce a target product profile (TPP) that guides product development and ensure that a next-generation test meets the needs of users in the resource-limited settings where typhoid is endemic.MethodsA structured literature review was conducted to develop a draft TPP for a next-generation typhoid diagnostic test with minimal and optimal desired characteristics for 36 test parameters. The TPP was refined using feedback collected from a Delphi survey of key stakeholders in clinical medicine, microbiology, diagnostics and public and global health.ResultsA next-generation typhoid diagnostic test should improve patient management through the diagnosis and treatment of infection with acute Salmonella enterica serovars Typhi or Paratyphi with a sensitivity ≥90% and specificity ≥95%. The test would ideally be used at the lowest level of the healthcare system in settings without a reliable power or water supply and provide results in less than 15 minutes at a cost of <$1.00 USD.ConclusionThis report outlines the first comprehensive TPP for typhoid fever and is intended to guide the development of a next-generation typhoid diagnostic test. An accurate POC test will reduce the morbidity and mortality of typhoid fever through rapid diagnosis and treatment and will have the greatest impact in reducing antimicrobial resistance if it is combined with diagnostics for other causes of acute febrile illness in a treatment algorithm.

scholarly journals Redefining typhoid diagnosis: what would an improved test need to look like?

2019 ◽  
Vol 4 (5) ◽  
pp. e001831
Author(s):  
Richard G Mather ◽  
Heidi Hopkins ◽  
Christopher M Parry ◽  
Sabine Dittrich
Keyword(s):  
Typhoid Fever ◽  
Diagnostic Test ◽  
Clinical Medicine ◽  
Point Of Care ◽  
Treatment Algorithm ◽  
Febrile Illness ◽  
Diagnosis And Treatment ◽  
Acute Febrile Illness ◽  
Next Generation ◽  
Antibiotic Overuse

IntroductionTyphoid fever is one of the most common bacterial causes of acute febrile illness in the developing world, with an estimated 10.9 million new cases and 116.8 thousand deaths in 2017. Typhoid point-of-care (POC) diagnostic tests are widely used but have poor sensitivity and specificity, resulting in antibiotic overuse that has led to the emergence and spread of multidrug-resistant strains. With recent advances in typhoid surveillance and detection, this is the ideal time to produce a target product profile (TPP) that guides product development and ensure that a next-generation test meets the needs of users in the resource-limited settings where typhoid is endemic.MethodsA structured literature review was conducted to develop a draft TPP for a next-generation typhoid diagnostic test with minimal and optimal desired characteristics for 36 test parameters. The TPP was refined using feedback collected from a Delphi survey of key stakeholders in clinical medicine, microbiology, diagnostics and public and global health.ResultsA next-generation typhoid diagnostic test should improve patient management through the diagnosis and treatment of infection with acute Salmonella enterica serovars Typhi or Paratyphi with a sensitivity ≥90% and specificity ≥95%. The test would ideally be used at the lowest level of the healthcare system in settings without a reliable power or water supply and provide results in <15 min at a cost of <US$1.00.ConclusionThis report outlines the first comprehensive TPP for typhoid fever and is intended to guide the development of a next-generation typhoid diagnostic test. An accurate POC test will reduce the morbidity and mortality of typhoid fever through rapid diagnosis and treatment and will have the greatest impact in reducing antimicrobial resistance if it is combined with diagnostics for other causes of acute febrile illness in a treatment algorithm.

Using Clinical Profiles and Complete Blood Counts to Differentiate Causes of Acute Febrile Illness during the 2009–11 Outbreak of Typhoid and Chikungunya in a Dengue Endemic Area

2020 ◽  
Vol 66 (5) ◽  
pp. 504-510
Author(s):  
Kamolwish Laoprasopwattana ◽  
Wannee Limpitikul ◽  
Alan Geater
Keyword(s):  
Typhoid Fever ◽  
Predictive Value ◽  
Nonstructural Protein ◽  
Specific Treatment ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Negative Results ◽  
Nonstructural Protein 1 ◽  
Clinical Profiles ◽  
Complete Blood Counts

Abstract Background and aims After the 2009–11 outbreak of typhoid and chikungunya (CHIK) in Thailand, an effort was made to use complete blood counts and clinical profiles to differentiate these diseases to facilitate earlier specific treatment. Methods Patients aged 2–15 years having fever on first visit ≤3 days without localizing signs were enrolled retrospectively. Typhoid fever was confirmed by hemoculture, dengue by nonstructural protein-1 or polymerase chain reaction (PCR), and CHIK by PCR. Febrile children with negative results for these infections were classified as other acute febrile illness (AFI). Results Of the 264 cases, 56, 164, 25 and 19 had typhoid fever, dengue viral infection (DVI), CHIK and other AFI, respectively. Arthralgia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value of 0.96, 0.97, 0.80 and 0.99, respectively, to differentiate CHIK from the others. After excluding CHIK by arthralgia, the PPV of the WHO 1997 and 2009 criteria for DVI increased from 0.65 and 0.73 to 0.95 and 0.84, respectively. Children with one of myalgia, headache or leukopenia had sensitivity of 0.84, specificity of 0.76 and PPV of 0.92 to differentiate DVI from typhoid and other AFIs. Patients with one of abdominal pain, diarrhea or body temperature &gt;39.5°C were more likely to have typhoid fever than another AFI with PPV of 0.90. Conclusion Using this flow chart can help direct physicians to perform more specific tests to confirm the diagnosis and provide more specific treatment. Nevertheless, clinical follow-up is the most important tool in unknown causes of febrile illness.

scholarly journals An Analysis of Hematological Parameters as a Diagnostic test for Malaria in Patients with Acute Febrile Illness: An Institutional Experience

2014 ◽  
Vol 29 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Zeeba Shamim Jairajpuri ◽  
Safia Rana ◽  
Mohd Jaseem Hassan ◽  
Farhat Nabi ◽  
Sujata Jetley
Keyword(s):  
Diagnostic Test ◽  
Hematological Parameters ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Institutional Experience

scholarly journals Evaluation of loop-mediated isothermal amplification assay for detection of scrub typhus in patients with acute febrile illness presenting to a Tertiary Care Center in Puducherry, India

2019 ◽  
Vol 11 (01) ◽  
pp. 082-086 ◽  
Author(s):  
Patricia Anitha Karthikeyan ◽  
Sugeerappa Laxmanappa Hoti ◽  
Reba Kanungo
Keyword(s):  
Diagnostic Test ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Lamp Assay ◽  
Febrile Illness ◽  
Isothermal Amplification ◽  
Acute Febrile Illness ◽  
Loop Mediated Isothermal Amplification ◽  
Igm Antibodies ◽  
Two Samples

Abstract PURPOSE: Scrub typhus an acute febrile illness has diverse clinical manifestations, which overlap with other febrile illnesses. Due to this reason, it is misdiagnosed, leading to inappropriate treatment, sometimes resulting in fatality. Thus, accurate diagnosis of scrub typhus is important for appropriate treatment. This study evaluated the loop-mediated isothermal amplification (LAMP) assay as a diagnostic test for scrub typhus among patients with fever. MATERIALS AND METHODS: A total of 50 cases of acute febrile illness clinically resembling scrub typhus, with or without an eschar, or cases of pyrexia of unknown origin were included in the study. Blood samples collected from these cases were subjected to detection of IgM antibodies to Orientia tsutsugamushi by ELISA, conventional groEL polymerase chain reaction (PCR), and the LAMP assay. RESULTS: Twelve cases had fever for less than a week, and two had fever for more than 3 weeks. IgM antibodies to O. tsutsugamushi were detected in 37 out of 50 samples (74%). LAMP assay was positive in 33 samples (66%). groEL gene-based PCR detected 35 (70%) samples as positive. Two samples negative by LAMP assay were positive by this PCR. Twenty samples collected from patients with dengue, typhoid, and malaria tested by the LAMP assay were negative, indicating its good specificity. LAMP assay and the conventional groEL-based PCR could detect 72.7% and 74.3% of the samples, respectively before the 10th day after onset of fever, whereas IgM ELISA could detect only 40.5% of the 37 samples. CONCLUSION: This study suggests that LAMP assay could be a useful diagnostic test for detecting scrub typhus in the acute phase of the illness and a cheaper alternative to other molecular methods in resource poor settings.

scholarly journals Dengue Typhoid Co-infection: a New Threat

2019 ◽  
Vol 10 (1) ◽  
pp. 96-97
Author(s):  
Md Mahmudur Rahman Siddiqui ◽  
Quazi Tarikul Islam ◽  
Mohammad Shahidul Islam
Keyword(s):  
Public Health ◽  
Developing Countries ◽  
Typhoid Fever ◽  
Dengue Fever ◽  
Clinical Diagnosis ◽  
Clinical Presentation ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Medical College ◽  
Common Clinical Presentation

Acute febrile illness is the most common clinical presentation among patients attending to doctor in developing countries. In Bangladesh, dengue and typhoid fever have emerged as major public health problems. Co-infection with both these diseases is rarely reported and are known to present with overlapping symptoms making the clinical diagnosis difficult. The exact incidence of dengue and typhoid co-infection is not known. Here we report a case of co-infection of dengue fever with typhoid fever. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 96-97

scholarly journals Coinfections of Zika and Chikungunya Viruses in Bahia, Brazil, Identified by Metagenomic Next-Generation Sequencing

2016 ◽  
Vol 54 (9) ◽  
pp. 2348-2353 ◽  
Author(s):  
Silvia I. Sardi ◽  
Sneha Somasekar ◽  
Samia N. Naccache ◽  
Antonio C. Bandeira ◽  
Laura B. Tauro ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Next Generation Sequencing ◽  
Chikungunya Virus ◽  
Clinical Presentation ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Next Generation ◽  
Zikv Infection ◽  
Viral Pathogens ◽  
Generation Sequencing

Metagenomic next-generation sequencing (mNGS) of samples from 15 patients with documented Zika virus (ZIKV) infection in Bahia, Brazil, from April 2015 to January 2016 identified coinfections with chikungunya virus (CHIKV) in 2 of 15 ZIKV-positive cases by PCR (13.3%). While generally nonspecific, the clinical presentation corresponding to these two CHIKV/ZIKV coinfections reflected infection by the virus present at a higher titer. Aside from CHIKV and ZIKV, coinfections of other viral pathogens were not detected. The mNGS approach is promising for differential diagnosis of acute febrile illness and identification of coinfections, although targeted arbovirus screening may be sufficient in the current ZIKV outbreak setting.

scholarly journals Point of care biomarkers to guide antibiotic prescription for acute febrile illness in sub-Saharan Africa: promises and caveats

2020 ◽  
Author(s):  
Johan van Griensven ◽  
Lieselotte Cnops ◽  
Anja De Weggheleire ◽  
Steven Declercq ◽  
Emmanuel Bottieau
Keyword(s):  
Antibiotic Prescription ◽  
Point Of Care ◽  
Febrile Illness ◽  
Sub Saharan Africa ◽  
Acute Febrile Illness ◽  
Sub Saharan

Abstract

scholarly journals Acute Febrile Illness Among Children in Butajira, South–Central Ethiopia During the Typhoid Fever Surveillance in Africa Program

2019 ◽  
Vol 69 (Supplement_6) ◽  
pp. S483-S491 ◽  
Author(s):  
Mekonnen Teferi ◽  
Mulualem Desta ◽  
Biruk Yeshitela ◽  
Tigist Beyene ◽  
Ligia Maria Cruz Espinoza ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Febrile Illness ◽  
Incidence Rates ◽  
Acute Febrile Illness ◽  
Healthcare Facilities ◽  
South Central ◽  
Etiological Agents ◽  
Tract Infections ◽  
Pathogenic Agents ◽  
Malaria Microscopy

Abstract Background Clearly differentiating causes of fever is challenging where diagnostic capacities are limited, resulting in poor patient management. We investigated acute febrile illness in children aged ≤15 years enrolled at healthcare facilities in Butajira, Ethiopia, during January 2012 to January 2014 for the Typhoid Fever Surveillance in Africa Program. Methods Blood culture, malaria microscopy, and blood analyses followed by microbiological, biochemical, and antimicrobial susceptibility testing of isolates were performed. We applied a retrospectively developed scheme to classify children as malaria or acute respiratory, gastrointestinal or urinary tract infection, or other febrile infections and syndromes. Incidence rates per 100 000 population derived from the classification scheme and multivariate logistic regression to determine fever predictors were performed. Results We rarely observed stunting (4/513, 0.8%), underweight (1/513, 0.2%), wasting (1/513, 0.2%), and hospitalization (21/513, 4.1%) among 513 children with mild transient fever and a mean disease severity score of 12 (95% confidence interval [CI], 11–13). Blood cultures yielded 1.6% (8/513) growth of pathogenic agents; microscopy detected 13.5% (69/513) malaria with 20 611/µL blood (95% CI, 15 352–25 870) mean parasite density. Incidences were generally higher in children aged ≤5 years than >5 to ≤15 years; annual incidences in young children were 301.3 (95% CI, 269.2–337.2) for malaria and 1860.1 (95% CI, 1778.0–1946.0) for acute respiratory and 379.9 (95% CI, 343.6–420.0) for gastrointestinal tract infections. Conclusions We could not detect the etiological agents in all febrile children. Our findings may prompt further investigations and the reconsideration of policies and frameworks for the management of acute febrile illness.

Kawasaki Disease: Early Presentation to the Otolaryngologist

1993 ◽  
Vol 108 (4) ◽  
pp. 344-347 ◽  
Author(s):  
Michael A. Seicshnaydre ◽  
Mary Ann Frable
Keyword(s):  
Kawasaki Disease ◽  
Early Diagnosis ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
Diagnosis And Treatment ◽  
Unknown Etiology ◽  
Cardiac Complications ◽  
Acute Febrile Illness ◽  
Conjunctival Injection ◽  
Early Presentation

Kawasaki disease is an acute febrile illness of unknown etiology that occurs primarily in childhood. Early diagnosis and treatment can reduce the risk of cardiac complications of Kawasaki disease, which carries a 1% to 2% mortality for cardiovascular events. Clinical features include: (1) fever (2) conjunctival injection (3) oral cavity changes (4) changes in the peripheral extremities (5) erythematous rash and (6) cervical adenopathy without suppuration. We describe three cases in detail and survey a series of 42 patients at our institution. Otolaryngologic manifestations were found to occur in the early stages of Kawasaki disease. The otolaryngologist may see these patients early in the disease and should be alert to the signs and symptoms for appropriate diagnosis and treatment. Characteristics of Kawasaki disease, difficulties in diagnosis during the initial febrile stage, and the importance of early diagnosis by the otolaryngologist is stressed.

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