Enteric Fever (Salmonella Typhi and Salmonella Paratyphi A & B)

2021 ◽  
Author(s):  
Audino Podda
Keyword(s):  
Enteric Fever ◽  
Treatment Options ◽  
Field Trials ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Sensu Stricto ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Live Attenuated Vaccine ◽  
Middle Income

Typhoid and Paratyphoid fevers (collectively, enteric fever) are indistinguishable, acute generalized febrile infections caused by Salmonella enterica serovars Typhi and Paratyphi A and Paratyphi B sensu stricto. Enteric Fever is a significant cause of morbidity and mortality worldwide, particularly in low- and middle-income countries (LMIC), where social and sanitary conditions are poor. In 2017, approximately 14.3 million cases of disease and 135,900 deaths were reported. Antibiotic treatment reduces severity and duration of disease. However, the emergence of several multidrug resistant strains (MDR) and, more recently, of extensively drug-resistant (XDR) strains of S. Typhi has decreased treatment options. Due to significant disease burden and increasing antimicrobial resistance, particularly in South/South-East Asia and sub-Saharan Africa, it is essential to implement vaccination campaigns with safe and effective vaccines. Three vaccine types are available against S. Typhi: the live attenuated vaccine (Ty21a), the unconjugated Vi polysaccharide vaccine (Vi-PS) and the typhoid conjugated vaccine (TCV), while no vaccine is yet available against S. Paratyphi strains. Most recently licensed and WHO prequalified TCVs can be used for immunization of infants starting at 6 months of age. Field trials in endemic Asian and African countries have shown that TCV has a >80% clinical efficacy.

scholarly journals Enteric Fever in Mediterranean North Africa

2009 ◽  
Vol 3 (10) ◽  
pp. 753-761 ◽  
Author(s):  
Khalifa Sifaw Ghenghesh ◽  
Ezzedin Franka ◽  
Khaled Tawil ◽  
Momtaz Wasfy ◽  
Salwa F. Ahmed ◽  
...  
Keyword(s):  
North Africa ◽  
Salmonella Enterica ◽  
Enteric Fever ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Population Based ◽  
North African ◽  
African Region ◽  
African Countries ◽  
The Mediterranean

Typhoid fever is endemic in the Mediterranean North African countries (Morocco, Algeria, Tunisia, Libya, and Egypt) with an estimated incidence of 10-100 cases per 100,000 persons. Outbreaks caused by Salmonella enterica serovar Typhi are common and mainly due to the consumption of untreated or sewage-contaminated water. Salmonella enterica Paratyphi B is more commonly involved in nosocomial cases of enteric fever in North Africa than expected and leads to high mortality rates among infants with congenital anomalies. Prevalence among travellers returning from this region is low, with an estimate of less than one per 100,000. Although multidrug resistant strains of Salmonella Typhi and Paratyphi are prevalent in this region, the re-emergence of chloramphenicol- and ampicillin-susceptible strains has been observed. In order to better understand the epidemiology of enteric fever in the Mediterranean North African region, population-based studies are needed. These will assist the health authorities in the region in preventing and controlling this important disease.

scholarly journals Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

2021 ◽  
Vol 18 (23) ◽  
pp. 12449
Author(s):  
Ahmad Alkhatib ◽  
Lawrence Achilles Nnyanzi ◽  
Brian Mujuni ◽  
Geofrey Amanya ◽  
Charles Ibingira
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Sub Saharan Africa ◽  
Lifestyle Interventions ◽  
African Countries ◽  
Middle Income ◽  
Non Communicable Diseases ◽  
Economic Disparity ◽  
Middle Income Countries ◽  
Sub Saharan

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
Democratic Republic ◽  
Antihypertensive Drugs ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

scholarly journals Improving Our Understanding of Salmonella enterica Serovar Paratyphi B through the Engineering and Testing of a Live Attenuated Vaccine Strain

mSphere ◽  
2018 ◽  
Vol 3 (6) ◽  
Author(s):  
Ellen E. Higginson ◽  
Girish Ramachandran ◽  
Tracy H. Hazen ◽  
Dane A. Kania ◽  
David A. Rasko ◽  
...  
Keyword(s):  
Vaccine Strain ◽  
Salmonella Enterica ◽  
Enteric Fever ◽  
Sensu Stricto ◽  
Live Attenuated Vaccine ◽  
Content Type ◽  
Heterologous Challenge ◽  
Paratyphi B ◽  
Homologous Challenge ◽  
Ideal Vaccine

ABSTRACT Enteric fever is caused by three Salmonella enterica serovars: Typhi, Paratyphi A, and Paratyphi B sensu stricto. Although vaccines against two of these serovars are licensed (Typhi) or in clinical development (Paratyphi A), as yet there are no candidates for S. Paratyphi B. To gain genomic insight into these serovars, we sequenced 38 enteric fever-associated strains from Chile and compared these with reference genomes. Each of the serovars was separated genomically based on the core genome. Genomic comparisons identified loci that were aberrant between serovars Paratyphi B sensu stricto and Paratyphi B Java, which is typically associated with gastroenteritis; however, the majority of these were annotated as hypothetical or phage related and thus were not ideal vaccine candidates. With the genomic information in hand, we engineered a live attenuated S. Paratyphi B sensu stricto vaccine strain, CVD 2005, which was capable of protecting mice from both homologous challenge and heterologous challenge with S. Paratyphi B Java. These findings extend our understanding of S. Paratyphi B and provide a viable vaccine option for inclusion in a trivalent live attenuated enteric fever vaccine formulation. IMPORTANCE We developed a live attenuated Salmonella enterica serovar Paratyphi B vaccine that conferred protection in mice against challenge with S. Paratyphi B sensu stricto and S. Paratyphi B Java, which are the causes of enteric fever and gastroenteritis, respectively. Currently, the incidence of invasive S. Paratyphi B sensu stricto infections is low; however, the development of new conjugate vaccines against other enteric fever serovars could lead to the emergence of S. Paratyphi B to fill the niche left by these other pathogens. As such, an effective S. Paratyphi B vaccine would be a useful tool in the armamentarium against Salmonella infections. Comparative genomics confirmed the serovar-specific groupings of these isolates and revealed that there are a limited number of genetic differences between the sensu stricto and Java strains, which are mostly hypothetical and phage-encoded proteins. The observed level of genomic similarity likely explains why we observe some cross-protection.

scholarly journals Antibiogram of Salmonella Isolates from Blood with an Emphasis on Nalidixic Acid and Chloramphenicol Susceptibility in a Tertiary Care Hospital in Coastal Karnataka: A Prospective Study

2012 ◽  
Vol 4 (02) ◽  
pp. 074-077 ◽  
Author(s):  
Anup Kumar Shetty ◽  
Ichlampady Nagaraj Shetty ◽  
Zevita Venisha Furtado ◽  
Beena Antony ◽  
Rekha Boloor
Keyword(s):  
Blood Culture ◽  
Nalidixic Acid ◽  
Antibiotic Susceptibility ◽  
Enteric Fever ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
First Line ◽  
Periodic Analysis ◽  
Paratyphi B

ABSTRACT Background: Enteric fever is caused by the serotypes Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B and Salmonella Paratyphi C. After emergence of multidrug resistant Salmonellae Ciprofloxacin, a fluorquinolone antibiotic was the first-line therapy. Treatment failure was observed with Ciprofloxacin soon and such strains showed in-vitro resistance to Nalidixic acid. Recent reports suggest re-emergence of Chloramphenicol sensitive strains and increasing Nalidixic acid resistance. This study is aimed at detecting the current trend in the antibiogram of Salmonella isolates from blood culture in coastal Karnataka, with an emphasis on antibiotic susceptibility of Nalidixic acid and Chloramphenicol and evaluate, if there is a need to modify the strategies in the antibiotic therapy for enteric fever. Materials and Methods: Blood samples received for culture in the laboratory between June 2009 and August 2011 was cultured in Brain Heart infusion broth, bile broth or in a commercial BACTEC culture media. The growth from blood cultures were processed for identification and antibiotic susceptibility as per standard methods. Antibiotic susceptibility for Ampicillin, Trimethoprim-sulphamethoxazole, Chloramphenicol, Ciprofloxacin, Ceftriaxone and Nalidixic acid were noted. Results: Out of 9053 blood culture specimens received, Salmonella was isolated from 103 specimens. There were 85 Salmonella Typhi isolates, 16 Salmonella Paratyphi A and two Salmonella Paratyphi B. Salmonella Typhi and Salmonella Paratyphi A showed the highest resistance to Nalidixic acid. Salmonella Typhi showed highest susceptibility to Ceftriaxone and Salmonella Paratyphi A to trimethoprim-sulphamethoxazole and Chloramphenicol. Two isolates were multidrug resistant. One Salmonella Paratyphi A was resistant to Ceftriaxone. Conclusion: Routine screening of Nalidixic acid susceptibility is practical to predict fluorquinolone resistance in Salmonella and preventing therapeutic failure while treating with it. It is worthwhile to consider replacing fluorquinolones with Chloramphenicol or Ceftriaxone as the first line of therapy for enteric fever. Periodic analysis of Salmonella antibiogram should be done to formulate the best possible treatment strategies.

scholarly journals The Causal Relationship Between China-Africa Trade, China OFDI, and Economic Growth of African Countries

SAGE Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 215824402110648
Author(s):  
Emma Serwaa Obobisa ◽  
Haibo Chen ◽  
Emmanuel Caesar Ayamba ◽  
Claudia Nyarko Mensah
Keyword(s):  
Economic Growth ◽  
Low Income ◽  
Negative Impact ◽  
Empirical Studies ◽  
Generalized Least Squares ◽  
Causal Link ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Middle Income ◽  
Sub Saharan

Recently, China has emerged as the largest trading partner and a significant source of investment in the African continent. Although there is consent on the increasing importance of China and Africa’s economic partnership, there are many controversies on how it affects African countries. Debates on China in Africa have, however, relied on grandiloquence rather than empirical studies. This study explores the causal link between China-Africa trade, China’s outward foreign direct (OFDI), and economic growth of 24 Sub-Saharan Africa countries from 1999 to 2018. The aggregated panel is classified into upper-middle-income, low-middle income, and low-income Sub-Saharan African countries. In the long run, key findings from the feasible generalized least squares (FGLS) estimator unveiled that; (i) China-Africa trade negatively contributes to economic growth among all panels. (ii) China’s OFDI improves economic growth in the low middle and low-income African countries whereas a significant negative liaison is evidenced in the upper-middle-income African countries. (iii) Labor force have a negative impact on economic growth whiles gross capital formation is evidenced to positively impact economic growth at all the panels. The Dumitrescu and Hurlin Granger causality unveiled a one-sided causal link from China-Africa trade to economic growth at all panels. The study proposes policy recommendations based on the results.

Multidrug Resistant Gene(S) Harboring On A 20 Kb Plasmid In Salmonella typhi That Causes Typhoid-Enteric Fever

2000 ◽  
Vol 3 (6) ◽  
pp. 911-914 ◽  
Author(s):  
Md. Abdul Hye Khan ◽  
Asif Hasan Chowdhoury ◽  
M. Ashik Mosaddik ◽  
M. Shajahan
Keyword(s):  
Enteric Fever ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Resistant Gene

Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action

2019 ◽  
Vol 60 (5) ◽  
pp. 806-811 ◽  
Author(s):  
Razak M Gyasi ◽  
David R Phillips
Keyword(s):  
Sub Saharan Africa ◽  
Vulnerable Groups ◽  
Noncommunicable Diseases ◽  
Mortality Data ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Demographic Aging ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public–private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.

scholarly journals Developing nephrology services in low income countries: a case of Tanzania

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Francis F. Furia ◽  
Jacqueline Shoo ◽  
Paschal J. Ruggajo ◽  
Kajiru Kilonzo ◽  
Gopal Basu ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Low Income ◽  
Kidney Diseases ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Care Providers ◽  
African Countries ◽  
Middle Income ◽  
Sub Saharan

Abstract Background The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.

scholarly journals Irrational use of azithromycin in typhoid endemic areas: A challenge on multidrug-resistant typhoid treatment

2021 ◽  
Vol 1 (2) ◽  
pp. 37-40
Author(s):  
Irfan Ullah ◽  
Kiran Shafiq Khan ◽  
Qasim Mehmood ◽  
Muhammad Junaid Tahir ◽  
Muhammad Irfan Malik ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Typhoid Fever ◽  
Developed Countries ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Fatal Disease ◽  
Middle Income ◽  
Middle Income Countries ◽  
Food Borne ◽  
Marked Decline

Typhoid is a food-borne fatal disease caused by Salmonella typhi. It causes inflammation of the intestine, resulting in diarrhoea, fever, headache, cough, and muscle pain. Improved hygiene has resulted in a marked decline in typhoid fever cases in many developed countries. However, significant typhoid cases emerge in low and middle-income countries annually, including Pakistan. Typhoid fever accounts for a larger percentage of acute febrile illnesses in Pakistan. Azithromycin is the only effective drug used in multidrug-resistant typhoid. The emergence of drug resistance typhoid has been of more significant concern in recent years due to its irrational use of azithromycin. It is considered the last antibiotic to eradicate multidrug-resistant typhoid fever from Pakistan. In this article, we express our concern of the irrational use of azithromycin in Pakistan and its effect on typhoid in the country.

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