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Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses

BACKGROUND: Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S....

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Autores principales: Khanam, Farhana, Sayeed, Md. Abu, Choudhury, Feroza Kaneez, Sheikh, Alaullah, Ahmed, Dilruba, Goswami, Doli, Hossain, Md. Lokman, Brooks, Abdullah, Calderwood, Stephen B., Charles, Richelle C., Cravioto, Alejandro, Ryan, Edward T., Qadri, Firdausi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388457/
https://www.ncbi.nlm.nih.gov/pubmed/25849611
http://dx.doi.org/10.1371/journal.pntd.0003619
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author Khanam, Farhana
Sayeed, Md. Abu
Choudhury, Feroza Kaneez
Sheikh, Alaullah
Ahmed, Dilruba
Goswami, Doli
Hossain, Md. Lokman
Brooks, Abdullah
Calderwood, Stephen B.
Charles, Richelle C.
Cravioto, Alejandro
Ryan, Edward T.
Qadri, Firdausi
author_facet Khanam, Farhana
Sayeed, Md. Abu
Choudhury, Feroza Kaneez
Sheikh, Alaullah
Ahmed, Dilruba
Goswami, Doli
Hossain, Md. Lokman
Brooks, Abdullah
Calderwood, Stephen B.
Charles, Richelle C.
Cravioto, Alejandro
Ryan, Edward T.
Qadri, Firdausi
author_sort Khanam, Farhana
collection PubMed
description BACKGROUND: Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains. METHODS: As a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest) during acute typhoid fever in adults. We similarly assessed membrane preparation (MP) IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years) with those seen in older children (6-17 years), adults (18-59 years), and age-matched healthy controls. PRINCIPAL FINDINGS: We found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid. CONCLUSIONS: This study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest can be used as marker of recent typhoid fever, even in young children.
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spelling pubmed-43884572015-04-21 Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses Khanam, Farhana Sayeed, Md. Abu Choudhury, Feroza Kaneez Sheikh, Alaullah Ahmed, Dilruba Goswami, Doli Hossain, Md. Lokman Brooks, Abdullah Calderwood, Stephen B. Charles, Richelle C. Cravioto, Alejandro Ryan, Edward T. Qadri, Firdausi PLoS Negl Trop Dis Research Article BACKGROUND: Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains. METHODS: As a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest) during acute typhoid fever in adults. We similarly assessed membrane preparation (MP) IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years) with those seen in older children (6-17 years), adults (18-59 years), and age-matched healthy controls. PRINCIPAL FINDINGS: We found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid. CONCLUSIONS: This study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest can be used as marker of recent typhoid fever, even in young children. Public Library of Science 2015-04-07 /pmc/articles/PMC4388457/ /pubmed/25849611 http://dx.doi.org/10.1371/journal.pntd.0003619 Text en © 2015 Khanam et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Khanam, Farhana
Sayeed, Md. Abu
Choudhury, Feroza Kaneez
Sheikh, Alaullah
Ahmed, Dilruba
Goswami, Doli
Hossain, Md. Lokman
Brooks, Abdullah
Calderwood, Stephen B.
Charles, Richelle C.
Cravioto, Alejandro
Ryan, Edward T.
Qadri, Firdausi
Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title_full Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title_fullStr Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title_full_unstemmed Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title_short Typhoid Fever in Young Children in Bangladesh: Clinical Findings, Antibiotic Susceptibility Pattern and Immune Responses
title_sort typhoid fever in young children in bangladesh: clinical findings, antibiotic susceptibility pattern and immune responses
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388457/
https://www.ncbi.nlm.nih.gov/pubmed/25849611
http://dx.doi.org/10.1371/journal.pntd.0003619
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