1
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Ullah R, Khan S, Ahmad A, Owais Haseeb S, Karim S. Asymptomatic Salmonella Myocarditis: A Case Report of a Rare Entity. Cureus 2024; 16:e54502. [PMID: 38516462 PMCID: PMC10955454 DOI: 10.7759/cureus.54502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Enteric fever typically displays symptoms like high fever, abdominal pain, constipation, and headaches, primarily affecting the digestive system. While it is commonly seen as a gastrointestinal infection, it can also lead to rare but significant cardiovascular issues. There have been only a few reported cases of enteric fever causing heart manifestations. We present a case of a young male with enteric fever-induced myocarditis, which, due to its rarity, can be challenging to diagnose and is essentially a diagnosis of exclusion. Cardiac MRI (CMR) is crucial for diagnosis, supported by ECG, echocardiograms, and troponin levels. The treatment involves standard approaches for cardiomyopathy, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics. However, our patient presented as a case of asymptomatic myocarditis and fully recovered with treatment without any long-lasting heart problems. Our study aims to contribute to the limited body of knowledge on heart-related complications of enteric fever, raising awareness among clinicians of such presentations in enteric fever cases.
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Affiliation(s)
- Rizwan Ullah
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Suleman Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Aftab Ahmad
- Geriatrics, Cork University Hospital, Cork, IRL
| | - Syed Owais Haseeb
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Saad Karim
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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2
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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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3
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Nain Z. High Dose Dexamethasone in Complicated Typhoid Fever: What is the Evidence? Indian J Pediatr 2023; 90:1162. [PMID: 37184716 DOI: 10.1007/s12098-023-04666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Zulquar Nain
- Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India.
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4
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Galli M, Oreni L, Ridolfo AL, Formenti A, Luconi E, Boracchi P, Antinori S, Biganzoli E, Vaglienti F. Milan's forgotten epidemic of summer 1629, a few months before the last great plague: An investigation into the possible cause. PLoS One 2023; 18:e0279218. [PMID: 37289732 PMCID: PMC10249863 DOI: 10.1371/journal.pone.0279218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
An epidemic not attributable to plague caused thousands of deaths in Milan in the summer of 1629, a time of war and famine that immediately preceded the even more fatal Great Plague of 1630 that killed an estimated ten of thousands of people. The 5,993 deaths of 1629 recorded in the Liber Mortuorum of Milan (a city with an estimated population of 130,000 inhabitants at the time) were 45.7% more than the average number recorded between 1601 and 1628. Registered deaths peaked in July, and 3,363 of the deaths (56,1%) were attributed to a febrile illness which, in most cases (2,964, 88%), was not associated with a rash or organ involvement. These deaths involved 1,627 males and 1,334 females and occurred at a median age of 40 years (range 0-95). In this paper, we discuss the possible cause of the epidemic, which may have been an outbreak of typhoid fever.
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Affiliation(s)
- Massimo Galli
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Letizia Oreni
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Lisa Ridolfo
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Angelo Formenti
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Spinello Antinori
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Folco Vaglienti
- Department of History and Historical Documentation Sciences, Università degli Studi di Milano, Milan, Italy
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5
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Koh JY, Ko JH, Lim SY, Bae S, Huh K, Cho SY, Kang CI, Chung DR, Chung CR, Kim SH, Peck KR, Lee JS. Triple immune modulator therapy for aberrant hyperinflammatory responses in severe COVID-19. Clin Immunol 2023; 251:109628. [PMID: 37119951 PMCID: PMC10139747 DOI: 10.1016/j.clim.2023.109628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/01/2023]
Abstract
A dysregulated hyperinflammatory response is a key pathogenesis of severe COVID-19, but optimal immune modulator treatment has not been established. To evaluate the clinical effectiveness of double (glucocorticoids and tocilizumab) and triple (plus baricitinib) immune modulator therapy for severe COVID-19, a retrospective cohort study was conducted. For the immunologic investigation, a single-cell RNA sequencing analysis was performed in serially collected PBMCs and neutrophil specimens. Triple immune modulator therapy was a significant factor in a multivariable analysis for 30-day recovery. In the scRNA-seq analysis, type I and II IFN response-related pathways were suppressed by GC, and the IL-6-associated signature was additionally downregulated by TOC. Adding BAR to GC and TOC distinctly downregulated the ISGF3 cluster. Adding BAR also regulated the pathologically activated monocyte and neutrophil subpopulation induced by aberrant IFN signals. Triple immune modulator therapy in severe COVID-19 improved 30-day recovery through additional regulation of the aberrant hyperinflammatory immune response.
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Affiliation(s)
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Yun Lim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong Seok Lee
- Genome Insight, Inc., San Diego, La Jolla, CA, USA; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
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6
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Lim N, Festa M, Lade S, Britton P. Multiple Complications of Typhoid in a Returned Child Traveler. Clin Pediatr (Phila) 2022; 61:741-744. [PMID: 35686371 DOI: 10.1177/00099228221103083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Natalie Lim
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Samantha Lade
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Philip Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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7
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Gandhi A, Joe G, Soman R. Enteric Fever Still haunts us with New Challenges. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:65-67. [PMID: 36461847 DOI: 10.25259/nmji_725_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Aashna Gandhi
- Department of Infectious Diseases, Jupiter Hospital, Baner, Pune, Maharashtra, India
| | - Geethu Joe
- Department of Microbiology, Jupiter Hospital, Baner, Pune, Maharashtra, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Baner, Pune, Maharashtra, India
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8
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Nabarro LE, McCann N, Herdman MT, Dugan C, Ladhani S, Patel D, Morris-Jones S, Balasegaram S, Heyderman RS, Brown M, Parry CM, Godbole G. British Infection Association Guidelines for the Diagnosis and Management of Enteric Fever in England. J Infect 2022; 84:469-489. [PMID: 35038438 DOI: 10.1016/j.jinf.2022.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
Enteric fever (EF) is an infection caused by the bacteria called Salmonella Typhi or Paratyphi. Infection is acquired through swallowing contaminated food or water. Most EF in England occurs in people returning from South Asia and other places where EF is common; catching EF in England is rare. The main symptom is fever, but stomach pain, diarrhoea, muscle aches, rash and other symptoms may occur. EF is diagnosed by culturing the bacteria from blood and/or stool in a microbiology laboratory. EF usually responds well to antibiotic treatment. Depending on how unwell the individual is, antibiotics may be administered by mouth or by injection. Over the past several years, there has been an overall increase in resistance to antibiotics used to treat enteric fever, in all endemic areas. Additionally, since 2016, there has been an ongoing outbreak of drug-resistant EF in Pakistan. This infection is called extensively drug-resistant, or XDR, EF and only responds to a limited number of antibiotics. Occasionally individuals develop complications of EF including confusion, bleeding, a hole in the gut or an infection of the bones or elsewhere. Some people may continue to carry the bacteria in their stool for a longtime following treatment for the initial illness. These people may need treatment with a longer course of antibiotics to eradicate infection. Travellers can reduce their risk of acquiring EF by following safe food and water practices and by receiving the vaccine at least a few weeks before travel. These guidelines aim to help doctors do the correct tests and treat patients for enteric fever in England but may also be useful to doctors and public health professionals in other similar countries.
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Affiliation(s)
- L E Nabarro
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; St George's University Hospitals NHS Foundation Trust, London, UK; British Infection Association, UK
| | - N McCann
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - C Dugan
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Ladhani
- United Kingdom Health Security Agency, UK; Paediatric Infectious Diseases Research Group, St George's University, London, UK
| | - D Patel
- National Travel Health Network and Centre (NaTHNaC), UK
| | - S Morris-Jones
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - R S Heyderman
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - M Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - C M Parry
- Liverpool School of Tropical Medicine, Liverpool, UK; Alder Hey Hospital and Liverpool University Hospitals, Liverpool, UK; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - G Godbole
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; British Infection Association, UK.
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9
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Murillo-Cerda FJ, Martínez-Reséndez MF. Typhoid encephalopathy as a neuropsychiatric manifestation of salmonellosis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:259-260. [PMID: 34794929 DOI: 10.1016/j.rgmxen.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- F J Murillo-Cerda
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico.
| | - M F Martínez-Reséndez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
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10
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Affiliation(s)
- Buddha Basnyat
- Oxford University Clinical Research Unit-Patan Academy of Health Science Kathmandu, Nepal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | | | - Christopher M Parry
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Alder Hey Children' Hospital and Liverpool University Hospitals. Liverpool, UK
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11
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Al Khodari K, Baig T, Alkhateeb MH, Naeem M. Acute sensorineural hearing loss as atypical presentation of typhoid fever in adult patient. SAGE Open Med Case Rep 2020; 8:2050313X20958548. [PMID: 33062279 PMCID: PMC7533951 DOI: 10.1177/2050313x20958548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Salmonella Typhi is the main cause of an acute febrile, sometimes fatal, multisystemic illness called typhoid fever. The diverse presentations of this disease make it a diagnostic challenge in some patients. Involvement of the neurological system, including cochleovestibular system, is very rare with less than a handful of reported cases. This case report describes the condition of a previously healthy 23-year-old Pakistani man with acute onset of hearing loss associated with fever, headache, and disorientation. The most likely differential diagnoses were bacterial or viral meningoencephalitis, and other bacterial infections, such as Rickettsial and spirochetal diseases. Salmonella Typhi grew on blood culture; thus, treatment with intravenous antibiotics and systemic steroids was provided with excellent response. Hearing loss gradually improved and almost completely resolved within 3 to 4 weeks.
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Affiliation(s)
- Khaled Al Khodari
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | | | - Muhammad Naeem
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
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12
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Selenium Deficiency Is Associated with Mortality Risk from COVID-19. Nutrients 2020; 12:nu12072098. [PMID: 32708526 PMCID: PMC7400921 DOI: 10.3390/nu12072098] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 12/22/2022] Open
Abstract
SARS-CoV-2 infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for a high death toll particularly among elderly subjects and those with comorbidities. Selenium (Se) is an essential trace element of high importance for human health and particularly for a well-balanced immune response. The mortality risk from a severe disease like sepsis or polytrauma is inversely related to Se status. We hypothesized that this relation also applies to COVID-19. Serum samples (n = 166) from COVID-19 patients (n = 33) were collected consecutively and analyzed for total Se by X-ray fluorescence and selenoprotein P (SELENOP) by a validated ELISA. Both biomarkers showed the expected strong correlation (r = 0.7758, p < 0.001), pointing to an insufficient Se availability for optimal selenoprotein expression. In comparison with reference data from a European cross-sectional analysis (EPIC, n = 1915), the patients showed a pronounced deficit in total serum Se (mean ± SD, 50.8 ± 15.7 vs. 84.4 ± 23.4 µg/L) and SELENOP (3.0 ± 1.4 vs. 4.3 ± 1.0 mg/L) concentrations. A Se status below the 2.5th percentile of the reference population, i.e., [Se] < 45.7 µg/L and [SELENOP] < 2.56 mg/L, was present in 43.4% and 39.2% of COVID samples, respectively. The Se status was significantly higher in samples from surviving COVID patients as compared with non-survivors (Se; 53.3 ± 16.2 vs. 40.8 ± 8.1 µg/L, SELENOP; 3.3 ± 1.3 vs. 2.1 ± 0.9 mg/L), recovering with time in survivors while remaining low or even declining in non-survivors. We conclude that Se status analysis in COVID patients provides diagnostic information. However, causality remains unknown due to the observational nature of this study. Nevertheless, the findings strengthen the notion of a relevant role of Se for COVID convalescence and support the discussion on adjuvant Se supplementation in severely diseased and Se-deficient patients.
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13
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Moghaddam A, Heller RA, Sun Q, Seelig J, Cherkezov A, Seibert L, Hackler J, Seemann P, Diegmann J, Pilz M, Bachmann M, Minich WB, Schomburg L. Selenium Deficiency Is Associated with Mortality Risk from COVID-19. Nutrients 2020. [PMID: 32708526 DOI: 10.20944/preprints202007.0113.v1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for a high death toll particularly among elderly subjects and those with comorbidities. Selenium (Se) is an essential trace element of high importance for human health and particularly for a well-balanced immune response. The mortality risk from a severe disease like sepsis or polytrauma is inversely related to Se status. We hypothesized that this relation also applies to COVID-19. Serum samples (n = 166) from COVID-19 patients (n = 33) were collected consecutively and analyzed for total Se by X-ray fluorescence and selenoprotein P (SELENOP) by a validated ELISA. Both biomarkers showed the expected strong correlation (r = 0.7758, p < 0.001), pointing to an insufficient Se availability for optimal selenoprotein expression. In comparison with reference data from a European cross-sectional analysis (EPIC, n = 1915), the patients showed a pronounced deficit in total serum Se (mean ± SD, 50.8 ± 15.7 vs. 84.4 ± 23.4 µg/L) and SELENOP (3.0 ± 1.4 vs. 4.3 ± 1.0 mg/L) concentrations. A Se status below the 2.5th percentile of the reference population, i.e., [Se] < 45.7 µg/L and [SELENOP] < 2.56 mg/L, was present in 43.4% and 39.2% of COVID samples, respectively. The Se status was significantly higher in samples from surviving COVID patients as compared with non-survivors (Se; 53.3 ± 16.2 vs. 40.8 ± 8.1 µg/L, SELENOP; 3.3 ± 1.3 vs. 2.1 ± 0.9 mg/L), recovering with time in survivors while remaining low or even declining in non-survivors. We conclude that Se status analysis in COVID patients provides diagnostic information. However, causality remains unknown due to the observational nature of this study. Nevertheless, the findings strengthen the notion of a relevant role of Se for COVID convalescence and support the discussion on adjuvant Se supplementation in severely diseased and Se-deficient patients.
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Affiliation(s)
- Arash Moghaddam
- ATORG, Aschaffenburg Trauma and Orthopedic Research Group, Center for Orthopedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
| | - Raban Arved Heller
- HTRG, Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, D-69118 Heidelberg, Germany.,Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Qian Sun
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Julian Seelig
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Asan Cherkezov
- ATORG, Aschaffenburg Trauma and Orthopedic Research Group, Center for Orthopedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
| | - Linda Seibert
- ATORG, Aschaffenburg Trauma and Orthopedic Research Group, Center for Orthopedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
| | - Julian Hackler
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Petra Seemann
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Joachim Diegmann
- ATORG, Aschaffenburg Trauma and Orthopedic Research Group, Center for Orthopedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
| | - Manuel Bachmann
- ATORG, Aschaffenburg Trauma and Orthopedic Research Group, Center for Orthopedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
| | - Waldemar B Minich
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-13353 Berlin, Germany
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14
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Throckmorton L, Hancher J. Management of Travel-Related Infectious Diseases in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020; 8:50-59. [PMID: 32377443 PMCID: PMC7200320 DOI: 10.1007/s40138-020-00213-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of Review Emergency physicians generally have limited exposure to internationally acquired illnesses. However, travelers can present quite ill, and delays in recognition and treatment can lead to increased morbidity and mortality. This paper aims to summarize typical presentations of common international diseases and provide the emergency physician with a practical approach based on current guidelines. Recent Findings In the treatment of traveler’s diarrhea, azithromycin has become the treatment of choice due to the growing antibiotic resistance. Intravenous artesunate was approved in 2019 under investigational new drug protocol for the treatment of severe malaria, and artemisinin-based combination therapies (ACTs) have become the first-line treatment for most cases of uncomplicated malaria. Since the 2015 outbreak, Zika has become a concern to many travelers, but the current treatment is supportive. Summary Clinicians should be aware of a few noteworthy updates in the treatment of internationally acquired illnesses, but more importantly, they must recognize warning signs of severe illness and treat promptly. Future research on workup and disposition could help emergency physicians identify which patients need admission in well-appearing febrile travelers.
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Affiliation(s)
- Laura Throckmorton
- 1Center for Emergency Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106 USA
| | - Jonathan Hancher
- 2Department of Emergency Medicine, University of North Carolina Hospitals, University of North Carolina, Physician Office Building, 170 Manning Drive, CB# 7594, Chapel Hill, NC 27599-7594 USA
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High-dose Dexamethasone in a Child With Enteric Encephalopathy Caused by Salmonella enterica serovar Typhi. Pediatr Infect Dis J 2020; 39:e49-e51. [PMID: 32176188 DOI: 10.1097/inf.0000000000002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increased antimicrobial resistance to Salmonella species threatens successful treatment of typhoid and other infectious diseases. Consequently, rare complications arising from incompletely treated typhoid could increase in frequency. We describe a case of enteric encephalopathy caused by Salmonella enterica serovar Typhi and the utility of adjunct treatment with corticosteroids.
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Liu PY, Wang KC, Hong YP, Chen BH, Shi ZY, Chiou CS. The first imported case of extensively drug-resistant Salmonella enterica serotype Typhi infection in Taiwan and the antimicrobial therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:740-744. [PMID: 32253142 DOI: 10.1016/j.jmii.2020.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 02/05/2023]
Abstract
The first imported case of XDR typhoid fever in Taiwan contracted with a bacterial strain, which was most closely related to the blaCTX-M-15-carrying strains linked to Pakistan. Meropenem, in combination with an antimicrobial with intracellular activity against Salmonella, should be used for the treatment of XDR typhoid fever.
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Affiliation(s)
- Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kung-Ching Wang
- Central Regional Center, Centers for Disease Control, Taiwan
| | - Yu-Ping Hong
- Center for Research, Diagnosis and Vaccine Development, Centers for Disease Control, Taiwan
| | - Bo-Han Chen
- Center for Research, Diagnosis and Vaccine Development, Centers for Disease Control, Taiwan
| | - Zhi-Yuan Shi
- Infection Control Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Shun Chiou
- Center for Research, Diagnosis and Vaccine Development, Centers for Disease Control, Taiwan.
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Antimicrobial Therapy in the Context of the Damage-Response Framework: the Prospect of Optimizing Therapy by Reducing Host Damage. Antimicrob Agents Chemother 2020; 64:AAC.01800-19. [PMID: 31740558 DOI: 10.1128/aac.01800-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
By design, antimicrobial agents act directly on microbial targets. These drugs aim to eliminate microbes and are remarkably effective against susceptible organisms. Nonetheless, some patients succumb to infectious diseases despite appropriate antimicrobial therapy. Today, with very few exceptions, physicians select antimicrobial therapy based on its activity against the targeted organism without consideration of how the regimen affects patients' immune responses. An important concept to emerge in the past few decades is that immune responses to microbes can be detrimental by enhancing host damage, which can translate into clinical disease. A central tenet of the damage-response framework (DRF) of microbial pathogenesis is that the relevant outcome of host-microbe interaction is the damage that occurs in the host, which can be due to microbial factors, host factors, or both. Given that host damage can make patients sick, reducing it should be a goal of treating infectious diseases. Inflammation and damage that stem from the host response to an infectious disease can increase during therapy with some antimicrobial agents and decrease during therapy with others. When a patient cannot eliminate a microbe with their own immune response, antimicrobial therapy is essential for microbial elimination, and yet it can affect the inflammatory response. In this essay, we discuss antimicrobial therapy in the context of the DRF and propose that consideration of the DRF may help tailor therapy to a patient's need to augment or reduce inflammation.
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Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus 2019; 11:e5049. [PMID: 31511802 PMCID: PMC6716968 DOI: 10.7759/cureus.5049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Typhoid is an endemic hassle, especially in third-world countries like Pakistan. It is an enteric fever characterized by systemic manifestations that include high temperature and abdominal pain. If not properly treated, at times, it can transgress into complications predominantly involving the gut, where the site of pathology lies. Sometimes, however, it can involve other organ systems and pose diagnostic challenges owing to unfamiliar modes of presentation. Here in, we present a case of a 14-year-old male, previously afflicted and treated for typhoid who presented to the medical consult service with abdominal pain, high-grade fever, and mild chest discomfort. His hemodynamic parameters deteriorated within weeks as he developed pulmonary edema and hypoxemia. He was later diagnosed with echocardiography which earlier on, showed signs of acute myocarditis and eventually dilated cardiomyopathy. The patient was treated with antibiotics coupled with supportive and intensive care which yielded relief in his symptoms. He was later followed up with serial echocardiograms and showed improvement in the cardiac parameters.
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Affiliation(s)
- Abdul Majid
- Cardiology, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Syed Hamza Bin Waqar
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sanjay Kumar
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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Abstract
Vasodilatory shock is the most common type of circulatory shock in critically ill patients; sepsis the predominant cause. Steroid use in septic shock gained favor in the 1970s; however, studies of high-dose steroids demonstrated excess morbidity and mortality. Lower dosage steroid use was driven by trials demonstrating improved hemodynamic status and the possibility of relative adrenal insufficiency; however, divergent results led to uncertainty about hydrocortisone treatment. Two recent trials are likely to reinforce the role of steroids in septic shock and change the recommendation in future clinical practice guidelines. Future work could include elucidating mechanisms of shock reversal, interaction of hydrocortisone with other agents, identifying steroid responsiveness using biochemical or gene signatures, and clarifying the role of fludrocortisone.
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Affiliation(s)
- Balasubramanian Venkatesh
- Department of Intensive Care, The Wesley Hospital, Coronation Drive, QLD 4066, Australia; Department of Intensive Care, Princess Alexandra Hospital, Ipswich Road, University of Queensland, QLD 4102, Australia; Division of Critical Care, The George Institute for Global Health, University of New South Wales, King Street, NSW 2050, Australia.
| | - Jeremy Cohen
- Department of Intensive Care, The Wesley Hospital, Coronation Drive, QLD 4066, Australia; Department of Intensive Care, The Royal Brisbane and Women's Hospital, University of Queensland, Herston Road, QLD 4066, Australia; Division of Critical Care, The George Institute for Global Health, King Street, Sydney, NSW 2050, Australia
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20
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Martino EA, Baiardo Redaelli M, Sardo S, Lembo R, Giordano VF, Winterton D, Ruggeri L, Hajjar LA, Zangrillo A, Landoni G. Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials. J Cardiothorac Vasc Anesth 2018; 32:2252-2260. [PMID: 29793761 DOI: 10.1053/j.jvca.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. DESIGN A meta-analysis of randomized trials. SETTING PubMed, Embase, BioMed Central, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched to February 1, 2018, for randomized trials comparing corticosteroids with placebo or standard care. PARTICIPANTS Critically ill or surgical adult patients. INTERVENTIONS Corticosteroids compared with placebo or standard care. MEASUREMENTS AND MAIN RESULTS A total of 44,553 patients from 135 studies were included. Overall, mortality in the corticosteroid group and in the control group were similar (16% v 16%; p = 0.9). Subanalyses identified a beneficial effect of corticosteroids on survival in patients with respiratory system diseases (9% v 13%; p < 0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental effect on survival in patients with traumatic brain injury (22% v 19%; p < 0.001). No differences in mortality were found in patients with cardiac diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8% v 3.2% p = 0.14), and when treatment duration or patient age were considered. CONCLUSIONS This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.
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Affiliation(s)
- Enrico A Martino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Sardo
- Department of Medical Sciences "M. Aresu," University of Cagliari, Cagliari, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vito F Giordano
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Winterton
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Ruggeri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ludhmilla A Hajjar
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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21
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Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, Ahmed T. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture-proven typhoid patients admitted to an urban hospital in Bangladesh. Trop Med Int Health 2018; 23:359-366. [PMID: 29432657 DOI: 10.1111/tmi.13037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Typhoid fever is one of the major causes of morbidity and mortality in typhoid endemic countries like Bangladesh. However, data on the clinical and microbiological profile as well as factors associated with complications of typhoid in Bangladesh are scarce. We intended to characterise the clinical and microbiological profile of culture-proven typhoid fever and to identify factors associated with complications. METHODOLOGY Retrospective analysis of clinical data from 431 patients with culture-confirmed typhoid fever admitted to Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, between January 2010 and December 2014. Clinical and microbiological profiles of the patients including age, sex, and duration of illness prior to hospital admission, haematological parameters and the antimicrobial resistance profile of the infecting isolate, duration of hospital stay and defervescence time were examined by logistic regression to identify the factors associated with complications. RESULT About one of three patients were children under 5 years, and 21.5% of them were severely malnourished. During hospitalisation, 17.4% patients developed complications; mainly encephalopathy (6.7%), ileus (6.5%) and pneumonia (3.5%). Among culture-positive cases, 28.3% isolates showed multidrug resistant (MDR) and more than 90% of isolates were resistant to nalidixic acid and had intermediate sensitivity to ciprofloxacin. Five isolates were resistant to azithromycin; all isolates were sensitive to cefixime and ceftriaxone. Complication was independently associated with duration of fever before admission (adjusted odds ratio: 0.85; 95% CI: 0.074-0.97; P < 0.05), thrombocytopenia on admission (AOR: 2.84; 95% CI: 01.06-7.57; P < 0.05), duration of hospital stay (AOR: 1.34; 95% CI: 1.15-1.57; P < 0.01) and defervescence time (AOR: 0.83; 95% CI: 0.70-0.99; P < 0.05). CONCLUSION The high prevalence of typhoid fever among under-five children and complications among hospitalised patients are matters of concern. Sensitivity of Salmonella Typhi to ceftriaxone and cefixime was better than to other conventional antibiotics. Shorter duration of fever and thrombocytopenia on admission can be considered as early signs of complications.
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Affiliation(s)
- Halima Khatun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shoeb Bin Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syed Aminul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur Haque Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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22
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Affiliation(s)
- H M Oh
- Department of Medicine IV, Tan Tock Seng Hospital, Singapore
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23
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Bann M, Kaul DR, Haider MZ, Saint S, Goldberger ZD. Home Sweet Home. N Engl J Med 2018; 378:461-466. [PMID: 29385373 DOI: 10.1056/nejmcps1704731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Maralyssa Bann
- From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infectious Disease (D.R.K.), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - both in Ann Arbor
| | - Daniel R Kaul
- From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infectious Disease (D.R.K.), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - both in Ann Arbor
| | - Mahri Z Haider
- From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infectious Disease (D.R.K.), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - both in Ann Arbor
| | - Sanjay Saint
- From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infectious Disease (D.R.K.), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - both in Ann Arbor
| | - Zachary D Goldberger
- From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infectious Disease (D.R.K.), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (S.S.) - both in Ann Arbor
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24
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Rose E. Other Potentially Life-Threatening Conditions with Mucocutaneous Findings (Leptospirosis, Typhoid Fever, Dengue, Diphtheria, Murine Typhus). LIFE-THREATENING RASHES 2018. [PMCID: PMC7123152 DOI: 10.1007/978-3-319-75623-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
There are several conditions with mucocutaneous findings that are potentially life-threatening, particularly in certain vulnerable populations. In this chapter, leptospirosis, typhoid fever, dengue, diphtheria, and murine typhus are reviewed. The disease time course of classic and atypical presentations is detailed to assist making the diagnosis in subtle cases. Associated symptoms are discussed as well as a comparison with disease mimics and differential diagnoses. Key diagnostic features are emphasized, and evidence-based management of each condition is detailed in this chapter.
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Affiliation(s)
- Emily Rose
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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25
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Adjuvant therapies in critical care: steroids to treat infectious diseases. Intensive Care Med 2017; 44:1306-1309. [DOI: 10.1007/s00134-017-5020-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
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Mellon G, Eme AL, Rohaut B, Brossier F, Epelboin L, Caumes E. Encephalitis in a traveller with typhoid fever: efficacy of corticosteroids. J Travel Med 2017; 24:4339101. [PMID: 29088483 DOI: 10.1093/jtm/tax063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/16/2017] [Indexed: 11/14/2022]
Abstract
Typhoid fever is a bacterial infection caused by Salmonella typhi or S. paratyphi, recognized as a classical cause of fever in returning travellers. However, neuropsychiatric presentations are rarely reported in travellers diagnosed in western countries, whereas they are more commonly described in patients treated in endemic areas. We describe such a case and discuss the pathophysiologic mechanisms of this complication.
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Affiliation(s)
- Guillaume Mellon
- Department of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Anne-Line Eme
- Department of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Benjamin Rohaut
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.,Sorbonne Universités, UPMC, Medical School Paris 6 University, Paris, France
| | - Florence Brossier
- Department of Microbiology, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Loïc Epelboin
- Department of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Eric Caumes
- Department of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Pitié Salpétrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Dolecek C. Typhoid Fever and Other Enteric Fevers. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ugas MB, Carroll T, Kovar L, Chavez-Bueno S. Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone. J Investig Med High Impact Case Rep 2016; 4:2324709616652642. [PMID: 27294165 PMCID: PMC4887870 DOI: 10.1177/2324709616652642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022] Open
Abstract
Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics.
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Affiliation(s)
| | - Timothy Carroll
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Lacey Kovar
- Acute Disease Service of the Oklahoma State Department of Health, Oklahoma City, OK, USA
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Schwingshackl A, Meduri GU. Rationale for Prolonged Glucocorticoid Use in Pediatric ARDS: What the Adults Can Teach Us. Front Pediatr 2016; 4:58. [PMID: 27379217 PMCID: PMC4906037 DOI: 10.3389/fped.2016.00058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/23/2016] [Indexed: 12/21/2022] Open
Abstract
Based on molecular mechanisms and physiologic data, a strong association has been established between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS patients, glucocorticoid receptor-mediated downregulation of systemic inflammation is essential to restore homeostasis, decrease morbidity and improve survival and can be significantly enhanced with prolonged low-to-moderate dose glucocorticoid treatment. A large body of evidence supports a strong association between prolonged glucocorticoid treatment-induced downregulation of the inflammatory response and improvement in pulmonary and extrapulmonary physiology. The balance of the available data from eight controlled trials (n = 622) provides consistent strong level of evidence for improving patient-centered outcomes and hospital survival. The sizable increase in mechanical ventilation-free days (weighted mean difference, 6.48 days; CI 95% 2.57-10.38, p < 0.0001) and intensive care unit-free days (weighted mean difference, 7.7 days; 95% CI, 3.13-12.20, p < 0.0001) by day 28 is superior to any investigated intervention in ARDS. For treatment initiated before day 14 of ARDS, the increased in hospital survival (70 vs. 52%, OR 2.41, CI 95% 1.50-3.87, p = 0.0003) translates into a number needed to treat to save one life of 5.5. Importantly, prolonged glucocorticoid treatment is not associated with increased risk for nosocomial infections (22 vs. 27%, OR 0.61, CI 95% 0.35-1.04, p = 0.07). Treatment decisions involve a tradeoff between benefits and risks, as well as costs. This low-cost, highly effective therapy is familiar to every physician and has a low risk profile when secondary prevention measures are implemented.
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Affiliation(s)
- Andreas Schwingshackl
- Department of Pediatrics, Division of Critical Care Medicine, Mattel Children's Hospital at UCLA , Los Angeles, CA , USA
| | - Gianfranco Umberto Meduri
- Departments of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Memphis Veterans Affairs Medical Center , Memphis, TN , USA
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Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clin Microbiol Rev 2015; 28:901-37. [PMID: 26180063 PMCID: PMC4503790 DOI: 10.1128/cmr.00002-15] [Citation(s) in RCA: 623] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica, initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, Otago, New Zealand Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Sjölund-Karlsson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melita A Gordon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Abstract
Salmonella are gram-negative bacilli within the family Enterobacteriaceae. They are the cause of significant morbidity and mortality worldwide. Animals (pets) are an important reservoir for nontyphoidal Salmonella, whereas humans are the only natural host and reservoir for Salmonella Typhi. Salmonella infections are a major cause of gastroenteritis worldwide. They account for an estimated 2.8 billion cases of diarrheal disease each year. The transmission of Salmonella is frequently associated with the consumption of contaminated water and food of animal origin, and it is facilitated by conditions of poor hygiene. Nontyphoidal Salmonella infections have a worldwide distribution, whereas most typhoidal Salmonella infections in the United States are acquired abroad. In the United States, Salmonella is a common agent for food-borne–associated infections. Several outbreaks have been identified and are most commonly associated with agricultural products. Nontyphoidal Salmonella infection is usually characterized by a self-limited gastroenteritis in immunocompetent hosts in industrialized countries, but it may also cause invasive disease in vulnerable individuals (eg, children less than 1 year of age, immunocompromised). Antibiotic treatment is not recommended for treatment of mild to moderate gastroenteritis by nontyphoidal Salmonella in immunocompetent adults or children more than 1 year of age. Antibiotic treatment is recommended for nontyphoidal Salmonella infections in infants less than 3 months of age, because they are at higher risk for bacteremia and extraintestinal complications. Typhoid (enteric) fever and its potential complications have a significant impact on children, especially those who live in developing countries. Antibiotic treatment of typhoid fever has become challenging because of the emergence of Salmonella Typhi strains that are resistant to classically used first-line agents: ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol. The choice of antibiotics for the management of typhoid fever should be guided by the local resistance pattern. Recommendations include using an extended spectrum cephalosporin, azithromycin, or a fluoroquinolone. Fecal carriage of Salmonella is an important factor in the spread of the organism to healthy individuals. The most important measures to prevent the spread and outbreaks of Salmonella infections and typhoid fever are adequate sanitation protocols for food processing and handling as well as hand hygiene. In the United States, 2 vaccines are commercially available against Salmonella Typhi. The WHO recommends the use of these vaccines in endemic areas and for outbreak control.
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Parry CM, Basnyat B, Crump JA. The management of antimicrobial-resistant enteric fever. Expert Rev Anti Infect Ther 2014; 11:1259-61. [PMID: 24215240 DOI: 10.1586/14787210.2013.858019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Christopher M Parry
- Oxford University Clinical Research Unit- Patan Academy of Health Sciences, Kathmandu, Nepal
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Parry CM, Thompson C, Vinh H, Chinh NT, Phuong LT, Ho VA, Hien TT, Wain J, Farrar JJ, Baker S. Risk factors for the development of severe typhoid fever in Vietnam. BMC Infect Dis 2014; 14:73. [PMID: 24512443 PMCID: PMC3923984 DOI: 10.1186/1471-2334-14-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica serovar Typhi. Age, sex, prolonged duration of illness, and infection with an antimicrobial resistant organism have been proposed risk factors for the development of severe disease or fatality in typhoid fever. METHODS We analysed clinical data from 581 patients consecutively admitted with culture confirmed typhoid fever to two hospitals in Vietnam during two periods in 1993-1995 and 1997-1999. These periods spanned a change in the antimicrobial resistance phenotypes of the infecting organisms i.e. fully susceptible to standard antimicrobials, resistance to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole (multidrug resistant, MDR), and intermediate susceptibility to ciprofloxacin (nalidixic acid resistant). Age, sex, duration of illness prior to admission, hospital location and the presence of MDR or intermediate ciprofloxacin susceptibility in the infecting organism were examined by logistic regression analysis to identify factors independently associated with severe typhoid at the time of hospital admission. RESULTS The prevalence of severe typhoid was 15.5% (90/581) and included: gastrointestinal bleeding (43; 7.4%); hepatitis (29; 5.0%); encephalopathy (16; 2.8%); myocarditis (12; 2.1%); intestinal perforation (6; 1.0%); haemodynamic shock (5; 0.9%), and death (3; 0.5%). Severe disease was more common with increasing age, in those with a longer duration of illness and in patients infected with an organism exhibiting intermediate susceptibility to ciprofloxacin. Notably an MDR phenotype was not associated with severe disease. Severe disease was independently associated with infection with an organism with an intermediate susceptibility to ciprofloxacin (AOR 1.90; 95% CI 1.18-3.07; p = 0.009) and male sex (AOR 1.61 (1.00-2.57; p = 0.035). CONCLUSIONS In this group of patients hospitalised with typhoid fever infection with an organism with intermediate susceptibility to ciprofloxacin was independently associated with disease severity. During this period many patients were being treated with fluoroquinolones prior to hospital admission. Ciprofloxacin and ofloxacin should be used with caution in patients infected with S. Typhi that have intermediate susceptibility to ciprofloxacin.
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Affiliation(s)
- Christopher M Parry
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK
| | - Corinne Thompson
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
| | - Ha Vinh
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Tran Chinh
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Le Thi Phuong
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Vo Anh Ho
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Tran Tinh Hien
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - John Wain
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, University of East Anglia, Norwich, UK
| | - Jeremy J Farrar
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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Khanam F, Sheikh A, Sayeed MA, Bhuiyan MS, Choudhury FK, Salma U, Pervin S, Sultana T, Ahmed D, Goswami D, Hossain ML, Mamun KZ, Charles RC, Brooks WA, Calderwood SB, Cravioto A, Ryan ET, Qadri F. Evaluation of a typhoid/paratyphoid diagnostic assay (TPTest) detecting anti-Salmonella IgA in secretions of peripheral blood lymphocytes in patients in Dhaka, Bangladesh. PLoS Negl Trop Dis 2013; 7:e2316. [PMID: 23951368 PMCID: PMC3708850 DOI: 10.1371/journal.pntd.0002316] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 06/03/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Rapid and reliable diagnostic assays for enteric (typhoid and paratyphoid) fever are urgently needed. We report the characterization of novel approach utilizing lymphocyte secretions, for diagnosing patients with enteric fever by the TPTest procedure. METHODOLOGY TPTest detects Salmonella-specific IgA responses in lymphocyte culture supernatant. We utilized TPTest in patients with suspected enteric fever, patients with other illnesses, and healthy controls. We also evaluated simplified modifications of TPTest for adaptation in laboratories with limited facilities and equipment. PRINCIPAL FINDINGS TPTest was positive in 39 (27 typhoid and 12 paratyphoid A) patients confirmed by blood culture and was negative in 74 healthy individuals. Among 32 individuals with other illnesses, 29 were negative by TPTest. Of 204 individuals with suspected enteric fever who were negative by blood culture, 44 were positive by TPTest and the patients were clinically indistinguishable from patients with confirmed bacteremia, except they were more likely to be under 5 years of age. We evaluated simplifications in TPTest, including showing that lymphocytes could be recovered using lysis buffer or buffy coat method as opposed to centrifugation, that incubation of cells at 37°C did not require supplemental CO2, and that results were available for majority of samples within 24 hours. Positive results by TPTest are transient and revert to negative during convalescence, supporting use of the test in endemic areas. The results can also be read using immunodot blot approach as opposed to ELISA. Since no true gold standard currently exists, we used a number of definitions of true positives and negatives. TPTest had sensitivity of 100% compared to blood culture, and specificity that ranged from 78-97% (73-100, 95% CI), depending on definition of true negative. CONCLUSION The TPTest is useful for identification of patients with enteric fever in an endemic area, and additional development of simplified TPTest is warranted.
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Affiliation(s)
- Farhana Khanam
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Alaullah Sheikh
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Md. Abu Sayeed
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Md. Saruar Bhuiyan
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Feroza Kaneez Choudhury
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Umme Salma
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Shahnaz Pervin
- Department of Microbiology, Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh
| | - Tania Sultana
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Md. Lokman Hossain
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - K. Z. Mamun
- Department of Microbiology, Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh
| | - Richelle C. Charles
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - W. Abdullah Brooks
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Stephen B. Calderwood
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Edward T. Ryan
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, Dhaka, Bangladesh
- * E-mail:
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Abstract
Salmonella enterica infections result in diverse clinical manifestations. Typhoid fever, caused by S. enterica serovar Typhi (S. Typhi) and S. Paratyphi A, is a bacteremic illness but whose clinical features differ from other Gram-negative bacteremias. Non-typhoidal Salmonella (NTS) serovars cause self-limiting diarrhea with occasional secondary bacteremia. Primary NTS bacteremia can occur in the immunocompromised host and infants in sub-Saharan Africa. Recent studies on host-pathogen interactions in Salmonellosis using genome sequencing, murine models, and patient studies have provided new insights. The full genome sequences of numerous S. enterica serovars have been determined. The S. Typhi genome, compared to that of S. Typhimurium, harbors many inactivated or disrupted genes. This can partly explain the different immune responses both serovars induce upon entering their host. Similar genome degradation is also observed in the ST313 S. Typhimurium strain implicated in invasive infection in sub-Saharan Africa. Virulence factors, most notably, type III secretion systems, Vi antigen, lipopolysaccharide and other surface polysaccharides, flagella, and various factors essential for the intracellular life cycle of S. enterica have been characterized. Genes for these factors are commonly carried on Salmonella Pathogenicity Islands (SPIs). Plasmids also carry putative virulence-associated genes as well as those responsible for antimicrobial resistance. The interaction of Salmonella pathogen-associated molecular patterns (PAMPs) with Toll-like receptors (TLRs) and NOD-like receptors (NLRs) leads to inflammasome formation, activation, and recruitment of neutrophils and macrophages and the production of pro-inflammatory cytokines, most notably interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, and interferon-gamma (IFN)-γ. The gut microbiome may be an important modulator of this immune response. S. Typhimurium usually causes a local intestinal immune response, whereas S. Typhi, by preventing neutrophil attraction resulting from activation of TLRs, evades the local response and causes systemic infection. Potential new therapeutic strategies may lead from an increased understanding of infection pathogenesis.
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Affiliation(s)
- Hanna K. de Jong
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, the Netherlands
| | - Chris M. Parry
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Tom van der Poll
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, the Netherlands
- Department of Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, the Netherlands
| | - W. Joost Wiersinga
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, the Netherlands
- Department of Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, the Netherlands
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Smarick SD, Haskins SC, Boller M, Fletcher DJ. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 6: Post-cardiac arrest care. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S85-101. [DOI: 10.1111/j.1476-4431.2012.00754.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Manuel Boller
- Department of Emergency Medicine, Center for Resuscitation Science, School of Medicine, and the Department of Clinical Studies; School of Veterinary Medicine, University of Pennsylvania; Philadelphia; PA
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Leung DT, Bogetz J, Itoh M, Ganapathi L, Pietroni MAC, Ryan ET, Chisti MJ. Factors associated with encephalopathy in patients with Salmonella enterica serotype Typhi bacteremia presenting to a diarrheal hospital in Dhaka, Bangladesh. Am J Trop Med Hyg 2012; 86:698-702. [PMID: 22492156 DOI: 10.4269/ajtmh.2012.11-0750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To characterize clinical correlates of typhoid fever-associated encephalopathy, we performed a retrospective chart review of patients with Salmonella enterica serotype Typhi bacteremia who were hospitalized at the International Centre for Diarrhoeal Disease Research, Bangladesh, from February of 2009 to June of 2011. Of 207 patients bacteremic with Salmonella Typhi who were ≥ 5 years of age, we identified 43 (21%) patients with encephalopathy. Univariate analysis revealed that patients with encephalopathy more often presented at ages of 10-24 years and had severe dehydration, low oxygen saturation, high respiratory rate, low leukocyte count, low platelet count, and Widal flagellar H agglutinin (TH) titer ≥ 1:640 compared with typhoid patients without encephalopathy. Multivariate analysis using logistic regression showed that age, dehydration, leukocyte count, and Widal TH titer were independently associated with encephalopathy. Our findings suggest that age, severity of disease, and immune responses are associated with encephalopathy during Salmonella Typhi bacteremia, perhaps reflecting the impact of prominent inflammatory responses.
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Affiliation(s)
- Daniel T Leung
- Division of Infectious Disease, Massachusetts General Hospital, Boston, 02114, USA.
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Silvestri L, Rommes JH, Petros AJ, Taylor N, van Saene HKF. Selective decontamination of the digestive tract may reinforce the efficacy of corticosteroids. Am J Respir Crit Care Med 2012; 185:344. [PMID: 22298370 DOI: 10.1164/ajrccm.185.3.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Punjabi NH, Taylor WRJ, Murphy GS, Purwaningsih S, Picarima H, Sisson J, Olson JG, Baso S, Wangsasaputra F, Lesmana M, Oyofo BA, Simanjuntak CH, Subekti D, Corwin AL, Richie TL. Etiology of acute, non-malaria, febrile illnesses in Jayapura, northeastern Papua, Indonesia. Am J Trop Med Hyg 2012; 86:46-51. [PMID: 22232450 PMCID: PMC3247108 DOI: 10.4269/ajtmh.2012.10-0497] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We conducted a prospective, inpatient fever study in malaria-endemic Papua, Indonesia to determine non-malaria fever etiologies. Investigations included malaria blood films, blood culture, paired serologic samples analysis for dengue, Japanese encephalitis, leptospirosis, scrub typhus, murine typhus, and spotted fever group rickettsia. During 1997–2000, 226 patients (127 males and 99 females) 1–80 years of age (median age = 25 years) were enrolled. Positive blood cultures (n = 34, 15%) were obtained for Salmonella Typhi (n = 13), Escherichia coli (n = 8), Streptococcus pneumoniae (n = 6), Staphylococcus aureus (n = 5), Streptococcus pyogenes (n = 1), and Klebsiella pneumoniae (n = 1). Twenty (8.8%) patients were positive for leptospirosis by polymerase chain reaction. Eighty (35.4%) of 226 patients had ≥ 1 positive serology, diagnostic for 15 rickettsial and 9 dengue cases. Acid-fast bacilli–positive sputum was obtained from three patients. Most common confirmed (81 of 226, 35.8%)/suspected diagnoses were typhoid fever (n = 41), pneumonia (n = 29), leptospirosis (n = 28), urinary tract infections (n = 20), rickettsioses (n = 19), dengue (n = 17), and meningitis/encephalitis (n = 15). There were 17 deaths, 7 (46.7%) were caused by meningitis/encephalitis. Multiple positive serologic results and few confirmed diagnoses indicate the need for improved diagnostics.
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Affiliation(s)
- Narain H. Punjabi
- *Address correspondence to Narain H. Punjabi, SOS Medika Jalan Puri Sakti, 10 Cipete, Jakarta Selatan 12410, Indonesia. E-mail:
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Contopoulos-Ioannidis DG, Ioannidis JPA. Claims for improved survival from systemic corticosteroids in diverse conditions: an umbrella review. Eur J Clin Invest 2012; 42:233-44. [PMID: 21880039 DOI: 10.1111/j.1365-2362.2011.02584.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Systemic corticosteroids have been proposed for numerous indications and there are many claims that corticosteroids can reduce mortality in diverse conditions. METHODS We performed an umbrella, agenda-wide review of the evidence on systemic corticosteroids and mortality, focusing primarily on large trials (defined as those with > 100 deaths) and meta-analyses. Searches were performed in PubMed and Cochrane Central Register of Controlled Trials (last update February 2011). We also examined whether spurious subset analyses may be responsible for claims of survival benefits in indications where only small trials had been available. RESULTS Among 257 identified randomized trials with mortality data in their abstract, we found 14 large trials pertaining to 10 different indications. Although 10 of these 14 trials have reported statistically significant survival differences in subset analyses, none shows a nominally statistically significant (P < 0·05) decrease in death risk for any of the tested conditions when all deaths on all randomized patients are analysed. Meta-analyses for these conditions show statistically significant reductions in mortality only with antenatal corticosteroids for preterm labour (relative risk 0·77, 95% CI, 0·67-0·89) and in tuberculous meningitis (relative risk 0·78, 95% CI, 0·67-0·91). For conditions without any large trials, statistically significant reductions in mortality in meta-analyses were noted for Pneumocystis pneumonia (relative risk 0·54, 95% CI, 0·38-0·79) and alcoholic hepatitis (relative risk 0·63, 95% CI, 0·50-0·80). Many small trials that claim significant benefits, even those for classic indications such as typhoid fever and tetanus, have shown these benefits only in subset analyses. CONCLUSIONS Corticosteroids have been documented to decrease mortality in some indications, in particular, antenatal use for preterm labour, tuberculous meningitis, Pneumocystis pneumonia, and alcoholic hepatitis. Many postulated benefits of corticosteroids on mortality may reflect 'vibration of treatment effects' leading to false-positive claims from spurious subset analyses and even for standard indications, such biases may have inflated the treatment effect estimates. More large trials are needed for serious, common conditions where use of corticosteroids is proposed.
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Audoly G, Vincentelli R, Edouard S, Georgiades K, Mediannikov O, Gimenez G, Socolovschi C, Mège JL, Cambillau C, Raoult D. Effect of rickettsial toxin VapC on its eukaryotic host. PLoS One 2011; 6:e26528. [PMID: 22046301 PMCID: PMC3203148 DOI: 10.1371/journal.pone.0026528] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 09/28/2011] [Indexed: 11/18/2022] Open
Abstract
Rickettsia are intracellular bacteria typically associated with arthropods that can be transmitted to humans by infected vectors. Rickettsia spp. can cause mild to severe human disease with a possible protection effect of corticosteroids when antibiotic treatments are initiated. We identified laterally transferred toxin-antitoxin (TA) genetic elements, including vapB/C, in several Rickettsia genomes and showed that they are functional in bacteria and eukaryotic cells. We also generated a plaque assay to monitor the formation of lytic plaques over time and demonstrated that chloramphenicol accelerates host cell lysis of vapB/C-containing Rickettsia. Whole-genome expression, TUNEL and FISH assays on the infected cells following exposure to the antibiotic revealed early apoptosis of host cells, which was linked to over-transcription of bacterial vapB/C operons and subsequent cytoplasmic VapC toxin release. VapC that is expressed in Escherichia coli and Saccharomyces cerevisiae or microinjected into mammalian cells is toxic through RNase activity and is prevented by dexamethasone. This study provides the first biological evidence that toxin-antitoxin elements act as pathogenic factors in bacterial host cells, confirming comparative genomic evidence of their role in bacterial pathogenicity. Our results suggest that early mortality following antibiotic treatment of some bacterial infections can be prevented by administration of dexamethasone.
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Affiliation(s)
- Gilles Audoly
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
| | | | - Sophie Edouard
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
| | | | - Oleg Mediannikov
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
| | - Grégory Gimenez
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
| | | | - Jean-Louis Mège
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
| | | | - Didier Raoult
- Unité des Rickettsies URMITE, UMR CNRS 6236- IRD 198, Marseille, France
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Beaulieu AA, Boggild AK. Enteric fever in two vaccinated travellers to Latin America. CMAJ 2011; 183:1740-5. [PMID: 21690226 DOI: 10.1503/cmaj.101320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Andrée-Anne Beaulieu
- Department of Microbiology and Infectious Diseases, University of Sherbrooke, Sherbrooke, Quebec
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Impact of salmonella infection on host hormone metabolism revealed by metabolomics. Infect Immun 2011; 79:1759-69. [PMID: 21321075 DOI: 10.1128/iai.01373-10] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The interplay between pathogens and their hosts has been studied for decades using targeted approaches, such as the analysis of mutants and host immunological responses. Although much has been learned from such studies, they focus on individual pathways and fail to reveal the global effects of infection on the host. To alleviate this issue, high-throughput methods, such as transcriptomics and proteomics, have been used to study host-pathogen interactions. Recently, metabolomics was established as a new method to study changes in the biochemical composition of host tissues. We report a metabolomic study of Salmonella enterica serovar Typhimurium infection. Our results revealed that dozens of host metabolic pathways are affected by Salmonella in a murine infection model. In particular, multiple host hormone pathways are disrupted. Our results identify unappreciated effects of infection on host metabolism and shed light on mechanisms used by Salmonella to cause disease and by the host to counter infection.
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Levine MM, Farag TH. Invasive Salmonella Infections and HIV in Northern Tanzania. Clin Infect Dis 2011; 52:349-51. [DOI: 10.1093/cid/ciq109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Myron M. Levine
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tamer H. Farag
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
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New advances in typhoid Fever vaccination strategies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 697:17-39. [PMID: 21120717 DOI: 10.1007/978-1-4419-7185-2_3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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47
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Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.6.323] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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48
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A fall in Ghana. Am J Med 2009; 122:1088-92. [PMID: 19958884 PMCID: PMC7124212 DOI: 10.1016/j.amjmed.2009.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 09/02/2009] [Accepted: 09/03/2009] [Indexed: 11/24/2022]
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49
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Gupta S, Handa A, Chadha DS, Ganjoo RK, Panda RC. Profile of Culture Positive Enteric Fever from Bangalore. Med J Armed Forces India 2009; 65:328-31. [PMID: 27408286 DOI: 10.1016/s0377-1237(09)80093-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 08/12/2009] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- S Gupta
- Classified Specialist (Medicine and Neurology), Command Hospital Air Force, Agram PO, Bangalore - 560007
| | - A Handa
- (Medicine and Pulmonology), Command Hospital Air Force, Agram PO, Bangalore - 560007
| | - D S Chadha
- (Medicine and Cardiology), Command Hospital Air Force, Agram PO, Bangalore - 560007
| | - R K Ganjoo
- Ex Commandant, Command Hospital Air Force, Agram PO, Bangalore - 560007
| | - R C Panda
- Senior Advisor (Medicine), 7 Air Force Hospital, Nathu Singh Road, Kanpur -UP
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Japiassú AM, Salluh JIF, Bozza PT, Bozza FA, Castro-Faria-Neto HC. Revisiting steroid treatment for septic shock: molecular actions and clinical effects - a review. Mem Inst Oswaldo Cruz 2009; 104:531-48. [DOI: 10.1590/s0074-02762009000400001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 06/30/2009] [Indexed: 01/13/2023] Open
Affiliation(s)
- André M Japiassú
- Instituto Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, Brasil; Casa de Saúde São José, Brasil
| | - Jorge IF Salluh
- Instituto Oswaldo Cruz; Instituto Nacional de Câncer, Brasil
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