Ultrasound as a triaging tool for the diagnosis of malaria and typhoid in a resource constrained setting: A proposed frame-work.

INTRODUCTION: Ultrasound has proven to have great potentials in the diagnosis and work-up of patients affected by tropical diseases. Its role in the diagnosis of malaria and typhoid abounds, but its value as a triaging tool in a resource-constrained settings is indistinct. Our review aimed is aimed at assessing the utility of ultrasound in diagnosis and prognosis of malaria and typhoid. MATERIALS AND METHOD: Extensive literature search was conducted using the PubMed electronic database, for original peer reviewed articles in English language within 1964-2023. Keywords like "malaria", "typhoid", "S. Typhi", "Salmonella Typhi", "enteric fever", "ultrasound", "sonography" and "ultrasonography" were searched, using Boolean operators such as (OR, AND) applying the following filters (English, Human). A systematic synthesis of the literature was done. RESULT: Our initial search yielded 749 potentially relevant references out of which 55 were found to be eligible. Organs assessed include the liver, spleen, kidneys, intestines, mesenteric lymph nodes, among others. For malaria, pathognomonic conditions like splenic enlargement, hepatomegaly, renal abnormalities as well as mesenteric lymph nodes and intestinal wall thickening in patients with typhoid fever. CONCLUSION: Ultrasound by experienced clinicians adds significantly to the diagnosis and work-up of patients with malaria and typhoid fever. However, it is important to note that ultrasound alone may not be sufficient for definitive diagnosis as laboratory tests may still be required for confirmatory diagnosis. IMPLICATION FOR PRACTICE: This study provide information on ultrasound in diagnosis of Malaria and typhoid by evaluating the morphological changes in abdominal and other organs of the body. This can be a guide to clinicians and other healthcare providers for early diagnosis and work-up of patients in endemic areas where resources are scarce.

Abdominal ultrasonographic findings in typhoid fever: a comparison between typhoid patients and those with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis.

Typhoid fever is a major health problem in many developing countries and its clinical features are similar to other types of bacterial enterocolitis. Definitive diagnosis by blood culture requires several days and is often unfeasible to perform in developing countries. More efficient and rapid diagnostic methods for typhoid are needed. We compared the pathological changes in the bowel and adjacent tissues of patients having typhoid fever with those having bacterial enterocolitis using ultrasonography. A characteristic of patients with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis was mural thickening of the terminal ileum; only mild mural swelling or no swelling was observed in patients with typhoid fever. Mesenteric lymph nodes in patients with typhoid fever were significantly more enlarged compared to patients with other types of bacterial enterocolitis. Our findings suggest typhoid fever is not fundamentally an enteric disease but rather resembles mesenteric lymphadenopathy and ultrasound is a promising modality for diagnosing typhoid fever in developing countries.

Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program.

Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a "Typhoid Epidemiologic SWAT Team" to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.

Intestinal intussusception as a complication of typhoid fever.

Typhoid fever is a severe febrile illness caused by Salmonella typhi. Although ileal perforation and bleeding are seen more frequently, intestinal intussusception is a very rare complication of typhoid fever. A male patient was admitted to hospital due to abdominal distension and pain. Abdominal computerised tomography revealed ileal intussusception. The patient underwent exploratory laparotomy. Ileal intussusception was determined and segmental ileal resection was performed. Examination of the resected ileal segment revealed multiple ulcerous lesions that led to intussusception. The postoperative course was uneventful. The operative treatment is the subject of debate because of insufficient evidence. We recommend segmental bowel resection because of the underlying pathology.

Clinical Perspectives of Multiple and Extensively Drug-Resistant Typhoid; result from a tertiary care hospital from Pakistan.

INTRODUCTION: Typhoid fever remains a problem in developing countries, including Pakistan. The emergence of multidrug-resistant and, since 2016, of extensively drug-resistant cases is a continuous challenge for health care workers. The COVID-19 pandemic is making management more difficult. METHODOLOGY: In the present study, a total of 52 confirmed cases of typhoid have been studied during 2019. Detailed clinical features, complications and, lab findings were studied. Typhoid culture and sensitivity were recorded and patients were treated accordingly. Patients were asked about risk factors to aim at informing prevention. RESULTS: Out of the 52 having blood culture positive for Salmonella Typhi 47 (90.4%) and Salmonella Paratyphi 5 (9.6%), 4 (7.7%) were sensitive to first-line (Non-resistant), 11 (21.2%) MDR and 37 (71.2%) patient were XDR. One case was resistant to azithromycin. Nausea, vomiting or, abdominal pain was present in 12 (23%), abdominal distension present in 9 (17.3%), abdominal tenderness in 8 (15.4%), hepatomegaly in 10 (19.2%) and, splenomegaly in 22 (42.3%).There were ultrasound abnormalities in 58% of patients and GI complications in 19% of patients. No significant difference was found in clinical findings and complications between resistant and non-resistant cases. Only 23-27% of patients were aware of typhoid prevention and vaccination measures. CONCLUSIONS: The increasing prevalence of resistance and higher degree of complications seen in typhoid fever raises the concern further about prevention and effective infection management in the community as well as clinical settings. Moreover, judicial use of antibiotics is much needed in developing countries like Pakistan.

Role of computed tomography of abdomen in difficult to diagnose typhoid fever: a case series.

Background and Aim Diagnosis of typhoid is challenging when blood cultures fail to isolate Salmonella species. We report our experience with interpreting computed tomography (CT) abdomen findings in a case series of typhoid fever. Methods The case series consisted of patients who had a CT abdomen done as part of their investigations and a final diagnosis of typhoid fever. The CT films were reviewed and findings evaluated for distinctive features. Results During 2011-2017, 11 patients met the inclusion criteria. Indication for CT was pyrexia of unknown origin in the majority of patients. Review of CT films revealed mesenteric lymphadenopathy (100%), terminal ileum thickening (85%), hepatosplenomegaly (45%), retroperitoneal lymphadenopathy (18%) and ascites (9%). Conclusions Enhancing discrete mesenteric lymphadenopathy and terminal ileum thickening are non-specific findings noted in typhoid fever. Absence of matted necrotic nodes and peritoneal thickening rule out tuberculosis and raise suspicion of typhoid fever in endemic regions.

[Pleural empyema due to Salmonella typhi]. / Salmonella typhi'ye bagli ampiyem.

65 years old female was admitted to hospital with fever, purulent sputum and dyspnea. The patient has hepatic cirrhosis secondary to autoimmune hepatitis and hepatocellular carcinoma. Immunosuppressive treatment is used for autoimmune hepatitis. In physical examination matute and diminished respiratory sounds were determined at right hemithorax. Ascitis was determined in abdominal examination. Chest X-ray showed pleural effusion in right hemithorax. Serohemorrhagic fluid was aspirated by thoraco-synthesis. Pleural fluid pH was 6.9 and had an exudative nature. The patient was the diagnosed as empyema. Right tube thoracostomy was performed and sulbactam-ampicillin 6 g/day therapy was started. In patient's ascite fluid no bacteria and leucocytes was seen. Salmonella typhi was isolated from pleural fluid. No microorganisms were isolated from ascite fluid, urine and stool culture. Klebsiella pneumoniae is isolated in patient's hemoculture. Clinical improving was detected. Chest X-ray showed total regression of pleural fluid and the tube thoracostomy removed. We presented this case because of rarely seen microorganism (S. typhi) in immunocompromised patients a cause of pleural empyema which is frequently seen gastrointestinal infections.

Gallium detection of Salmonella costochondritis.

A case of Salmonella costochondritis developed at a traumatic focus in a 37-yr-old Hispanic male without hemoglobinopathy or systemic disease. Bone scans and gallium scans were initially positive and remained abnormal, despite a variable clinical course and repeatedly negative serology and blood cultures. Scintigraphy was valuable for both detection and monitoring of antibiotic treatment, as well as providing localization for subsequent surgical resection.

Multiple brain abscesses caused by Salmonella typhi: case report.

BACKGROUND: Focal intracranial infections caused by Salmonella species are uncommon. The authors report a case of multiple brain abscesses caused by Salmonella typhi. CASE DESCRIPTION: A 2-month-old girl was admitted to the hospital because of diarrhea, vomiting, fever, and poor feeding. Neurological examination revealed cervical hyperextension and absence of sucking and Moro reflexes. During the next 20 hours she developed complex partial seizures with secondary generalization and alternated irritability with drowsiness. Investigation showed hemoglobin 6.3 g/dl; white blood cell count of 19500/mm3 with a marked shift to the left. The analysis of the cerebrospinal fluid revealed white cell count of 1695/mm3, lymphocytes 61%, protein 300 mg/dl and glucose 6 mg/dl. The patient was treated for acute gastroenterocolitis, sepsis, and meningitis. Blood culture taken on the day of admission showed gram-negative bacilli, later identified as S. typhi. Computed tomography scan demonstrated a lesion in the right parietal lobe compatible with a brain abscess. Follow-up computed tomography after 7 days showed several other lesions with the same features. Surgical drainage of the right parietal lesion was performed on the 13th day, through a burr hole. The patient was discharged 5 weeks after admission without neurological deficit. CONCLUSION: Bacteremia, sepsis, and meningitis are relatively common in children with Salmonella infection but intracranial abscesses are very rare. Surgical drainage combined with prolonged antibiotic therapy (drug of choice: chloramphenicol) is the best treatment for Salmonella brain abscesses. The possibility of intracranial infection should be considered in patients with Salmonellosis and neurological dysfunction.

Diffuse abdominal gallium-67 citrate uptake in salmonella infections.

Two pediatric patients with salmonella infections (one with typhoid fever and the second with salmonella C2 gastroenteritis), had a diffuse abdominal uptake of Ga-67 citrate. The possible explanation for this finding is discussed. Salmonella infection should be included as a cause in the differential diagnosis of diffuse accumulation of Ga-67 citrate.

Clinical features and early diagnosis of typhoid fever emphasizing usefulness of detecting mesenteric lymphadenopathy with ultrasound as diagnostic method.

Typhoid fever is endemic in Pakistan. Most patients are children. As the symptoms and signs are often unspecific, it is difficult to diagnose typhoid fever without blood culture. We retrospectively reviewed 51 cases of typhoid fever who were all admitted from 1 June through 31 August 2002. Sixteen cases were positive by blood culture and confirmed as typhoid fever. All cases had Salmonella typhi. Although 16 cases were culture-negative, they were clinically diagnosed as typhoid fever. The remaining 19 cases were clinically diagnosed without blood culture. The clinical features of the culture-confirmed cases were more severe than the culture-negative cases. Mesenteric lymphadenopathy was very frequently detected with ultrasonography, in both culture-confirmed and culture-negative cases. The rates of detecting mesenteric lymphadenopathy were 69% and 63%, respectively. Meanwhile, the rate in non-typhoid fever patients was 5.5%. It was considered that detecting mesenteric lymphadenopathy with ultrasonography was very useful in the diagosis of typhoid fever in endemic areas.

[Recurrent thoracic abscess due to Salmonella typhi].

Abscess formation by Salmonella typhi is an unusual manifestation. A woman aged 62 suffered from recurrent abscess in the anterior thorax for 35 years, which was released by spontaneous pus drainage each time. Pus cultures grew S. typhi, and the CT scan revealed a large abscess enclosing the sternum and left ribs.

[The function of the hypophyseal-thyroid system in chronic opisthorchiasis and its combination with the Salmonella typhi carrier state]. / Sostoianie gipofizarno-tireoidnoi sistemy pri khronicheskom opistorkhoze i ego sochetanii s nositel'stvom Salmonella typhi.

The hormonal function of the hypophysis and thyroid (TTG, T3, T4) and its dependence on hepatobiliary function, examined by hepatobiliscintigraphy, were studied by radioimmunoassay in 71 patients with chronic opisthorchiasis and in 18 chronic carriers of Salmonella typhi. in both groups. The decrease of T3 and T4 in the presence of normal TTG level was found. The imbalance of thyroid hormones activity is likely to be associated with hepatobiliary dysfunction. In chronic opisthorchiasis the hormonal disturbance may be one of the factors favouring the S. typhi carriership.

The role of abdominal ultrasound in the diagnosis of typhoid fever: an observational study.

OBJECTIVES: To study the usefulness of abdominal ultrasound in the diagnosis of typhoid fever and to determine the common ultrasound findings early in the course of the disease. METHODS: Abdominal ultrasound examination was performed within the first week of initiation of symptoms in 350 cases with clinical diagnosis of typhoid fever. Subsequent ultrasound follow-up examination was done 15 days later (beginning of the third week). All the patients proved to have positive Widal test and Sallmonella culture. The study was performed in Erbil-Iraq from the period January 1993 to October 2010. RESULTS: The following ultrasound findings were reported: hepatomegaly (31.4%), prominent intrahepatic bile ducts (64.85%), splenomegaly (100%), mesenteric lymphadenopathy (42.85%), bowel wall thickening (35.71%), acalculous cholecystitis (16.28%), perforations (1.14%), and ascites in (3.4%). CONCLUSION: The current study showed that the findings are typical enough to justify initiation of treatment for typhoid fever when serology is equivocal and culture is negative, and is fairly safe to say that normal ultrasound examination early in the course of febrile illness rules out typhoid fever.

Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever.

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Computed tomography features in enteric fever.

INTRODUCTION: Enteric fever is a common infection in endemic areas; however, there are few reports describing the computed tomography (CT) manifestations of enteric fever. We aim to describe and illustrate CT findings in enteric fever in this study. MATERIALS AND METHODS: A retrospective search of medical records in our institute for patients with positive blood cultures for Salmonella typhi, and Salmonella paratyphi organisms yielded 39 cases. Among these patients, 12 had undergone a CT study of the abdomen. The CT images, laboratory and clinical findings of these 12 patients were reviewed. RESULTS: The most common clinical presentation was fever (100%). Typical features of gastroenteritis were present in only over half of the patients. Liver function tests were abnormal in all patients. The most common abdominal manifestations on CT were the presence of mesenteric lymphadenopathy and splenomegaly (75%). Other features were circumferential small bowel wall thickening (58.3%) and free intraperitoneal fluid (50%). Three patients were found to have complications; one with bleeding from terminal ileal ulceration, another with an ileal perforation and the third with renal abscess formation. CONCLUSION: CT is useful in evaluating enteric fever in patients with severe forms of presentation, a longer clinical course or less specific symptoms. Although the imaging features overlap with other abdominal infections, when combined with clinical features, travel history to endemic areas and presence of transaminitis, the diagnosis of enteric fever should be considered. CT in particular, is useful for the detection of complications such as perforation, bleeding and abscess formation.