加纳加西区发热病人中的疟疾和伤寒。
Malaria and typhoid fever among patients presenting with febrile illnesses in Ga West Municipality, Ghana.
机构信息
Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
出版信息
PLoS One. 2023 May 25;18(5):e0267528. doi: 10.1371/journal.pone.0267528. eCollection 2023.
BACKGROUND
Clinicians in areas where malaria and typhoid fever are co-endemic often treat infected patients irrationally, which may lead to the emergence of drug resistance and extra cost to patients. This study determined the proportion of febrile conditions attributable to either malaria and/or typhoid fever and the susceptibility patterns of Salmonella spp. isolates to commonly used antimicrobial agents in Ghana.
METHODS
One hundred and fifty-seven (157) febrile patients attending the Ga West Municipal Hospital, Ghana, from February to May 2017 were sampled. Blood samples were collected for cultivation of pathogenic bacteria and the susceptibility of the Salmonella isolates to antimicrobial agents was performed using the Kirby-Bauer disk diffusion method with antibiotic discs on Müller Hinton agar plates. For each sample, conventional Widal test for the detection of Salmonella spp was done as well as blood film preparation for detection of Plasmodium spp. Data on the socio-demographic and clinical characteristics of the study participants were collected using an android technology software kobo-collect by interview.
RESULTS
Of the total number of patients aged 2-37 years (median age = 6 years, IQR 3-11), 82 (52.2%) were females. The proportion of febrile patients with falciparum malaria was 57/157 (36.3%), while Salmonella typhi O and H antigens were detected in 23/157 (14.6%) of the samples. The detection rate of Salmonella spp in febrile patients was 10/157 (6.4%). Malaria and typhoid fever coinfection using Widal test and blood culture was 9 (5.7%) and 3 (1.9%), respectively. The isolates were highly susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and amikacin but resistant to ampicillin, tetracycline, co-trimoxazole, gentamicin, cefuroxime, chloramphenicol, and meropenem.
CONCLUSION
Plasmodium falciparum and Salmonella spp coinfections were only up to 1.9%, while malaria and typhoid fever, individually, were responsible for 36.3% and 6.4%, respectively. Treatment of febrile conditions must be based on laboratory findings in order not to expose patients to unnecessary side effects of antibiotics and reduce the emergence and spread of drug resistance against antibiotics.
背景
在疟疾和伤寒同时流行的地区，临床医生常常不合理地治疗感染患者，这可能导致耐药性的出现和患者额外的费用负担。本研究旨在确定加纳发热患者中疟疾和/或伤寒引起的发热比例，以及沙门氏菌属分离株对常用抗菌药物的敏感性模式。
方法
2017 年 2 月至 5 月，从加纳西部市立医院采集了 157 名发热患者的血液样本。将血液样本用于培养致病菌，并用 Kirby-Bauer 纸片扩散法在 Mueller Hinton 琼脂平板上检测沙门氏菌分离株对抗菌药物的敏感性。对于每个样本，还进行了传统的肥达氏试验以检测沙门氏菌属，以及血片制备以检测疟原虫属。使用安卓技术软件 kobo-collect 通过访谈收集研究参与者的社会人口学和临床特征数据。
结果
在年龄为 2-37 岁的患者中（中位数年龄=6 岁，IQR 3-11），82 名（52.2%）为女性。157 例发热患者中，有 57 例（36.3%）为恶性疟原虫疟疾，23 例（14.6%）的样本中检测到伤寒杆菌 O 和 H 抗原。157 例发热患者中沙门氏菌属的检出率为 10 例（6.4%）。使用肥达氏试验和血液培养法检测到的疟疾和伤寒混合感染分别为 9 例（5.7%）和 3 例（1.9%）。分离株对头孢噻肟、头孢曲松、环丙沙星和阿米卡星高度敏感，但对氨苄西林、四环素、复方磺胺甲噁唑、庆大霉素、头孢呋辛、氯霉素和美罗培南耐药。
结论
恶性疟原虫和沙门氏菌属的混合感染率仅为 1.9%，而疟疾和伤寒分别占 36.3%和 6.4%。发热患者的治疗必须基于实验室发现，以免使患者遭受不必要的抗生素副作用，并减少抗生素耐药性的出现和传播。
Zotero 插件