A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

Rapeephan R. Maude; Aniruddha Ghose; Rasheda Samad; Hanna K. de Jong; Masako Fukushima; Lalith Wijedoru; Mahtab Uddin Hassan; Md Amir Hossain; Md Rezaul Karim; Abdullah Abu Sayeed; Stannie van den Ende; Sujat Pal; A. S.M. Zahed; Wahid Rahman; Rifat Karnain; Rezina Islam; Dung Thi Ngoc Tran; Tuyen Thanh Ha; Anh Hong Pham; James I. Campbell; H. Rogier van Doorn; Richard J. Maude; Tom van der Poll; W. Joost Wiersinga; Nicholas P.J. Day; Stephen Baker; Arjen M. Dondorp; Christopher Parry; Md Abul Faiz

doi:10.1186/s12879-016-1886-3

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

Rapeephan R. Maude
, Aniruddha Ghose
, Rasheda Samad
, Hanna K. de Jong
, Masako Fukushima
, Lalith Wijedoru
, Mahtab Uddin Hassan
, Md Amir Hossain
, Md Rezaul Karim
, Abdullah Abu Sayeed
, Stannie van den Ende
, Sujat Pal
, A. S.M. Zahed
, Wahid Rahman
, Rifat Karnain
, Rezina Islam
, Dung Thi Ngoc Tran
, Tuyen Thanh Ha
, Anh Hong Pham
, James I. Campbell

H. Rogier van Doorn, Richard J. Maude, Tom van der Poll, W. Joost Wiersinga, Nicholas P.J. Day, Stephen Baker, Arjen M. Dondorp, Christopher Parry, Md Abul Faiz

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Background:

Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.

Methods:

Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.

Results:

We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.

Conclusion:

Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

Original language	English
Article number	567
Journal	BMC Infectious Diseases
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s12879-016-1886-3
Publication status	Published - 13 Oct 2016

Keywords

Bangladesh
Enteric fever
Non-malaria febrile illness

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12879-016-1886-3Licence: CC BY

BMC Inf Dis 16 567 A prospective study of the importance of enteric feverFinal published version, 360 KBLicence: CC BY

Cite this

Maude, R. R., Ghose, A., Samad, R., de Jong, H. K., Fukushima, M., Wijedoru, L., Hassan, M. U., Hossain, M. A., Karim, M. R., Sayeed, A. A., van den Ende, S., Pal, S., Zahed, A. S. M., Rahman, W., Karnain, R., Islam, R., Tran, D. T. N., Ha, T. T., Pham, A. H., ... Faiz, M. A. (2016). A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh. BMC Infectious Diseases, 16(1), Article 567. https://doi.org/10.1186/s12879-016-1886-3

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title = "A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh",

abstract = "Background:Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.Methods:Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.Results:We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 \%), lower respiratory tract infection in 48 (16.0 \%), non-specific febrile illness in 48 (16.0 \%), a CNS infection in 37 patients (12.3 \%), urinary sepsis in 23 patients (7.7 \%), an upper respiratory tract infection in 21 patients (7.0 \%), and diarrhea or dysentery in 21 patients (7.0 \%). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 \%) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 \%) patients died during their hospital admission (15/160 (9.4 \%) of children and 14/144 (9.7 \%) adults). Two of 52 (3.8 \%) patients with enteric fever, 5/48 (10.4 \%) patients with lower respiratory tract infections, and 12/37 (32.4 \%) patients with CNS infection died.Conclusion:Enteric fever was confirmed in 11.3 \% of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.",

keywords = "Bangladesh, Enteric fever, Non-malaria febrile illness",

author = "Maude, \{Rapeephan R.\} and Aniruddha Ghose and Rasheda Samad and \{de Jong\}, \{Hanna K.\} and Masako Fukushima and Lalith Wijedoru and Hassan, \{Mahtab Uddin\} and Hossain, \{Md Amir\} and Karim, \{Md Rezaul\} and Sayeed, \{Abdullah Abu\} and \{van den Ende\}, Stannie and Sujat Pal and Zahed, \{A. S.M.\} and Wahid Rahman and Rifat Karnain and Rezina Islam and Tran, \{Dung Thi Ngoc\} and Ha, \{Tuyen Thanh\} and Pham, \{Anh Hong\} and Campbell, \{James I.\} and \{van Doorn\}, \{H. Rogier\} and Maude, \{Richard J.\} and \{van der Poll\}, Tom and Wiersinga, \{W. Joost\} and Day, \{Nicholas P.J.\} and Stephen Baker and Dondorp, \{Arjen M.\} and Christopher Parry and Faiz, \{Md Abul\}",

year = "2016",

month = oct,

day = "13",

doi = "10.1186/s12879-016-1886-3",

language = "English",

volume = "16",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd",

number = "1",

}

Maude, RR, Ghose, A, Samad, R, de Jong, HK, Fukushima, M, Wijedoru, L, Hassan, MU, Hossain, MA, Karim, MR, Sayeed, AA, van den Ende, S, Pal, S, Zahed, ASM, Rahman, W, Karnain, R, Islam, R, Tran, DTN, Ha, TT, Pham, AH, Campbell, JI, van Doorn, HR, Maude, RJ, van der Poll, T, Wiersinga, WJ, Day, NPJ, Baker, S, Dondorp, AM, Parry, C & Faiz, MA 2016, 'A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh', BMC Infectious Diseases, vol. 16, no. 1, 567. https://doi.org/10.1186/s12879-016-1886-3

TY - JOUR

T1 - A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

AU - Maude, Rapeephan R.

AU - Ghose, Aniruddha

AU - Samad, Rasheda

AU - de Jong, Hanna K.

AU - Fukushima, Masako

AU - Wijedoru, Lalith

AU - Hassan, Mahtab Uddin

AU - Hossain, Md Amir

AU - Karim, Md Rezaul

AU - Sayeed, Abdullah Abu

AU - van den Ende, Stannie

AU - Pal, Sujat

AU - Zahed, A. S.M.

AU - Rahman, Wahid

AU - Karnain, Rifat

AU - Islam, Rezina

AU - Tran, Dung Thi Ngoc

AU - Ha, Tuyen Thanh

AU - Pham, Anh Hong

AU - Campbell, James I.

AU - van Doorn, H. Rogier

AU - Maude, Richard J.

AU - van der Poll, Tom

AU - Wiersinga, W. Joost

AU - Day, Nicholas P.J.

AU - Baker, Stephen

AU - Dondorp, Arjen M.

AU - Parry, Christopher

AU - Faiz, Md Abul

PY - 2016/10/13

Y1 - 2016/10/13

N2 - Background:Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.Methods:Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.Results:We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.Conclusion:Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

AB - Background:Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.Methods:Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.Results:We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5–31) years and median (IQR) illness duration before admission of five (2–8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.Conclusion:Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

KW - Bangladesh

KW - Enteric fever

KW - Non-malaria febrile illness

U2 - 10.1186/s12879-016-1886-3

DO - 10.1186/s12879-016-1886-3

M3 - Article

SN - 1471-2334

VL - 16

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 567

ER -

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

Abstract

Keywords

UN SDGs

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