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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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Parker EM, Valcanis M, Edwards LJ, Andersson P, Mollenkopf DF, Wittum TE. Antimicrobial-resistant Salmonella is detected more frequently in feed milling equipment than in raw feed components or processed animal feed. Aust Vet J 2022; 100:213-219. [PMID: 35040117 PMCID: PMC9304270 DOI: 10.1111/avj.13146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Food for human and animal consumption can provide a vehicle for the transfer of pathogenic and antimicrobial‐resistant bacteria into the food chain. We investigated the antimicrobial susceptibility of 453 Salmonella isolates collected from raw feed components, equipment and finished feed from 17 commercial feed mills in Australia between 2012 and 2021. Previous studies have found Salmonella prevalence and the diversity of Salmonella serotypes are greatest in the raw feed components. We, therefore, hypothesised that we would find a greater proportion of antimicrobial‐resistant Salmonella isolates in the raw feed components compared to other sample types. We found that of 453 isolates tested, 356 (0.80) were susceptible to all antimicrobials tested, 49 (0.11) were nonsusceptible to streptomycin only and 48 (0.11) were resistant to two or more antimicrobials. Of the 48 antimicrobial‐resistant isolates, 44 were found in feed milling equipment, two in raw feed components and two in finished feed. Statistical analysis, using a logistic regression with random effects model, found that the population‐adjusted mean probability of detecting antimicrobial‐resistant Salmonella isolates from feed milling equipment of 0.39, was larger than the probability of detecting resistant isolates in raw feed components 0.01, (P < 0.001) and in finished feed, 0.11, (P = 0.006). This propensity for antimicrobial‐resistant bacteria to colonise feed milling equipment has not been previously reported. Further studies are required to understand the ecology of antimicrobial‐resistant Salmonella in the feed milling environment.
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Affiliation(s)
- E M Parker
- The Department of Veterinary Preventive Medicine, The Ohio State University, 1920, Coffey Road, Columbus, Ohio, 43210, USA
| | - M Valcanis
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - L J Edwards
- Ridley AgriProducts Pty Ltd, 70-80, Bald Hill Road, Pakenham, Victoria, 3810, Australia
| | - P Andersson
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - D F Mollenkopf
- The Department of Veterinary Preventive Medicine, The Ohio State University, 1920, Coffey Road, Columbus, Ohio, 43210, USA
| | - T E Wittum
- The Department of Veterinary Preventive Medicine, The Ohio State University, 1920, Coffey Road, Columbus, Ohio, 43210, USA
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Shaheen A, Tariq A, Iqbal M, Mirza O, Haque A, Walz T, Rahman M. Mutational Diversity in the Quinolone Resistance-Determining Regions of Type-II Topoisomerases of Salmonella Serovars. Antibiotics (Basel) 2021; 10:antibiotics10121455. [PMID: 34943668 PMCID: PMC8698434 DOI: 10.3390/antibiotics10121455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/24/2023] Open
Abstract
Quinolone resistance in bacterial pathogens has primarily been associated with mutations in the quinolone resistance-determining regions (QRDRs) of bacterial type-II topoisomerases, which are DNA gyrase and topoisomerase IV. Depending on the position and type of the mutation (s) in the QRDRs, bacteria either become partially or completely resistant to quinolone. QRDR mutations have been identified and characterized in Salmonella enterica isolates from around the globe, particularly during the last decade, and efforts have been made to understand the propensity of different serovars to carry such mutations. Because there is currently no thorough analysis of the available literature on QRDR mutations in different Salmonella serovars, this review aims to provide a comprehensive picture of the mutational diversity in QRDRs of Salmonella serovars, summarizing the literature related to both typhoidal and non-typhoidal Salmonella serovars with a special emphasis on recent findings. This review will also discuss plasmid-mediated quinolone-resistance determinants with respect to their additive or synergistic contributions with QRDR mutations in imparting elevated quinolone resistance. Finally, the review will assess the contribution of membrane transporter-mediated quinolone efflux to quinolone resistance in strains carrying QRDR mutations. This information should be helpful to guide the routine surveillance of foodborne Salmonella serovars, especially with respect to their spread across countries, as well as to improve laboratory diagnosis of quinolone-resistant Salmonella strains.
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Affiliation(s)
- Aqsa Shaheen
- Department of Biochemistry and Biotechnology, Hafiz Hayat Campus, University of Gujrat, Gujrat 50700, Pakistan
- Correspondence: (A.S.); (M.R.); Tel.: +92-53-3643112-187 (A.S.); +92-42-35953122 (M.R.)
| | - Anam Tariq
- Drug Discovery and Structural Biology Group, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad 38000, Pakistan; (A.T.); (M.I.)
| | - Mazhar Iqbal
- Drug Discovery and Structural Biology Group, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad 38000, Pakistan; (A.T.); (M.I.)
| | - Osman Mirza
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Abdul Haque
- Human Infectious Diseases Group, Akhuwat First University, Faisalabad 38000, Pakistan;
| | - Thomas Walz
- Laboratory of Molecular Electron Microscopy, Rockefeller University, New York, NY 10065, USA;
| | - Moazur Rahman
- School of Biological Sciences, Quaid-I-Azam Campus, University of the Punjab, Lahore 54590, Pakistan
- Correspondence: (A.S.); (M.R.); Tel.: +92-53-3643112-187 (A.S.); +92-42-35953122 (M.R.)
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Aljindan RY, Alkharsah KR. Pattern of increased antimicrobial resistance of Salmonella isolates in the Eastern Province of KSA. J Taibah Univ Med Sci 2020; 15:48-53. [PMID: 32110182 PMCID: PMC7033400 DOI: 10.1016/j.jtumed.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The antimicrobial resistance of Salmonella species is increasing worldwide. This study was conducted to determine the pattern of antimicrobial susceptibility of Salmonella species in a tertiary hospital from 2011 to 2018. METHODS In this retrospective study, the medical records of all patients with Salmonella infections were reviewed. The clinical, demographic, and microbiological data of the selected patients were analysed. RESULTS A total of 752 patients were included. The resistance of Salmonella species to antimicrobial drugs increased from 24.6% in 2011 to 37.8% in 2018 (p = 0.002). By 2018 all Salmonella isolates were completely resistant to cefalotin, cefuroxime, and cefoxitin, while we found some susceptibility to other cephalosporins and ciprofloxacin. The most commonly isolated Salmonella serogroups were groups D (36.5%), C (23.5%), and B (11.7%). CONCLUSIONS The incidence of resistance of Salmonella to antibiotics is on the rise. The results of this study highlight the need for an active monitoring system of antibiotic usage in humans and domestic animals.
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Affiliation(s)
- Reem Y. Aljindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA
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Joshi S, Adhikary R, Beena HB, Bhavana MV, Bhalwar R. Trends in antibiotic susceptibility of enteric fever isolates from South India, 2002–2013. Med J Armed Forces India 2019; 75:81-85. [DOI: 10.1016/j.mjafi.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
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Williamson DA, Lane CR, Easton M, Valcanis M, Strachan J, Veitch MG, Kirk MD, Howden BP. Increasing Antimicrobial Resistance in Nontyphoidal Salmonella Isolates in Australia from 1979 to 2015. Antimicrob Agents Chemother 2018; 62:e02012-17. [PMID: 29180525 PMCID: PMC5786757 DOI: 10.1128/aac.02012-17] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
Abstract
Australia has high and increasing rates of salmonellosis. To date, the serovar distribution and associated antimicrobial resistance (AMR) patterns of nontyphoidal Salmonella enterica (NTS) in Australia have not been assessed. Such information provides critical knowledge about AMR in the food chain and informs decisions about public health. We reviewed longitudinal data on NTS in two Australian states over a 37-year period, between 1979 and 2015, and antimicrobial resistance since 1984. Overall, 17% of isolates were nonsusceptible to at least one antimicrobial, 4.9% were nonsusceptible to ciprofloxacin, and 0.6% were nonsusceptible to cefotaxime. In total, 2.5% of isolates were from invasive infections, with no significant difference in AMR profiles between invasive and noninvasive isolates. Most isolates with clinically relevant AMR profiles were associated with travel, particularly to Southeast Asia, with multiple "incursions" of virulent and resistant clones into Australia. Our findings represent the largest longitudinal surveillance system for NTS in Australia and provide valuable public health knowledge on the trends and distribution of AMR in NTS. Ongoing surveillance is critical to identify local emergence of resistant isolates.
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Affiliation(s)
- Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marion Easton
- Department of Health and Human Services, Victoria, Australia
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Janet Strachan
- Department of Health and Human Services, Victoria, Australia
| | - Mark G Veitch
- Department of Health and Human Services, Tasmania, Australia
| | | | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
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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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8
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Besser JM. Salmonella epidemiology: A whirlwind of change. Food Microbiol 2017; 71:55-59. [PMID: 29366469 DOI: 10.1016/j.fm.2017.08.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/01/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
The field of infectious disease epidemiology for Salmonella and other enteric pathogens is undergoing some of the most profound changes since the time of Kauffman and White. Rapid advances in "big data" technologies such as genomics and metagenomics are making it possible to monitor and control salmonellosis in new and exciting ways. Epidemiological methods are becoming increasingly robust through the routine use of standardized hypothesis-generating questionnaires, iterative open-ended interviewing, informational trace-backs and new modeling techniques for describing the attribution of disease to food sources. In addition, Salmonella epidemiology is facing important challenges and new opportunities due to the rapid adoption of culture independent diagnostic test panels by clinical laboratories. Where is this unprecedented wave of change taking us? This chapter will examine emerging trends in Salmonella epidemiology, and take a peek into the not-so-distant future.
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Affiliation(s)
- John M Besser
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C03, Atlanta, GA 30329, United States.
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9
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Abstract
Typhoid fever is an important cause of morbidity and mortality in the developing world, particularly in children, but is infrequently observed in the developed world and can occur in patients without a significant travel history. Rhabdomyolysis as a complication has rarely been reported, and never in a child. A child with Salmonella enterica serovar Typhi septicemia, complicated by rhabdomyolysis, encephalopathy and pancreatitis is described and all 15 reported cases to date are summarized.
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10
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Sparham SJ, Kwong JC, Valcanis M, Easton M, Trott DJ, Seemann T, Stinear TP, Howden BP. Emergence of multidrug resistance in locally-acquired human infections with Salmonella Typhimurium in Australia owing to a new clade harbouring bla CTX-M-9. Int J Antimicrob Agents 2017; 50:101-105. [PMID: 28476613 DOI: 10.1016/j.ijantimicag.2017.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 10/19/2022]
Abstract
Antimicrobial resistance in non-typhoidal Salmonella is a critical problem globally, with the emergence of resistance to third-generation cephalosporins (3GCs) a particular concern. The aim of this study was to use whole-genome sequencing (WGS) to characterise recently identified human and non-human isolates of 3GC-resistant Salmonella enterica subsp. enterica serovar Typhimurium from Australia. The Illumina NextSeq sequencing platform was used to determine the genome sequences of 78 S. Typhimurium definitive type 44 isolated in Australia between 1992 and 2016, including 31 3GC-resistant isolates. Phylogenetic and bioinformatics analyses were subsequently performed using a number of in silico tools. We report the emergence of 3GC resistance in locally-acquired Australian S. Typhimurium for the first time. Phenotypically resistant isolates of human and animal origin were geographically restricted and were found by WGS all to be closely related and to carry blaCTX-M-9. Dairy cattle were the suspected source based on geographical clustering of animal isolates, which were predominantly bovine in origin. In conclusion, locally-acquired human cases of S. Typhimurium carrying blaCTX-M-9 were identified that appear to be of bovine origin, raising concerns regarding the human impact of off-label use of ceftiofur in cattle.
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Affiliation(s)
- Sarah J Sparham
- Microbiological Diagnostic Unit Public Health Laboratory, Melbourne, VIC, Australia; Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia
| | - Jason C Kwong
- Microbiological Diagnostic Unit Public Health Laboratory, Melbourne, VIC, Australia; Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia; Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, Melbourne, VIC, Australia
| | - Marion Easton
- Department of Health and Human Services, Victorian Government, Australia
| | - Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Melbourne, VIC, Australia; Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia; Melbourne Bioinformatics, The University of Melbourne, Carlton, VIC, Australia
| | - Timothy P Stinear
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Melbourne, VIC, Australia; Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia; Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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Lane CR, Sutton B, Valcanis M, Kirk M, Walker C, Lalor K, Stephens N. Travel Destinations and Sexual Behavior as Indicators of Antibiotic Resistant Shigella Strains--Victoria, Australia. Clin Infect Dis 2015; 62:722-729. [PMID: 26679624 DOI: 10.1093/cid/civ1018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Knowledge of relationships between antibiotic susceptibility of Shigella isolates and travel destination or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia. METHODS We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobial sensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors, including recent travel. Data were analyzed using Stata 13.1 to examine associations between risk factors and resistant strains. RESULTS Of the 500 cases of shigellosis, 249 were associated with overseas travel and 210 were locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel-related isolates were resistant to all tested oral antimicrobials. Male-to-male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections among adult males, characterized by distinct periodic Shigella sonnei outbreaks. CONCLUSIONS Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.
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Affiliation(s)
- Courtney R Lane
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne
- Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Australia
| | - Brett Sutton
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
| | - Cathryn Walker
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne
| | - Karin Lalor
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne
| | - Nicola Stephens
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne
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Emergence of Ciprofloxacin-Resistant Salmonella enterica Serovar Typhi in Italy. PLoS One 2015; 10:e0132065. [PMID: 26121266 PMCID: PMC4488240 DOI: 10.1371/journal.pone.0132065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/09/2015] [Indexed: 11/21/2022] Open
Abstract
In developed countries, typhoid fever is often associated with persons who travel to endemic areas or immigrate from them. Typhoid fever is a systemic infection caused by Salmonella enterica serovar Typhi. Because of the emergence of antimicrobial resistance to standard first-line drugs, fluoroquinolones are the drugs of choice. Resistance to ciprofloxacin by this Salmonella serovar represents an emerging public health issue. Two S. enterica ser. Typhi strains resistant to ciprofloxacin (CIP) were reported to the Italian surveillance system for foodborne and waterborne diseases (EnterNet-Italia) in 2013. The strains were isolated from two Italian tourists upon their arrival from India. A retrospective analysis of 17 other S. enterica ser. Typhi strains isolated in Italy during 2011–2013 was performed to determine their resistance to CIP. For this purpose, we assayed for susceptibility to antimicrobial agents and conducted PCR and nucleotide sequence analyses. Moreover, all strains were typed using pulsed-field gel electrophoresis to evaluate possible clonal relationships. Sixty-eight percent of the S. enterica ser. Typhi strains were resistant to CIP (MICs, 0.125–16 mg/L), and all isolates were negative for determinants of plasmid-mediated quinolone resistance. Analysis of sequences encoding DNA gyrase and topoisomerase IV subunits revealed mutations in gyrA, gyrB, and parC. Thirteen different clonal groups were detected, and the two CIP-resistant strains isolated from the individuals who visited India exhibited the same PFGE pattern. Because of these findings, the emergence of CIP-resistant S. enterica ser. Typhi isolates in Italy deserves attention, and monitoring antibiotic susceptibility is important for efficiently managing cases of typhoid fever.
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Dave J, Sefton A, de Pinna E, Woodford N, Meade R, Jordan M, Grant K, Holliman R, Millar M. Trends in antibiotic susceptibility of enteric fever isolates in East London. Travel Med Infect Dis 2015; 13:230-4. [DOI: 10.1016/j.tmaid.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
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Abstract
Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas, especially those in Africa. The main barriers to control are vaccines that are not immunogenic in very young children and the development of multidrug resistance, which threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow surveillance and to implement control measures.
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Affiliation(s)
- John Wain
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Rene S Hendriksen
- National Food Institute, Technical University of Denmark, WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and European Union Reference Laboratory for Antimicrobial Resistance, Kongens Lyngby, Denmark
| | - Matthew L Mikoleit
- National Enteric Reference Laboratory Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Division in the National Health Laboratory Service (NHLS), Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Teh CSJ, Chua KH, Thong KL. Paratyphoid fever: splicing the global analyses. Int J Med Sci 2014; 11:732-41. [PMID: 24904229 PMCID: PMC4045793 DOI: 10.7150/ijms.7768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/05/2014] [Indexed: 11/24/2022] Open
Abstract
The incidence of enteric fever caused by Salmonella enterica serovar Paratyphi A (S. Paratyphi A) is increasing in many parts of the world. Although there is no major outbreak of paratyphoid fever in recent years, S. Paratyphi A infection still remains a public health problem in many tropical countries. Therefore, surveillance studies play an important role in monitoring infections and the emergence of multidrug resistance, especially in endemic countries such as India, Nepal, Pakistan and China. In China, enteric fever was caused predominantly by S. Paratyphi A rather than by Salmonella enterica serovar Typhi (S. Typhi). Sometimes, S. Paratyphi A infection can evolve into a carrier state which increases the risk of transmission for travellers. Hence, paratyphoid fever is usually classified as a "travel-associated" disease. To date, diagnosis of paratyphoid fever based on the clinical presentation is not satisfactory as it resembles other febrile illnesses, and could not be distinguished from S. Typhi infection. With the availability of Whole Genome Sequencing technology, the genomes of S. Paratyphi A could be studied in-depth and more specific targets for detection will be revealed. Hence, detection of S. Paratyphi A with Polymerase Chain Reaction (PCR) method appears to be a more reliable approach compared to the Widal test. On the other hand, due to increasing incidence of S. Paratyphi A infections worldwide, the need to produce a paratyphoid vaccine is essential and urgent. Hence various vaccine projects that involve clinical trials have been carried out. Overall, this review provides the insights of S. Paratyphi A, including the bacteriology, epidemiology, management and antibiotic susceptibility, diagnoses and vaccine development.
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Affiliation(s)
- Cindy Shuan Ju Teh
- 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
| | - Kek Heng Chua
- 2. Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
| | - Kwai Lin Thong
- 3. Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur
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Comeau JL, Tran TH, Moore DL, Phi CM, Quach C. Salmonella enterica serotype Typhi infections in a Canadian pediatric hospital: a retrospective case series. CMAJ Open 2013; 1:E56-61. [PMID: 25077103 PMCID: PMC4006666 DOI: 10.9778/cmajo.20120012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In developed countries, typhoid fever generally occurs in travellers or recent immigrants from endemic areas. Our aim was to describe the epidemiology of Salmonella enterica serotype Typhi infections among children presenting to a pediatric teaching hospital in Montréal, Quebec. METHODS We included all patients less than 18 years of age who presented to the Montreal Children's Hospital between 1991 and 2011 with a laboratory-confirmed diagnosis of typhoid fever (Salmonella enterica ser. Typhi isolated from blood or stool) in a retrospective case series. RESULTS During the study period, we identified 39 cases of typhoid fever (mean age of patient 7.5 yr). Four (10.3%) of these cases occurred in newly arrived immigrants shortly after their arrival in Canada (median 15.5 d). Most cases (76.9%) occurred in children who had visited friends and relatives in their home country. None of the travellers had received a vaccination against typhoid fever before their departure. All cases presented with high fever (mean temperature 40.4°C) that lasted for a mean of 15.8 days. Common accompanying symptoms included anorexia, abdominal pain, vomiting and diarrhea. All 39 isolates of S. enterica ser. Typhi were susceptible to third-generation cephalosporins, and 7 were resistant to ciprofloxacin. Ampicillin resistance occurred in 10 (25.6%) of the isolates. No deaths occurred among the study participants. INTERPRETATION Most cases of typhoid fever occurred in children who had travelled to endemic areas to visit friends and relatives. Thus, there is a role for increased awareness on the part of family physicians and pediatricians caring for these children to discuss travel-related infections during regularly scheduled appointments, because parents might not consult travel clinics or discuss their travel plans before travelling back to their home country.
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Affiliation(s)
- Jeannette L. Comeau
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Thai Hoa Tran
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Dorothy L. Moore
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Chi-Minh Phi
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Caroline Quach
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
- Department of Microbiology, Montreal Children’s Hospital, McGill University, Montréal, Que
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