scholarly journals TYPHOID FEVER

2007 ◽  
Vol 14 (04) ◽  
pp. 620-626
Author(s):  
MAQSOOD AHMAD ◽  
Badar Bashir ◽  
MUHAMMAD SAEED AKHTAR ◽  
Muhammad Irfan ◽  
MUHAMMAD AMER ADIL ◽  
...  

Objectives: To find out the efficacy and safety of Levofloxacinin patients suffering from typhoid fever. Design: Non-comparative and prospective study. Setting: Medical Units ofAllied & DHQ Hospital (PMC) Faisalabad. Period: From May 2002 to July 2004. Material & Methods: All suspectedfebrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose ofstudy till they were satisfactorily discharged. Results: This clinical study was conducted on 70 patients of Enteric Fever.Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58± 8.13while the mean age of females was 21.92± 4.73 years. Fever as a symptom was present in all 70(100%) of thepatients. Anorexia was there in 61(85.5%)patients and abdominal pain in 49(70%) patients. Twenty-seven (38.5%)patients had constipation along with other features. Diarrhea was present in 6 (8.5%) patients. Relative bradycardiawas present in 20(28.5%) patients. Hepatomegaly was there in 31(44.3%) and Splenomegaly in 24(34.3%). Elevatedliver enzymes were found in 29 (41.4%) of the patients and blood cultures positive for Salmonella typhi was seen in19(27.1%) patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18%of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of feverand other symptoms and signs. The side effects were seen in 17(24.2%) patients. Conclusions: In conclusionlevofloxacin is effective in treatment of typhoid fever and its use in this indication is safe.

2012 ◽  
Vol 35 (2) ◽  
pp. 53-58 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Fahim Ahmed Rupam ◽  
Farhana Chaiti

Background & objectives: The clinical diagnosis of typhoid fever is difficult, as the presenting symptoms are often diverse and similar to those observed with other febrile illnesses. The definitive diagnosis of typhoid fever requires the isolation of Salmonella typhi or paratyphi from the patient concerned. Since patients often receive antibiotics prior to a confirmatory diagnosis, there is uncertainty that bacteria can be isolated from the blood cultures. Besides this, the facilities for blood culture are not always available or feasible. All these limitations have made Widal test the most utilized diagnostic test for typhoid fever. Many studies have produced data which had cast serious doubts on the value of the Widal Test and thus reappraisal of the role of a single Widal test is needed.Methods & materials: This study was carried out to determine the changes in clinical pattern of enteric fever. A total of 153 children, aged 0 to 14 years, diagnosed as typhoid fever (either positive blood culture for Salmonella typhi or paratyphi) were induced in the study. Of them, 86 children were with a definitive diagnosis of typhoid or paratyphoid fever as indicated by the isolation of S. typhi or S. paratyphi from the blood and 17 had negative blood culture but were clinically suspected of having typhoid fever. The control group was comprised of 50 children with non-typhoidal fevers The Widal test was carried out using rapid slide agglutination method and its accuracy was assessed by comparing the findings with that obtained through blood culture.Result: The mean age of the patients was 5.2 ± 2.8 years and the youngest and oldest patients were 0.7 and 14 years respectively and male to female ratio was roughly 1:1. Nearly one-quarter (24.6%) of the patients had been suffering from the disease for >10 days and the mean duration of illness was 8.2 ± 3.3 days. Widal Test result showed that an ‘O’ agglutinin titer of cut-off value e”1:40 gave a sensitivity of 87.2%, a specificity of 47.1%, a positive predictive value (PPV) of 89.2% and a negative predictive value (NPV) of 42.1%. The sensitivity and NPV decreased with the increase in titer levels and were 56.9% and 31.5% at cut-off value of e” 1:320, while the specificity and PPV increased with the increase in titer levels from 47.1% and 89.2% respectively at a titer of e”1:40 to 100% at a titer of e” 1:320. The ‘titer behaved in the same way as did the ‘O’ agglutinin titer. Similarly when H’ agglutinin was used the sensitivity and NPV decreased from 65% and 31.7% at a titer of e”1:40 to only 25% and 20% respectively at a titer of > 1:320, while specificity and PPV increased from 76.4% and 81.1% at >1:40 to 94.1% and 95.6% respectively at e” 1:320. When either ‘O’ or ‘H’ antibody titer of e”1:160 was used, a good sensitivity (71%), specificity (70.6%) and PPV (92.4%) resulted, though NPV decreased to 32.4%.Conclusion: The Widal test can be of diagnostic value when blood cultures are not available nor practically feasible.DOI: http://dx.doi.org/10.3329/bjch.v35i2.10377  Bangladesh J Child Health 2011; Vol 35 (2): 53-58


2012 ◽  
Vol 34 (3) ◽  
pp. 80-85 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Sanjana Zaman ◽  
Farhana Chaiti ◽  
Naveen Sheikh ◽  
Gopen Kumar Kundu

Background: Recent reports from developing countries show that the clinical presentation, diagnosis and treatment of typhoid have significantly altered often leading to missed diagnosis. The incidence of complications is also reported to be variable. The consequence of missed diagnosis is immense in terms of burden on limited health resources and patients’ suffering. Therefore, its clinical spectrum requires constant reappraisal to update our physicians with current knowledge. This study was carried out to determine the changes in clinical pattern of typhoid fever. Patients & Methods: A total of 106 children, aged up to 14 years, diagnosed primarily as typhoid fever, were included as study population. The diagnostic criteria were either positive blood culture for Salmonella typhi or Salmonella paratyphi or at least a four-fold rise in antibody titre on Widal test. The study included mode of clinical presentations, treatment received before admission, Widal test findings and culture and sensitivity to antibiotics. Results: The mean age of the patients was 5.2 years and males were a little than the females. The mean duration of illness was 11.2±3.3 days. Majority of the patients presented with classical signs and symptoms like step ladder pattern of fever (nearly 70%) coated tongue (69.8%), diarrhoea (49.1%), toxemia (68.9%), relative leucopenia (71.7%), hepatomegaly (55.7%), pain in the right hypochondrium (41.5%) and splennomegaly (18.9%). Very few cases had a typical manifestations. Over 85% of the patients had raised SGPT (>40 IU/L) and 13.8% had detectable jaundice (serum billirubin >3 mg/dl). Widal test demonstrated that about 45% of the patients’ ‘O’ antibody titer increased to 4-fold, 27.4% to 8-fold or more. In case of antibody ‘H’, 35.8% exhibited 4-fold and 39.7% 8-fold or more increase. Of the 103 cases, 68(66%) were positive for Salmonella typhi. Majority of the isolated organisms was sensitive to cefixime, ceftriaxone and gentamycin (83%, 84% and 82% respectively). The second line of sensitivity was obtained to amikacin (64.2%), meropenem (50%), ciprofloxacin (46.2%), imepenem (46.2%) and azithromycin (43.4%). The least sensitive drugs were amoxicillin (28.3%), cotrimoxazole (27.4%) and chloramphenicol (22.6%). Onethird (33.8%) of the patients had multidrug resistant (MDR) strains. However, No significant association was found between multi-drug resistant (MDR) strains and atypical clinical manifestations. Conclusion: Clinical presentation of most typhoid fever still conforms with the classic pattern. High fever, anorexia, coated tongue, diarrhoea, relative leucopenia and hepatosplenomegaly are still common manifestations of typhoid fever. So, majority of the patients could be treated blindly based on clinical diagnosis. However, treatment should be given with first line of drugs like cefexime or ceftriaxone. DOI: http://dx.doi.org/10.3357/bjch.v34i3.10357 BJCH 2010; 34(3): 80-85


2019 ◽  
Vol 91 (8) ◽  
pp. 67-74
Author(s):  
E A Klimova ◽  
E Z Burnevich ◽  
V P Chulanov ◽  
D A Gusev ◽  
O O Znoyko ◽  
...  

Aim. Evaluate efficacy and safety of a combination of direct - acting antivirals narlaprevir/ritonavir with daclatasvir in patients with viral hepatitis C. Materials and methods. The study enrolled adult patients with HCV genotype 1b infection without demonstrated NS5A resistance - associated substitutions Y93C/H/N/S and/or L31F/M/V/I. Patients were treated with narlaprevir 200 mg QD, ritonavir 100 mg QD and daclatasvir 60 mg QD. Treatment duration was 12 weeks. Proportion of patients achieving sustained virological response 12 weeks after treatment (SVR12) was the primary efficacy endpoint. Results and discussion. In total, 105 (75.0%) patients were treatment with the study combination. Patients’ age varied from 21 to 69 years, the mean age being 43.2±10.9 years. There were slightly more women (55.2%), and 69 patients (65.7%) had comorbidities. SVR 12 was 89.5% (95% CI 82.0-94.7%). In 10 of 11 patients with treatment failures NS5A resistance - associated substitutions in residues 31 and/or 93 were found, as well as less clinically relevant substitutions L28M, P58S, R30Q, Q62K. Adverse events (AEs) were found in less than one half of patients (45 patients, or 42.9% in the safety population). Almost all recorded AEs were mild to moderate. Conclusion. Efficacy of treatment with a combination of narlaprevir/ritonavir and daclatasvir in treatment - naïve patients with HCV genotype 1b was close to 90%. This combination was found to be safe and well - tolerated.


1970 ◽  
Vol 19 (2) ◽  
pp. 137-144 ◽  
Author(s):  
ABM Sarwer-E-Alom Sarker ◽  
Samir K Saha ◽  
Maksuda Islam ◽  
MA Hossain

The study of the trend of infection, susceptibility to antibiotics and molecular level analysis of the cause of reduced susceptibility of Salmonella typhi isolates from the patients in Bangladesh were studied. Out of 9040 blood cultures obtained during the study period, 1266 (14.0%) showed significant growth. Nearly three?fourths of the positive blood cultures were due to S. typhi and rests were mostly of S. paratyphi A. The prevalence was highest between the age group 25 and 60 months. Male showed slightly higher rate of infection than female. Among all 943 S. typhi isolates, 42.6, 42 and 41.4% were sensitive to ampicillin, cotrimoxazol and chloramphenicol, respectively. All isolates were sensitive to ceftriaxon and ceftazidim; 9 isolates were ciprofloxacin resistant, others were moderate to highly sensitive; whereas, only 2.2% isolates were sensitive and almost all (97.8%) were found resistant to nalidixic acid. The E?strip test among 411 isolates showed the MIC value of 53 isolates nearer to the very sensitive (< 0.125 μg/ml), 252 isolates between 0.125 and 0.5 μg/ml, 95 isolates between 0.5 and 2.0 μg/ml and rest other 11 isolates showed from > 2.0 μg/ml to very highly resistant (512 μg/ml). VNTR pattern of all ciprofloxacine resistant S. typhi was also same. Restriction fragment analysis of gyrase?A gene indicated point mutations in different loci that bear the cause of being resistant to ciprofloxacin.    Key words: Reduced susceptibility; Typhoid fever; Salmonella typhi; Fluoroquinolone DOI: http://dx.doi.org/10.3329/dujbs.v19i2.8955 DUJBS 2010; 19(2): 137-144


2015 ◽  
Vol 22 (04) ◽  
pp. 439-442
Author(s):  
Muhammad Usman Anjum ◽  
Hafizullah Khan ◽  
Syed Humayun Shah

Typhoid fever is a systemic infection which is caused by Samonella entericaserotype typhi. It is a multi-system disorder involving many organs including liver. Liverinvolvement could be in the form of jaundice, rise in liver enzymes or hepatomegaly. It canpresent as acute hepatitis in rare cases, called typhoid hepatitis. Objectives: This study wascarried out to study the association of typhoid fever in patients with jaundice. To determinethe frequency of typhoid fever among patients presenting with jaundice. Design: Descriptivecross sectional study Setting: at Gastroenterology Unit, Ayub Teaching Hospital, Abbottabad,Period: March 2011 to December 2011. Methods: Total 115 patients were included in thestudy based on inclusion and exclusion criteria. Typhidot IgM test was performed to confirmthe diagnosis of typhoid fever. Results: The mean age of patients was 28.5 ± 10.14 years,with 54.8% male gender predominating the overall sample. The male to female ratio was 1.2:1.Typhoid fever was found in 22 (19.1%) out of 115 patients with jaundice and there were 68.2%were males and 31.8% were females. Conclusions: Typhoid fever is not rare to present asjaundice in our part of the world where typhoid fever is endemic. Therefore, all those patientswho have fever, jaundice, abnormal liver function tests or hepatomegaly must be screened fortyphoid fever especially in areas where typhoid fever is endemic.


2016 ◽  
Vol 5 (3) ◽  
Author(s):  
Vika Rahma Velina ◽  
Akmal M. Hanif ◽  
Efrida Efrida

AbstrakDiagnosis definitif demam tifoid adalah dengan biakan, tetapi pada beberapa daerah sering tidak tersedia fasilitas untuk biakan, maka cara lain untuk membantu menegakkan diagnosis yang praktis dan tersedia di rumah sakit yaitu uji Widal. Tujuan penelitian ini adalah untuk mengetahui gambaran hasil uji Widal pada pasien suspek demam tifoid. Penelitian ini dilakukan di Bagian Rekam Medik  RS Dr. M. Djamil Padang. Jenis penelitian ini adalah retrospektif deskriptif yang telah dilaksanakan dari Juli 2013 sampai Februari 2014. Jumlah sampel yang didapatkan adalah sebanyak 46 orang. Dari 46 sampel didapatkan hasil uji Widal dengan titer antibodi terhadap antigen O 1:80 sebanyak 6,51%, 1:160 sebanyak 73,89%, 1:320 sebanyak 19,54%, dan 1:640 sebanyak 0%. Titer antibodi terhadap antigen H 1:80 sebanyak 4,34%, 1:160 sebanyak 47,80%, 1:320 sebanyak 45,63%, dan 1:640 sebanyak 2,17%. Kesimpulan hasil studi ini ialah 1:160 adalah titer yang tersering ditemukan dengan titer antibodi terhadap antigen O tertinggi yakni 1:320 lebih sering ditemukan pada lama demam dengan rentang 6 – 8 hari sedangkan titer antibodi terhadap antigen H tertinggi yakni 1:640 ditemukan pada lama demam dengan rentang 6 – 8 hari.Kata kunci: demam tifoid, uji Widal, Salmonella typhi AbstractThe definitive diagnosis of typhoid fever is  proven by culture, but in some areas is often no way of culture. There is another examination that has been found to help the diagnosis that is practical and available in hospital which is called Widal test. The objective of this study was to describe the results of Widal test in patients with suspected typhoid fever. This research was conducted at the medical record of Dr. M. Djamil Padang Hospital. This is a descriptive research which was held in July 2013 – February 2014. The number of samples obtained are as many as 46 people.  The 46 samples obtained Widal test, the results was made with titres of antibodies against O antigens 1:80 as much as 6,51%, 1:160 as much as 73,89%, 1:320 as much as 19,54%, and 1:640 as much as  0%. Titers of antibodies against H antigens 1:80 as much as 4,34%, 1:160 as much as 47,80%, 1:320 as much as 45,63%, and 1:640 as much as 2,17%. The conclusion is 1:160 is the most often titres found in patients with suspected typhoid fever with the highest value of antibody titers against the O antigens that is 1:320, is more common in duration of fever with a range of 6-8 days and the highest value of antibody titers against H antigens that is 1:640 has found in duration of fever with range 6-8 days.Keywords: typhoid fever, Widal test, Salmonella typhi


2015 ◽  
Vol 30 (2) ◽  
pp. 46-50
Author(s):  
Shafinaz Khan ◽  
Md Ruhul Amin Miah ◽  
Shammin Haque ◽  
Chowdhury Rafia Naheen

The diagnosis of typhoid fever currently depends on isolation of Salmonella Typhi from blood. The sensitivity of blood culture is very low due to prior antibiotic treatment which is a common practice in Bangladesh. The sensitivity of blood culture also decreases at later stage of the disease. Widal test is the most utilized test in Bangladesh next to blood culture because it is inexpensive, less invasive. But the result of the test is controversial due to false negative & false positive results in some cases.  In this study, a recently introduced polymerase chain reaction-based technique (which has 100% specificity for S. Typhi) was compared with widal test among 80 clinically suspected typhoid fever cases.  Among 80 cases, the respective figures of positivity for PCR & widal test were 70% & 43.75% respectively.  It can be concluded that PCR based technique is more sensitive & much superior to widal for diagnosis of typhoid fever. DOI: http://dx.doi.org/10.3329/bjpp.v30i2.22683 Bangladesh J Physiol Pharmacol 2014; 30(2): 46-50


Author(s):  
Shetty Jeevan

Objective: This study was undertaken to establish a cutoff significant titer for Widal test using healthy volunteers as control group. Utilizing the baseline titer obtained from the control group, a diagnosis of typhoid fever was made in the test group comprising outpatients and inpatients. Methods: Blood samples were collected from healthy volunteers and patients attending G.S Medical College and Hospital, Pilkhuwa, over a period of 6 months from September 2016 to March 2017. Antibodies to Salmonella typhi (TO, TH) and Paratyphi A (AH) and Paratyphi B (BH) are determined by this tube agglutination test. A total of 124 healthy controls and 303 patients having clinical suspicion of typhoid fever were subjected to Widal test. Results: In healthy control group, titer TO ≥20 was observed in 43 (34.7%), TO ≥40 in 48 (38.7%), TO≥80 in 25 (20.2%), and titer TO ≥160, TO ≥320 was observed in none of the control group. Titer TH ≥40 in 58 (46.8%), AH ≥40 in 7 (5.6%), and BH ≥40 in 13 (10.5%) were observed in the control group. Among the test group, 96 (31.7%) sera were positive out of 303 clinically suspected enteric fever by the Widal test. Among different age group studied, 34 (46.6%) patients belonged to the age group of 11-20 years which formed the highest followed by the age group of 21-30 years (33.3%). Conclusion: Based on the study, a cutoff titer of ≥160 for anti-O and anti-H antibodies and titer of ≥80 for anti-AH and anti-BH antibodies be considered as significant titer in diagnosis of enteric fever in this region. The baseline titer helps in early recognition and treatment of this serious health problem.


2020 ◽  
Vol 16 ◽  
Author(s):  
Hasta Handayani Idrus ◽  
Mochammad Hatta ◽  
Veny Hadju ◽  
Suryani As'ad ◽  
Vivien Novarina Kasim ◽  
...  

Background: Manila sapodilla fruit (Achras zapota L) has been widely known empirically in the community, namely fruit used for the treatment of typhoid fever by means of raw fruit in washing / cleaning then the fruit is shredded and the result of grated squeezed using fine leaves and the filter is drunk in patients with typhoid fever. High Motility Group Box 1 (HMGB1) is a protein that is expressed constitutively in almost all types of cells. Objective: To determine the effect of Manila Palm fruit extract (Achras Zapota L) on the expression of the High Motility Group Box 1 (HMGB1) gene in mice infected with Salmonella typhi. Methods: The method used for extracting sapodilla fruit is the maceration method and the tool used to see changes in HMGB1 mRNA gene expression is PCR with boom extraction method. Conclusion: Some sapodilla manila fruit extract dose 510 mg / KgBB (p = 0.016, p <0.05) (∆ mean = 1.90) and 750 mg / KgBB (p = 0.000, p <0.05) (∆ mean = 4.19), can decrease HMGB1 mRNA expression was observed at day 4, 10 to day 30 with no effect with levofloxacin 98 mg / KgBB (p = 0.000, p <0.05) (∆ mean = 5.97).


Author(s):  
Saurabh Parauha ◽  
M. A. Hullur ◽  
Prashanth. A. S.

Typhoid fever is an acute illness associated with fever that is most often caused by the Salmonella typhi bacteria. Once the bacteria is ingested it quickly multiplies within the stomach, liver or gall bladder and finally enters the blood stream causing symptoms like fever, headache etc. these cases as of 2010 caused about 190000 deaths up from 137000 in 1990 in whole world, India, Pakistan and Egypt are also known high risk area for developing this disease. A clinical study comprising of 15 patients of either sex attending OPD clinic of AMVH Hubli and presenting with clinical manifestation of Typhoid confirmed by Widal test were selected for observational study. All the patients received Sanjivani Vati 2 tab. bid with Kiratadisapta Kashaya (20 ml) twice daily after food. It was given for 21 days and follow up period was of 1 month with weekly visit. From the result obtained we can conclude that therapy with this Ayurvedic combination of drugs shown significant relief (p less than 0.001) in symptoms after 21 days of treatment.


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