Dr Sara Fayyaz Cheema, Dr Ramsha Ghaffar, Dr. Urwa Khalil
Aim: Salmonella enterica serovar Typhi is estimated to cause 22 million cases of typhoid fever and 218 500 deaths worldwide annually. We studied an epidemic of unexplained febrile diseases along the Lahore frontier with neurological results which were concluded to be typhoid fever. Methods. The research involved intensive observation, interviews, observations of individuals who were sick and convalescent, patient record analyses, and laboratory experiments. Our current research was conducted at Lahore General Hospital, Lahore from June 2018 to May 2019. Classification of a potential case includes fever and another $1 diagnosis (e.g., vomiting or stomach pain); a likely case requires fever and a positive fast immunoglobulin Manti typhoid body test; a proven case requires blood or stool detection of Salmonella Typhi. Isolates were tested for antimicrobial resistance and were subtyped by electrophoresis of pulsed-field gel. Results. We reported 309 cases from 32 villages with onset; 214 were suspected, 49 were likely, and 46 were confirmed. Forty patients showed focal brain disorders, including upper motor neuron symptoms (n 5 19), ataxia (n 5 22), and parkinsonism (n 6 9). Fifteen citizens fled. All 48 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; and nalidixic acid was also resistant. PFGE was isolated from 35 of 47 isolates.; Conclusions. The irregular neurological symptoms raised a diagnostic problem which was overcome in the Malawi national reference laboratory by means of accelerated typhoid antibody testing in the field and eventual confirmation of blood culture. Extending laboratory diagnosis ability to populations at risk for typhoid fever in Africa, including blood culture, would enhance epidemic identification, response and clinical care. Keywords: Typhoid-Resistant Multidrug Fever, Lahore, Karachi, Pakistan.