We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi.
- Authors
Olgemoeller, Franziska; Waluza, Jonathan J; Zeka, Dalitso; Gauld, Jillian S; Diggle, Peter J; Read, Jonathan M; Edwards, Thomas; Msefula, Chisomo L; Chirambo, Angeziwa; Gordon, Melita A; Thomson, Emma; Heyderman, Robert S; Borgstein, Eric; Feasey, Nicholas A
- 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.
- Subjects
MALAWI; INTESTINAL perforation -- Risk factors; MORTALITY risk factors; CONFIDENCE intervals; DISEASES; EPIDEMICS; LONGITUDINAL method; MULTIDRUG resistance; POISSON distribution; POLYMERASE chain reaction; PUBLIC health surveillance; RISK assessment; SALMONELLA; SURGICAL therapeutics; TYPHOID fever; TREATMENT effectiveness; HUMAN research subjects; PATIENT selection; INTESTINAL perforation; DISEASE complications
- Publication
Clinical Infectious Diseases, 2020, Vol 71, pS96
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciaa405