Leptospirosis: possibilities of early laboratory and clinical diagnosis

This retrospective study aims to identify and describe the problems associated with the laboratory and clinical diagnosis of leptospirosis. A total of 4,813 patients with suspected leptospirosis from an area of the Czech Republic, with a total population of 1.15 million, were examined during the period 2002?C2010. Our study included only 855 patients: 545 men (mean age 41.03 ± 19.24) and 310 women (mean age 41.47 ± 20.3) who were examined using microscopic agglutination test (MAT) and a polymerase chain reaction (PCR). All patients and their physicians filled in questionnaires, which included anamnestic data, clinical symptoms and the results of laboratory tests. Out of total suspected, 89 patients (1.85%), tested positive for leptospirosis, of which 50 have been examined only serologically by MAT. Of 855 patients in our study undergoing both PCR and MAT tests, 39 have tested positive for leptospirosis. The most frequent symptom in patients with leptospirosis included fever (91.6%) and headache (69.4%). The correct laboratory diagnosis of leptospirosis depends on biological material being tested before the start of antibiotic treatment, since leptospires are extremely sensitive to antibiotics. Consequently, the PCR results alone may produce a false negative result after 24 hours following treatment with antibiotics.     

Typhoid and Paratyphoid Fever: A 10-Year Retrospective Study of 41 Cases in a Parisian Hospital

BACKGROUND: Enteric fever remains a major cause of fever in travelers. We evaluated new trends in enteric fever. METHODS: We reviewed the epidemiological, clinical, biological, bacteriological data, and outcome of all cases of typhoid and paratyphoid fever seen in our department over the last decade. The inclusion criteria were the presence of signs compatible with enteric fever and isolation of Salmonella typhi or Salmonella paratyphi A, B, or C from blood or stool cultures or any other site. RESULTS: Among the 41 patients, 38 (93%) had travel-associated enteric fever. The main geographic source of contamination was the Indian subcontinent. One patient had been vaccinated with parenteral Vi vaccine 1 year previously. Fever and headaches were the only signs which were present in more than 80% of patients. The Widal test at inclusion was positive in 27%, and a second serological test was found to be positive in 50% of evaluated cases. Blood cultures and stool cultures were positive in 34 cases and 10 cases, respectively. Salmonellae spp were isolated in both hemocultures and stool cultures in 4 cases and in urine in 1 case. Two strains of S. typhi were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. One strain of S. typhi and one of S. paratyphi B were nalidixic acid resistant. All evaluable patients were cured with the exception of 2 patients (1 failure, 1 relapse). We observed 3 toxic reactions. No patients died. CONCLUSION: The diagnosis and outcome of enteric fever are hampered by the lack of specificity of clinical and biological signs, the increasing rates of antimicrobial resistance, and the occurrence of toxic reactions during treatment.     

Evaluation of polymerase chain reaction method for monitoring of fungal infection in compromised hosts

Diagnosis of fungal infections in compromised hosts has been difficult because of insufficient sensitivity and specificity of conventional methods such as culturing and serum testing. Therefore, antifungal agents are usually started in febrile patients who are resistant to antibiotics even if these monitoring tests were negative. In this study, therefore, in order to increase the reliability of these monitoring, polymerase chain reaction (PCR) methods for detection of blood fungus were also performed in compromised hosts including 14 patients with hematological malignancies and one with solid tumor who were undergoing chemotherapies. From these patients, total of 56 peripheral blood samples was collected periodically, irrespective of the presence of infectious signs. At each time point of venopuncture, status of the patient was allocated to one of the followings: A, receiving an intravenous antifungal therapy because of sustaining fever which had not responded to prior antibiotic therapies and also positive for culturing and/or serum beta-D-glucan tests; B, receiving an additional intravenous antifungal therapy but negative for culturing and serum-tests; C, febrile but not yet receiving any intravenous fungal therapy; D, afebrile status. During the study, 10 blood samples from 3 patients were allocated in group A, and one sample of them was positive while remaining 9 were all negative for PCR. Six samples from 4 patients were in group B, and one was PCR positive while remaining 5 were negative. Fifteen samples from 7 patients were in group C, and 3 were positive and 12 were negative for PCR. Twenty-five samples were in group D, and 5 were positive and 20 were negative for PCR. Thus, the results from fungal PCR in these patients were in some case showed discrepancies from those expected from the clinical course and/or conventional monitoring tests. Further evaluation of fungal PCR may gain insight into the more precise diagnosis of fungal infection in these patients.     

酶联免疫吸附试验诊断梅毒螺旋体感染的临床价值

目的 探究梅毒螺旋体(TP)感染中应用酶联免疫吸附试验(ELISA)诊断的临床价值.方法 150例疑似梅毒螺旋体感染患者,分别采用酶联免疫吸附试验及快速血浆反应素环状卡片试验(RPR)进行诊断,以梅毒螺旋体明胶凝集试验(TPPA)检测结果为金标准,分析梅毒螺旋体感染阳性和阴性患者的检测结果,并对比酶联免疫吸附试验及快速...     

Value of examining buffy coats for intragranulocytic micro-organisms in patients with fever.

To determine the significance of the presence of intragranulocytic micro-organisms in the blood buffy coat in patients with suspected infection, buffy coat examination and blood cultures were simultaneously performed in 455 consecutive patients with fever. There was no general correlation between the finding of intragranulocytic micro-organisms in the buffy coat and positive blood cultures. Patients with persistent bacteraemia and sterile blood cultures were, however, shown to have persistently positive buffy coat findings on repeated examination. These patients, who had culture-negative endocarditis or catheter-associated infections, had sterile blood cultures because of antibiotic treatment. Repeated positive findings in the buffy coat may therefore be valuable in detecting patients with persistent bacteraemia, but sporadic findings of micro-organisms in the buffy coats of acutely ill patients seem to have little diagnostic value.     

Imaging data suggesting acute pyelonephritis in the kidney graft: report of five cases with atypical clinical presentation

Acute pyelonephritis is a common complication of kidney transplantation, occurring in up to 1% of grafts. Diagnosis is mainly clinical and atypical presentations have seldom been reported. The diagnostic role of imaging techniques has not been defined. Five cases of acute graft pyelonephritis are reported (three kidney, two pancreas-kidney grafts). The patients (median age 48 years) comprised three females and two males. Median post-transplant follow-up was 3 months, with three patients having predisposing factors for diabetes and one for an enteric bladder. None of the patients presented the 'classic' diagnostic tetrad (i.e. fever, positive urine cultures, low urinary tract symptoms and serum creatinine increase); although, at diagnosis, two of five patients presented with fever, one had increased creatinine levels and one had positive urine cultures. Of note, three patients had leucocyte casts at urinary sediment analysis, thus raising clinical suspicion. Renal ultrasounds were negative in all patients. Renal (99m)Tc-MAG3 (mercaptoacetyltriglycine) scintigraphy, which was used for the definition of kidney function impairment (one patient) or because of the presence of urinary casts (three patients), or after the biopsy diagnosis to locate the parenchymal lesions (one patient), was positive in all patients. The presence and pyelonephritic origin of the parenchymal lesions was confirmed by nuclear magnetic resonance or computed tomography scans. Acute graft pyelonephritis may develop in the absence of a full-blown clinical picture. Smouldering symptoms may occur in the presence of large perfusion deficits. (99m)Tc-MAG3 scintigraphy could be an important diagnostic tool in such cases.     

Screening of Iranian Plants for Antimicrobial Activity

The methanol extracts of 306 plants of 52 families obtained from Northeast of Iran (Khorasan Province), were tested for antimicrobial activity (in vitro) using the cylinder plate assay method. Activity against Escherichia coli, Klebsiella pneumoniae, Salmonella typhi, Pseudomonas aeruginosa, Morganella morganii (Gram negative), Bacillus subtilis and Staphylococcus aureus (Gram positive) and Candida albicans is discussed.     

巢式聚合酶链反应快速检测血液标本中

目的建立一种检测血液中伤寒沙门菌的方法.方法根据伤寒沙门菌特异鞭毛基因设计两对引物,通过巢式聚合酶链反应(PCR)扩增伤寒沙门菌DNA片断,扩增产物通过凝胶电泳进行分析.结果用伤寒沙门菌DNA系列稀释液进行试验,巢式PCR能够检出10个伤寒沙门菌.36份培养阳性标本,33份PCR阳性;6份培养阴性但临床高度可疑的伤寒病人标本PCR阳性10份其它原因引起发热的临床标本均为阴性.结论巢式PCR能够快速、特异、准确地检出血液中的伤寒沙门菌.     

Usefulness of real-time PCR for the diagnosis of sepsis in ICU-acquired infections

Real-time PCR methods are able to rapidly detect a wide panel of microorganisms. These methods are of interest in critically ill patients to determine the presence of bacteria in the blood and other biological samples, especially in those patients with prior antimicrobial treatment. In intensive care unit (ICU), the LightCycler SeptiFast (LC-SF) Test provides 1.5 to 2 fold higher positivity rate compared with conventional blood cultures. Although identification of the bacterium by LC-SF is rapid and sensitive, susceptibility test could not be performed using this technique, except the methicillin- resistance for Staphylococci. The conventional cultures remain necessary for samples in ICU because of the high incidence of multidrug-resistant bacteria and the need for antimicrobial susceptibility of the bacterium to treat the patient correctly. A negative result for a Gram positive or negative bacterium allows deescalating the initial antimicrobial treatment, and decreasing the pressure of selection. Moreover, it is necessary to understand and interpret a DNA signal knowing that a dead bacterial material may be detected in a patient without any infection. What is the clinical relevance of bacterial DNA present in the blood and does the DNAemia found reflect true infection? Cost-effectiveness of the real-time PCR should be determined. Meanwhile, this test should be restricted to severe clinical situations, especially ICU patients with severe sepsis. In the future, real-time PCR tests should include more pathogens and antimicrobial resistant targets.     

安徽省淮南市首起0139霍乱弧菌疫情检测分析

目的探讨淮南市首起0139霍乱弧菌疫情的发生原因和生物学特性。方法血清学及常规细菌学方法对菌株进行鉴定,聚合酶链式反应（PCR）检测霍乱毒力基因,改良K—B药敏实验。结果（1）培养分离及血清凝集试验结果,2例患者粪便标本全部阳性,密切接触者6人肛拭子全部阴性;甲鱼塘水样18份,阳性5份;甲鱼产蛋沙场样9份,2份阳性;甲鱼蛋7份,阳性3份;甲鱼排泄物11份,均为阴性。（2）血清凝集试验阳性培养物对头孢哌酮、强力霉素耐药;对氨苄西林、四环素中敏;对氟哌酸、庆大霉素、环丙沙星等敏感。（3）血清凝集试验阳性培养物霍乱毒素（CT）、毒素协同调节菌毛（TCP）全部阳性。结论该起0139霍乱弧菌疫情是因甲鱼养殖塘水污染引起,首例患者分离株与该患者所食甲鱼分离株PFGE带型一致,该菌种对头孢哌酮、强力霉素耐药并携带eta、tcpa毒力基因。     

177例登革热患者临床检验结果分析

目的 探讨登革热患者的临床检验结果特征,为该疾病的诊断提供实验室依据.方法 回顾统计2014年7月至11月在广东省中医院就诊的登革热病例的临床资料和临床检验结果,分析其特征.结果 疑似登革热病例217例,确诊阳性177例,阴性40例.病例中0～13岁组20例,14～50岁组125例,≥51岁组72例,阳性率分别为70.0％、85.6％和77.8％.阳性患者出现白细胞计数(WBC)降低、血小板计数(PLT)降低和中性粒细胞百分比下降的比例分别为62.1％、32.2％和35.0％,血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶升高以及肌酐异常的比例分别为54.8％、29.4％和21.5％均高于阴性组,而血清尿素异常的比例为10.7％.14～50岁组与≥51岁组WBC和PLT降低程度比0～13岁组更为明显.成年组及老年组的登革阳性率高于儿童组,WBC和PLT降低程度更明显.结论 本实验室检验结果符合登革热诊断指南的描述特点,但患者年龄较以往报道偏大;WBC和PLT具有一定筛查价值.     

分析灌洗液不同检测方法在支气管结核诊断中的价值

目的:分析在支气管结核诊断中不同灌洗液检测方法的价值.方法:研究对象是某院2017年11月～2018年11月期间收治的56例肺结核患者(观察组)与28例非结核性肺部疾病患者(对照组),均实施支气管镜检查,取肺泡灌洗液进行荧光定量PCR法、培养法、涂片法、结核抗体法检验结核杆菌,对比4种检验结果.结果:菌阳肺结核组FQ-...     

FC、PCT、IL-6、hs-CRP联合检测及腹部超声诊断新生儿NEC的临床价值

目的:探究粪钙卫蛋白(FC)、降钙素原(PCT)、白介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)联合检测及腹部超声诊断新生儿坏死性小肠结肠炎(NEC)的临床价值。方法:选取2018年7月~2019年6月住院的疑似新生儿NEC患儿60例作为研究对象,随机分为对照组和试验组。对照组30例,采用临床诊疗常规手段进行检查与治疗;试验组30例,采用全身及局部炎性因子检测、腹部彩超检查,并根据检查结果进行针对性治疗。两组新生儿另外采用粪便细菌培养检测,并以细菌培养检测结果为金标准,分别对比两组新生儿NEC检测结果,对比阳性率、准确性、灵敏性、特异性以及治疗预后情况。结果:对照组与观察组患者Ramsay评分和BCS评分差异不大,差异无统计学意义(P>0.05),从镇痛剂的使用上来看,观察组患者使用镇痛剂的使用率明显低于对照组,手术后的不良反应发生率明显低于对照组,差异均具有统计学意义(P<0.05)。结论:FC、PCT、IL-6、hs-CRP联合检测及腹部超声诊断可以提高新生儿NEC的临床诊断效果,并对新生儿NEC患儿预后治疗具有较好的预测作用。     

Blood culture and susceptibility results and allergy history do not influence fluoroquinolone use in the treatment of community-acquired pneumonia

STUDY OBJECTIVE: To determine the influence of blood culture and susceptibility results and antimicrobial allergy history on fluoroquinolone use in the treatment of community-acquired pneumonia. DESIGN: Retrospective analysis of medical records. SETTING: Centers for Medicare and Medicaid Services, Seattle, Washington. PATIENTS: A total of 10,275 Medicare beneficiaries hospitalized with the diagnosis of pneumonia received antimicrobial treatment within 24 hours of admission. Of these patients, 288 had blood cultures positive for pneumococcus and were matched one-to-one with patients with negative blood and sputum cultures. MEASUREMENTS AND MAIN RESULTS: Antimicrobial use at the beginning and end of hospitalization, culture and susceptibility results, and patient allergies were recorded retrospectively and compared between two matched groups: patients with blood cultures positive for Streptococcus pneumoniae and those whose blood and sputum cultures were negative. Neither culture and susceptibility results nor allergy history affected the rate of fluoroquinolone use. Despite infection due to penicillin-susceptible pneumococci and no penicillin allergy, patients received therapy with fluoroquinolones (26.7%) as frequently as those with culture-negative pneumonia (34.9%; p=0.401). CONCLUSION: Fluoroquinolones are prescribed despite microbiologic confirmation of penicillin-susceptible pneumococcal pneumonia in the absence of penicillin allergy. These prescribing patterns may contribute to selection pressure associated with fluoroquinolone-resistant gram-positive and gram-negative bacteria.     

Antimicrobial therapy and outcome of septicemia patients admitted to a University Hospital in Delhi

Septicemia is a common clinical condition encountered in most of the hospitals in this region of the world. However, limited information is available in the Indian literature on antimicrobial usage in patients with suspected or proven cases of septicemia. The aim of the present study is on the one hand to describe the clinical characteristics of septicemia, the causative pathogens, the current pattern of antimicrobial use, the clinical outcome, the acquisition cost of commonly used antimicrobial regimens and on the other hand to monitor adverse drug reactions (ADRs) during therapy of septicemia patients admitted to a University Hospital in Delhi. We prospectively reviewed the antimicrobial therapy in 34 clinically diagnosed septicemia cases admitted to a University Hospital from July 2009 to December 2009. All study patients presented various clinical signs and symptoms, fever, diarrhoea and vomiting were most commonly reported. Microorganisms could be identified in 13 (38.2%) of the patients. Escherichia coli (41.2%) constituted the most prevalent bacterial pathogen. Among culture positive patients, 15.4% received ceftriaxone as the most common empirical antimicrobial therapy; among culture negative patients, 19% received cefotaxime plus amikacin as the most common empirical antimicrobial therapy. The average acquisition cost of the 1st line antimicrobial regimen was higher in culture positive than in culture negative patients, but it was reversed for the 2nd line therapy. Overall, 67.6% patients were discharged after recovery, 23.5% were transferred out and 8.8% died during the course of therapy. 9 (26.5%) patients experienced ADRs during the antimicrobial therapy. These findings may have an important implication for developing comprehensive, evidence-based guidelines for the practical treatment of septicemia, adherence to which may lead to a more rational antimicrobial therapy, to cost reduction and to an improved level of care of patients with septicemia.     

Brucella spondylitis with paravertebral abscess due to Brucella melitensis infection: a case report

This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. Magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. Culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.     

Evaluation of a New Latex Agglutination Test for Fecal Lactoferrin in Travelers' Diarrhea

Background . The detection and diagnosis of travelers' diarrhea by fecal culture method, often insensitive, expensive, and time consuming, could well be replaced with the latex agglutination test to detect fecal lactoferrin. As an initial screening, this test could be useful to differentiate between those patients who are more likely to have an invasive enteropathogen and those patients requiring antidiarrheal chemotherapy only.
Methods . Fecal samples from 92 patients with travelers' diarrhea were tested for occult blood, fecal leukocytes, and fecal lactoferrin at stool dilutions of 1:50 and 1:200. The results were compared with findings from fecal cultures for enteropathogens. Statistical analyses were performed measuring the performance of the latex agglutination test for fecal lactoferrin to calculate its sensitivity, specificity, and positive and negative predictive values.
Results . Invasive pathogens were identified in 36 (39%), and a noninvasive pathogen was found in 18, or 20%, of the cases. At the stool dilution of 1:50, fecal lactoferrin showed more sensitivity than did leukocytes or occult blood in detecting the presence of invasive enteropathogens and, with a negative predictive value of 94%, was superior in predicting their absence. At the 1:200 dilution, a lower sensitivity of 55%, but a higher specificity of 82%, compared to 55% with the 1:50 dilution, was demonstrated.
Conclusions . The determination of fecal lactoferrin might prove to be more useful and less expensive and time consuming as an initial screening for patients presenting with travelers' diarrhea. Further evaluation and antibacterial treatment could, therefore, be reserved for those with a positive lactoferrin test.     

Influence of the diagnosis and treatment guidelines for mycosis profunda (deep mycosis) in the field of emergency and critical care medicine--with reference to patient background

PURPOSE: This study was designed to elucidate the present situation of diagnosis and treatment for mycosis in the field of emergency and critical care medicine following presentation of the diagnosis and treatment guidelines for deep mycosis (in February, 2003). METHODS: In patients (administered antimycotics or who have pyrexia showing no response to any antimicrobial drug), medically examined and suspected of having had a fungal infection at 15 medical institutions throughout Japan, participating in the Japanese Society for the Study of Critical Care for Mycosis during the period from May 2003 through August 2004 and with facilities for emergency and critical care medicine, patient background, risk factors, contents of treatment, and patient outcomes were totaled and assessed. RESULTS: The subjects of this assessment were 125 patients consisting of 87 (69.6%) men and 38 (30.4%) women. Their mean age was 59.6 years, and 36.8% were 70 years of age or older. Intravascular catheterization was conducted in 78.4% of the 125 subjects. Antimycotics were administered to 89 patients, and the frequencies of fluconazole (FLCZ) for the initial administration and during the period of data registration were the highest (74.2% and 80.9%, respectively). The frequency with which a carbapenem antimicrobial drug was administered prior to antimycotics was the highest (41.6%). Blood culture was conducted in 85 patients (68.0%), monitoring culture in 108 (86.4%). Fungi were detected in 10 patients (11.8%) with blood culture and 72 (66.7%) with monitoring culture. The frequency of Candida albicans detection was the highest, 50.0% (5/10), with blood culture. With monitoring culture as well, the frequency of C. albicans detection was the highest, 55.6% (40/72). Alleviation of fever at the completion of registration was recognized in 65.6%. The survival rates at the completion of and at 28 days after the start of data registration of were 78.4% and 69.6%, respectively. CONCLUSION: Many patients in the field of emergency and critical care medicine had risk factors for deep mycosis; 11.8% and 66.7% of our 125 subjects were positive on blood and monitoring cultures, respectively. The majority of the fungi detected belonged to the Candida group, and FLCZ was the most frequently used antimycotic.     

2015-2017年中山市某医院沙门菌的药敏分析及肠毒素基因检测

目的 研究中山市西北部区域沙门菌感染患者的流行病学特征、耐药特点及其相关肠毒素基因型。方法 2015年1月-2017年12月，我院从4019例腹泻患者的粪便标本中共分离出沙门菌108株，进行血清分型及药物敏感试验，同时采用PCR方法检测其肠毒素基因(spvA、spvB、rck)。结果 108株沙门菌可分为17个血清型，以鼠伤寒沙门菌和斯坦利沙门菌为主，分别占42.6%(46/108)和15.7%(17/108)，2015年分别检出伤寒沙门菌、乙型副伤寒沙门菌和丙型副伤寒沙门菌各一株；108株沙门菌对氨苄西林(61.11%)和氨苄西林/舒巴坦(49.07%)耐药率最高，未发现对亚胺培南及哌拉西林/三唑巴坦的耐药菌株；在108株沙门菌中，所有菌株均含有spvA基因，34株为spvB阳性，28株为rck阳性，spvB基因阳性患者其高热、便血的比率显著高于spvB阴性患者(χ2=4.185, P<0.05; χ2=6.13, P<0.05)；rck基因阳性患者其高热、便血的比率显著高于rck阴性患者(χ2=5.274, P<0.05, χ2=8.887，P<0.05)。结论 本地区沙门菌感染患者以鼠伤寒沙门菌和斯坦利沙门菌为主，高发季节集中在夏秋两季，沙门菌株耐药率较高。沙门菌感染患者高热及便血的发生率与spvB基因、rck基因的检出具有明显相关性。     

Clinical Importance of Salmonella Paratyphi A Infection to Enteric Fever in Nepal

Background : Enteric fever in Nepal is caused by infection with Salmonella typhi or Salmonella paratyphi A. The clinical presentation of these two illnesses has never been compared in a population of travelers and expatriates. If the illnesses are clinically comparable, and if S. paratyphi A infection is sufficiently common, the choice of typhoid vaccine for Nepal may have to take into account the vaccine's efficacy in preventing infection with S. paratyphi A.
Methods : NonNepalese patients presenting to the CIWEC Clinic with a history of 3 days of fever or greater were considered eligible for the study. Patients with positive blood or stool cultures for S. typhi or S. paratyphi A were entered into the study (along with three patients who had positive Widal titers only). A questionnaire was administered by a physician to determine signs and symptoms. Treatment with oral chloramphenicol was openly compared to treatment with oral ciprofloxacin.
Results : Forty-five cases of enteric fever were diagnosed during the 2 years of the study. Infection with S. typhi accounted for 20 cases, and S. paratyphi A was isolated in 22 cases. The illnesses were clinically indistinguishable. Treatment with chloramphenicol and ciprofloxacin was clinically comparable.
Conclusions : Infection with S. paratyphi A accounts for a significant percentage of enteric fever presentations among tourists in Nepal, and the illness is comparable to infection with S. typhi. Therefore, the choice of typhoid vaccine for long-term travelers or expatriates in Nepal should take into account the vaccine's potential ability to also prevent S. paratyphi A infection. The only typhoid vaccine that can currently offer this type of cross protection is the whole-cell killed preparation.