We report a case of fulminant hepatic failure associated with Salmonella paratyphi A infection, in a 29-yearold patient who was admitted to the intensive care unit （ICU） with fever of two days, headache and vomiting...We report a case of fulminant hepatic failure associated with Salmonella paratyphi A infection, in a 29-yearold patient who was admitted to the intensive care unit （ICU） with fever of two days, headache and vomiting followed by behavioural changes and disorientation. On examination, the patient appeared acutely ill, agitated, confused, and deeply jaundiced. Temperature 38.5℃, pulse 92/min, blood pressure 130/89 mmHg. Both samples of blood grew S. paratyphi A, which was sensitive to ceftriaxone and ciprofloxacin. Ceftriaxon was administered with high-dose dexamethasone. Two weeks after treatment with ceftriaxon, the patient was discharged in satisfactory condition.展开更多
Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and...Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.028, diarrhoea p = 0.038, loose or watery stool p = 0.021 and mild general condition p = 0.02 remained independently associated with Salmonella infection. Conclusion: Typhoid Fever being endemic, laboratory diagnosis was a key for confirmation after clinical diagnosis. SAT can accurately be used to detect the disease where culture is unavailable. However, antibiotic sensitivity tests were crucial when determining the drug of choice as Salmonella isolates were multi-drug resistant. Establishment of prescribing antimicrobial policies and guidelines can periodically monitor the antibiogram patterns.展开更多
文摘We report a case of fulminant hepatic failure associated with Salmonella paratyphi A infection, in a 29-yearold patient who was admitted to the intensive care unit （ICU） with fever of two days, headache and vomiting followed by behavioural changes and disorientation. On examination, the patient appeared acutely ill, agitated, confused, and deeply jaundiced. Temperature 38.5℃, pulse 92/min, blood pressure 130/89 mmHg. Both samples of blood grew S. paratyphi A, which was sensitive to ceftriaxone and ciprofloxacin. Ceftriaxon was administered with high-dose dexamethasone. Two weeks after treatment with ceftriaxon, the patient was discharged in satisfactory condition.
文摘Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.028, diarrhoea p = 0.038, loose or watery stool p = 0.021 and mild general condition p = 0.02 remained independently associated with Salmonella infection. Conclusion: Typhoid Fever being endemic, laboratory diagnosis was a key for confirmation after clinical diagnosis. SAT can accurately be used to detect the disease where culture is unavailable. However, antibiotic sensitivity tests were crucial when determining the drug of choice as Salmonella isolates were multi-drug resistant. Establishment of prescribing antimicrobial policies and guidelines can periodically monitor the antibiogram patterns.
