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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border
Clinical Infectious Diseases, Volume 54, No. 8, Year 2012
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Description
Background. Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216 000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border.Methods.The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). Results. We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n = 19), ataxia (n = 22), and parkinsonism (n = 8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE.Conclusions.The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment. © 2012 The Author.
Authors & Co-Authors
Lutterloh, Emily C.
United States, Atlanta
Centers for Disease Control and Prevention
Likaka, Andrew
Malawi, Lilongwe
Ministry of Health Malawai
Sejvar, James J.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Manda, Robert
Malawi, Lilongwe
Ministry of Health Malawai
Naiene, Jeremias Domingos
Mozambique, Maputo
Ministério da Saúde
Monroe, Stephan S.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Khaila, Tadala
Malawi, Lilongwe
Ministry of Health Malawai
Chilima, Ben Z.
Malawi, Lilongwe
Ministry of Health Malawai
Mallewa, MacPherson
Malawi, Zomba
University of Malawi
Kampondeni, Sam D.
Malawi, Blantyre
Queen Elizabeth Central Hospital Malawi
Lowther, Sara A.
United States, Atlanta
Centers for Disease Control and Prevention
Capewell, Linda G.
United States, Atlanta
Centers for Disease Control and Prevention
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Date, Kashmira A.
United States, Atlanta
Centers for Disease Control and Prevention
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Townes, David Andrew
United States, Atlanta
Centers for Disease Control and Prevention
Redwood, Yanique A.
United States, Atlanta
Centers for Disease Control and Prevention
Schier, Joshua G.
United States, Atlanta
National Center for Environmental Health
Nygren, Benjamin L.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Tippett-Barr, Beth A.
United States, Atlanta
Centers for Disease Control and Prevention
Demby, Austin H.
United States, Atlanta
Centers for Disease Control and Prevention
Phiri, Abel F.N.D.
Malawi, Lilongwe
Ministry of Health Malawai
Lungu, Rudia
Malawi, Lilongwe
Ministry of Health Malawai
Kaphiyo, James
Malawi, Lilongwe
Ministry of Health Malawai
Humphrys, Michael S.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Talkington, Deborah F.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Joyce, Kevin J.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Stockman, Lauren J.
United States, Atlanta
Centers for Disease Control and Prevention
Armstrong, Gregory L.
United States, Atlanta
Centers for Disease Control and Prevention
Mintz, Eric Daniel
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Statistics
Citations: 86
Authors: 28
Affiliations: 7
Identifiers
Doi:
10.1093/cid/cis012
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Infectious Diseases
Study Locations
Malawi
Mozambique