Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi.
| Title: | Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi. |
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| Authors: | Olgemoeller F; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.; Waluza JJ; Surgical Department, College of Medicine, University of Malawi, Blantyre, Malawi.; Zeka D; Surgical Department, College of Medicine, University of Malawi, Blantyre, Malawi.; Gauld JS; Institute for Disease Modeling, Bellevue, Washington, USA.; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom.; Diggle PJ; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom.; Read JM; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom.; Edwards T; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.; Msefula CL; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi.; Chirambo A; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Pathology Department, College of Medicine, University of Malawi, Blantyre, Malawi.; Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.; Gordon MA; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.; Thomson E; Surgical Department, College of Medicine, University of Malawi, Blantyre, Malawi.; Heyderman RS; University College London, London, United Kingdom.; Borgstein E; Surgical Department, Ministry of Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.; Feasey NA; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. |
| Source: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2020 Jul 29; Vol. 71 (Suppl 2), pp. S96-S101. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: Jan. 2011- : Oxford : Oxford University Press; Original Publication: Chicago, IL : The University of Chicago Press, c1992- |
| MeSH Terms: | Intestinal Perforation*/epidemiology ; Typhoid Fever*/complications ; Typhoid Fever*/epidemiology ; Epidemics*; Humans ; Malawi ; Prospective Studies ; Salmonella typhi |
| Abstract: | Background: Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease.; Methods: We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008-2017.; Results: We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03-.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance.; Conclusions: The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.; (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.) |
| References: | Lancet Infect Dis. 2017 Oct;17(10):1042-1052. (PMID: 28818544); World J Gastroenterol. 2017 Mar 21;23(11):1925-1931. (PMID: 28373758); Ann Trop Paediatr. 1999 Sep;19(3):267-72. (PMID: 10715713); N Engl J Med. 2002 Nov 28;347(22):1770-82. (PMID: 12456854); PLoS Negl Trop Dis. 2017 Feb 27;11(2):e0005376. (PMID: 28241011); Clin Infect Dis. 2004 Jul 1;39(1):61-7. (PMID: 15206054); Rev Infect Dis. 1985 Mar-Apr;7(2):244-56. (PMID: 3890097); Expert Rev Vaccines. 2017 Mar;16(3):249-260. (PMID: 27797598); PLoS One. 2014 Apr 17;9(4):e93784. (PMID: 24743649); BMC Infect Dis. 2017 Sep 25;17(1):641. (PMID: 28946853); Vaccine. 2015 Jun 19;33 Suppl 3:C16-20. (PMID: 25921727); Pediatr Surg Int. 2007 Jan;23(1):33-9. (PMID: 17086425); Lancet Infect Dis. 2019 Apr;19(4):369-381. (PMID: 30792131); PLoS Negl Trop Dis. 2019 Jul 17;13(7):e0007539. (PMID: 31314752); Clin Infect Dis. 2015 Nov 1;61 Suppl 4:S363-71. (PMID: 26449953); Rev Infect Dis. 1985 Mar-Apr;7(2):257-71. (PMID: 3890098) |
| Contributed Indexing: | Keywords: Salmonella Typhi; antimicrobial resistance; complication; surgery |
| Entry Date(s): | Date Created: 20200730 Date Completed: 20210427 Latest Revision: 20210427 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC7388708 |
| DOI: | 10.1093/cid/ciaa405 |
| PMID: | 32725231 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't