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    Risk factors for typhoid fever among adult patients in Diyarbakir, Turkey
    (Cambridge Univ Press, 2006) Hosoglu, S.; Celen, M. K.; Geyik, M. F.; Akalin, S.; Ayaz, C.; Acemoglu, H.; Loeb, Mark
    We conducted a case-control study to assess risk factors for typhoid fever in Diyarbakir, Turkey, a region where transmission of Salmonella typhi is endemic. We prospectively identified febrile patients from Diyarbakir and the surrounding area who were admitted to hospital. Cases were defined as patients who had S. typhi isolated from at least one blood culture. Sixty-four cases with blood culture-confirmed S. typhi were identified between May 2001 and May 2003. In total, 128 age- and sex-matched controls selected from neighbourhoods as cases were enrolled. We hypothesized that consumption of raw vegetables contaminated with sewage would be associated with an increased risk of typhoid fever. Conditional logistic regression modelling revealed that living in a crowded household (OR 3(.)31, 95 % CI 1(.)58-6(.)92, P= 0(.)002), eating cig kofte (a traditional raw food) (OR 5(.)29, 95 % CI 2(.)20-12(.)69, P= 0(.)000) and lettuce salad (OR 3(.)55, 95 % CI 1(.)52-8(.)28, P=0(.)003) in the 15 days prior to symptoms onset was independently associated with typhoid fever. We conclude that living in a crowded household and consumption of raw vegetables outside the home increase the risk of typhoid fever in this region.
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    A simple validated prediction rule to diagnose typhoid fever in Turkey
    (Royal Soc Tropical Medicine, 2006) Hosoglu, Salih; Geyik, Mehmet Faruk; Akalin, Serife; Ayaz, Celal; Kokoglu, Omer Faruk; Loeb, Mark
    The goal of this study was to develop a simple prediction rule for the diagnosis of typhoid fever. A model for the prediction of patients with typhoid fever at hospital admission was derived and validated by assigning weighted point values to independent predictive factors associated with a diagnosis of typhoid fever at hospital admission. Patient demographic, clinical and laboratory variables were used to compare patients with blood culture-confirmed typhoid fever with patients with fever of unknown origin. The model was derived and validated in two separate cohorts of patients from Dicle University Hospital in Diyarbakir, Turkey. A total of 371 patients were enrolled. A diagnostic index score was created using seven independent predictive factors associated with typhoid fever at hospital admission: age <30 years, abdominal. distention, confusion, leukopenia, relative bradycardia, positive Widal test and a typhoid tongue. A clinical prediction rule helped to differentiate patients with typhoid fever. (C) 2006 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.