BRIEF REPORTS

Some workers 8 have suggested ways of solving this problem. Some practical suggestions that are useful in alleviating the nutritional problems of children in the developing countries include the following:

References 1. Dema IS. Nutrition in relation to agricultural production. F.A.O., 1965. 2. Atobatele JT. Crops production: Trends and developments. Ibadan, Nigeria: Dept of Agric Economics, University of Ibadan, Mimeo, 1983. 3. Nicol BM. The caloric requirements of Nigerian peasant farmers. Br J Nutr 1959; 13: 293-306.

An Outbreak of Typhoid Fever Resistant to Chloramphenicol and Other Drugs in Gharbeya Governorate in Egypt by Azza El-Sherbini Tanta Fever Hospital, Tanta, Egypt Summary An outbreak of Typhoid fever (TF) occurred in Gharbeya Governorate in Egypt during November and December 1990. Ninety children with mean age of 9.64 ±3.67 years and 43 adults with mean age 22.51 ± 5 J 6 years were treated in Tanta fever hospital (TFH) during this outbreak. Resistance of TF during the outbreak to the usual antibiotics given in TFH was the main feature of the outbreak, including resistance to chloramphenicol, co-trimoxazole, ampicillin, tetracycline, and gentamycin. Such resistance was detected in vitro as well as in vivo. Sensitivity was present in vitro and in vivo to ofloxacin (OF) and cefotaxime. The clinical response of OF was 96 per cent in children and 82 per cent in adults. No significant difference in side effects was detected in children treated with OF and those treated with other drugs after 6 months follow up.

Acknowledgements I would like to express my gratitude to Professor M. Kantoush and Professor S. Moustafa for previous and continuing advices. Journal of Tropical Pediatrics

Vol.38

December 1992

Introduction

Chloramphenical (CM) has been the drug of choice for treatment of typhoid fever (TF) since 1948.1 CMresistance in salmonella (5. typhii) infections was 331

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1. Improvement of the energy and nutrient density of weaning foods and other cereal-based foods of children in the developing countries. Most African staple foods have very low energy density and protein contents. 9 " 1 ' 2. Nutrition education, which apart from stressing the special nutrient needs of infants and pre-school children, should also alert the people to the consequences of deficiencies of important nutrients. 3. Improvement of the purchasing power of families by the provision of foods at affordable prices.

4. Whitehead RG, Paul AA, Cole TJ. A critical analysis of measured food energy intakes during infancy and early childhood in comparison with current international recommendations. J Hum Nutr 1981; 35: 339-48. 5. FAO/WHO/UNU Expert Consultation Report. Energy and protein requirements. Technical Report Series 724. Geneva: WHO. 6. Prentice AM, Lucas A, Vasquez-Velasquez L, Davies PSW, Whitehead RG. Are current dietary guidelines for young children a prescription for overfeeding? Lancet 1988; ii: 1066-9. 7. Whitehead RG, Lawrence M, Prentice AM. Maternal nutrition and breastfeeding. Hum Nutr: Appl Nutr 1986; 40Asuppl 1: 1-10. 8. Chabonnier A, Jones CDR, Schutz, PR, Murgatroyd PR, Whitehead RG, Jequier E, Spinnier G. A whole body calorimeter for human use in the tropics. Eur J Clin Nutr 1990; 44: 725-31. 9. Hudson GJ, John PMV, Paul AA. Variation in the composition of Gambian foods: The importance of water in relation to protein and energy content. Ecol Food Nutr 1980; 10:9-17. 10. Mosha AC, Svanberg U. Preparation of weaning foods with high nutrient density using flour of germinated cereals. UNU Food Nutr Bull 1983; 5(2): 10-14. 11. Whitehead RG. Infant feeding in the developing world. Core J Paediat 1977; 1: A3-7.

BRIEF REPORTS

apparently first reported in England in 1950.2 It was subsequenty observed in sporadic cases in India in 1962,3 West Africa in 1965,* and in the Saigon area of Vietnam in 1971.' The epidemic of TF in Mexico in 1972 was the first outbreak of the disease produced by 5. typhii resistant to CM, tetracycline (TC), ampicillin (AM), streptomycin, and sulphonamides.6 Recently, an epidemic multiresistant TF was reported in Eastern India in 1989.7 An outbreak of CM-resistant TF occurred in Gharbeya Govemorate (GG) in Egypt in late 1990. Tanta fever hospital (TFH) is one of the major infectious diseases hospitals in GG. The use of ofloxacin (OF) for resistant TF in children, is reported in this paper.

Results

Figure 1representsthe typhoid cases treated in TFH in the previous years for the study and control months. Most of the epidemiological data in Table 1 show 100-1 90 80 70 -

Patients and Methods

S 50 -

As the outbreak began in late October and lasted until mid-December, cases treated in TFH during November and December are described. Typhoid cases treated in TFH during August, September, and October 1990 are taken as a comparison group. Data about the cases were obtained from hospital records including age, sex, residence, duration of fever, symptoms, signs, laboratory investigations, and treatment given. Sick children specially those treated with OF (oral form, Tarivid, Hoechst) were clinically followed up for 6 months after being discharged from TFH. All investigations were done in the laboratory of TFH except for microbiological cultures which were done in the Central Laboratories, Cairo. Statistical analysis was carried out by Student's t and chisquare tests.

O C

4030 20 10 . 0

Aug. Sep. Oct. Nov. Dec Months FIG.

1.

TABLE 11 Clinical data

XN of cases per month Male:female Urban:rura) Adultxhild XA for children XA for adults Fever >38.5°C (XD) Abdominal pain Headache Constipation Toxic fades Splenomegaly Hepatomegaly Arthralgia UTI

Assodated SCH Positive O titre ^ 1/160

Before the outbreak n = 59 cases

During the outbreak n=133 cases

19.67 ±1.53 1.95:1 1:1.8 1:1.1 9.1 ±2.97 27.89 ±10.38 100% (18.9 ±7)

66.5 ±4.95 1.93:1 1.66:1 1:2.1 9.64 ±3.67 22.51 ±5.36 100% (26.5±11.1)

80% 40% 12% 7% 51%

81% 44% 8% 25% 38% 12%

18.6% 3%

15.2% 7.7% 71.9%

Significant difference

0.8% 49.5% 18%

57.1%

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An outbreak of typhoid fever resistant to chloramphenicol and other drugs in Gharbeya Governorate in Egypt.

An outbreak of Typhoid fever (TF) occurred in Gharbeya Governorate in Egypt during November and December 1990. Ninety children with mean age of 9.64 +...
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