Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program

Megan Birkhold; Shrimati Datta; Gi Deok Pak; Justin Im; Olakayode O Ogundoyin; Dare I Olulana; Taiwo A Lawal; Oludolapo O Afuwape; Aderemi Kehinde; Marie-France Phoba; Gaëlle Nkoji; Abraham Aseffa; Mekonnen Teferi; Biruk Yeshitela; Oluwafemi Popoola; Michael Owusu; Lady Rosny Wandji Nana; Enoch G Cakpo; Moussa Ouedraogo; Edgar Ouangre; Isso Ouedraogo; Anne-Sophie Heroes; Jan Jacobs; Ondari D Mogeni; Andrea Haselbeck; Leah Sukri; Kathleen M Neuzil; Octavie Lunguya Metila; Ellis Owusu-Dabo; Yaw Adu-Sarkodie; Abdramane Soura Bassiahi; Raphaël Rakotozandrindrainy; Iruka N Okeke; Raphaël M Zellweger; Florian Marks

doi:10.1093/ofid/ofad138

Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program

Megan Birkhold, Shrimati Datta, Gi Deok Pak, Justin Im, Olakayode O Ogundoyin, Dare I Olulana, Taiwo A Lawal, Oludolapo O Afuwape, Aderemi Kehinde, Marie-France Phoba, Gaëlle Nkoji, Abraham Aseffa, Mekonnen Teferi, Biruk Yeshitela, Oluwafemi Popoola, Michael Owusu, Lady Rosny Wandji Nana, Enoch G Cakpo, Moussa Ouedraogo, Edgar OuangreIsso Ouedraogo, Anne-Sophie Heroes, Jan Jacobs, Ondari D Mogeni, Andrea Haselbeck, Leah Sukri, Kathleen M Neuzil, Octavie Lunguya Metila, Ellis Owusu-Dabo, Yaw Adu-Sarkodie, Abdramane Soura Bassiahi, Raphaël Rakotozandrindrainy, Iruka N Okeke, Raphaël M Zellweger, Florian Marks

Tropical Bacteriology

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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Abstract

BACKGROUND: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria.

METHODS: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures.

RESULTS: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation.

CONCLUSIONS: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

Original language	English
Journal	Open Forum Infectious Diseases
Volume	10
Issue number	Suppl 1
Pages (from-to)	S67-S73
Number of pages	7
ISSN	2328-8957
DOIs	https://doi.org/10.1093/ofid/ofad138
Publication status	Published - 2023

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10.1093/ofid/ofad138Licence: CC BY

2023ofid0S67Final published version, 883 KBLicence: CC BY

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Birkhold, M., Datta, S., Pak, G. D., Im, J., Ogundoyin, O. O., Olulana, D. I., Lawal, T. A., Afuwape, O. O., Kehinde, A., Phoba, M.-F., Nkoji, G., Aseffa, A., Teferi, M., Yeshitela, B., Popoola, O., Owusu, M., Nana, L. R. W., Cakpo, E. G., Ouedraogo, M., ... Marks, F. (2023). Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program. Open Forum Infectious Diseases, 10(Suppl 1), S67-S73. https://doi.org/10.1093/ofid/ofad138

@article{088d6901355b43d69cb8c09b009a898c,

title = "Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program",

abstract = "BACKGROUND: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria.METHODS: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures.RESULTS: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation.CONCLUSIONS: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.",

author = "Megan Birkhold and Shrimati Datta and Pak, {Gi Deok} and Justin Im and Ogundoyin, {Olakayode O} and Olulana, {Dare I} and Lawal, {Taiwo A} and Afuwape, {Oludolapo O} and Aderemi Kehinde and Marie-France Phoba and Ga{\"e}lle Nkoji and Abraham Aseffa and Mekonnen Teferi and Biruk Yeshitela and Oluwafemi Popoola and Michael Owusu and Nana, {Lady Rosny Wandji} and Cakpo, {Enoch G} and Moussa Ouedraogo and Edgar Ouangre and Isso Ouedraogo and Anne-Sophie Heroes and Jan Jacobs and Mogeni, {Ondari D} and Andrea Haselbeck and Leah Sukri and Neuzil, {Kathleen M} and Metila, {Octavie Lunguya} and Ellis Owusu-Dabo and Yaw Adu-Sarkodie and Bassiahi, {Abdramane Soura} and Rapha{\"e}l Rakotozandrindrainy and Okeke, {Iruka N} and Zellweger, {Rapha{\"e}l M} and Florian Marks",

note = "FTX; DOAJ; (CC BY 4.0); {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2023",

doi = "10.1093/ofid/ofad138",

language = "English",

volume = "10",

pages = "S67--S73",

journal = "Open Forum Infectious Diseases",

issn = "2328-8957",

publisher = "Oxford University Press",

number = "Suppl 1",

}

Birkhold, M, Datta, S, Pak, GD, Im, J, Ogundoyin, OO, Olulana, DI, Lawal, TA, Afuwape, OO, Kehinde, A, Phoba, M-F, Nkoji, G, Aseffa, A, Teferi, M, Yeshitela, B, Popoola, O, Owusu, M, Nana, LRW, Cakpo, EG, Ouedraogo, M, Ouangre, E, Ouedraogo, I, Heroes, A-S , Jacobs, J, Mogeni, OD, Haselbeck, A, Sukri, L, Neuzil, KM, Metila, OL, Owusu-Dabo, E, Adu-Sarkodie, Y, Bassiahi, AS, Rakotozandrindrainy, R, Okeke, IN, Zellweger, RM & Marks, F 2023, 'Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program', Open Forum Infectious Diseases, vol. 10, no. Suppl 1, pp. S67-S73. https://doi.org/10.1093/ofid/ofad138

TY - JOUR

T1 - Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program

AU - Birkhold, Megan

AU - Datta, Shrimati

AU - Pak, Gi Deok

AU - Im, Justin

AU - Ogundoyin, Olakayode O

AU - Olulana, Dare I

AU - Lawal, Taiwo A

AU - Afuwape, Oludolapo O

AU - Kehinde, Aderemi

AU - Phoba, Marie-France

AU - Nkoji, Gaëlle

AU - Aseffa, Abraham

AU - Teferi, Mekonnen

AU - Yeshitela, Biruk

AU - Popoola, Oluwafemi

AU - Owusu, Michael

AU - Nana, Lady Rosny Wandji

AU - Cakpo, Enoch G

AU - Ouedraogo, Moussa

AU - Ouangre, Edgar

AU - Ouedraogo, Isso

AU - Heroes, Anne-Sophie

AU - Jacobs, Jan

AU - Mogeni, Ondari D

AU - Haselbeck, Andrea

AU - Sukri, Leah

AU - Neuzil, Kathleen M

AU - Metila, Octavie Lunguya

AU - Owusu-Dabo, Ellis

AU - Adu-Sarkodie, Yaw

AU - Bassiahi, Abdramane Soura

AU - Rakotozandrindrainy, Raphaël

AU - Okeke, Iruka N

AU - Zellweger, Raphaël M

AU - Marks, Florian

N1 - FTX; DOAJ; (CC BY 4.0); © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria.METHODS: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures.RESULTS: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation.CONCLUSIONS: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

AB - BACKGROUND: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria.METHODS: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures.RESULTS: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation.CONCLUSIONS: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

U2 - 10.1093/ofid/ofad138

DO - 10.1093/ofid/ofad138

M3 - A1: Web of Science-article

C2 - 37274524

SN - 2328-8957

VL - 10

SP - S67-S73

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

IS - Suppl 1

ER -

Characterization of typhoid intestinal perforation in Africa: results from the severe typhoid fever surveillance in Africa program

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