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Britto CD, Mathias S, Bosco A, Dyson ZA, Dougan G, Raveendran S, Abin VL, Jose S, Nagaraj S, Holt KE, Pollard AJ. Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes. Trop Med Health 2020; 48:58. [PMID: 32684794 PMCID: PMC7359007 DOI: 10.1186/s41182-020-00247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND India is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors.Blood culture surveillance was conducted at St. John's Medical College Hospital, Bangalore, between July 2016 and June 2017. Clinical, laboratory and demographic data were collected from each case, and bacterial isolates were subjected to whole genome sequencing. Comparative analysis between adults and paediatric patients was carried out to ascertain differences between adult and paediatric disease. RESULTS Among the 113 cases of blood culture-confirmed enteric fever, young adults (16-30 years) and children < 15 years accounted for 47% and 37% of cases, respectively. Anaemia on presentation was seen in 46% of cases, and 19% had an abnormal leucocyte count on presentation. The majority received treatment as inpatients (70%), and among these, adults had a significantly longer duration of admission when compared with children (p = 0.002). There were atypical presentations including arthritis, acute haemolysis and a case of repeated typhoid infection with two separate S. Typhi genotypes. There was no association between infecting genotype/serovar and treatment status (outpatient vs inpatient), month of isolation, duration of admission, patient age (adult or child), antimicrobial susceptibility, Widal positivity or haematologic parameters. CONCLUSIONS Amidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors. Robust clinical surveillance as well monitoring of pathogen population structure is required to inform treatment and preventive strategies.
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Affiliation(s)
- Carl D. Britto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE UK
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
- Division of Infectious Disease, St. John’s Research Institute, Bengaluru, 560034 India
| | - Sitarah Mathias
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
| | - Ashish Bosco
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
| | - Zoe A. Dyson
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Savitha Raveendran
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - V. L. Abin
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Sanju Jose
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Savitha Nagaraj
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Kathryn E. Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE UK
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