Outbreak of Paratyphoid in the Edinburgh Area

Sharp, J. C. M.; Brown, Phillip P.; Sangster, G.

doi:10.1136/bmj.1.5393.1282

Cited by 11 publications

(4 citation statements)

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“…Most imported cases of paratyphoid B in England are seen in travelers returning from South America and the Middle East.2 To date, there have been few other cases described of paratyphoid B acquired in England and only a couple of case series from Wales 3 and Scotland. 4 Disease is typically described as being milder and of shorter duration than infections caused by other host-adapted enteric fever serovars like S. Typhi and S. Paratyphi A. Acute mortality is reduced by treating with antibiotics at this stage.…”

Section: Introductionmentioning

confidence: 99%

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Salmonella Paratyphi B; Public Health and Parental Choice

Fidler

Dudley

Cloke

et al. 2021

Pediatric Infectious Disease Journal

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Background: Salmonella Paratyphi B (Paratyphoid B) is a rare infection and a notifiable disease in England. Disease is typically mild, and chronic carriage in children has been described in endemic countries. Almost all cases in England are imported, with very few cases of community transmission reported.Methods: The aim of this work was to describe an unusual cluster of Paratyphoid B cases transmitted within England, examining clinical, epidemiologic and microbiologic data. Detailed phylogenetic analysis is presented to corroborate public health epidemiologic links between cases.Results: One child had recently returned from an endemic area and had mild gastrointestinal symptoms. One year later, 2 other children with no travel history developed invasive disease requiring hospitalization. Epidemiologic links confirmed person-to-person spread between these three cases. All isolates of S. Paratyphi B (n = 93) received by the Gastrointestinal Bacteria Reference Unit between 2014 and 2019 were typed using whole genome sequencing. Three cases of Paratyphoid B were identified in the same geographical location over a 2-year period. S. Paratyphi B strains isolated from the stool and blood of the three cases were closely linked (0-5 single-nucleotide polymorphisms) using whole genome sequencing.Conclusions: This case series highlights the potential public health risks of paratyphoid B and the range of pediatric complications associated with this illness, especially in younger children. Although rare, chronic carriage of Paratyphoid B can lead to transmission in nonendemic areas and should be considered in all children presenting with signs of enteric fever even where there is no history of foreign travel.

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Section: Introductionmentioning

confidence: 99%

“…2 To date, there have been few other cases described of paratyphoid B acquired in England and only a couple of case series from Wales 3 and Scotland. 4…”

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Salmonella Paratyphi B; Public Health and Parental Choice

Fidler

Dudley

Cloke

et al. 2021

Pediatric Infectious Disease Journal

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“…During the early 1960s, several outbreaks of enteric fever occurred in Scotland, largely due to contaminated imported foodstuffs such as frozen Chinese egg or canned meat. The most notable of these episodes were paratyphoid fever in Edinburgh in 1963 (Sharp, Brown & Sangster, 1964) and typhoid in Aberdeen in 1964 (Report, 1964;Anderson & Hobbs, 1973).…”

Section: Introductionmentioning

confidence: 99%

Enteric fever in Scotland, 1967–1974

Sharp

Heymann

1976

J. Hyg.

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A review of 194 cases of enteric infection in Scotland during 1967-74, is reported. Diagnosis was confirmed by the laboratory isolation of Salmonella typhi (64 cases), S. paratyphi A (3) and S. paratyphi B (127), from blood or faeces; 174 persons were clinically ill and 20 were symptomless infections. Most patients (81-0%) were under 35 years of age, with the highest incidence occurring among young adults of 15-24 years, many of whom had been travelling overseas. One-third of all cases (65) were imported infections; the remaining 129 patients had not been outside the United Kingdom. A significantly greater proportion of typhoid infection (54-7%) was contracted overseas, in contrast to paratyphoid B with only one-fifth of cases (21-2%) being imported; all three cases of paratyphoid A were imported. The geographic distribution of origin of imported infections is discussed, along with the frequency of organisms belonging to different phage types. Two deaths occurred, one of which was the result of complications of paratyphoid fever. All other patients responded well to treatment, although two persons continued to excrete and became chronic carriers. A few examples are given of episodes of particular epidemiological interest. It is expected that in future years there will be a continued increase in the proportion of imported infections as more persons travel overseas, concurrent with the continuing decline in the number of chronic carriers resident in the British Isles.

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“…In Edinburgh in 1963 11 (5.8%) out of 188 persons infected were still excreting Salmonella paratyphi B after three months (Sharp et al, 1964), of whom six (3.2%) became chronic carriers. Of the two types of enteric carrier the faecal excreter is more common than the urinary excreter.…”

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Chronic enteric carriers: management of personal problems.

Sharp¹

1966

BMJ

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Anaemia and Big Spleen Disease-Hamilton et al. Bp'Isii 551 cases were found to have lymphocytic infiltrates in the hepatic sinusoids on liver biopsy and a significantly raised antibody titre for malaria, and 26 of the 29 had palpable splenomegaly. This syndrome is called locally big spleen disease. These 29 cases constitute a special group, and are described in detail. Thirteen patients presented with acute haemolytic episodes shown by acholuric jaundice and high reticulocyte counts. Such acute episodes have not been seen in 90 non-pregnant cases with this syndrome.Non-pregnant cases have all been shown to have a shortened red-cell survival of varying degrees. It is concluded that the pregnant patients have a chronic low-grade haemolytic process which predisposes them to acute haemolytic episodes during pregnancy. The possible factors producing these acute attacks and the danger to the mother and foetus are discussed.Big spleen disease is believed to be an abnormal immune response to malaria. It should be suspected when splenomegaly is found, and can be diagnosed by liver biopsy. Pregnant women with this condition with or without anaemia should be treated with a course of 15 mg. of primaquine daily for 15 days coupled with a curative course of chloroquine and followed by prolonged chemoprophylaxis against malaria throughout pregnancy and in all subsequent pregnancies.We are grateful to Professors

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Outbreak of Paratyphoid in the Edinburgh Area

Cited by 11 publications

References 3 publications

Salmonella Paratyphi B; Public Health and Parental Choice

Salmonella Paratyphi B; Public Health and Parental Choice

Enteric fever in Scotland, 1967–1974

Chronic enteric carriers: management of personal problems.

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