Abstract:
BACKGROUND:Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. METHODOLOGY/PRINCIPAL FINDINGS:A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009-December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1-December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. CONCLUSIONS/SIGNIFICANCE:Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.
journal_name
PLoS Negl Trop Disjournal_title
PLoS neglected tropical diseasesauthors
Walters MS,Routh J,Mikoleit M,Kadivane S,Ouma C,Mubiru D,Mbusa B,Murangi A,Ejoku E,Rwantangle A,Kule U,Lule J,Garrett N,Halpin J,Maxwell N,Kagirita A,Mulabya F,Makumbi I,Freeman M,Joyce K,Hill V,Downing R,Mintdoi
10.1371/journal.pntd.0002726subject
Has Abstractpub_date
2014-03-06 00:00:00pages
e2726issue
3eissn
1935-2727issn
1935-2735pii
PNTD-D-13-01499journal_volume
8pub_type
杂志文章abstract::Chikungunya virus (CHIKV) infection is characterized by rash, acute high fever, chills, headache, nausea, photophobia, vomiting, and severe polyarthralgia. There is evidence that arthralgia can persist for years and result in long-term discomfort. Neurologic disease with fatal outcome has been documented, although at ...
journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
pub_type: 杂志文章,评审
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journal_title:PLoS neglected tropical diseases
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journal_title:PLoS neglected tropical diseases
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章,随机对照试验
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journal_title:PLoS neglected tropical diseases
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pub_type: 杂志文章,随机对照试验
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journal_title:PLoS neglected tropical diseases
pub_type: 已发布勘误
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journal_title:PLoS neglected tropical diseases
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