دورية أكاديمية
أعرض في EDS

Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance.

التفاصيل البيبلوغرافية
العنوان: Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance.
المؤلفون: Ohanu ME; Department of Medical Microbiology, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu, Nigeria., Iroezindu MO; Department of Medicine, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu, Nigeria., Maduakor U; Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Nigeria., Onodugo OD; Department of Medicine, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu, Nigeria., Gugnani HC; Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
المصدر: Malawi medical journal : the journal of Medical Association of Malawi [Malawi Med J] 2019 Sep; Vol. 31 (3), pp. 184-192.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Published by Montfort Press for the Medical Association of Malawi Country of Publication: Malawi NLM ID: 9500170 Publication Model: Print Cited Medium: Internet ISSN: 1995-7270 (Electronic) Linking ISSN: 19957262 NLM ISO Abbreviation: Malawi Med J Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Lilongwe, Malawi : Published by Montfort Press for the Medical Association of Malawi, [1990-
مواضيع طبية MeSH: Agglutination Tests/*methods , Anti-Bacterial Agents/*pharmacology , Antibodies, Bacterial/*blood , Fever/*etiology , Salmonella typhi/*drug effects , Salmonella typhi/*isolation & purification , Typhoid Fever/*diagnosis , Typhoid Fever/*epidemiology, Adult ; Anti-Bacterial Agents/therapeutic use ; Case-Control Studies ; Drug Resistance, Bacterial ; Female ; Humans ; Microbial Sensitivity Tests ; Nigeria/epidemiology ; Prevalence ; Prospective Studies ; Sensitivity and Specificity ; Typhoid Fever/drug therapy ; Typhoid Fever/microbiology
مستخلص: Background: Over-dependence on clinical presentation and/or the Widal agglutination test for the diagnosis of typhoid fever in developing countries can lead to antibiotic abuse. In Nigeria, the antibiotic resistance of typhoid organisms is poorly characterized. In this study, we determined the prevalence of culture positivity among patients suspected of having typhoid fever, evaluated the diagnostic value of the Widal test and the burden created by the multi-drug resistance of typhoid organisms in South-East Nigeria.
Methodology: This was a prospective and case-controlled study carried out between 2013 and 2016. We acquired samples of blood/stool/urine cultures, and data relating to the Widal agglutination test and malaria parasites from 810 febrile patients (suspected of having typhoid) and 288 apparently healthy controls. Individuals with a history of antibiotic use within the previous 14 days were excluded. We then carried out antibiotic susceptibility tests on all isolates. Multi-drug resistance was defined as a resistance to ≥3 of the antibiotics tested. We determined the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Widal test for typhoid laboratory diagnosis compared to bacterial culture which is the gold standard. A P-value <0.05 was considered to be statistically significant.
Results: The mean age of typhoid suspects was 33.1±6.5 years and 50.7% were women. Of the 810 typhoid suspects tested, 114 (14.1%) had positive cultures for the typhoid organisms Salmonella enterica serovar paratyphi (72) and S. enterica serovar Typhi (42). Sample-specific rates of culture positivity were as follows: stool (72; 8.9%), blood (21; 2.6%) and urine (21; 2.6%), P<0.001. None of the controls had typhoid isolates. The sensitivity, specificity, PPV and NPV of the Widal test were 49.1%, 90.7%, 46.2% and 91.6%, respectively. Malaria parasitaemia was detected in 180 (22.2%) febrile patients, out of whom 115 (63.9%) had a positive Widal test for O/H antigens vs. 1% (6/630) in those with negative malaria parasite test results (P<0.001). The rate of false-positive Widal titres was 48%. Antibiotic multi-drug resistance was detected in 52.6% of patients. The antibiotics with the highest susceptibility were ciprofloxacin, levofloxacin and meropenem (all 100% susceptibility) and ceftriaxone (95.6% susceptibility).
Conclusion: Our data showed that while typhoid fever is common in Nigeria, malaria is more prevalent. Our analysis showed that the Widal test performed poorly as a diagnostic test and that the burden created by multi-drug resistance was high. Our data indicate that periodic surveillance of antibiotic susceptibility is critical for optimal typhoid therapy.
(© 2019 The College of Medicine and the Medical Association of Malawi.)
References: FEMS Microbiol Lett. 2002 Oct 8;215(2):249-53. (PMID: 12399042)
PLoS One. 2012;7(1):e29119. (PMID: 22276105)
Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S9-S16. (PMID: 26933028)
Trop Doct. 2010 Jan;40(1):43-4. (PMID: 19850607)
BMC Infect Dis. 2010 Jun 22;10:180. (PMID: 20565990)
Clin Infect Dis. 2002 Nov 15;35(10):1265-8. (PMID: 12410488)
Trop Doct. 2009 Oct;39(4):223-4. (PMID: 19762576)
J Infect Dev Ctries. 2008 Dec 01;2(6):421-5. (PMID: 19745517)
J Clin Microbiol. 2004 Apr;42(4):1477-82. (PMID: 15070992)
Singapore Med J. 2002 Jul;43(7):354-8. (PMID: 12437043)
Z Naturforsch C J Biosci. 2000 May-Jun;55(5-6):489-93. (PMID: 10928566)
PLoS Negl Trop Dis. 2017 Feb 27;11(2):e0005376. (PMID: 28241011)
Postgrad Med J. 2000 Feb;76(892):80-4. (PMID: 10644383)
Int J Infect Dis. 2015 Jun;35:96-102. (PMID: 25931197)
Trans R Soc Trop Med Hyg. 2006 Nov;100(11):1063-7. (PMID: 16714040)
Bull World Health Organ. 2004 May;82(5):346-53. (PMID: 15298225)
BMC Infect Dis. 2016 Oct 13;16(1):567. (PMID: 27737634)
Clin Diagn Lab Immunol. 2002 Jul;9(4):938-41. (PMID: 12093703)
Microbiol Immunol. 2000;44(7):577-83. (PMID: 10981830)
J Infect Dev Ctries. 2014 May 14;8(5):661-5. (PMID: 24820472)
Adv Prev Med. 2012;2012:875419. (PMID: 23056954)
Indian J Med Res. 2009 Jan;129(1):95-8. (PMID: 19287065)
Indian J Med Microbiol. 2005 Apr;23(2):125-7. (PMID: 15928444)
Trop Med Int Health. 2003 Jun;8(6):575-8. (PMID: 12791064)
Bull World Health Organ. 2011 Sep 1;89(9):640-7. (PMID: 21897484)
Lancet Glob Health. 2014 Oct;2(10):e570-80. (PMID: 25304633)
Lancet Infect Dis. 2019 Apr;19(4):369-381. (PMID: 30792131)
J Clin Microbiol. 2004 May;42(5):1885-9. (PMID: 15131144)
BMC Infect Dis. 2015 Nov 14;15:523. (PMID: 26573629)
Niger J Med. 2003 Oct-Dec;12(4):187-92. (PMID: 14768191)
J Glob Health. 2012 Jun;2(1):010401. (PMID: 23198130)
BMJ. 2006 Jul 8;333(7558):78-82. (PMID: 16825230)
Bull World Health Organ. 2008 Apr;86(4):260-8. (PMID: 18438514)
BMC Res Notes. 2014 Sep 17;7:653. (PMID: 25231649)
Trans R Soc Trop Med Hyg. 2007 Mar;101(3):308-10. (PMID: 16950486)
Niger Med J. 2016 May-Jun;57(3):145-9. (PMID: 27397952)
J Glob Health. 2015 Dec;5(2):020407. (PMID: 26649174)
فهرسة مساهمة: Keywords: Antibiotics; Widal test; diagnosis; malaria; multi-drug resistance; typhoid
المشرفين على المادة: 0 (Anti-Bacterial Agents)
0 (Antibodies, Bacterial)
تواريخ الأحداث: Date Created: 20191217 Date Completed: 20200305 Latest Revision: 20200305
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC6895380
DOI: 10.4314/mmj.v31i3.4
PMID: 31839887
قاعدة البيانات: MEDLINE
الوصف
تدمد:1995-7270
DOI:10.4314/mmj.v31i3.4