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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese district, Uganda, 2008-2009
Clinical Infectious Diseases, Volume 54, No. 8, Year 2012
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Description
Background. Salmonella enterica serovar Typhi (Salmonella Typhi) causes an estimated 22 million typhoid fever cases and 216 000 deaths annually worldwide. In Africa, the lack of laboratory diagnostic capacity limits the ability to recognize endemic typhoid fever and to detect outbreaks. We report a large laboratory-confirmed outbreak of typhoid fever in Uganda with a high proportion of intestinal perforations (IPs).Methods.A suspected case of typhoid fever was defined as fever and abdominal pain in a person with either vomiting, diarrhea, constipation, headache, weakness, arthralgia, poor response to antimalarial medications, or IP. From March 4, 2009 to April 17, 2009, specimens for blood and stool cultures and serology were collected from suspected cases. Antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) were performed on Salmonella Typhi isolates. Surgical specimens from patients with IP were examined. A community survey was conducted to characterize the extent of the outbreak. Results. From December 27, 2007 to July 30, 2009, 577 cases, 289 hospitalizations, 249 IPs, and 47 deaths from typhoid fever occurred; Salmonella Typhi was isolated from 27 (33%) of 81 patients. Isolates demonstrated multiple PFGE patterns and uniform susceptibility to ciprofloxacin. Surgical specimens from 30 patients were consistent with typhoid fever. Estimated typhoid fever incidence in the community survey was 8092 cases per 100 000 persons. Conclusions. This typhoid fever outbreak was detected because of an elevated number of IPs. Underreporting of milder illnesses and delayed and inadequate antimicrobial treatment contributed to the high perforation rate. Enhancing laboratory capacity for detection is critical to improving typhoid fever control. © 2012 The Author.
Authors & Co-Authors
Neil, Karen P.
United States, Atlanta
Centers for Disease Control and Prevention
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Sodha, Samir V.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Lukwago, Luswa
Uganda, Kampala
Uganda Ministry of Health
O-Tipo, Shikanga
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Mikoleit, Matthew L.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Simington, Sherricka D.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Mukobi, Peter
Uganda, Kasese
Kasese District Health Office
Balinandi, Stephen Karabyo
Kenya, Kisumu
Centers for Disease Control and Prevention, Kenya
Majalija, Samuel
Uganda, Kampala
Makerere University
Ayers, Joseph
United States, New York
Catholic Medical Missions Board
Kagirita, Atek A.
Uganda, Kampala
Central Public Health Laboratories
Wefula, Edward
Uganda
Kilembe Mines Hospital
Asiimwe, Frank
Uganda, Kasese
Kagando Hospital
Kweyamba, Vianney
Uganda
Bwera Hospital
Talkington, Deborah F.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Shieh, Wun Ju
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Adem, Patricia
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Batten, Brigid C.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Zaki, Sherif R.
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Mintz, Eric Daniel
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Statistics
Citations: 103
Authors: 20
Affiliations: 11
Identifiers
Doi:
10.1093/cid/cis025
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda