Figure 1 - uploaded by Leon Ochiai
Content may be subject to copyright.
Flow of patients visiting the participating treatment centers for fever in the North Jakarta study site, 1 August 2001 to 31 July 2003
Source publication
We undertook a prospective community-based study in North Jakarta, Indonesia, to determine the incidence, clinical characteristics, seasonality, etiologic agent, and antimicrobial susceptibility pattern of enteric fever.
Following a census, treatment centre-based surveillance for febrile illness was conducted for two-years. Clinical data and a bloo...
Context in source publication
Similar publications
Background
Typhoid fever and paratyphoid fever are one of the most criticial public health issues worldwide, especially in developing countries. The incidence of this disease may be closely related to socio-economic factors, but there is a lack of research on the spatial level of relevant determinants of typhoid fever and paratyphoid fever.
Method...
Background:
Blood culture is the standard diagnostic method for typhoid and paratyphoid (enteric) fever in surveillance studies and clinical trials, but sensitivity is widely acknowledged to be suboptimal. We conducted a systematic review and meta-analysis to examine sources of heterogeneity across studies and quantified the effect of blood volume...
BACKGROUND:Typhoid is an important public health challenge for India, especially with the spread of antimicrobial resistance. The decision about whether to introduce a public vaccination programme needs to be based on an understanding of disease burden and the age-groups and geographic areas at risk. METHODS:We searched Medline and Web of Science d...
Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of thes...
Purpose
This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC)...
Citations
... The proportion of confirmed typhoid fever cases was low (4.72%), similar to a recent study by Gasem et al. [23]. Although this may not be a representative figure of typhoid fever in Indonesia, it is comparable to the proportion reported by Punjabi et al. [24] in a study conducted in North Jakarta hospitals in patients admitted with a history of fever for 3 days or more accompanied by abdominal complaints. To date, few studies have reported the prevalence of typhoid fever. ...
Introduction:
Typhoid fever diagnosis is challenging for clinicians in areas with limited laboratory facilities. Scoring methods based on signs and symptoms are useful for screening for probable cases of typhoid fever. The Nelwan Score variables are derived from the clinical signs and symptoms of patients with suspected typhoid. We validated the Nelwan Score compared to laboratory tests as the gold standard.
Methods:
This cross-sectional study was conducted between July 2017 and January 2018 in five hospitals and two primary health care centers in Jakarta and Tangerang, Indonesia. Patients with fever for 3-14 days and gastrointestinal symptoms were evaluated using the Nelwan Score. Blood cultures, samples for polymerase chain reaction testing, and additional rectal swab cultures were collected simultaneously to confirm the diagnosis of typhoid. Data were analyzed using a contingency table to measure sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and the optimal cut-off of the Nelwan Score for typhoid diagnosis was determined using a receiver-operating characteristic curve.
Result:
Typhoid was confirmed in 11 of the 233 patients (4.7%) with suspected typhoid. Among laboratory-confirmed typhoid cases, the median Nelwan Score was 11 (range: 9-13) and the optimal cut-off value was 10, with an area under the curve of 71.3%, sensitivity of 81.8%, specificity of 60.8%, PPV of 9.3%, and NPV of 98.5%.
Conclusion:
A Nelwan Score of 10 is the best cut-off value for screening for typhoid fever. It is useful as screening tool for typhoid fever, where laboratory resources are limited, and could help to decrease irrational antibiotic use.
... In correspondence with us, a likewise study in Pakistan reported that the resistance S. typhi was 88.2% for ciprofloxacin, 66.1% for ampicillin (Qamar et al., 2014). In sharp contrast to us, a community-based 2001 to 2003 in Indonesia showed a low resistance of S. typhi (only 2.5%) against ampicillin, with no resistance against ceftriaxone, or ciprofloxacin (Punjabi et al., 2013). The antibiotic resistance pattern may vary among the countries. ...
... Further research on combining a clinical prediction algorithm with disease-specific blood cultures for patients with febrile illnesses in typhoid-endemic areas could be a potential route to improve patient outcomes in a community-based setting while waiting for the wider adoption of molecular and serological testing. Among cases of S. Typhi and S. Paratyphi A bacteremia, the prevalence of antimicrobial resistance to the antibiotic of choice was only 3.9% (Fig 2), which is similar to previous studies in Indonesia [64][65][66]. In the 2011-2015 period, rates of resistance against most antimicrobials for S. Typhi and S. Paratyphi A were low, indicating that there is a distinct epidemiological dynamic of enteric fever in Indonesia compared to the rest of the world [64,67]. ...
Blood culturing remains the “gold standard” for bloodstream infection (BSI) diagnosis, but the method is inaccessible to many developing countries due to high costs and insufficient resources. To better understand the utility of blood cultures among patients in Indonesia, a country where blood cultures are not routinely performed, we evaluated data from a previous cohort study that included blood cultures for all participants. An acute febrile illness study was conducted from July 2013 to June 2016 at eight major hospitals in seven provincial capitals in Indonesia. All participants presented with a fever, and two-sided aerobic blood cultures were performed within 48 hours of hospital admission. Positive cultures were further assessed for antimicrobial resistance (AMR) patterns. Specimens from participants with negative culture results were screened by advanced molecular and serological methods for evidence of causal pathogens. Blood cultures were performed for 1,459 of 1,464 participants, and the 70.6% (1,030) participants that were negative by dengue NS1 antigen test were included in further analysis. Bacteremia was observed in 8.9% (92) participants, with the most frequent pathogens being Salmonella enterica serovar Typhi (41) and Paratyphi A (10), Escherichia coli (14), and Staphylococcus aureus (10). Two S . Paratyphi A cases had evidence of AMR, and several E . coli cases were multidrug resistant (42.9%, 6/14) or monoresistant (14.3%, 2/14). Culture contamination was observed in 3.6% (37) cases. Molecular and serological assays identified etiological agents in participants having negative cultures, with 23.1% to 90% of cases being missed by blood cultures. Blood cultures are a valuable diagnostic tool for hospitalized patients presenting with fever. In Indonesia, pre-screening patients for the most common viral infections, such as dengue, influenza, and chikungunya viruses, would maximize the benefit to the patient while also conserving resources. Blood cultures should also be supplemented with advanced laboratory tests when available.
... S. typhi was also highly resistant to antibiotics like gentamycin and amikacin. In sharp contrast to us, a community-based study in Indonesia showed almost no resistance against ceftriaxone or ciprofloxacin (Punjabi et al., 2013). The antibiotic resistance pattern may vary among the countries. ...
Enteric fever is a severe public health threat because of the rising antibiotic resistance of Salmonella species in developing countries, especially in its endemic areas like Bangladesh. This retrospective study was aimed to assess the effectiveness of a range of 17 commonly used antimicrobials against Salmonella Typhi and Salmonella Paratyphi A isolated from 601 enteric fever cases in Dhaka, Bangladesh. Conventional biochemical tests were used to identify Salmonella strains and the Kirby-Bauer disc diffusion method to perform the antibiotic sensitivity in SAIC Digital Diagnostic Lab, Dhaka. The 2017 Clinical Laboratory Standard Institute (CLSI) guideline was employed to interpret the antibiogram results, and statistical software SPSS (version 22.0) to analyze the obtained data. The number of male patients (54.74%) dominated over their female counterparts (45.26%). The patients aged from 1 month to 75 years, with a mean of 19.74±12.79 years. Among 601 Salmonella spp. isolates, S. Typhi (56.57%) prevailed over S. Paratyphi A (43.42%). Both strains showed >85% antimicrobial insusceptibility to three major antibiotics: ciprofloxacin, gentamicin, and amikacin. S. Typhi (65.29%) showed significantly greater resistance to azithromycin compared to S. Paratyhi A (14.9%) (p<0.001). Both pathogens reported over 95% sensitivity to ceftriaxone, cefixime, ceftazidime, amoxiclav, cephalexin, aztreonam, imipenem, and cefuroxime. To conclude, this study found an increased antibiotic resistance of Salmonella spp. to commonly prescribed antibiotics. These findings would help physicians and policymakers make informed decisions and provide better treatment to the affected patients.
... A retrospective study from Nepal in 2017 has reported a decline in MDR strains over a period of 23 years [10). Studies from Indonesia, Bangladesh, and Vietnam in 2017 have reported low MDR rates of 1.8% to 4.3 % over a span of five years [9,[11][12][13]. ...
... In our study, the proportion of confirmed typhoid fever cases was low (4.72%). Although this may not be a representative figure of typhoid fever in Indonesia, it is similar to the proportion reported by the study conducted in north Jakarta hospitals by Punjabi et al. 18 The low incidence might have contributed to the lower positive predictive values in our study. Another limitation is that cultures both blood and rectal swab taken only at one time point may have limited diagnostic . ...
... The small proportion result in their study was due to passive case detection, which made typhoid fever patients who were not coming to the hospitals in their study area remained unknown. 18 Additionally, Al Emran et.al also reported that only a small proportion of typhoid fever cases that can be detected by blood culture. In their study, antibiotics administration and duration between onset of disease and sample collection contributed to the small number of typhoid cases. ...
... 20 Another reason why this study only reported a small proportion of typhoid fever case is that cultures (especially rectal swab culture) have a limited sensitivity which varies throughout the course of disease (40-80% during incubation period) and at the same time influenced by antibiotics administration. 18,19 The same factors also apply to PCR. Although some studies showed that PCR has a high sensitivity and specificity, false negative may still occur. ...
Introduction. Typhoid fever can be challenging to diagnose since clinicians often depend merely on clinical presentation. Clinical scores are useful to provide more accurate diagnosis. Variables in Nelwan Score are derived from clinical signs and symptoms of suspected cases for typhoid. Diagnostic value of Nelwan Score based on a cut-off value has never been evaluated.
Methods . A cross sectional study was conducted between July 2017 and January 2018 in five hospitals and two Primary Health Centers in Jakarta and Tangerang. The inclusion criteria were patients with 3-14 days of fever and gastrointestinal symptoms between July 2017 and January 2018. Diagnosis are confirmed by blood culture, rectal swab culture, or PCR. Cut-off analysis was performed by using Receiver Operating Characteristic (ROC) curve and diagnostic value was analyzed to generate sensitivity, specificity, predictive value and likelihood ratio.
Result . From 233 subjects involved, 4.72% of them were confirmed to have typhoid fever. The optimal cut-off value of Nelwan Score is 10 with AUC 71.3%. This cut-off value has sensitivity 81.8%, specificity 60.8%, PPV 9.3%, NPV 98.5%, LR + 2.086, and LR – 0.299.
Conclusion . Nelwan Score with cut-off value of 10 provides a good diagnostic performance as a screening tool for patients with suspected typhoid fever clinical presentation.
... In this study, we explored the correlation between the level of resistance and the associated mechanism in S. [16][17][18][19] . However, the prevalence of S. Paratyphi collected between 2016 and 2017 is much higher than that The reason for this change may be related to the improvements in environmental conditions and the increased use of Vi polysaccharide vaccine in recent years 22 . ...
Objective:
To investigate the prevalence of Salmonella Typhi and Paratyphi resistance to quinolones and characterize the underlying mechanism in Jiangsu Province of China.
Methods:
Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion system. Quinolone resistance-determining region (QRDR), plasmid-mediated quinolone resistance (PMQR) determinant genes were detected by PCR and sequencing.
Results:
Out of 239 Salmonella isolates, 164 were S. Typhi and 75 were S. Paratyphi. 128 (53.6%) Salmonella isolates were resistant to nalidixic acid; 11 (4.6%) isolates to ciprofloxacin and 66 (27.6%) isolates were intermediate to ciprofloxacin. QRDR were present in 69 S. Typhi isolates, among which mutation at codon 83 (n = 45) and 133 (n = 61) predominated. In S. Paratyphi, the most common mutations were detected in gyrA at codon 83(n = 24) and parC: T57S (n = 8). Seven mutations were first reported in Salmonella isolates including gyrB: S426G, parC: D79G and parE: [S498T, E543K, V560G, I444S, Y434S]. PMQR genes including qnrD1, qnrA1, qnrB4, aac (6')-Ib-cr4 and qnrS1 were detected in 1, 2, 3, 7 and 9 isolates, relatively.
Conclusions:
High resistance to quinolones in Salmonella remains a serious problem in Jiangsu, China. The presence of the novel mutations increases the complexity of quinolone-resistant genotypes and poses a threat to public health. Subject terms: Salmonella Typhi, Salmonella Paratyphi, antimicrobial resistance, QRDR, PMQR.
... Since 1981 the outbreaks related to salmonellosis had been reported by Cobet et al. (1981) who isolated 158 Salmonella Oranienburg from 150 hospitalized patients with diarrhoea. Punjabi et al. (2013) reported 296 laboratoryconfirmed enteric fever cases during the 7 months surveillance period in North Jakarta Indonesia, of which 221 (75%) were typhoid fever and 75 (25%) were the paratyphoid fever. Most of the cases occurred among children under five years old. ...
This study was aimed to determine the prevalence, the level and the main contributing factors to contamination of Salmonella spp. in four selected chicken-based side dishes prepared for the school canteens. One hundred and seven samples were collected from four different food processing chains, i.e. fried chicken with precooking, fried chicken without precooking, breaded fried chicken, and sauced chicken. Salmonella contamination was determined by the most probable number (MPN) and confirmed with polymerase chain reaction. Salmonella spp. were detected in 8 of 21 chicken cuts samples (360-920 MPN/g) and in 4 of 30 end products samples (0.61-3 MPN/g). The fact that Salmonella was still found at the end product indicated that cross-contamination and/or inadequate heating process likely occurred. Besides the chicken cuts, the contributing factors to the Salmonella contamination were water (4 of 17 samples) and seasonings (8 of 13 samples). To ensure the safety of chicken-based side dishes prepared for the school canteen, adequate cooking process must be performed by all food handlers. The results of this study might contribute to analysing the risk of salmonellosis in Indonesia.
... All five studies identified from Southeast Asia and the four from East Asia found 0% MDR in S. Paratyphi A (Additional file 1: Figures S9-S11 Figure S12). Only three studies from Southeast Asia were identified; two from Indonesia [72,73] found no FQNS and one from Cambodia [74] found 11% (183 isolates) FQNS S. Paratyphi A (Additional file 1: Figure S13). All six studies from East Asia were from 2004 onwards and found very high levels of FQNS in S. Paratyphi A (Additional file 1: Figure S14). ...
Background:
Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.
Methods:
We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance.
Findings:
We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified.
Interpretation:
Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice.
Trial registration:
PROSPERO CRD42018029432.
... Some countries, such as Vietnam and Indonesia, showed low resistance rates; both showed uniform sensitivity to ciprofloxacin (0% resistance), Nepal showed 3.9% resistance to ciprofloxacin. Pakistan showed a high rate of ciprofloxacin resistance (88%) [10][11][12][13] . There was no previously published data about local antimicrobial susceptibility pattern of salmonellosis among the population in Bahrain. ...
Background: Salmonella is a food-borne enteropathogenic organism which causes illness with different clinical manifestations, commonly gastroenteritis, or enteric fever by typhoidal strain. It continues to be of public health concern in most developed and developing countries despite all efforts to control.
