RESUMO
Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever.
Assuntos
Tifo Endêmico Transmitido por Pulgas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Febre/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Reação em Cadeia da Polimerase , Rickettsia typhi/genética , Rickettsia typhi/isolamento & purificação , Febre Tifoide/diagnóstico , Febre Tifoide/epidemiologia , Tifo Endêmico Transmitido por Pulgas/diagnóstico , Tifo Endêmico Transmitido por Pulgas/microbiologiaRESUMO
We performed pulsed-field gel electrophoresis (XbaI) on 114 bloodstream isolates of Salmonella enterica serotype Paratyphi A and S. enterica serotype Typhi collected from febrile patients in Kathmandu, Nepal. Of the 56 S. Paratyphi A isolates, 51 (91%) were indistinguishable, which suggests the emergence of a single clone. In contrast, only 21 (36%) of the 58 S. Typhi isolates exhibited a common genotype, which is consistent with endemic disease from multiple sources.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Febre Paratifoide/epidemiologia , Salmonella paratyphi A/isolamento & purificação , Febre Tifoide/epidemiologia , Adolescente , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Doenças Transmissíveis Emergentes/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Febre Paratifoide/tratamento farmacológico , Febre Tifoide/tratamento farmacológico , Saúde da População UrbanaRESUMO
In Nepal, many infections remain poorly characterized, partly due to limited diagnostic facilities. We studied consecutive febrile adults presenting to a general hospital in Kathmandu, Nepal. Of the 876 patients enrolled, enteric fever and pneumonia were the most common clinical diagnoses. Putative pathogens were identified in 323 (37%) patients, the most common being Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A (117), Rickettsia typhi (97), Streptococcus pneumoniae (53), Leptospira spp. (36), and Orientia tsutsugamushi (28). Approximately half of the Salmonella isolates were resistant to nalidixic acid. No clinical predictors were identified to reliably distinguish between the different infections. These findings confirm the heavy burden of enteric fever and pneumonia in Kathmandu, and highlight the importance of murine typhus, scrub typhus, and leptospirosis. Given the lack of reliable clinical predictors, the development of cheap and accurate diagnostic tests are likely to be of great clinical utility in this setting.