A Case of A 15-Year Old with Perforated Gallbladder Type II Secondary To Acute Acalculous Cholecystitis, Severe Secondary to Typhoid Fever with Bile Peritonitis, in Sepsis

Typhoid fever is one of the most common enteric fever in low to middle income countries. In the pediatric population, it is a rare cause of acalculous cholecystitis in which one of the dreaded complication is gall bladder perforation. This was a case of a 15-year-old male with 1-month history of intermittent undocumented fever, anorexia and weight loss. The patient presented with signs of pancytopenia and abdominal examination revealed acute abdomen. Patient was optimized and prepared for surgery. Intraoperative findings revealed Type II gall bladder perforation with bile peritonitis, and patient underwent exploratory laparotomy, cholecystectomy, lavage, Jackson-Pratt drain. The sepsis eventually resolved postoperatively, and the patient was discharged. Preoperative diagnosis in patients with gall bladder perforation is often challenging and sophisticated, due to its rarity. However, it should be considered as one of the differential diagnoses in pediatric patients presenting with atypical history of abdominal pain. At present, there are no specific guidelines in the management of complications such as gall bladder perforation in patients with typhoid fever. Therefore, early diagnosis and immediate surgical intervention of gall bladder perforation are of prime importance in the successful outcomes of these patients, given the high morbidity and mortality associated with this condition.

Molecular Insights into the Assembly and Functional Diversification of Typhoid Toxin

Typhoid fever is a devastating disease that kills more than 115,000 people every year and is caused by Salmonella Typhi. Typhoid toxin, exclusively produced by S .

Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program

Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a “Typhoid Epidemiologic SWAT Team” to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.

Curcumin Analogues as a Potential Drug against Antibiotic Resistant Protein, β-Lactamases and L, D-Transpeptidases Involved in Toxin Secretion in Salmonella typhi: A Computational Approach

Typhoid fever caused by the bacteria Salmonella typhi gained resistance through multidrug-resistant S. typhi strains. One of the reasons behind β-lactam antibiotic resistance is -lactamase. L, D-Transpeptidases is responsible for typhoid fever as it is involved in toxin release that results in typhoid fever in humans. A molecular modeling study of these targeted proteins was carried out by various methods, such as homology modeling, active site prediction, prediction of disease-causing regions, and by analyzing the potential inhibitory activities of curcumin analogs by targeting these proteins to overcome the antibiotic resistance. The five potent drug candidate compounds were identified to be natural ligands that can inhibit those enzymes compared to controls in our research. The binding affinity of both the Go-Y032 and NSC-43319 were found against β-lactamase was −7.8 Kcal/mol in AutoDock, whereas, in SwissDock, the binding energy was −8.15 and −8.04 Kcal/mol, respectively. On the other hand, the Cyclovalone and NSC-43319 had an equal energy of −7.60 Kcal/mol in AutoDock, whereas −7.90 and −8.01 Kcal/mol in SwissDock against L, D-Transpeptidases. After the identification of proteins, the determination of primary and secondary structures, as well as the gene producing area and homology modeling, was accomplished. The screened drug candidates were further evaluated in ADMET, and pharmacological properties along with positive drug-likeness properties were observed for these ligand molecules. However, further in vitro and in vivo experiments are required to validate these in silico data to develop novel therapeutics against antibiotic resistance.

Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

HUBUNGAN TITER WIDAL DENGAN JUMLAH LIMFOSIT PADA KASUS DEMAM TIFOID DI WILAYAH KERJA PUSKESMAS SAWOO

Typhoid fever is a systemic infection that is still a global problem, especially in Indonesia. This disease is caused by Salmonella bacteria. The Widal test is used to detect antibodies to Salmonella bacteria based on agglutination reactions between bacterial antigens and antibodies called agglutinins. Routine blood tests be used to see the body's defense mechanism against infection. Lymphocytes are produced by bone marrow, the presence of bacterial endotoxin causes inhibition of the formation of lymphocytes, so that in some cases of typhoid fever, low lymphocyte counts are often found. The purpose of this study was to determine the relationship between Widal titer and lymphocyte count in patients with suspected typhoid fever. The Widal test was examined using a microscope to see the agglutination formed, while the number of lymphocytes was calculated using a hematology analyzer. The results of the Widal test with a titer of 1/160 were 63.3% with normal lymphocyte counts and 10% with low lymphocytes. While the titer 1/320 obtained 10% of respondents with normal lymphocyte count and 16.7% with low lymphocyte count. The research design used was analytic observation with the type of cross sectional study. Statistical analysis using Kendall's Tau-b correlation test with SPSS. From the correlation test, the significance value is 0.009, and the correlation coefficient is -0.404**, which means that there is a relationship between the Widal titer and the number of lymphocytes with sufficient closeness.

Literature Riview : Penerapan Kompres Air Hangat Untuk Menurunkan Suhu Tubuh Pada Pasien Demam Thypoid

Typhoid fever is a systemic infection caused by salmonella enterica bacteria, especially its derivative variants, namely salmonella typhi, paratyphi A, paratyphi B, paratyphi C. These germs attack the digestive tract, especially in the stomach and intestines, nursing problems that often occur in patients with typhoid fever, namely hyperthermia. Hyperthermia is a condition in which an individual has an increase in body temperature above 37.8 C parrectal due to external factors. A warm compress is a procedure used to improve control of body heat loss through evaporation and conduction which is usually performed on patients who have a high fever. The purpose of scientific papers is to see an overview of the application of warm compresses to reduce body temperature in typhoid fever patients. The method is carried out by searching several research journals entitled about the application of warm water compresses to reduce body temperature in typhoid fever patients. The results obtained after the action of warm water compresses, body temperature decreased within normal limits. The conclusion of this scientific paper is that the action of warm water compresses can reduce body temperature in patients with typhoid fever. Suggestions for nurses are expected to apply warm compresses to reduce body temperature in typhoid fever patients.Keywords: Key words: typhoid fever, hyperthermia, warm water compress AbstrakDemam typhoid adalah infeksi sistemik yang di sebabkan oleh bakteri salmonella enterika, khususnya varian-varian turunannya, yaitu salmonella typhi, paratyphi A, paratyphi B, paratyphi C. Kuman-kuman tersebut menyerang saluran pencernaan, terutatama di perut dan usus masalah keperawatan yang sering terjadi pada pasien demam tifoid yaitu hipertermia . Hipertermi adalah suatu keadaan dimana seorang individu mengalami peningkatan suhu tubuh di atas 37,8⁰C parrektal karena factor eksternal. Kompres air hangat adalah prosedur yang di gunakan untuk meningkatkan control kehilangan panas tubuh melalui evaporasi dan konduksi yang biasanya di lakukan pada pasien yang mengalami demam tinggi. Tujuan dari karya tulis ilmiah adalah untuk mengetahui gambaran tentang penerapan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid. Metode yang dilakukan dengan mencari beberapa jurnal penelitian berjudul tentang penerapan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid. Hasil yang didapatkan setelah dilakukan tindakan kompres air hangat suhu tubuh mengalami penurunan dalam batas normal. Kesimpulan karya tulis ilmiah ini bahwa tindakan kompres air hangat dapat menurunkan suhu tubuh pada pasien demam thypoid. Saran bagi perawat diharapkan dapat menerapkan tindakan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid.Kata kunci: Demam Thypoid, Hipertermi, Kompres air hangat