http://www.journalofinfection.com/article/S0163445322000135/pdf

British Infection Association Guidelines for the Diagnosis and Management of Enteric Fever in England

The emergence and re-emergence of zoonotic diseases significantly impact human health, particularly those who live in impoverished areas and have close contact with domestic or wild animals. Nearly 75% of zoonotic diseases are transmitted directly from animals to humans or indirectly via vector/agent interactions between animals and humans. Growing populations, globalization, urbanization, and the interaction of the environment with humans and livestock all play roles in the emergence and spread of zoonotic diseases. “One Health” is a multidisciplinary concept aimed at improving human, animal, and environmental health, but this concept is not widely accepted in developing countries. In Pakistan, environmental, human, and animal health are severely affected due to a lack of sufficient resources. This review article provides an overview of the most common zoonotic diseases found in Pakistan and emphasizes the importance of the “One Health” concept in managing these diseases. Given the current situation, interdisciplinary research efforts are required to implement and sustain effective and long-term control measures in animal, human, and environmental health surveillance and accurate diagnostic methods.

/pdf/one-health-paradigm-to-confront-zoonotic-health-threats-a-29atw8l1.pdf

One Health Paradigm to Confront Zoonotic Health Threats: A Pakistan Prospective

We investigated pulse-temperature relationships in 66 children with enteric fever (group 1) and in 76 with other infections (group 2). Group 1 children were older than group 2 children (mean age +/- SD, 91 +/- 36 vs. 66 +/- 32 months, respectively; P .2); however, group 1 children had lower mean baseline pulse rates +/- SD than did group 2 children (119 +/- 25 vs. 127 +/- 28 beats/min, respectively; P .5). After adjustment of the mean initial pulse rate +/- SD to age of 72 months, there was no difference between group 1 and group 2 children (126 +/- 24 vs. 126 +/- 20 beats/min, respectively; P > .5). From 4 to 72 hours after commencement of treatment, the mean oral temperature in group 1 patients was approximately 0.3 degrees C higher than that in group 2 patients, and the age-adjusted pulse rate was 5 beats/min higher in group 1 children than in group 2 children. These data suggest that relative bradycardia is not characteristic of enteric fever in children.

Relative Bradycardia is not a feature of Enteric Fever in Children

The occurrence and antimicrobial resistance (AMR) of typhoid fever in the WHO Eastern Mediterranean Region (EMR) are poorly characterized. Robust surveillance data are needed to inform strategies for typhoid control and prevention in the region. We conducted a systematic review of typhoid fever occurrence, complications, and AMR patterns in EMR countries. We identified 70 studies published from 1990 to 2021, including a total of 44,541 cases with blood culture confirmed typhoid fever in 12 EMR countries, with 48 (69%) studies and 42,008 cases from Pakistan. Among 56 studies with AMR data, fluroquinolone (68% of 13,013 tested isolates), and multidrug resistance (40% of 15,765 tested isolates) were common. Forty (57%) of the 56 studies were from Pakistan, and all reports of extensively drug resistant Salmonella Typhi (48% of 9,578 tested isolates) were from studies in Pakistan. Our findings support the need for continued efforts to strengthen surveillance and laboratory capacity for blood-culture detection of typhoid fever in the region, including data from an ongoing collaboration among CDC, the American University of Beirut, and the WHO EMR office.

https://www.ajtmh.org/downloadpdf/journals/tpmd/108/2/article-p285.pdf

Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990-2021.

Typhoid fever is endemic in developing countries like India. An increasing prevalence of resistance to cephalosporins and fluoroquinolones by Salmonella isolates is seen. We present an 8-month-old boy with invasive Salmonella typhi disease. Blood culture showed S. typhi sensitive to ampicillin-sulbactam and cotrimoxazole but resistant to fluoroquinolones and third-generation cephalosporins. Cerebrospinal fluid examination revealed an aseptic meningitic picture. He was treated with intravenous meropenem and azithromycin following which his condition improved. This case highlights the need for improvement in environment sanitation and hygiene combined with early vaccination against typhoid fever and antimicrobial stewardship to help reduce the emerging resistance to cephalosporins and fluoroquinolones.

https://journals.sagepub.com/doi/pdf/10.1177/2050313X20917835

Cephalosporin-resistant typhoid:

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed "extensively resistant typhi," has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

https://journals.sagepub.com/doi/pdf/10.1177/0009922819881203

Drug-Resistant Salmonella typhi in Pakistan:

A 19-month-old, previously healthy African American female presented with fever and increased work of breathing. A week prior to admission she was evaluated at the local hospital emergency department (ED) and diagnosed with Influenza A for which she was prescribed oseltamivir. She took the medication as prescribed and had mild improvement in her symptoms. She returned to the ED because she developed a Tmax of 104 °F and signs of increased work of breathing with a grunt. At triage, the patient’s temperature was 99.6 °F, pulse 188 bpm (beats per minute), blood pressure 81/56 mm Hg, respiratory rate 67 breaths per minute, and oxygen saturation 93% on 10 L of high-flow nasal cannula at a FiO2 (fraction of inspired oxygen) of 50%. At initial evaluation she was in moderate distress. She was alert and interactive. Her conjunctiva appeared normal and her pupils were equal and reactive. She was tachycardic on examination with normal heart sounds without a murmur. Pulmonary examination was notable for coarse breath sounds in the left lung with diminished breath sounds in the entire right lung. Her abdomen was soft, nontender, and nondistended with bowel sounds present and without any signs of bruising or hemorrhage. Her capillary refill was less than 2 seconds, and she did not appear diaphoretic. A complete blood count demonstrated leukocytosis to 17.6 × 103/μL with a neutrophilic predominance and a left shift. She had a normocytic anemia with a hemoglobin and hematocrit of 9 g/dL and 26.4%, respectively. Platelets were elevated to 389 × 103/μL. A comprehensive metabolic panel was notable for moderate hyponatremia with a sodium of 127 mmol/L, potassium 4.7 mmol/L, chloride 98 mmol/L, bicarbonate 15 mmol/L, and metabolic acidosis with an anion gap of 16 mmol/L. She also had an acute kidney injury with a BUN (blood urea nitrogen) of 37 mg/dL and creatinine of 1.4 mg/dL. Her baseline renal function is unknown, but presumptively normal since she has no previous history of renal disease. Comprehensive metabolic panel was also notable for an acute transaminitis with an initial aspartate aminotransferase of 9060 U/L, alanine aminotransferase of 4360 U/L, and a normal alkaline phosphatase of 226 U/L. There was concern for acute liver failure since the patient had an INR (international normalized ratio) of 2.3. C-reactive protein was significantly elevated to 73.1 mg/L. Lactic acid was elevated at 4.2 mmol/L. A chest X-ray (CXR) was notable for a clear left lung, partial atelectasis in the right upper lobe, a right perihilar opacity concerning for pneumonia, and no pneumothorax. She was given intravenous (IV) fluids and solumedrol, and continuous albuterol treatments with minimal improvement in her symptoms. She was transferred to our hospital for further evaluation and management of her severe liver dysfunction and respiratory failure. On admission to the pediatric intensive care unit, the patient had a repeat CXR that demonstrated a complete opacification of the right lung concerning for an infection with pleural effusion. She was empirically started on IV ceftriaxone and vancomycin for sepsis secondary to pneumonia. A chest tube was placed and resulted in 130 mL of serosanguineous drainage. The patient’s respiratory status immediately improved, and she was weaned from 10 L high-flow nasal cannula to room air. Pleural fluid studies demonstrated gram positive cocci. Blood cultures from the outside hospital grew Group A Streptococcus (GAS). Vancomycin was subsequently discontinued as the patient was presumed to have pneumonia sensitive to ceftriaxone. An extensive workup was completed to evaluate for intrinsic liver disease as the patient had significantly elevated liver function tests and an elevated INR. The workup included antinuclear antibody, ceruloplasmin, Epstein–Barr virus, and cytomegalovirus titers, celiac disease panel with anti-tissue transglutaminase IgA (immunoglobulin) and IgG, acute hepatitis panel, and a thyroid stimulating hormone and free T4. As all of these 962734 CPJXXX10.1177/0009922820962734Clinical PediatricsLe et al research-article2020

Pneumonia With Effusion? Guess Again!

maxillary antrostomy with tissue removal, endoscopic total ethmoidectomy with tissue removal, endoscopic frontal recess resection, and endoscopic orbital decompression. He was continued on IV antibiotic therapy (vancomycin, ceftriaxone, and metro-nidazole) in consultation with otolaryngology, ophthalmology, and pediatric infectious disease. Postsurgical visual acuity was 20/20 in the right eye and no light per-ception (NLP) in the left. Erythromycin ointment was also initiated due to concern for corneal exposure, and he received a 5-day course of nasal mupirocin.

Monocular Vision Loss Subsequent to Complicated Orbital Cellulitis

P-042: Phase 1 dose-escalation study of sotatercept in combination with lenalidomide and dexamethasone or pomalidomide and dexamethasone in relapsed/refractory multiple myeloma

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Alexandra Wright

Author Tools

Chat about Author

Papers

Drug-Resistant Salmonella typhi in Pakistan:

Pneumonia With Effusion? Guess Again!

Monocular Vision Loss Subsequent to Complicated Orbital Cellulitis

P-042: Phase 1 dose-escalation study of sotatercept in combination with lenalidomide and dexamethasone or pomalidomide and dexamethasone in relapsed/refractory multiple myeloma