Reemergence of Chloramphenicol Sensitivity in Enteric Fever

Background

Enteric fever is a global health problem and rapidly developing resistance to various drugs makes the situation more alarming. Drug sensitivity in Salmonella enterica serovar typhi and Salmonella enterica serovar paratyphi A isolated from 45 blood culture positive cases of enteric fever was tested to determine in-vitro susceptibility pattern of prevalent strains in northern India.

Methods

Strains isolated from 45 blood culture positive cases of typhoid and paratyphoid fever over a period of three years were studied and their sensitivity patterns to chloramphenicol, ampicillin, ciprofloxacin, ceftriaxone, nalidixic acid, amikacin and ofloxacin were analysed.

Results

Our results show a high sensitivity of both Salmonella enterica serovar typhi (96%) and Salmonella enterica serovar paratyphi A (100%) to chloramphenicol. Sensitivity to ciprofloxacin and amikacin was 88% and 84% respectively. All the isolates were sensitive to ofloxacin, nalidixic acid and ceftriaxone. Sensitivity of Salmonella enterica serovar paratyphi A was 100% to chloramphenicol, ciprofloxacin, ofloxacin, nalidixic acid and ceftriaxone, 95% to amikacin and 30% to ampicillin. Overall 44 out of 45 isolates of Salmonellae were sensitive to chloramphenicol.

Conclusion

These findings suggest changing pattern of antibiotic resistance in enteric fever with reemergence of chloramphenicol sensitivity in northern India.Key Words: Enteric fever, Chloramphenicol, Salmonella enterica serovar typhi, Salmonella enterica serovar paratyphi A     

Profile of Culture Positive Enteric Fever from Bangalore

Background

Enteric fever is endemic in India. The aim of this study was to analyse the clinical, laboratory, antibiotic sensitivity profile and response to antibiotics of culture positive enteric fever patients from Bangalore.

Methods

In this retrospective study only culture positive enteric fever patients were taken and their clinical, laboratory, antibiotic sensitivity profile and the clinical response to antibiotics studied.

Result

Eighty one culture positive enteric fever patients were taken into the study. Presenting symptoms included fever, pain abdomen (18.5%), loose stools (25%), vomiting (33%) and headache (30%). Absolute bradycardia at admission was not found in any of our patients. Normal or low total leucocyte count was seen in 97.5%. Typhoid hepatitis was seen in 8.5%. Salmonella enterica subspecies enterica serovar typhi (S typhi) were isolated in 80% of cases; 83% of all cases showed nalidixic acid resistance. All isolates were sensitive to chloramphenicol and third generation cephalosporins. Ciprofloxacin resistance was found in 19% cases. The time to defervescence in patients treated with ceftriaxone was 4.3 days. There was no statistical difference in time to defervescence in nalidixic acid resistant and sensitive strains. Complications included gastro intestinal bleed and encephalopathy. Conclusion: Prevalence of nalidixic acid resistance is high, while clinical resistance to quinolones may be higher than that found in the laboratory which requires detailed study. Chloramphenicol sensitivity has returned and nalidixic acid resistant and sensitive isolates are uniformly sensitive to third generation cephalosporins with no difference in time to defervescence.Key Words: Enteric fever, Nalidixic acid resistance, Ciprofloxacin resistance, Time to defervescence     

Outbreak of Multi-drug Resistant Salmonella Typhi Enteric Fever in Mumbai Garrison

Background

There was an epidemic of enteric fever in Mumbai garrison during Nov-Dec 2000 with more than 150 cases admitted to a tertiary care service hospital.

Methods

All the cases presented with fever and some had splenomegaly, bradycardia, abdominal pain and diarrhoea. The epidemic was investigated by the station health organization (SHO) and the case and bacteriological study was carried out in pathology laboratory of the service hospital. The serological study was carried out at Armed Forces Medical College (AFMC), Pune and the Phage typing was carried out at Lady Harding Medical College, New Delhi.

Results

Blood cultures were positive in 92(63%) for Salmonella typhi and Widal test was positive in 83(55%). All strains were resistant to four primary drugs i.e. ampicillin, chloramphenicol, co-trimoxazole and tetracycline. All but two were treated successfully with ceftriaxone. The Salmonella typhi belonged to phage group E1 and biotype I.

Conclusion

Extensive epidemiological investigation of cases and water sources of cantonment area pointed to a common source of the epidemic i.e. the well near ‘Gurudwara''.Key Words: Enteric fever, Multi-drug resistant, Phage type, Salmonella typhi     

氮咪青霉素与氟哌酸联合治疗难治性伤寒

本文试用氮咪青霉素(mecillinam)及氟哌酸(norfloxacin)治疗15例经治不愈的耐药性伤寒患者。其中13例为二药联合治疗,另二例分别为氮(艹卓)咪青霉素及氟哌酸单独治疗。13例联合治疗者平均4.8天退热,3天肠出血停止,3.1天中毒性肠麻痹消失。4天中毒状态消失。停药后大便培养均三次阴性,治疗后血嗜酸性粒细胞计数均从零上升到正常。疗效满意。15例中3例复发。联合疗法疗程达2～3周者无一例复发。本文为伤寒耐药菌种感染者的治疗提供了切实有效的方法。     

Enteric Fever: A retrospective 6-year analysis of 82 paediatric cases in a teaching hospital

Objective: To evaluate the clinical and laboratory properties, to see the response to therapy, incidence of antimicrobial resistance and complications of Enteric Fever in children. Methods: This is a retrospective study of 82 cases of enteric fever admitted in department of pediatrics, Manipal Teaching hospital, Pokhara, Nepal .Study period was six years from (Jan 2000 to Dec 2005). Results: Total of 82 cases of Salmonella infections were admitted .There were 50 (60%) males and 32 (40%) females. Most of the patients were above the age of five. The leading clinical feature were Fever (100%) , GI symptoms (73%), followed by splenomegaly (60%), hepatomegaly (58%) , chills & rigor (41%), headache(33%),coated tongue(17%), lymphadenopathy (13%), Respiratory signs (13%) , toxic look (7%). The laboratory reports revealed leucopenia in 26% and leukocytosis in 16%. Widal test was positive in 83%, Blood culture was positive in 37 %.Bone marrow was done in 8 cases, out of which 5(62.5%) were culture positive. Out of 35 culture positive cases 32 were Salmonella typhi and 3 were Salmonella paratyphi A. Regarding the treatment 55% were treated with ciprofloxacin, 29 % with ceftriaxone , 7% with ampicillin , 6% with cefotaxime and 2.4 % with chloramphenicol . Response to therapy was assessed by day of defervescence after antibiotics. Best response was observed with ciprofloxacin (4.7 days) followed by ceftriaxone (5days), ampicillin (5.5 days), cefotaximee (6.4 days), chloramphenicol (10 days) respectively. In the antibiogram resistance was 43% with chloramphenicol, 37% with ampicillin, 31% with trimethoprim- sulfamethoxazole, 5.7%with ciprofloxacin and 4% with cefotaxime .Resistance was 0% with ceftriaxone, cefuroxime, and ofloxacin. Gentamycin was found to show high sensitivity (91%). The complications observed were anemia in 10%, 5% had neurologic signs like clouding of consciousness and 3.7% had CNS irritability. Conclusion: It is important to include Enteric fever in the differential diagnosis of febrile patients with abdominal symptoms. Though blood culture is the definite test, Widal test plays supportive role in diagnosis of enteric fever, especially when patients come after a course of antibiotics. Sometimes when both blood culture and Widal tests are negative Bone marrow can be the diagnostic tool for the diagnosis. Based on this analysis ciprofloxacin is still a good drug for the treatment of Enteric Fever. Ceftriaxone, Cefuroxime and Ofloxacin can be considered as first line treatment for Enteric fever since resistance was nil with these drugs on culture reports. Key words: Enteric fever, salmonella infections.     

基于CiteSpace的中国家庭医生签约服务研究热点和趋势分析

背景家庭医生签约服务是推进分级诊疗、深化医疗卫生体制改革的重大举措,了解家庭医生签约服务领域的研究热点和研究演进趋势,是进一步开展相关研究的基础。目的系统地梳理家庭医生签约服务领域的研究热点和研究演进趋势。方法本文运用CiteSpace软件,对1986-01-01至2018-09-29中国知网收录的家庭医生签约服务领域的研究从作者、研究机构和关键词3个方面进行共现网络分析,并根据关键词的时区图和相关政策文件,归纳梳理我国家庭医生签约服务的研究演进趋势。结果我国家庭医生签约服务领域的研究呈现出文献数量增加速度加快、区域间研究合作网络松散、研究尚未取得突破性进展的演进趋势。结论目前家庭医生签约服务领域的研究多为实证性研究,应切实加强相关理论的应用和创新研究,同时未来应加强跨区域机构间、作者间的密切交流合作。     

Enteric vaccines

Considerable progress has been made in the past decade in developing vaccines against the most important bacterial and viral infections of the gastrointestinal tract. Members of the Division of Geographic Medicine in the Center for Vaccine Development have played a prominent role in the laboratory development and clinical testing of these vaccines. A new oral typhoid vaccine, Ty21a, has been licensed in the United States. A genetically engineered live oral cholera vaccine developed in the CVD is undergoing clinical trials in cholera-endemic areas. Multiple vaccine candidates against Shigella, enterotoxigenic E. coli, and rotavirus are in clinical trial in the United States or overseas. Rapid advances in molecular biology, together with new knowledge of mucosal and cellular immunity, will produce more vaccine candidates in the future. The CVD intends to be in the forefront of these developments.     

Knowledge Domain and Emerging Trends of Chinese Medicine in Management of Pediatric Asthma:A Scientometric Study

Objective:To analyze the intellectual landscape and emerging research trends of Chinese medicine(CM)in the management of pediatric asthma through a scientometric study.Methods:Publications related to CM in the management of pediatric asthma were retrieved from the Web of Science Core Collection using relevant keywords.A scientometric study was performed using CiteSpace and VOSviewer.Results:A total of 1,673 original articles and reviews from 1991 to 2019 were included in the analysis.The amount of annual publications had a gradual increase with time.USA was the major contributor both in country and institution analyses.Based on the co-citation,the published journals were grouped into 4 clusters.Keyword analysis indicated that the main hotspots were:(1)comprehensive management;(2)risk factors,mechanism,and prevalence;(3)prevention and treatment;(4)inflammation;and(5)environmental research.Lastly,we predicted that three emerging trends were quality of life promotion,immune response,and combination therapy.Conclusions:CM research in the management of pediatric asthma will maintain the current trend of steady growth.This scientometric analysis may help scientists to identify the areas of interests and future directions in the field.     

老年性肠神经退行性变

老年人胃肠神经系统结构和功能发生改变,涉及肠肌间神经丛和黏膜下神经丛,其主要特征为胆碱能神经元丢失,氮能神经纤维受损,交感神经纤维轴病,伴神经化学递质改变,这些变化影响胃肠神经肌肉传输功能。老年性脑神经退变可能与经突触逆行传输的α-突触核蛋白阳性路径有关。本文总结了老年相关性胃肠神经退行性变最新文献,为合理防治此类疾病提供翔实资料。     

Enteric fever: Diagnostic value of clinical features.

Objectives: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. Design: Prospective observational study Setting: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal Materials and methods: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. Results: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. Conclusion: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever. Key words: enteric fever, clinical features, diagnostic criteria.