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Lee SY, Howard-Jones AR, Ln Lavu V, Norton S, Sintchenko V, Britton PN, Bag S, Khatami A. The increasing healthcare burden of enteric fever in a low-incidence setting. Infect Dis Now 2024; 54:104919. [PMID: 38643864 DOI: 10.1016/j.idnow.2024.104919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Enteric fever carries appreciable morbidity in non-endemic settings, particularly in returned travelers. This study aimed to characterize the healthcare burden of enteric fever in a low-incidence setting and to identify risk factors and opportunities for preventative interventions. METHODS Analysis of a retrospective case series from a tertiary pediatric center (2015-2019), augmented by public health notification and microbiological laboratory data (2018-2019), from Western Sydney, Australia, a region with frequent travel links to South Asia. RESULTS Eighty-nine (89) patients were diagnosed with enteric fever, including 43 children with complete demographic and travel data. Enteric fever cases increased over time (by 4.9 % per year) and incidence was three times higher in the pediatric population (<15 years old) compared to adults. Travel to India and visiting friends and relatives (VFR) travel were risk factors. Few children received enteric fever vaccination prior to travel, as pre-travel advice most commonly was not sought. CONCLUSIONS Children visiting relatives in high-incidence countries are increasingly at risk for enteric fever, particularly when travelling to South Asia. Targeted health advice to travelers visiting friends and relatives is warranted to mitigate the healthcare burden of enteric fever in low-incidence settings.
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Affiliation(s)
- Seung Y Lee
- Department of General Paediatrics, The Children's Hospital at Westmead, Westmead NSW 2145 Australia.
| | - Annaleise R Howard-Jones
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia
| | - Venkata Ln Lavu
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia
| | - Sophie Norton
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia
| | - Vitali Sintchenko
- New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Sydney Institute for Infectious Diseases, The University of Sydney, Westmead NSW 2145 Australia
| | - Philip N Britton
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead NSW 2145 Australia
| | - Shopna Bag
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia
| | - Ameneh Khatami
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead NSW 2145 Australia
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Chatterjee R, Chowdhury AR, Mukherjee D, Chakravortty D. From Eberthella typhi to Salmonella Typhi: The Fascinating Journey of the Virulence and Pathogenicity of Salmonella Typhi. ACS OMEGA 2023; 8:25674-25697. [PMID: 37521659 PMCID: PMC10373206 DOI: 10.1021/acsomega.3c02386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Salmonella Typhi (S. Typhi), the invasive typhoidal serovar of Salmonella enterica that causes typhoid fever in humans, is a severe threat to global health. It is one of the major causes of high morbidity and mortality in developing countries. According to recent WHO estimates, approximately 11-21 million typhoid fever illnesses occur annually worldwide, accounting for 0.12-0.16 million deaths. Salmonella infection can spread to healthy individuals by the consumption of contaminated food and water. Typhoid fever in humans sometimes is accompanied by several other critical extraintestinal complications related to the central nervous system, cardiovascular system, pulmonary system, and hepatobiliary system. Salmonella Pathogenicity Island-1 and Salmonella Pathogenicity Island-2 are the two genomic segments containing genes encoding virulent factors that regulate its invasion and systemic pathogenesis. This Review aims to shed light on a comparative analysis of the virulence and pathogenesis of the typhoidal and nontyphoidal serovars of S. enterica.
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Affiliation(s)
- Ritika Chatterjee
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Atish Roy Chowdhury
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Debapriya Mukherjee
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Dipshikha Chakravortty
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
- Centre
for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka 560012, India
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Self JL, Judd MC, Huang J, Fields PI, Griffin PM, Wong KK. Epidemiology of Salmonellosis Among Infants in the United States: 1968-2015. Pediatrics 2023:191251. [PMID: 37161700 DOI: 10.1542/peds.2021-056140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES Describe characteristics of gastroenteritis, bacteremia, and meningitis caused by nontyphoidal Salmonella among US infants. METHODS We analyze national surveillance data during 1968-2015 and active, sentinel surveillance data during 1996-2015 for culture-confirmed Salmonella infections by syndrome, year, serotype, age, and race. RESULTS During 1968-2015, 190 627 culture-confirmed Salmonella infections among infants were reported, including 165 236 (86.7%) cases of gastroenteritis, 6767 (3.5%) bacteremia, 371 (0.2%) meningitis, and 18 253 (9.7%) with other or unknown specimen sources. Incidence increased during the late 1970s-1980s, declined during the 1990s-early 2000s, and has gradually increased since the mid-2000s. Infants' median age was 4 months for gastroenteritis and bacteremia and 2 months for meningitis. The most frequently reported serotypes were Typhimurium (35 468; 22%) for gastroenteritis and Heidelberg for bacteremia (1954; 29%) and meningitis (65; 18%). During 1996-2015 in sentinel site surveillance, median annual incidence of gastroenteritis was 120, bacteremia 6.2, and meningitis 0.25 per 100 000 infants. Boys had a higher incidence of each syndrome than girls in both surveillance systems, but most differences were not statistically significant. Overall, hospitalization and fatality rates were 26% and 0.1% for gastroenteritis, 70% and 1.6% for bacteremia, and 96% and 4% for meningitis. During 2004-2015, invasive salmonellosis incidence was higher for Black (incident rate ratio, 2.7; 95% confidence interval, 2.6-2.8) and Asian (incident rate ratio, 1.8; 95% confidence interval, 1.7-1.8) than white infants. CONCLUSIONS Salmonellosis causes substantial infant morbidity and mortality; serotype heidelberg caused the most invasive infections. Infants with meningitis were younger than those with bacteremia or gastroenteritis. Research into risk factors for infection and invasive illness could inform prevention efforts.
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Affiliation(s)
- Julie L Self
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CSELS, and
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael C Judd
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Huang
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia I Fields
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia M Griffin
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen K Wong
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
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Birkhold M, Datta S, Pak GD, Im J, Ogundoyin OO, Olulana DI, Lawal TA, Afuwape OO, Kehinde A, Phoba MF, Nkoji G, Aseffa A, Teferi M, Yeshitela B, Popoola O, Owusu M, Nana LRW, Cakpo EG, Ouedraogo M, Ouangre E, Ouedraogo I, Heroes AS, Jacobs J, Mogeni OD, Haselbeck A, Sukri L, Neuzil KM, Metila OL, Owusu-Dabo E, Adu-Sarkodie Y, Bassiahi AS, Rakotozandrindrainy R, Okeke IN, Zellweger RM, Marks F. Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program. Open Forum Infect Dis 2023; 10:S67-S73. [PMID: 37274524 PMCID: PMC10236516 DOI: 10.1093/ofid/ofad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Background Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Conclusions Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.
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Affiliation(s)
- Megan Birkhold
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gi Deok Pak
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Olakayode O Ogundoyin
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Dare I Olulana
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Taiwo A Lawal
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Oludolapo O Afuwape
- Division of Gastrointestinal Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
| | - Gaëlle Nkoji
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
| | - Abraham Aseffa
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Biruk Yeshitela
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Owusu
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lady Rosny Wandji Nana
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Enoch G Cakpo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Moussa Ouedraogo
- Laboratorie d'Analyses Medicales, Hopital Protestant Schiphra, Ouagadougou, Burkina Faso
| | - Edgar Ouangre
- Service de Chirurgie Viscérale, Hopital Yalgado, Ouagadougou, Burkina Faso
| | - Isso Ouedraogo
- Pediatric Department, Hopital Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Anne-Sophie Heroes
- Department of Tropical Bacteriology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Jan Jacobs
- Department of Tropical Bacteriology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Ondari D Mogeni
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Andrea Haselbeck
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Leah Sukri
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Octavie Lunguya Metila
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ellis Owusu-Dabo
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdramane Soura Bassiahi
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | | | - Iruka N Okeke
- Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Raphaël M Zellweger
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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Kim SH, Bansal J. A Rare Case of Typhoid Fever in the United States Associated With Travel to Mexico. Cureus 2022; 14:e22316. [PMID: 35350527 PMCID: PMC8933273 DOI: 10.7759/cureus.22316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/03/2022] Open
Abstract
Typhoid fever is an infectious febrile illness caused by Salmonella typhi that is rare in the United States but is endemic in regions of South Asia and Africa. Typhoid fever initially presents with nonspecific symptoms such as fever, malaise, and abdominal pain. We describe a case of typhoid fever in an adult in the United States with recent travel to Mexico. After a nonspecific presentation, the patient developed Faget sign and computed tomography (CT) of the abdomen revealed mesenteric adenitis, which prompted additional workup. Diagnosis of typhoid fever was established by blood culture and the patient was treated with ciprofloxacin.
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6
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Bhutta ZA. International Travel and the Risk of Extensively Drug-resistant Typhoid: Issues and Potential Solutions. Clin Infect Dis 2021; 73:e4590-e4591. [PMID: 32609356 DOI: 10.1093/cid/ciaa908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
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Narala B, Suhail M, Leelaruban V, Ndzelen L, Mbome Y, Saverimuttu J. Non-typhoidal, Non-paratyphoidal Salmonella Species Causing Sacroiliitis and Pyomyositis in a Healthy 19-Year-Old Athlete. Cureus 2021; 13:e18753. [PMID: 34790498 PMCID: PMC8589003 DOI: 10.7759/cureus.18753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/26/2022] Open
Abstract
Salmonella is a gram-negative bacterium, subdivided into typhoidal and non-typhoidal Salmonella. It is usually caused by eating raw or undercooked meat, poultry, eggs, or egg products. The clinical manifestations of Salmonella infection can be divided into five syndromes: enterocolitis (food poisoning), enteric (typhoid) fever, bacteremia/septicemia, focal infection, and a chronic carrier state, which is usually asymptomatic. The most common clinical presentation is diarrhea. Salmonella osteomyelitis occurs most frequently in patients with sickle-cell disease; other risk factors include other hemoglobinopathies, immunocompromised status, and chronic Salmonella carrier state. The incidence of Salmonella osteomyelitis/septic arthritis in otherwise healthy individuals is rare. The duration of symptoms can range from a few months to several years, and multifocal involvement occurs in 15% of reported cases of Salmonella osteomyelitis. The symptoms of Salmonella osteomyelitis are pain and variable swelling of the affected limb; high temperatures are rarely noted. Our patient is a 19-year-old boy with no known past medical history who presented with severe right-sided sacroiliitis with extensive surrounding osteomyelitis on both sides of the sacroiliac joint with non-typhoidal, non-paratyphoidal Salmonella bacteremia.
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Affiliation(s)
- Bhavya Narala
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Maham Suhail
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | | | - Laura Ndzelen
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Yolande Mbome
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Jessie Saverimuttu
- Infectious Disease, Richmond University Medical Center, Staten Island, USA
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Inayath SB, Broor S, Gupta R, Agarwal P, Majumder S, Anveshi AK, Gaind R. Validation of Pefloxacin for detection of fluoroquinolone (FQ) resistance among Salmonella Typhi with special reference to GyrB mutations. J Med Microbiol 2021; 70. [PMID: 34356003 DOI: 10.1099/jmm.0.001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Fluoroquinolone (FQ) resistant Salmonella are classified as high priority pathogens by WHO. FQ resistance among Salmonella Typhi has emerged rapidly and is predominantly mediated by mutations in the topoisomerase genes gyrA, and parC. Mutations in GyrA result in classical FQ resistance (DCS-NAR) i.e. decreased susceptibility to ciprofloxacin (MIC of 0.12 to 0.5 µg ml-1) (DCS) and resistance to nalidixic acid (NAR). Previously a nalidixic acid disc test was proposed for detection of DCS. Recently isolates with non-classical FQ resistance caused by plasmid-mediated quinolone resistance (PMQR) and mutations in GyrB have emerged. These mechanisms also result in DCS but are nalidixic acid susceptible (NAS) and thus pose diagnostic challenges. CLSI and EUCAST have recommended use of 5 µg pefloxacin discs for detection of DCS in Salmonella.Hypothesis. The CLSI and EUCAST recommendations for use of 5 µg pefloxacin for detection of DCS has not been validated on typhoidal Salmonella and resistance mediated by GyrB mutation in Salmonella species.Aim. The aim of the present study was to validate the performance of the 5 µg pefloxacin discs to detect isolates of S. Typhi with DCS with special reference to GyrB mutations.Methodology. A total of 180 clinical isolates of Salmonella Typhi (2005-2014) were investigated for genetic mechanisms of resistance. Zone diameters for nalidixic acid (30μg), ciprofloxacin (5μg) and pefloxacin (5µg) and minimum inhibitory concentration (MIC) for ciprofloxacin were determined using CLSI guidelines. Performance of the three discs was evaluated to detect FQ resistance in S. Typhi.Results. Topoisomerase mutations in GyrB +/ ParC and GyrB were detected in 112 and 34 isolates respectively. Different mutations have a varied effect on the MIC for ciprofloxacin. The current breakpoints for susceptible (≤0.06 µg ml-1) and non-susceptible (≥0.125 µg ml-1), failed to detect all isolates with a resistance mechanism. Performance of both ciprofloxacin and pefloxacin discs were excellent compared to nalidixic acid in differentiating isolates with non-classical resistance mediated by GyrB from wild-type.Conclusion. The pefloxacin disc can be used to detect FQ resistance among S. Typhi. This is the first report of validation of pefloxacin for detection of FQ resistance in S. Typhi mediated by GyrB mutation.
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Affiliation(s)
- Shakila Banu Inayath
- Department of Microbiology, Faculty of Medicine & Health Sciences, SGT Medical College, Hospital & Research Institute, Budhera, Gurugram-122505, Haryana, India.,Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi- 110029, India
| | - Shobha Broor
- Department of Microbiology, Faculty of Medicine & Health Sciences, SGT Medical College, Hospital & Research Institute, Budhera, Gurugram-122505, Haryana, India
| | - Ruchi Gupta
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi- 110029, India
| | - Priti Agarwal
- Department of Microbiology, Faculty of Medicine & Health Sciences, SGT Medical College, Hospital & Research Institute, Budhera, Gurugram-122505, Haryana, India
| | - Subhradeep Majumder
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi- 110029, India
| | - Anupam Kumar Anveshi
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi- 110029, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi- 110029, India
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Sosa T, Kinnear B, Choe AY, Geha R, Haslam DB, Weiss PF, Parker MW. Caught in the Hotbox. J Hosp Med 2021; 16:304-307. [PMID: 33929950 DOI: 10.12788/jhm.3493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Tina Sosa
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kinnear
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Y Choe
- Division of Hospital Medicine, Children's Hospital of Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rabih Geha
- Department of Medicine, University of California, San Francisco, California
- Medical Service, San Francisco VA Medical Center, San Francisco, California
| | - David B Haslam
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Pamela F Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle W Parker
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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10
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The Brief Case: Salmonella enterica Serovar Typhi in a Central American Refugee. J Clin Microbiol 2021; 59:59/5/e01359-20. [PMID: 33879561 DOI: 10.1128/jcm.01359-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Manesh A, Meltzer E, Jin C, Britto C, Deodhar D, Radha S, Schwartz E, Rupali P. Typhoid and paratyphoid fever: a clinical seminar. J Travel Med 2021; 28:6129661. [PMID: 33550411 DOI: 10.1093/jtm/taab012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/07/2021] [Indexed: 01/06/2023]
Abstract
Rationale for review: Enteric fever (EF) caused by Salmonella enterica subspecies enterica serovar Typhi (Salmonella Typhi) and S. Paratyphi (Salmonella Paratyphi) remains an important cause of infectious morbidity and mortality in many low-income countries and, therefore, still poses a major infectious risk for travellers to endemic countries. Main findings: Although the global burden of EF has decreased over the past two decades, prevalence of EF remains high in Asia and Africa, with the highest prevalence reported from the Indian subcontinent. These statistics are mirrored by data on travel-related EF. Widespread and increasing antimicrobial resistance has narrowed treatment options for travel-related EF. Ceftriaxone- and azithromycin-based therapies are commonly used, even with the emergence of extremely drug-resistant typhoid in Pakistan. Preventive measures among locals and travellers include provision of safe food and water and vaccination. Food and water precautions offer limited protection, and the efficacy of Salmonella Typhi vaccines is only moderate signifying the need for travellers to be extra cautious. Recommendations: Improvement in the diagnosis of typhoid with high degree of clinical suspicion, better diagnostic assays, early and accurate detection of resistance, therapy with appropriate drugs, improvements in hygiene and sanitation with provision of safe drinking water in endemic areas and vaccination among travellers as well as in the endemic population are keys to controlling typhoid. While typhoid vaccines are recommended for travellers to high-risk areas, moderate efficacy and inability to protect against Salmonella Paratyphi are limitations to bear in mind. Improved Salmonella Typhi vaccines and vaccines against Salmonella Paratyphi A are required.
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Affiliation(s)
- Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Eyal Meltzer
- Department of Medicine `C', Center for Geographic Medicine, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Celina Jin
- Oxford Vaccine Group, Department of Pediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Carl Britto
- Oxford Vaccine Group, Department of Pediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Divya Deodhar
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Sneha Radha
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Eli Schwartz
- Department of Medicine `C', Center for Geographic Medicine, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
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12
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Extensively drug-resistant Salmonella Typhi in a patient returning from Pakistan, complicated by relapse with meropenem monotherapy. IDCases 2021; 23:e01048. [PMID: 33520658 PMCID: PMC7820545 DOI: 10.1016/j.idcr.2021.e01048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
In developing countries, typhoid fever is a common cause of febrile illness accompanied by abdominal pain and weakness. It is caused by Salmonella enterica serovar Typhi. Humans are the only known reservoir of infection, and typhoid fever is common in regions where access to clean water and sanitation is limited. The antimicrobials of choice for a case of typhoid fever acquired outside Pakistan are third generation cephalosporins. Lately, cases of extensively drug-resistant (XDR) Salmonella Typhi have been reported in people with a travel history to Pakistan. We present a case of XDR typhoid fever which relapsed after treatment with meropenem.
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13
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Abstract
Enteric fever (typhoid and paratyphoid)is caused by Salmonella typhi and Salmonella paratyphi. It is spread by fecal-oral route, largely through contamination of water and foodstuff. Developing countries are the worst affected. It takes 7 – 21 days from ingestion of the organism to manifestation of symptoms which are generally Fever, relative bradycardia, and pain abdomen. Hepatosplenomegaly, intestinal bleeding, and perforation are the features at various stages of the disease. The bacteria invade the submucous layer and proliferate in the Payer's patches. Blood culture is the gold standard for diagnosis but it is only rarely positive. Fluroquinolones, cephalosporins, and azithromycin are antibiotics of choice. There is increasing evidence of the development of resistance to all antibiotics. Salmonella sepsis, though uncommon, can occur. Intestinal perforation, peritonitis, and secondary sepsis are complications that may require intensive care unit management. How to cite this article: Ray B, Raha A. Typhoid and Enteric Fevers in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S144–S149.
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Affiliation(s)
- Banambar Ray
- Department of Critical Care Medicine, Sum Ultimate Medicare, Bhubaneswar, Odisha, India
| | - Abhijeet Raha
- Department of Critical Care Medicine, Sum Ultimate Medicare, Bhubaneswar, Odisha, India
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14
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Birabaharan M, Hagmann SHF. Typhoid in U.S. Children: A Need to Understand Prevention Attitudes in South Asian Immigrant Communities. Clin Infect Dis 2020; 73:e2846-e2848. [PMID: 33085748 DOI: 10.1093/cid/ciaa1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morgan Birabaharan
- Department of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Stefan H F Hagmann
- Steven and Alexandra Cohen Children's Medical Center, Northwell Health, Division of Pediatric Infectious Diseases, New Hyde Park, New York, United States.,Donald and Barbara Zucker School of Medicine/Hofstra Northwell, New Hempstead, New York, United States
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15
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Epidemiological and Clinical Characteristics of International Travelers with Enteric Fever and Antibiotic Resistance Profiles of Their Isolates: a GeoSentinel Analysis. Antimicrob Agents Chemother 2020; 64:AAC.01084-20. [PMID: 32816733 DOI: 10.1128/aac.01084-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/20/2022] Open
Abstract
Enteric fever, caused by Salmonella enterica serovar Typhi (S Typhi) and S. enterica serovar Paratyphi (S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers (S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.
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16
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Birkhold M, Coulibaly Y, Coulibaly O, Dembélé P, Kim DS, Sow S, Neuzil KM. Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995-2019: A Scoping Review. World J Surg 2020; 44:2892-2902. [PMID: 32430740 PMCID: PMC7236653 DOI: 10.1007/s00268-020-05567-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Typhoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates <1%. However, an estimated 10.9 million cases still occur annually, most in low- and middle-income countries. With the availability of a new typhoid conjugate vaccine licensed for children and recommended by the World Health Organization, understanding severe complications, including associated mortality rates, is essential to inform country-level decisions on introduction of this vaccine. This scoping review summarizes over 20 years of the literature on typhoid intestinal perforation in sub-Saharan Africa. METHODS We searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019. RESULTS Twenty-four papers from six countries were included. Reported mortality rates ranged from 4.6-75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16-100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively. CONCLUSIONS Current estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.
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Affiliation(s)
- Megan Birkhold
- Department of Surgery, University of Maryland School of Medicine, 22 S. Greene St, S8B02, Baltimore, MD, 21201, USA.
| | | | - Oumar Coulibaly
- Service de Chirurgie pédiatrique, CHU Gabriel Touré, Bamako, Mali
| | | | - Daniel S Kim
- Department of Surgery, Koutiala Women's and Children's Hospital, Koutiala, Mali
| | - Samba Sow
- Center for Vaccine Development - Mali, Bamako, Mali
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Acetylation of Surface Carbohydrates in Bacterial Pathogens Requires Coordinated Action of a Two-Domain Membrane-Bound Acyltransferase. mBio 2020; 11:mBio.01364-20. [PMID: 32843546 PMCID: PMC7448272 DOI: 10.1128/mbio.01364-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acyltransferase-3 (AT3) domain-containing membrane proteins are involved in O-acetylation of a diverse range of carbohydrates across all domains of life. In bacteria they are essential in processes including symbiosis, resistance to antimicrobials, and biosynthesis of antibiotics. Their mechanism of action, however, is poorly characterized. We analyzed two acetyltransferases as models for this important family of membrane proteins, which modify carbohydrates on the surface of the pathogen Salmonella enterica, affecting immunogenicity, virulence, and bacteriophage resistance. We show that when these AT3 domains are fused to a periplasmic partner domain, both domains are required for substrate acetylation. The data show conserved elements in the AT3 domain and unique structural features of the periplasmic domain. Our data provide a working model to probe the mechanism and function of the diverse and important members of the widespread AT3 protein family, which are required for biologically significant modifications of cell-surface carbohydrates. Membrane bound acyltransferase-3 (AT3) domain-containing proteins are implicated in a wide range of carbohydrate O-acyl modifications, but their mechanism of action is largely unknown. O-antigen acetylation by AT3 domain-containing acetyltransferases of Salmonella spp. can generate a specific immune response upon infection and can influence bacteriophage interactions. This study integrates in situ and in vitro functional analyses of two of these proteins, OafA and OafB (formerly F2GtrC), which display an “AT3-SGNH fused” domain architecture, where an integral membrane AT3 domain is fused to an extracytoplasmic SGNH domain. An in silico-inspired mutagenesis approach of the AT3 domain identified seven residues which are fundamental for the mechanism of action of OafA, with a particularly conserved motif in TMH1 indicating a potential acyl donor interaction site. Genetic and in vitro evidence demonstrate that the SGNH domain is both necessary and sufficient for lipopolysaccharide acetylation. The structure of the periplasmic SGNH domain of OafB identified features not previously reported for SGNH proteins. In particular, the periplasmic portion of the interdomain linking region is structured. Significantly, this region constrains acceptor substrate specificity, apparently by limiting access to the active site. Coevolution analysis of the two domains suggests possible interdomain interactions. Combining these data, we propose a refined model of the AT3-SGNH proteins, with structurally constrained orientations of the two domains. These findings enhance our understanding of how cells can transfer acyl groups from the cytoplasm to specific extracellular carbohydrates.
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18
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Brockett S, Wolfe MK, Hamot A, Appiah GD, Mintz ED, Lantagne D. Associations among Water, Sanitation, and Hygiene, and Food Exposures and Typhoid Fever in Case-Control Studies: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2020; 103:1020-1031. [PMID: 32700668 DOI: 10.4269/ajtmh.19-0479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Typhoid fever transmission occurs through ingestion of food or water contaminated with Salmonella Typhi, and case-control studies are often conducted to identify outbreak sources and transmission vehicles. However, there is no current summary of the associations among water, sanitation, and hygiene (WASH); and food exposures and typhoid from case-control studies. We conducted a systematic review and meta-analysis of case-control studies to evaluate the associations among typhoid fever and predicted WASH or food exposure risk factors (13), and protective factors (7). Overall, 19 manuscripts describing 22 case-control studies were included. Two studies were characterized as having low risk of bias, one as medium risk, and 19 as high risk. In total, nine of 13 predicted risk factors were associated with increased odds of typhoid (odds ratio [OR] = 1.4-2.4, I 2 = 30.5-74.8%.), whereas five of seven predicted protective factors were associated with lower odds of typhoid (OR = 0.52-0.73, I 2 = 38.7-84.3%). In five types of sensitivity analyses, two (8%) of 26 summary associations changed significance from the original analysis. Results highlight the following: the importance of household hygiene transmission pathways, the need for further research around appropriate food interventions and the risk of consuming specific foods and beverages outside the home, and the absence of any observed association between sanitation exposures and typhoid fever. We recommend that typhoid interventions focus on interrupting household transmission routes and that future studies provide more detailed information about WASH and food exposures to inform better targeted interventions.
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Affiliation(s)
- Sarah Brockett
- Tufts University School of Medicine, Boston, Massachusetts
| | - Marlene K Wolfe
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California.,Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts
| | - Asa Hamot
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts
| | - Grace D Appiah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts
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19
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Gangathraprabhu B, Kannan S, Santhanam G, Suryadevara N, Maruthamuthu M. A review on the origin of multidrug-resistant Salmonella and perspective of tailored phoP gene towards avirulence. Microb Pathog 2020; 147:104352. [PMID: 32592823 DOI: 10.1016/j.micpath.2020.104352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/04/2020] [Accepted: 06/14/2020] [Indexed: 01/21/2023]
Abstract
Salmonellosis continues to remain a health problem as the causative organism Salmonella spp. developed resistance to many of the antibiotics. As per World Health Organization (WHO), it is estimated that enteric fever, accounts for almost 16 million cases annually and over 600,000 deaths worldwide. Recent data revealed that the multi-drug resistance (MDR) rate of enteric fever was as high as 70% in Asian countries, as compared with the overall reported incidence of 50%. Emergence of MDR typhoid fever demands the use of newer antibiotics which also not offer promising effect in recent days. Effective antimicrobial therapy is required to control morbidity and prevent death from typhoid fever. The studies on PhoP/Q regulation revealed it as a best-characterized transcriptional regulation; a two-component system required for Salmonella pathogenesis which controls the expression of more than 40 genes. The PhoP DNA binding proteins possess positively charged amino acids such as arginine, lysine and histidine which present in the DNA binding site. Prevention of PhoP binding in phoP box may ultimately prevent the expression of many regulatory mechanism which plays vital role in Salmonella virulence. Deepness study of PhoP protein and various mutation swots may offer effectual controlling of MDR Salmonella.
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Affiliation(s)
- Balasubramani Gangathraprabhu
- Department of Microbial Technology, School of Biological Sciences, Madurai Kamaraj University, Madurai, 625021, Tamilnadu, India
| | - Suganya Kannan
- Central Research laboratory, Vinayaka Mission Research Foundation (Deemed to be University), Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India
| | - Geethanjali Santhanam
- Department of Home Science, Mother Teresa Women's University, Kodaikanal, Tamilnadu, India
| | - Nagaraja Suryadevara
- Department of Biomedical Sciences, MAHSA University, Jenjarom, 42610, Selangor Dahrul Ehsan, Malaysia
| | - Murugan Maruthamuthu
- Department of Microbial Technology, School of Biological Sciences, Madurai Kamaraj University, Madurai, 625021, Tamilnadu, India.
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20
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Birabaharan M, Kainth MK, Kessel AD, Hagmann SHF. Case Report: Typhoid Fever Complicated by Acute Respiratory Distress Syndrome in a Pediatric Traveler. Am J Trop Med Hyg 2020; 101:319-322. [PMID: 31264556 DOI: 10.4269/ajtmh.19-0286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is seldom described as a complication of typhoid fever (TF). Only 13 cases have hitherto been reported in the English and non-English literature since 1990. We report an 8-year-old boy with TF after return from India who developed pediatric ARDS (pARDS) despite adequate antibiotic treatment. Among patients with available information including this case, we noted that most not born or raised in a TF-endemic country (4/6) compared with none (0/6) of the domestic cases in a TF-endemic country developed ARDS within 48 hours of starting the antibiotic treatment. Our case raises important questions regarding the frequency, pathophysiology, and appropriate management of ARDS and pARDS in patients with TF.
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Affiliation(s)
- Morgan Birabaharan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mundeep K Kainth
- Feinstein Institute for Medical Research, Manhasset, New York.,Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Aaron D Kessel
- Division of Pediatric Critical Care Medicine, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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21
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Phillips MT, Owers KA, Grenfell BT, Pitzer VE. Changes in historical typhoid transmission across 16 U.S. cities, 1889-1931: Quantifying the impact of investments in water and sewer infrastructures. PLoS Negl Trop Dis 2020; 14:e0008048. [PMID: 32187188 PMCID: PMC7105137 DOI: 10.1371/journal.pntd.0008048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 03/30/2020] [Accepted: 01/10/2020] [Indexed: 12/25/2022] Open
Abstract
Investments in water and sanitation systems are believed to have led to the decline in typhoid fever in developed countries, such that most cases now occur in regions lacking adequate clean water and sanitation. Exploring seasonal and long-term patterns in historical typhoid mortality in the United States can offer deeper understanding of disease drivers. We fit modified Time-series Susceptible-Infectious-Recovered models to city-level weekly mortality counts to estimate seasonal and long-term typhoid transmission. We examined seasonal transmission separately by city and aggregated by water source. Typhoid transmission peaked in late summer/early fall. Seasonality varied by water source, with the greatest variation occurring in cities with reservoirs. We then fit hierarchical regression models to measure associations between long-term transmission and annual financial investments in water and sewer systems. Overall historical $1 per capita ($16.13 in 2017) investments in the water supply were associated with approximately 5% (95% confidence interval: 3-6%) decreases in typhoid transmission, while $1 increases in the overall sewer system investments were associated with estimated 6% (95% confidence interval: 4-9%) decreases. Our findings aid in the understanding of typhoid transmission dynamics and potential impacts of water and sanitation improvements, and can inform cost-effectiveness analyses of interventions to reduce the typhoid burden.
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Affiliation(s)
- Maile T. Phillips
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katharine A. Owers
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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22
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Gioda FR, Grisotti M, Langdon EJ. Violência estrutural e adoecer no Haiti: reflexões sobre uma experiência. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-129020201801012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Falar sobre saúde e principalmente da busca pela cura das doenças em sociedades globais empobrecidas e desassistidas traz à tona amplas e conflitivas reflexões. O Haiti é o país mais pobre das Américas e um dos mais pobres do mundo. A extrema vulnerabilidade a que a população está exposta é facilmente percebida por meio da análise do processo saúde/enfermidade/atenção, uma vez que esse é um dos domínios em que se acentuam as vivências de sofrimento, a percepção da inequidade e as intervenções ineficazes, que se pode observar em cada relato de experiência a violência estrutural como um legado histórico. Perpetuada ainda hoje por forças sociais e políticas globais, a violência estrutural pode ser pensada como fator associado ao risco de adoecer e a viabilidade (ou não) da cura ou do controle das doenças. A partir de um relato particular, discute-se com base nessa teoria o processo de adoecimento e o percurso feito até a resolução do padecimento, considerando a realidade da saúde pública do país.
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23
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Kling K, Wichmann O, Burchard G. [Travel vaccinations for certain groups of persons]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 63:85-92. [PMID: 31811312 DOI: 10.1007/s00103-019-03067-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The number of international travelers has been continuously increasing in recent decades. Among travelers, there are more and more people at an increased risk for acquiring diseases that could be prevented by vaccines or for the development of a severe course of disease. Risk groups in travel medicine are senior travelers, children, pregnant and breast-feeding women, persons with pre-existing medical conditions, and persons who visit their friends and relatives abroad (VFR). Individuals in these groups require attention during pretravel advice consultations, particularly with regards to recommended vaccinations. On the other hand, for some risk groups, particular vaccines cannot be given for safety reasons or because the response to vaccines is reduced. Not all risk groups or each vaccine have sufficient evidence available, so each patient's risks and benefits must be weighed during pretravel consultation. In this article, the particularities for each risk group with respect to pretravel immunization are highlighted.
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Affiliation(s)
- Kerstin Kling
- Fachgebiet Impfprävention, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Ole Wichmann
- Fachgebiet Impfprävention, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Gerd Burchard
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland.,Ständige Impfkommission (STIKO), Berlin, Deutschland
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24
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Shakoor S, Platts-Mills JA, Hasan R. Antibiotic-Resistant Enteric Infections. Infect Dis Clin North Am 2019; 33:1105-1123. [DOI: 10.1016/j.idc.2019.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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25
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Meyer Sauteur PM, Stevens MJA, Paioni P, Wüthrich D, Egli A, Stephan R, Berger C, Bloemberg GV. Siblings with typhoid fever: An investigation of intrafamilial transmission, clonality, and antibiotic susceptibility. Travel Med Infect Dis 2019; 34:101498. [PMID: 31580900 DOI: 10.1016/j.tmaid.2019.101498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Typhoid fever usually manifests as an acute disease. However, asymptomatic carriage with Salmonella Typhi may occur. This study investigated a family setting of severe typhoid fever in Switzerland months after return from Bangladesh. METHOD Standard microbiological procedures were performed. Testing for S. Typhi IgM antibodies was done using a novel immunochromographic lateral flow assay. Whole genome sequencing (WGS) followed by comparative core genome multilocus sequence typing (cgMLST) was performed on the S. Typhi isolates. RESULTS Four months after returning from a visit to Bangladesh sibling 1 (9 months) was diagnosed with a S. Typhi meningitis and sibling 3 (8 years) was identified as asymptomatic S. Typhi carrier. Sibling 2 (2 years) was retrospectively diagnosed with typhoid fever by IgM serology at the time point of admission to the hospital. Parents were asymptomatic and culture-negative. WGS analysis of family S. Typhi isolates showed clonality and strongest homology with S. Typhi strains occurring in Bangladesh. The S. Typhi strain showed resistance against fluoroquinolones. A 4-week course of ceftriaxone resulted in full recovery of sibling 1. S. Typhi was eradicated from sibling 3 following azithromycin treatment for 14 days. CONCLUSION S. Typhi, acquired from a visit to Bangladesh, was most likely transmitted within the family from one brother as asymptomatic shedder to his 9-month-old brother who manifested S. Typhi meningitis as a very rare and life-threatening presentation of typhoid fever. S. Typhi infection should be considered even in case of uncommon manifestations and irrespective of the interval between disease presentation and travel to an endemic area.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Marc J A Stevens
- Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Daniel Wüthrich
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Roger Stephan
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Guido V Bloemberg
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland.
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26
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Abstract
BACKGROUND Contemporary incidence estimates of typhoid fever are needed to guide policy decisions and control measures and to improve future epidemiological studies. METHODS We systematically reviewed 3 databases (Ovid Medline, PubMed, and Scopus) without restriction on age, country, language, or time for studies reporting the incidence of blood culture-confirmed typhoid fever. Outbreak, travel-associated, and passive government surveillance reports were excluded. We performed a meta-analysis using a random-effects model to calculate estimates of pooled incidence, stratifying by studies that reported the incidence of typhoid fever and those that estimated incidence by using multipliers. RESULTS Thirty-three studies were included in the analysis. There were 26 study sites from 16 countries reporting typhoid cases from population-based incidence studies, and 17 sites in 9 countries used multipliers to account for underascertainment in sentinel surveillance data. We identified Africa and Asia as regions with studies showing high typhoid incidence while noting considerable variation of typhoid incidence in time and place, including in consecutive years at the same location. Overall, more recent studies reported lower typhoid incidence compared to years prior to 2000. We identified variation in the criteria for collecting a blood culture, and among multiplier studies we identified a lack of a standardization for the types of multipliers being used to estimate incidence. CONCLUSIONS Typhoid fever incidence remains high at many sites. Additional and more accurate typhoid incidence studies are needed to support country decisions about typhoid conjugate vaccine adoption. Standardization of multiplier types applied in multiplier studies is recommended.
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Affiliation(s)
| | - Chuen Yen Hong
- Centre for International Health, University of Otago, New Zealand
| | - John A Crump
- Centre for International Health, University of Otago, New Zealand
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Kashosi TM, Muhandule AB, Mwenebitu DL, Mihuhi N, Mutendela JK, Mubagwa K. [Antibiotic resistance of Salmonella spp strains isolated from blood cultures in Bukavu, Democratic Republic of the Congo]. Pan Afr Med J 2018; 29:42. [PMID: 29875924 PMCID: PMC5987141 DOI: 10.11604/pamj.2018.29.42.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction La fièvre typhoïde est un problème majeur de santé publique dans les pays en voie de développement jusqu'à ce jour à cause de la vétusté des infrastructures sanitaires et des circuits de distribution de l'eau presque inexistants. En RDC en général et à Bukavu en particulier, l'hémoculture est inaccessible à la majorité des patients. L'objectif de cette étude était d'évaluer la sensibilité de Salmonella spp aux antibiotiques couramment utilisés dans la prise en charge de la fièvre typhoïde à Bukavu. Méthodes Une étude transversale étalée sur 6 mois a était organisée. Tout malade suspect de la fièvre typhoïde a été sélectionné dans l'étude. L'hémoculture était faite systématiquement chez tout malade sélectionné. L'identification de la souche bactérienne et l'antibiogramme ont été réalisés par les méthodes conventionnelles. Les antibiotiques suivants ont été testés: amikacine, amoxicilline, augmentin, aeftazidime, ceftriaxone, cefuroxime, chloramphénicol, ciprofloxacine, cotrimoxazole, doxycycline, gentamicine, négram, norfloxacine. Résultats 460 malades ont été sélectionnés dans l'étude. 144 (31,30%) hémocultures positives ont été observées. Salmonella spp était le germe le plus isolé (41,66%). Les souches de Salmonella spp isolées à Bukavu sont sensibles à la ciprofloxacine (91,7%), au ceftazidime (81,7%), ceftriaxone (80%), norfloxacine (80%), amikacine (76,6%) et au cefuroxime (73,3%). Elles restent résistantes aux autres molécules d'antibiotiques. Conclusion Ces résultats montrent une sensibilité diminuée à plupart des antibiotiques testés. Un test d'antibiogramme est requis en cas de fièvre typhoïde pour une meilleure prise en charge.
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Affiliation(s)
- Théophile Mitima Kashosi
- Laboratoire de Recherche Biomédicale et de Santé Publique, Département des sciences Biomédicales, Faculté de Médecine et Santé Communautaire, Université Evangélique en Afrique, Bukavu, RD Congo.,International Center for Advanced Research and Training, Bukavu, RD Congo.,Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales (ISTM), Bukavu, DR Congo
| | - Archippe Birindwa Muhandule
- Laboratoire de Recherche Biomédicale et de Santé Publique, Département des sciences Biomédicales, Faculté de Médecine et Santé Communautaire, Université Evangélique en Afrique, Bukavu, RD Congo.,Département de Pédiatrie, Hôpital de Panzi, Faculté de Médecine et Santé Communautaire, Université Evangélique en Afrique, Bukavu, RD Congo
| | - David Lupande Mwenebitu
- Service de Microbiologie, Hôpital Provincial Général de Référence de Bukavu/Université Catholique de Bukavu (UCB), RD Congo.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Université de Kinshasa, RD Congo
| | - Nicolas Mihuhi
- Département de Pédiatrie, Hôpital de Panzi, Faculté de Médecine et Santé Communautaire, Université Evangélique en Afrique, Bukavu, RD Congo
| | | | - Kanigula Mubagwa
- International Center for Advanced Research and Training, Bukavu, RD Congo.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Yaita K, Yahara K, Hamada N, Sakai Y, Iwahashi J, Masunaga K, Watanabe H. Typhoid Vaccination among Japanese Travelers to South Asia and the Factors Associated with Compliance. Intern Med 2018; 57:1071-1074. [PMID: 29279484 PMCID: PMC5938494 DOI: 10.2169/internalmedicine.9405-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective In 2010, candid advice concerning the low rate of typhoid vaccination among Japanese travelers was received from Nepal. Recently, progressive Japanese travel clinics have encouraged Japanese travelers to be vaccinated against typhoid fever in conjunction with officially approved vaccines, such as hepatitis A vaccine. We herein report the status of typhoid vaccinations for Japanese travelers to the most endemic area (South Asia) and describe the factors associated with compliance. Methods In the travel clinic at Kurume University Hospital, we used the following criteria to retrospectively extract the records of new pre-travel Japanese clients between January 2011 and March 2015: hepatitis A vaccine administered, traveling to South Asian countries, and ≥2 years of age. We first summarized the participants and then divided them into typhoid-vaccinated and typhoid non-vaccinated groups for a comparative analysis. Results This study included 160 clients. A majority (70.0%) of these clients traveled for business. The duration of trips was long (≥1 month) (75.0%), and India was a popular destination (90.6%). A comparative study between the vaccinated group (n=122) and the non-vaccinated group (n=38) revealed that the two factors most positively associated with typhoid vaccination were business trips [adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 1.42-9.06] and coverage by a company/organization payment plan (aOR 7.14, 95% CI 2.67-20.3). Conclusion The trend toward typhoid vaccination among Japanese travelers to South Asia with pre-travel consultation is correlated with business trips and coverage by a company/organization payment plan. If problems concerning the cost of vaccines were resolved, more travelers would request typhoid vaccination.
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Affiliation(s)
- Kenichiro Yaita
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
| | - Koji Yahara
- Department of Bacteriology II, National Institute of Infectious Diseases, Japan
| | - Nobuyuki Hamada
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
| | - Yoshiro Sakai
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
- Department of Pharmacy, Kurume University Hospital, Japan
| | - Jun Iwahashi
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
| | - Kenji Masunaga
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
| | - Hiroshi Watanabe
- Department of Infection Control and Prevention, Kurume University School of Medicine, Japan
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Typhoid Fever due to Extended Spectrum β-Lactamase-Producing Salmonella enterica Serovar Typhi: A Case Report and Literature Review. Case Rep Infect Dis 2018; 2018:4610246. [PMID: 29666727 PMCID: PMC5832104 DOI: 10.1155/2018/4610246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/25/2017] [Accepted: 01/14/2018] [Indexed: 11/18/2022] Open
Abstract
Emergence of cephalosporin-resistant strains of Salmonella enterica serovar Typhi is a cause of concern in the management of enteric fever. Cephalosporin resistance in Salmonella species is mainly due to the production of extended-spectrum β-lactamases (ESBLs). The majority of ESBLs in Salmonella enterica serovar Typhi are derivatives of the TEM, SHV, and CTX-M β-lactamase families. Of these, CTX-M appears to be predominant. This paper discusses the detection and molecular characterization of an ESBL-producing Salmonella enterica serovar Typhi strain isolated from a patient who was admitted to a private hospital in Sri Lanka. The three main types of β-lactamases such as TEM, SHV, and CTX-M were identified in this isolate. This case report from Sri Lanka contributes to the knowledge of the increasingly reported cases of typhoid fever due to Salmonella enterica serovar Typhi resistant to β-lactamase by ESBL production.
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Abstract
BACKGROUND Enteric fever is a vaccine-preventable disease with cases in Australia predominantly acquired overseas. The aim of this study was to define the burden of enteric fever in children presenting to a pediatric hospital in Western Sydney between 2003 and 2015. METHODS Cases between January 2003 and December 2013 were ascertained through medical records using International Classification of Disease-coded discharge diagnoses, cross-referenced with microbiology laboratory data for all isolates of Salmonella enterica serovar typhi and S. enterica serovar paratyphi. Prospective cases from January 2014 to April 2015 were additionally captured through records maintained by the infectious diseases team. RESULTS Seventy-one cases of enteric fever were identified in 12.3 years with an average of 4 cases per year between 2003 and 2008 and 7 cases per year between 2009 and 2014. Two were visitors to Australia, 8 were recent migrants, and 59 were Australian residents returning from overseas travel. Two children had no history of overseas travel. Countries of travel predominantly included the Indian subcontinent (60/69) and Southeast Asia (7/69). Of 30 children with information available on pretravel medical consultation, 1 was offered and received typhoid vaccine. Ninety-four percent of children (67) required admission for 1-28 days (median: 5 days). Three children required readmission, with 1 case of presumed relapse. Ninety percent (64) were diagnosed by blood or stool culture with S. enterica serovar typhi the predominant organism (54/64). CONCLUSIONS In Australia, hospitalizations for pediatric enteric fever appear to be increasing; predominantly occurring in Australian-resident children. Greater awareness and education are required for parents and clinicians regarding travel health risks and prevention strategies.
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Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017; 65:e45-e80. [PMID: 29053792 PMCID: PMC5850553 DOI: 10.1093/cid/cix669] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022] Open
Abstract
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Rajal K Mody
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Theodore S Steiner
- Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO; 5Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | | | - Christine Wanke
- Division of Nutrition and Infection, Tufts University, Boston, Massachusetts,Cirle Alcantara Warren, MD
| | - Cirle Alcantara Warren
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Cantey
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Larry K Pickering
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
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Ohnishi K, Ainoda Y, Imamura A, Iwabuchi S, Okuda M, Nakano T. JAID/JSC Guidelines for Infection Treatment 2015-Intestinal infections. J Infect Chemother 2017; 24:1-17. [PMID: 28986191 DOI: 10.1016/j.jiac.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | - Kenji Ohnishi
- Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan
| | - Yusuke Ainoda
- Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan; Department of Infectious Diseases, Tokyo Women's Medical University, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Sentaro Iwabuchi
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - Masumi Okuda
- Department of Pediatrics, Sasayama Medical Center, Hyogo College of Medicine, Sasayama, Hyogo, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
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Chowdhury R, Ilyas H, Ghosh A, Ali H, Ghorai A, Midya A, Jana NR, Das S, Bhunia A. Multivalent gold nanoparticle-peptide conjugates for targeting intracellular bacterial infections. NANOSCALE 2017; 9:14074-14093. [PMID: 28901372 DOI: 10.1039/c7nr04062h] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Although nanoparticle-tagged antimicrobal peptides have gained considerable importance in recent years, their structure-function correlation has not yet been explored. Here, we have studied the mechanism of action of a designed antimicrobial peptide, VG16KRKP (VARGWKRKCPLFGKGG), delivered via gold nanoparticle tagging against Salmonella infection by combining biological experiments with high- and low-resolution spectroscopic techniques. In comparison with the free VG16KRKP peptide or gold nanoparticle alone, the conjugated variant, Au-VG16KRKP, is non-cytotoxic to eukaryotic cells, but exhibits strong bacteriolytic activity in culture. Au-VG16KRKP can penetrate host epithelial and macrophage cells as well as interact with intracellular S. Typhi LPS under both in vitro and in vivo conditions. Treatment of mice with Au-VG16KRKP post-infection with S. Typhi resulted in reduced intracellular bacterial recovery and highly enhanced protection against S. Typhi challenge. The three-dimensional high resolution structure of nanoparticle conjugated VG16KRKP depicted the generation of a well-separated amphipathic structure with slight aggregation, responsible for the increase of the local concentration of the peptide, thus leading to potent activity. This is the first report on the structural and functional characterization of a nanoparticle conjugated synthetic antimicrobial peptide that can kill intracellular pathogens and eventually protect against S. Typhi challenge in vivo.
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Affiliation(s)
- Rimi Chowdhury
- Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, P-33 CIT Road Scheme XM, Beliaghata, Kolkata-700010, India.
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Adams DA, Thomas KR, Jajosky RA, Foster L, Baroi G, Sharp P, Onweh DH, Schley AW, Anderson WJ. Summary of Notifiable Infectious Diseases and Conditions - United States, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 64:1-143. [PMID: 28796757 DOI: 10.15585/mmwr.mm6453a1] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Summary of Notifiable Infectious Diseases and Conditions - United States, 2015 (hereafter referred to as the summary) contains the official statistics, in tabular and graphical form, for the reported occurrence of nationally notifiable infectious diseases and conditions in the United States for 2015. Unless otherwise noted, data are final totals for 2015 reported as of June 30, 2016. These statistics are collected and compiled from reports sent by U.S. state and territories, New York City, and District of Columbia health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). This summary is available at https://www.cdc.gov/MMWR/MMWR_nd/index.html. This site also includes summary publications from previous years.
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Affiliation(s)
- Deborah A Adams
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Kimberly R Thomas
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Ruth Ann Jajosky
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Loretta Foster
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Gitangali Baroi
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Pearl Sharp
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Diana H Onweh
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Alan W Schley
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
| | - Willie J Anderson
- Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC
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Chu JT, Hossain R, Silverblatt FJ, Hyle EP, Turbett SE. Case 22-2017. A 21-Year-Old Woman with Fever, Headache, and Myalgias. N Engl J Med 2017; 377:268-278. [PMID: 28723324 DOI: 10.1056/nejmcpc1616399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jacqueline T Chu
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Rydhwana Hossain
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Frederic J Silverblatt
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Emily P Hyle
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Sarah E Turbett
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
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Troiano G, Mercone A, Bagnoli A, Nante N. International Travelers' Sociodemographic, Health, and Travel Characteristics: An Italian Study. Ann Glob Health 2017; 83:380-385. [PMID: 28619415 DOI: 10.1016/j.aogh.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Approximately the 8% of travelers requires medical care, with the diagnosis of a vaccine-preventable disease. The aim of our study was to analyze the socio-demographic, health and travel characteristics of the Italian international travelers. METHODS We conducted a cross sectional study from January 2015 to June 2016, at the Travel Medicine Clinic of Siena, asking the doctor to interview patients who attended the Clinic, recording socio-demographic and travel information, malaria prophylaxis, vaccinations. The data were organized in a database and processed by software Stata®. RESULTS We collected 419 questionnaires. Patients chose 71 countries for their travels; the favorite destinations were: India (6.31%), Thailand (6.31%), and Brazil (5.10%). The mean length of stay was 36.17 days. Italians, students, and freelancers tended to stay abroad for a longer time (mean: 36.4 days, 59.87 days and 64.16 days respectively). 33.17% of our sample used drugs for malaria chemoprophylaxis: 71.9% of them used Atovaquone/Proguanil (Malarone®), 26.6% used Mefloquine (Lariam®), 1.5% other drugs. The vaccinations that travelers mostly got in our study were to prevent hepatitis A (n = 264), the typhoid fever (n = 187), the Tetanus + Diphtheria + Pertussis (n = 165), the Yellow fever (n = 118) and the cholera (n = 78). Twenty-eight (6.68%) refused some recommended vaccinations. The vaccines mostly refused were for Typhoid fever (n = 20), hepatitis a (n = 9), and cholera (n = 9). CONCLUSION Our results demonstrated that Italian international travelers are at-risk because of their poor vaccinations adherence. This implies that pre-travel counseling is fundamental to increase the knowledge of the risks and the compliance of future travelers.
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Affiliation(s)
- Gianmarco Troiano
- Post Graduate School of Public Health University of Siena, Siena, Italy.
| | - Astrid Mercone
- Public Hygiene and Nutrition, USL Tuscany Southeast, Tuscany, Italy
| | | | - Nicola Nante
- Post Graduate School of Public Health University of Siena, Siena, Italy
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Harichandran D, Dinesh KR. Antimicrobial susceptibility profile, treatment outcome and serotype distribution of clinical isolates of Salmonella enterica subspecies enterica: a 2-year study from Kerala, South India. Infect Drug Resist 2017; 10:97-101. [PMID: 28352198 PMCID: PMC5358982 DOI: 10.2147/idr.s126209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/purpose Typhoid and paratyphoid fever continue to be important causes of illness and death in parts of Asia, being associated with poor sanitation and consumption of unsafe food and water. Antimicrobial resistance has emerged to traditional first-line drugs, namely, the fluoroquinolones, as well as to third-generation cephalosporins, posing challenges to treatment. Azithromycin has proven to be an effective alternative for treatment of uncomplicated typhoid fever. The purpose of this study was to determine the antimicrobial susceptibility, clinical outcome and serotype distribution pattern of clinical isolates belonging to Salmonella enterica subspecies enterica. Methodology All clinical isolates of S. enterica obtained from blood, sterile body fluids, as well as stool and urine samples at Amrita Institute of Medical Sciences and Research Centre, Kerala, India, between August 2011 and July 2013 were included in the study and processed based on standard microbiology protocols. Results A total of 118 isolates of Salmonella were obtained during the study period. Out of these, 79 were of S. Typhi (66.95%), followed by isolates of S. Paratyphi A (22; 18.64%) and S. Typhimurium 12 (10.17%). Five isolates could not be identified further. There was 100% susceptibility to ceftriaxone in all S. enterica subspecies. Ciprofloxacin susceptibility was 32.91% for S. Typhi and 40.90% for S. Paratyphi A as determined by the disk diffusion method. The susceptibility profile of S. Typhi isolates to different antimicrobials was as follows: chloramphenicol (94.93%), ampicillin (77.21%), cotrimoxazole (75.94%) and azithromycin (78.48%). For S. Typhi, the minimum inhibitory concentration (MIC) of ciprofloxacin required to inhibit the growth of 50% of organisms was 0.5 μg/mL (intermediate) and MIC required to inhibit the growth of 90% of organisms was 1 μg/mL (resistant). S. Typhimurium was 100% susceptible to cotrimoxazole, ampicillin, ceftriaxone, chloramphenicol, ofloxacin and azithromycin. Susceptibility to ciprofloxacin was 66.66%. Patients from whom S. Typhimurium was isolated had comorbidities with documented risk. Of the 118 patients, 3 expired. Two had typhoid fever and were in sepsis at admission. One had S. Typhimurium and was suffering from multiple myeloma. Conclusion S. Typhi was the predominant isolate. All isolates were susceptible to ceftriaxone. Chloramphenicol susceptibility was >90%. No multidrug-resistant Salmonella strains were isolated. Susceptibility to ciprofloxacin for S. Typhi was 33%. Recovery rate was 97%.
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Affiliation(s)
- Deepa Harichandran
- Department of Microbiology, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Kavitha Radhakrishnan Dinesh
- Department of Microbiology, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
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Boggild AK, Liles WC. Travel-Acquired Illnesses Associated with Fever. THE TRAVEL AND TROPICAL MEDICINE MANUAL 2017. [PMCID: PMC7152166 DOI: 10.1016/b978-0-323-37506-1.00020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Requena-Méndez A, Berrocal M, Almela M, Soriano A, Gascón J, Muñoz J. Enteric fever in Barcelona: Changing patterns of importation and antibiotic resistance. Travel Med Infect Dis 2016; 14:577-582. [PMID: 27890811 DOI: 10.1016/j.tmaid.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enteric fever's incidence is decreasing among residents of high-income countries, although it's rising in travelers coming from low-resource endemic settings. The study's aim is to describe epidemiological, clinical and laboratory features of patients with enteric fever. METHODS Retrospective descriptive study of enteric fever cases diagnosed at a Tropical Medicine Unit in Barcelona, 1993-2012. RESULTS Out of 40 patients, 31(77,5%) were returning travelers, and 70% of them had been in Southern Asia. In the rest of patients without an antecedent of a recent travel, the infection occurred mainly before year 2000. The more frequently reported symptoms were fever and diarrhea, lacking significant differences between S. typhi and S. paratyphi infections. Quinolones were used as empiric treatment in 47.2% of patients, 36.1% received 3rd generation cephalosporins, 2.78% azithromycin and 13.89% other combinations. Resistance to quinolones in the S. paratyphi group (66.7%) was significantly higher compared with the S. typhi group (20%) (p:0.02). 22.5% of patients had treatment failure and 23.6% patients presented complications, none of them had been previously vaccinated. CONCLUSIONS The diagnosis of enteric fever was more frequent among travelers coming from Southern-East Asia. Quinolone resistance is widely spread, particularly in S. paratyphi serotypes and should not be considered as first choice treatment anymore.
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Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain.
| | - Monica Berrocal
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain
| | - Manuel Almela
- Department of Microbiology (CDB), Hospital Clínic, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain
| | - José Muñoz
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain
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Fate BH, Steele RW. Fever in a Returning Traveler. Clin Pediatr (Phila) 2016; 55:1180-2. [PMID: 26531177 DOI: 10.1177/0009922815614361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bryan H Fate
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Russell W Steele
- Tulane University School of Medicine, New Orleans, LA, USA University of Queensland School of Medicine, Brisbane, Queensland, Australia Ochsner Children's Health Center, New Orleans, LA, USA
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Ugas MB, Carroll T, Kovar L, Chavez-Bueno S. Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone. J Investig Med High Impact Case Rep 2016; 4:2324709616652642. [PMID: 27294165 PMCID: PMC4887870 DOI: 10.1177/2324709616652642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022] Open
Abstract
Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics.
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Affiliation(s)
| | - Timothy Carroll
- University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Lacey Kovar
- Acute Disease Service of the Oklahoma State Department of Health, Oklahoma City, OK, USA
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Date KA, Newton AE, Medalla F, Blackstock A, Richardson L, McCullough A, Mintz ED, Mahon BE. Changing Patterns in Enteric Fever Incidence and Increasing Antibiotic Resistance of Enteric Fever Isolates in the United States, 2008-2012. Clin Infect Dis 2016; 63:322-9. [PMID: 27090993 DOI: 10.1093/cid/ciw232] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Enteric fever in the United States has been primarily associated with travel and with worrisome changes in global patterns of antimicrobial resistance. We present the first comprehensive report of National Typhoid and Paratyphoid Fever Surveillance System (NTPFS) data for a 5-year period (2008-2012). METHODS We reviewed data on laboratory-confirmed cases reported to NTPFS, and related antimicrobial susceptibility results of Salmonella Typhi and Paratyphi A isolates sent for testing by participating public health laboratories to the Centers for Disease Control and Prevention's National Antimicrobial Resistance Monitoring System laboratory. RESULTS During 2008-2012, 2341 enteric fever cases were reported, 80% typhoid and 20% paratyphoid A. The proportion caused by paratyphoid A increased from 16% (2008) to 22% (2012). Foreign travel within 30 days preceding illness onset was reported by 1961 (86%) patients (86% typhoid and 92% paratyphoid A). Travel to southern Asia was common (82% for typhoid, 97% for paratyphoid A). Among 1091 (58%) typhoid and 262 (56%) paratyphoid A isolates tested for antimicrobial susceptibility, the proportion resistant to nalidixic acid (NAL-R) increased from 2008 to 2012 (Typhi, 60% to 68%; Paratyphi A, 91% to 94%). Almost all NAL-R isolates were resistant or showed decreased susceptibility to ciprofloxacin. Resistance to at least ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug resistant [MDR]) was limited to Typhi isolates, primarily acquired in southern Asia (13%). Most MDR isolates were also NAL-R. CONCLUSIONS Enteric fever in the United States is primarily associated with travel to southern Asia, and increasing resistance is adding to treatment challenges. A bivalent typhoid and paratyphoid vaccine is needed.
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Affiliation(s)
- Kashmira A Date
- Epidemic Intelligence Service, Office of Workforce and Career Development Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna E Newton
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Felicita Medalla
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Blackstock
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LaTonia Richardson
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andre McCullough
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara E Mahon
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lane RJ, Holland D, McBride S, Perera S, Zeng I, Wilson M, Read K, Jelleyman T, Ingram RJH. Enteric fever in the Pacific: a regional retrospective study from Auckland, New Zealand. Intern Med J 2015; 45:148-55. [PMID: 25404003 DOI: 10.1111/imj.12644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are limited clinical data on enteric fever in the Pacific and New Zealand (NZ) compared with the Indian subcontinent (ISC) and South-East Asia (SEA). Our objective was to describe enteric fever in Auckland - a large Pacific city, focusing on disease acquired in these regions. METHODS We reviewed enteric fever cases hospitalised in Auckland from January 2005 to December 2010. RESULTS Microbiologically confirmed EF was identified in 162 patients. Travel regions: Pacific, 40 cases (25%) (Samoa, 38; Fiji, two), ISC, 72 (44%), SEA, seven (4%), other, three (2%), no travel, 40 (25%). Enteric fever rates for Auckland resident travellers were: India 50.3/100 000; Samoa 19.7/100 000.All Pacific cases were Salmonella Typhi. Of local isolates (without travel history), 38 were S. Typhi (36 fully susceptible, one multi-drug resistant (MDR) + nalidixic acid resistant (NAR), one unknown) and two S. Paratyphi (both NAR). Of non-Pacific travel, 56/82 (69%) isolates were S. Typhi, the remainder S. Paratyphi (15 isolates were fully susceptible, only 1% were MDR). Significant associations of serotype and antibiotic resistance with different travel regions and similarity of phage types (local and Pacific) were observed. Headache, vomiting and acute kidney injuries were more frequent with Pacific travel, while abdominal distension and cholecystitis with local disease. Shorter duration of treatment in the Pacific group was seen despite length of stay in hospital not being reduced. Local cases were associated with longer hospital admissions. CONCLUSIONS One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin.
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Affiliation(s)
- R J Lane
- Infectious Diseases Department, Middlemore Hospital, Auckland, New Zealand; Infectious Diseases Department, Auckland City Hospital, Auckland, New Zealand
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Miyazu M, Kikuchi H, Hamada A, Fukushima S, Ouchi K, Bosch Castells V, Mihara H, Bonnet MC. A Japanese study to assess immunogenicity and safety of a typhoid Vi polysaccharide vaccine. Vaccine 2015; 33:6697-702. [DOI: 10.1016/j.vaccine.2015.10.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/28/2015] [Accepted: 10/17/2015] [Indexed: 11/26/2022]
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Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clin Microbiol Rev 2015; 28:901-37. [PMID: 26180063 PMCID: PMC4503790 DOI: 10.1128/cmr.00002-15] [Citation(s) in RCA: 623] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica, initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, Otago, New Zealand Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Sjölund-Karlsson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melita A Gordon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Singh L, Cariappa MP. Blood culture isolates and antibiogram of Salmonella: Experience of a tertiary care hospital. Med J Armed Forces India 2015; 72:281-4. [PMID: 27546970 DOI: 10.1016/j.mjafi.2015.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 07/23/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Enteric fevers contribute majorly to the burden of morbidity from infectious diseases in the developing world. Due to growing antibiotic resistance seen in their management, Salmonella and its various species are required to be periodically tested for sensitivity and resistance patterns, to guide the clinical management at the local level. This will also enable planning of antibiotic recycling wherever feasible. METHODS A retrospective study of the results of blood culture isolates covering a period of 27 months was done at a tertiary care hospital. Blood samples were directly inoculated in Bactalert culture bottles and sub culture was done on Mac Conkey and Salmonella-Shigella Agar. Non-lactose fermenting colonies were processed for identification, antibiotic sensitivity and MIC value. Slide agglutination test using specific antisera was also done to confirm the serotype. Antimicrobial susceptibility was done in accordance with CLSI standards. RESULTS 8413 blood samples were processed and 1027 (12.20%) were assessed as 'culture positive'. Salmonella were isolated in 46 samples of which 38 (83%) were Salmonella typhi and a single isolate was Salmonella paratyphi B. S.typhi showed maximum sensitivity to imipenem (100%) (MIC <0.25 μg/ml) followed by ciprofloxacin (76.8%) (MIC >1 μg/ml) and nalidixic acid (50%) (MIC ≥ 32 μg/ml). S. paratyphi B showed 100% sensitivity to all the common antibiotics. Four samples (8%) were classified as multi drug resistant (MDR). CONCLUSION Our study has shown improved sensitivity to ceftriaxone and cotrimoxazole. A high degree of susceptibility to ampicillin among both S. typhi and S.paratyphi A is encouraging. However, low susceptibility to nalidixic acid and ciprofloxacin is a cause for concern. There is a need for further clinical studies to evaluate the response to chloramphenicol in MDR cases and to formulate uniform laboratory guidelines to test antibiotic sensitivity of S. typhi isolates.
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Affiliation(s)
- Lavan Singh
- Senior Adviser (Path & Microbiology), Military Hospital Meerut, UP, India
| | - M P Cariappa
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
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Abstract
Salmonella are gram-negative bacilli within the family Enterobacteriaceae. They are the cause of significant morbidity and mortality worldwide. Animals (pets) are an important reservoir for nontyphoidal Salmonella, whereas humans are the only natural host and reservoir for Salmonella Typhi. Salmonella infections are a major cause of gastroenteritis worldwide. They account for an estimated 2.8 billion cases of diarrheal disease each year. The transmission of Salmonella is frequently associated with the consumption of contaminated water and food of animal origin, and it is facilitated by conditions of poor hygiene. Nontyphoidal Salmonella infections have a worldwide distribution, whereas most typhoidal Salmonella infections in the United States are acquired abroad. In the United States, Salmonella is a common agent for food-borne–associated infections. Several outbreaks have been identified and are most commonly associated with agricultural products. Nontyphoidal Salmonella infection is usually characterized by a self-limited gastroenteritis in immunocompetent hosts in industrialized countries, but it may also cause invasive disease in vulnerable individuals (eg, children less than 1 year of age, immunocompromised). Antibiotic treatment is not recommended for treatment of mild to moderate gastroenteritis by nontyphoidal Salmonella in immunocompetent adults or children more than 1 year of age. Antibiotic treatment is recommended for nontyphoidal Salmonella infections in infants less than 3 months of age, because they are at higher risk for bacteremia and extraintestinal complications. Typhoid (enteric) fever and its potential complications have a significant impact on children, especially those who live in developing countries. Antibiotic treatment of typhoid fever has become challenging because of the emergence of Salmonella Typhi strains that are resistant to classically used first-line agents: ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol. The choice of antibiotics for the management of typhoid fever should be guided by the local resistance pattern. Recommendations include using an extended spectrum cephalosporin, azithromycin, or a fluoroquinolone. Fecal carriage of Salmonella is an important factor in the spread of the organism to healthy individuals. The most important measures to prevent the spread and outbreaks of Salmonella infections and typhoid fever are adequate sanitation protocols for food processing and handling as well as hand hygiene. In the United States, 2 vaccines are commercially available against Salmonella Typhi. The WHO recommends the use of these vaccines in endemic areas and for outbreak control.
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IMANISHI M, NEWTON AE, VIEIRA AR, GONZALEZ-AVILES G, KENDALL SCOTT ME, MANIKONDA K, MAXWELL TN, HALPIN JL, FREEMAN MM, MEDALLA F, AYERS TL, DERADO G, MAHON BE, MINTZ ED. Typhoid fever acquired in the United States, 1999-2010: epidemiology, microbiology, and use of a space-time scan statistic for outbreak detection. Epidemiol Infect 2015; 143:2343-54. [PMID: 25427666 PMCID: PMC5207021 DOI: 10.1017/s0950268814003021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 09/25/2014] [Accepted: 10/20/2014] [Indexed: 01/04/2023] Open
Abstract
Although rare, typhoid fever cases acquired in the United States continue to be reported. Detection and investigation of outbreaks in these domestically acquired cases offer opportunities to identify chronic carriers. We searched surveillance and laboratory databases for domestically acquired typhoid fever cases, used a space-time scan statistic to identify clusters, and classified clusters as outbreaks or non-outbreaks. From 1999 to 2010, domestically acquired cases accounted for 18% of 3373 reported typhoid fever cases; their isolates were less often multidrug-resistant (2% vs. 15%) compared to isolates from travel-associated cases. We identified 28 outbreaks and two possible outbreaks within 45 space-time clusters of ⩾2 domestically acquired cases, including three outbreaks involving ⩾2 molecular subtypes. The approach detected seven of the ten outbreaks published in the literature or reported to CDC. Although this approach did not definitively identify any previously unrecognized outbreaks, it showed the potential to detect outbreaks of typhoid fever that may escape detection by routine analysis of surveillance data. Sixteen outbreaks had been linked to a carrier. Every case of typhoid fever acquired in a non-endemic country warrants thorough investigation. Space-time scan statistics, together with shoe-leather epidemiology and molecular subtyping, may improve outbreak detection.
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Affiliation(s)
- M. IMANISHI
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A. E. NEWTON
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A. R. VIEIRA
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G. GONZALEZ-AVILES
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. E. KENDALL SCOTT
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K. MANIKONDA
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - T. N. MAXWELL
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J. L. HALPIN
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. M. FREEMAN
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - F. MEDALLA
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - T. L. AYERS
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G. DERADO
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B. E. MAHON
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E. D. MINTZ
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Bacterial Gastroenteritis. Clin Microbiol Rev 2015; 28:3-31. [PMID: 25567220 DOI: 10.1128/cmr.00073-14] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bacterial gastroenteritis is a disease that is pervasive in both the developing and developed worlds. While for the most part bacterial gastroenteritis is self-limiting, identification of an etiological agent by bacterial stool culture is required for the management of patients with severe or prolonged diarrhea, symptoms consistent with invasive disease, or a history that may predict a complicated course of disease. Importantly, characterization of bacterial enteropathogens from stool cultures in clinical laboratories is one of the primary means by which public health officials identify and track outbreaks of bacterial gastroenteritis. This article provides guidance for clinical microbiology laboratories that perform stool cultures. The general characteristics, epidemiology, and clinical manifestations of key bacterial enteropathogens are summarized. Information regarding optimal specimen collection, transport, and processing and current diagnostic tests and testing algorithms is provided. This article is an update of Cumitech 12A (P. H. Gilligan, J. M. Janda, M. A. Karmali, and J. M. Miller, Cumitech 12A, Laboratory diagnosis of bacterial diarrhea, 1992).
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Antimicrobial susceptibility of travel-related Salmonella enterica serovar Typhi isolates detected in Switzerland (2002-2013) and molecular characterization of quinolone resistant isolates. BMC Infect Dis 2015; 15:212. [PMID: 25963025 PMCID: PMC4435775 DOI: 10.1186/s12879-015-0948-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
Background Typhoid fever is an acute, invasive, and potentially fatal systemic infection caused by Salmonella enterica subspecies enterica serotype Typhi (S. Typhi). Drug resistance to antimicrobials such as ciprofloxacin is emerging in developing countries, threatening the efficacy of treatment of patients in endemic regions as well as of travellers returning from these countries. Methods We compared the antimicrobial resistance profiles of 192 S. Typhi isolated from patients over a time span of twelve years. Susceptibility testing was done by the disk diffusion method. A representative selection of isolates (n = 41) was screened by PCR for mutations in the quinolone resistance-determining regions (QRDRs) of the gyrA and parC genes and all 192 isolates were screened for plasmid-mediated quinolone resistance (PMQR) genes. Multilocus sequence typing (MLST) was used to investigate the sequence type of isolates from patients with a known history of international travel. Results Resistance rates for nalidixic acid increased from 20 % to 66.7 % between 2002 and 2013. Resistance to ciprofloxacin was detected in 55.6 % of the isolates by 2013. Ciprofloxacin resistance was predominantly associated with the triple substitutions Ser83 → Phe and Asp87 → Asn in GyrA and Ser80 → Ile in ParC. The plasmid-mediated resistance gene qnrS1 was detected in two isolates. Sequence type ST1 was associated with the Indian subcontinent, while ST2 was distributed internationally. Multidrug resistance was noted for 11.5 % of the isolates. Conclusions Fluoroquinolone resistant S. Typhi constitute a serious public health concern in endemic areas as well as in industrialized countries. Increased surveillance of global patterns of antimicrobial resistance is necessary and the control of resistant strains is of the utmost importance to maintain treatment options. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0948-2) contains supplementary material, which is available to authorized users.
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