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Current trends in the epidemiology and management of enteric fever in Africa: A literature review

Asian Pacific Journal of Tropical Medicine 2020年第5期13卷 204-213页

作者： oluwaseyitan a.adesegun Oluwafunmilola O.Adeyemi Osaze Ehioghae David F.Rabor Tolulope O.Binuyo Bisola A.Alafin Onyedikachi B.Nnagha Akolade O.Idowu Ayokunle Osonuga Department of Internal Medicine Babcock University Teaching HospitalIlishan-RemoOgun StateNigeria College of Medicine University of IbadanIbadanOyo StateNigeria Benjamin S.Carson(Snr.)School of Medicine Babcock UniversityIlishan-RemoOgun StateNigeria Oyo State Ministry of Health IbadanOyo StateNigeria Arubah Family Medical Centre LekkiLagos StateNigeria College of Medicine Imo State UniversityOwerriImo StateNigeria Medway Maritime Hospital KentUnited Kingdom

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through;vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sourcesof drinking water, good sanitation and hygiene, food safety and poverty allevi

关键词： Enteric fever Typhoid fever Epidemiology Africa Public health

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