Mona Mohamed Ali Ahmed
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Detection of Salmonella spp. Among School –Age Children at Wad Habouba Rural Hospital, Gezira State, Sudan (2018) Mona Mohamed Ali Ahmed (B.sc in Medical Microbiology Faculty of Medical Laboratory Sciences University of ElzaeimElazhary2005) Adissertation Submitted to the University of Gezira in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Science In Medical Microbiology Faculty of Medical Laboratory Sciences October 2018 1 Detection of Salmonella spp. Among School –Age Children at Wad Habouba, Gezira State, Sudan (2018) Mona Mohammed Ali Ahmed Supervision Committee: Name Position Signature Prof. Adam Dawoud Abakar main supervisor ____________ Dr. Sanaa Elfatih Co- supervisor ____________ Date Examination:______________ 2 Detection of Salmonella spp.Among School –Age Children at WadHabouba, Gezira State, Sudan (2018) Mona Mohammed Ali Ahmed Examination Committee: Name Position Signature Prof. Adam Dawoud Abakar Chairman ____________ _________________________ External Examiner ____________ _________________________ Internal Examiner ____________ 3 Declaration We hereby, declare that this work is original research work; undertakenunder the supervision of Prof. Adam Dawoud Abakar and has not been presentedelsewhere for award of a degree of certificate. All sources have been citedand appropriately acknowledged. Name:____________________________ Date:_____________________________ Signature:_________________________ 4 Dedication Tothe greatest love in my life, thewoman whom I loved and give me the strength, well and support all the time Dearest mother… Tothose whom always on my side Brothers and Sisters… To my supporters through my way Friends… 5 Acknowledgements All praiseandthanks to Allah forblessing and for giving me the welling to complete this study,after that I would like to express my appreciation to my supervisor Prof. Adam DawoudAbakar Salim, for his kind help and support,after that I would like to express my appreciation to my supervisor Dr. Sanaa Alfatihalso thanks extended to all staff of the bacteriology laboratory of the medical laboratory of the Gezira University,Also acknowledge with gratitude the assistance,received from my colleges in the Wad Haboubarural hospital. Finally special thanks to everyone who was beside me to complete this work. 6 Detection of Salmonella spp.Among School –Age Children at Wad Habouba Rural, Gezira State, Sudan (2018) Mona Mohammed Ali Ahmed Abstract Enteric Fever is an important cause of morbidity and mortality amongchildren indevelopingcountriesincludingSudan.This cross sectional hospital based study aimed to estimate the prevalence rate and risk factor of enteric fever among student attend to wad habouba rural hospital,Blood samples and stools were collected from student aged between (6- 15 years) and suspected to be infected with enteric fever.The study was conducted during the period from August to November 2017 at Wad habouba hospital.Datawascollectedbystructured questionnaire.Specimens were examined by Widal test and stool culture,five ml of blood specimens were collected from student,Out of 100 blood sample only 37 were positive for widal test.stool sample out of 37 sample only 4 were positive in aculture,This study indicate low prevalence rate of enteric fever among the pupils in wad haboubaarea Further studies with large number of patients and more advanced techniques are required to validate the resultsof this study. It is better to perform culture for diagnosing salmonella species more than widal test. 7 الكشف عن انواع بكتريا السالمونيﻻ وسط اطفال المدارس في منطقة ود حبوبة-وﻻية الجزيرة – السودان منى محمد علي أحمد ملخص الدراسة تعد حمى التيفويدمن المسببات الهامة لﻻمراضية ومن اهم اﻻسباب تمعظم حاﻻت الوفاة ﻻطفال الدول النامية ويعد السودان احد الدول النامية، هدفت هذه الدراسة لتقدير معدل انتشار وعوامل خطورة حمي التيفويد من طﻻب مرحلة اﻻساس من منطقة ود حبوبة، تم جمع مائة عينة دم منالطﻻب الذين تتراوح اعمارهم بين سن الخامسة والخامسة عشر الذين يشتبه في انهم مصابين بحمي التايفويد في الفترة من اغسطس الي نوفمبر لعام 2017، من مائة عينة دم وجدت 37 عينة موجبة ﻻختبار الفيدال، ومن سبعة وثﻻثون عينة فسحة وجدت اربعة عينات موجبة في التزريع، وتشير هذه الدراسة الي انخفاض معدل انتشار اﻻصابة بحمي التيفويد بين الطﻻب في منطقة ود حبوبة وﻻية الجزيرة. اجراء مزيد من الدراسات مع عدد كبير من العينات والمزيد من التقنيات المتقدمة للتحقق من صحة نتائج هذه الدراسة.من اﻷفضل أداء التذريع لتشخيص أنواع السالمونيﻻ أكثر من اختبار الفيدال. 8 TABLEOF CONTENTS Serial Title Page Supervision committee i Examination Committee Ii Declaration iii Dedication iv Acknowledgements v English Abstract vi Arabic Abstract vi List of Content vii List of tables ix List of Figures x List of Abbreviations xi CHAPTER ONE: INTRODUCTION 1.1 Introduction 1 1.2 Justification 2 1.3 Topic identification 2 1.4 Objectives 2 1.4.1 General Objective 2 1.4.2. Specific Objectives 2 CHAPTER TWO: LITERATURE REVIEW 9 2.1 The organism 3 2.1.1 Classification 3 2.2 The disease 3 2.3 Symptoms 3- 4 2.4 Antigenic Structure 5-6 2.5. Epidemiology 6 2.6 Contamination And Transmission 7 2.7 Laboratory Diagnosis 7 2.7.1 Specimens 8 2.7.1.1 Blood 8 2.7.1.2 Stool 8 2.7.1.3 Serum 8 2.7.2 Microbiological Procedure 9 2.7.2.1 Blood Culture 9 2.7.2.2 Stool Culture 9 2.7.3 Colony Characteristics 9- 10 2.7.4 Serology 10-11 2.7.4.1 Widal Test 10-11 2.7.4.2 Haemagglutination 11 2.7.4.3 Counter Immuno Electrophoresis 111 2.9 Prevention 11-13 2.10 Anti-microbial Therapy 13 CHAPTER THREE MATERIALS AND METHODS 10 3.1 Study Area 14 3.1.1 Study Population 14 3.2 Study design 14 3.3 Inclusion Criteria 14 3.4 Exlusion Criteria 14 3.5 Sample Size 14 3.6 Design 15 3.7 Data Collection 15 3.8 Data Analysis 15 3.9 Ethical consideration 15 3.10 Materials 15-16 3.11 Laboratory methods 16-20 3.11.1 Preparation Of Media 16-17 3.11.2 Collection of specimens 17 3.11.2.1 Collection of blood 17 3.11.2.2 Collection of stool 17 3.11.3 Procedure 17 3.11.4 Culture 17 3.11.4.1 Colonial morphology 17-18 3.11.4.2 Gram smears 18 3.11.4.3 Biochemical tests 18-19 3.11.4.3.1 KIA 18-19 3.11.4.3.2 Indole 19 11 3.11.4.3.3 Urease 19 3.11.4.3.4 Citrate 19 CHAPTER FOUR 4.1 RESULTS 21-31 CHAPTER FIVE 5.1 Discussion 31 5.2 Conclusions 32 5.3 Recommendations 32 References 33 Appendix 37 12 List of Tables Table No. Title Page Table(4.1.1) Distribution of study population according to residence 22 Table (4.1.2) Distribution of study population according to washing hand 24 before having meal Table(4.1.3) Distribution of study population according to water source 26 Table (4.1.4) Presenting symptom frequencies Table(4.1.5) Resultfromdiagnostic test under study 29 Table(4.1.6) Some risk factor associated with infection 30 Table(4.1.7) Frequency and percentage of isolated organism 31 Table(4.1.8) Seroprevalence data together with personal and demographic 31 variables 13 14 Listof Figures FIGURES Title Page Figure (4.1.1) Distribution of study population according to gender 21 Figure(4.1.2) Distribution of study population according to water source 23 Figure(4.1.3) Washing hand with soap after toilet 25 Figure(4.1.4) Cleaning of dirt at home 27 15 List of Abbreviations Abbreviations Expansion ATP Adenosine triphosphate CIE Counter current immuno electrophoresis DCA Deoxycholate agar ELISA Enzyme linked immunosorbent assay HA Haemagglutination test HAg Flagellar Antigen LPS Lipopoly saccharides LPSHA Lipopolysaccharides heamagglutination MP Macrophage OAg Somatic Antigen RPHA Reverse passive haemagglutantion test SPP Species SS Salmonella Shigella VI Virulent Antigen XLD Xylose-Lysine-deoxycholate Agar 16 CHAPTER ONE Introduction 1.1 Background Salmonella spp are important food-borne pathogen associated with many feed stuffs. In order to minimize & control these sources of human infection efforts should be made at all levels of food product supply-chain. Typhoid fever, also known as enteric fever is a bacterial infect caused by a gram -ve bacteria primarily by salmonella enterica, subspecies enteric aserovar typhoid & to lesser extent related serovar's paratyphoid A, B, C.(Chart etal.2007) Both causes symptoms mild to severe and usually begin six to thirty days after exposure. Often there is gradual onset of fever over several days, weakness, abdominal pain, constipation & headache. Some people develop rash with rose coloured spots. In severe cases there may be confusion. Some people may carry the bacterium without being affected, however they are still spread the disease to others (Prajpati etal.2008). Poor hygiene habits & public sanitation conditions are main routes the disease spreading so an epidemiological investigation is need to be performed to determine the prevalence rate & subsequently to evaluate appropriate intervention polices, determine control programs. In order to estimate the prevalence of salmonella & to evaluate. The effectiveness of the intervention accurately as possible, it is necessary to investigate bacteriology & serology method more thoroughly (Prajpati etal 2008). Serology is one approach for determining salmonella status at the individual or population level & it is performed by widal test, which demonstrates antibodies against salmonella antigen O – somatic & H–Flagellar & It is used extensively in serodiagnosis of typhoid fever (Olopoenia and King 2000). On other hand, stool culture: is more useful in the diagnosis of enteric fever. 17 1-2 Research Justification 1-Typhoid fever remain an important public health problem in Sudan mainly in rural areas, but its screaning is not done in the study area. 2-Scare information available regarding its prevalence in study area. 3-School age children are frequently presented to health care center and clinics with symptoms resembling typhoid fever.