Primary Anterior Thoracic Wall Abscess with Osteomyelitis by Salmonella paratyphi A : Case Report

Salmonella enterica serovar Typhi and Paratyphi have been imputed in the causation of enteric fever. Cardiovascular and extraintestinal Salmonella infections have been documented among immunocompromised individuals. Rarely these pathogens are ascribed in the causation of extraintestinal infections among immunocompetent hosts due to hematogenous seeding. We report a case of anterior chest wall abscess with osteomyelitis in an immunocompetent adult by Salmonella paratyphi A without any prior predisposing conditions or gastrointestinal symptoms. The patient underwent incision and drainage of the loculated pus and the involved costochondral junction was curetted. Medical management was guided by automated antibiotic susceptibility testing. Patient responded well to treatment and was discharged with no residual morbidities. Prompt diagnosis complements appurtenant treatment and thereby averts defunct consequential sequelae.

Case report of infective spondylodiscitis due to nalidixic acid-resistant Salmonella paratyphi A

Spondylodiscitis due to typhoidal Salmonella presents a therapeutic challenge for clinicians. Factors that complicate treatment include drug-resistant strains, poor antibiotic bone penetration, potential for neurological compromise and lack of established protocols and guidelines. We discuss a 57-year-old man with Salmonella paratyphi A spondylodiscitis involving lower thoracic vertebrae and discuss various aspects of management.

Highly adaptable and sensitive FRET-based aptamer assay for the detection of Salmonella paratyphi A

Here we demonstrate a facile and versatile fluorescence resonance energy transfer (FRET) based aptasensor for rapid detection of Salmonella paratyphi A. The assay shows a detection limit up to 10 cfu·mL^-1 with no cross-reactivity with other bacterial species. Less than 8% of inter-assay coefficient variance and recovery rate between 85 and 102% attests the assay reliability. The advantages of FRET-based aptamer assay over the conventional immunoassay formats such as ELISA are the specificity, speed, reliability, and simplicity of the assay. The ssDNA aptamers specific towards pathogenic Salmonella paratyphi A were generated via whole-cell SELEX. The aptamer was conjugated onto quantum dot (QD) that served as the molecular beacon and graphene oxide (GO) was used as a fluorescence quencher. Thus the proposed method enables detection of target pathogen using FRET-based assay. Further interaction of aptamer with pathogen protein DNA gyrase was explored using classical molecular dynamics simulation.

Simultaneous and high sensitive detection of Salmonella typhi and Salmonella paratyphi a in human clinical blood samples using an affordable and portable device

Enteric fever is one of the leading causes of infection and subsequent fatality (greater than 1.8 million) (WHO 2018), especially in the developing countries due to contaminated water and food inter twinned with unhygienic practices. Clinical gold standard technique of culture-based method followed by biochemical tests demand 72+ hours for diagnosis while newly developed techniques (like PCR, RT-PCR, DNA microarray etc.) suffer from high limit of detection or involve high-cost infrastructure or both. In this work, a quick and highly specific method, SMOL was established for simultaneous detection of Salmonella paratyphi A and Salmonella typhi in clinical blood samples. SMOL consists of (i) pre-concentration of S. typhi and S. paratyphi A cells using magnetic nanoparticles followed by (ii) cell lysis and DNA extraction (iii) amplification of select nucleic acids by LAMP technique and (iv) detection of amplified nucleic acids using an affordable portable device (costs less than $70). To identify the viability of target cells at lower concentrations, the samples were processed at two different time periods of t = 0 and t = 4 h. Primers specific for the SPA2539 gene in S. paratyphi A and STY2879 gene in S. typhi were used for LAMP. Within 6 h SMOL was able to detect positive and negative samples from 55 human clinical blood culture samples and detect the viability of the cells. The results were concordant with culture and biochemical tests as well as by qPCR. Statistical power analysis yielded 100%. SMOL results were concordant with culture and biochemical tests as well as by qPCR. The sensitive and affordable system SMOL will be effective for poor resource settings.

Characterization and protective efficacy of a Salmonella pathogenicity island 2 (SPI2) mutant of Salmonella Paratyphi A

Paratyphoid fever caused by Salmonella Paratyphi A is a serious public health problem in many countries. In order to and develop a live attenuated candidate vaccine of Salmonella Paratyphi A, a Salmonella pathogenicity island 2 (SPI2, approximate 40 kb) deletion mutant of Salmonella Paratyphi A was constructed by lambda Red recombination, then the biological characteristics and protective ability of the Salmonella Paratyphi A SPI2 mutant were evaluated. Our results showed that the growth and biochemical properties of the SPI2 mutant were consistent with that of its parent strain, and the mutant was stable with the loss of SPI2. The mice lethal test showed that the virulence of the SPI2 mutant was significantly decreased, it can colonize and persistent more than 14 days in the liver and spleen of mice. Vaccination with the SPI2 mutant in mice revealed no significant effect on body weight and clinical symptoms compared to control animals, and specific humoral and cellular immune responses were also significantly induced. Immunization of mice offered efficient protection against Salmonella Paratyphi A strain challenge at 14 days post vaccination based on mortality and clinical symptoms relative to control group. Overall, these findings suggested that SPI2 plays an important role in pathogenicity of Salmonella Paratyphi A, and the SPI2 mutant showed its potential to develop a live attenuated vaccine candidate.

[Characteristics of molecular typing and drug resistance of 67 Salmonella paratyphi A isolated in Zhengzhou from 2013 to 2015]

Objective: To investigate the antimicrobial resistance and pulsed field gel electrophoresis (PFGE) patterns of S.paratyphi A strains in Zhengzhou city isolated from sentinel hospitals in 2013-2015. Methods: According to Salmonella molecular typing and K-B drug susceptibility testing method published by international PulseNet bacterial infectious disease monitoring network and USA Clinical and Laboratory Standards Institute (CLSI2015), we analyzed drug sensitivity and PFGE molecular characteristics of 67 S.paratyphi A strains(11 strains in 2013, 7 strains in 2014, 49 strains in 2015) isolated from blood and stool samples in two sentinel hospitals of fever with rash syndrome surveillance system established in Zhengzhou city in 2013-2015. Results: The results showed 67 strains of S.paratyphi A had different levels of resistance to 13 kinds of antibiotics, 65 strains were multi-drug resistant strains (97.0%), 5 isolates were resistant to 2-3 kinds of antibiotics (7.5%), 41 isolates were resistant to 5-8 kinds of antibiotics (61.2%),11 isolates were resistant to 9-10 kinds of antibiotics(16.4%),8 isolates were resistant to 11-12 kinds of antibiotics(11.9%). 67 strains of S.paratyphi A were divided into 10 molecular patterns(PTYA1-PTYA10) by digestion with XbaⅠ restriction endonuclease and pulsed field gel electrophoresis, each pattern contains 1-48 strains with similarity ranged from 94.31%-100%. PTYA3 contained 48 strains, which was predominant band type; PTYA1, 9 contained 6 strains; PTYA 2, 4, 5, 6, 7, 8, 10 contained 1 strains among them. Conclusion: The status of drug resistance of clinical isolates of S.paratyphi A in Zhengzhou city was rather serious, PFGE patterns showed diversity and dominant characteristics. The PFGE patterns of partial strains and its corresponding anti-drug spectrum have certain relevance and cluster relationship.

[Taq Man probe-based quadruple real-time PCR for detection of Salmonella paratyphi A/B/C and Salmonella typhi]

OBJECTIVE

Establishment and application of Taq Man probe-based quadruple real-time PCR for detection of Salmonella paratyphi A/B/C and Salmonella typhi. Primers specific to Salmonella paratyphi A( SPAP), Salmonella paratyphi B( SPBP), Salmonella paratyphi C( SPCP), and Salmonella typhi( STP) were designed.

METHODS

A method of Taq Man probe-based quadruple real-time PCR was established according to the distinction of the 5'end of the probe mark of TET, ROX, FAM and HEX. 5 strains of SPA, 4 strains of SPB, 7 strains of SPC and 11 strains of ST were identified by amplification from SPAP, SPBP, SPCP and STP.

RESULTS

While other serotypes of salmonella and17 strains of non-salmonella got negative results of amplification. Amplification rate of SPAP, SPBP, SPCP, and STP were 84. 5%, 101. 8%, 92. 4% and 90. 9%, respectively. The linear correlation coefficient( R~2) were 0. 996, 0. 975, 0. 996 and 0. 984, respectively.

CONCLUSION

The PCR system is specific and sensitive for the identification of SPA, SPB, SPC and ST.

[An outbreak of paratyphoid fever in a county of Yunnan province, 2010-2011]

Objective: To identify the source and to comment on control program regarding an outbreak of paratyphoid A fever in a county, through field studies. Methods: Descriptive epidemiological methods were adopted to describe the epidemiological characteristics of the outbreak, which occurred in Yuanjiang county, Yunan province between 2010-2011, China. Case-control study with environmental investigation was performed to identify related risk factors and pathogens while isolation and susceptibility on the suspected pathogens were conducted. Subsequently, intervention and preventive measures were taken for the control of the outbreak. Results: A total of 600 cases were diagnosed and reported as paratyphoid fever A which spread over the whole Yuanjiang county, including 10 townships with different incidence rates. The disease was spatially clustered and the prevalence rates in these townships decreased with increasing distances from the polluted fields. Data from the case-control study discovered that consumption of raw vegetables was the main risk factor associated with this outbreak of paratyphoid fever (OR=65.3, P<0.001). Management of patients did not meet the requirements while feces and urine of the outpatients polluted the wastewater system in the city. Salmonella paratyphi A isolates were identified from the improperly disinfected wastewaters in hospitals and city systems, respectively. After the measures as prohibiting the planting of vegetables in contaminated fields and disinfection of hospital wastewater were taken, the outbreak subsided. Conclusions: Urban and hospital wastewater used for vegetables irrigation together with the tradition of eating uncooked vegetables seemed responsible for the outbreak of this paratyphoid fever. Intervention programs carried by the local government played a key role in controlling this large outbreak.

Antibiogram of Salmonella Isolates: Time to Consider Antibiotic Salvage

INTRODUCTION

Enteric fever is a major problem especially in developing countries. Timely and appropriate treatment plays a very important role in reducing the mortality. Fluoroquinolones and cephalosporins are the treatment options for enteric fever. Recent studies have shown that it is time to reconsider the use of earlier antibiotics.

AIM

The study was aimed to know whether salvage is possible and to avoid treatment failures following fluoroquinolone usage.

MATERIALS AND METHODS

A one year retrospective data of Salmonella species isolated from 319 blood samples from our hospital and other diagnostic centers were studied. Demographic data, organism isolated and their changing pattern of antibiogram were analysed.

RESULTS

Out of 319 Salmonella isolates, 52.4% (167) was Salmonella typhi (S. typhi) and 47.6% (152) Salmonella paratyphi A (S. paratyphi A), with a male preponderance. Most of the salmonellae were isolated in the months of June and July, with the majority being in the 1-10 and 21-30 years age groups. Both species were highly susceptible to chloramphenicol (95.2% and 100%) followed by third generation cephalosporins (97% and 98%), cotrimoxazole (95.8% and 98.6%) and ampicillin (94.6% and 93.4%) respectively. Highest resistance was seen for nalidixic acid (90.4% and100%) among both S. typhi and S. paratyphi A isolates followed by ciprofloxacin (62.2% and 54.6%) respectively. MDR to first line drugs was observed in a small proportion of S. typhi (1.7%) only.

CONCLUSION

The frequency of isolation of S. typhi and S. paratyphi A are in equal proportion and enteric fever is more prevalent in younger age group. It is ideal to adopt bivalent vaccination in Universal immunization schedule. The isolates show sensitivity to first line drugs, paving the way for salvage of the earlier drugs. Cephalosporins still remain the treatment of choice in MDR salmonella isolates.

Status of paratyphoid fever vaccine research and development

Salmonella enterica serovars Typhi and Paratyphi (S. Paratyphi) A and B cause enteric fever in humans. Of the paratyphoid group, S. Paratyphi A is the most common serovar. In 2000, there were an estimated 5.4 million cases of S. Paratyphi A worldwide. More recently paratyphoid fever has accounted for an increasing fraction of all cases of enteric fever. Although vaccines for typhoid fever have been developed and in use for decades, vaccines for paratyphoid fever have not yet been licensed. Several S. Paratyphi A vaccines, however, are in development and based on either whole cell live-attenuated strains or repeating units of the lipopolysaccharide O-antigen (O:2) conjugated to different protein carriers. An O-specific polysaccharide (O:2) of S. Paratyphi A conjugated to tetanus toxoid (O:2-TT), for example, has been determined to be safe and immunogenic after one dose in Phase I and Phase II trials. Two other conjugated vaccine candidates linked to diphtheria toxin and a live-attenuated oral vaccine candidate are currently in preclinical development. As promising vaccine candidates are advanced along the development pipeline, an adequate supply of vaccines will need to be ensured to meet growing demand, particularly in the most affected countries.

Structural analysis of the O-acetylated O-polysaccharide isolated from Salmonella paratyphi A and used for vaccine preparation

Salmonella paratyphi A is increasingly recognized as a common cause of enteric fever cases and there are no licensed vaccines against this infection. Antibodies directed against the O-polysaccharide of the lipopolysaccharide of Salmonella are protective and conjugation of the O-polysaccharide to a carrier protein represents a promising strategy for vaccine development. O-Acetylation of S. paratyphi A O-polysaccharide is considered important for the immunogenicity of S. paratyphi A conjugate vaccines. Here, as part of a programme to produce a bivalent conjugate vaccine against both S. typhi and S. paratyphi A diseases, we have fully elucidated the O-polysaccharide structure of S. paratyphi A by use of HPLC-SEC, HPAEC-PAD/CD, GLC, GLC-MS, 1D and 2D-NMR spectroscopy. In particular, chemical and NMR studies identified the presence of O-acetyl groups on C-2 and C-3 of rhamnose in the lipopolysaccharide repeating unit, at variance with previous reports of O-acetylation at a single position. Moreover HR-MAS NMR analysis performed directly on bacterial pellets from several strains of S. paratyphi A also showed O-acetylation on C-2 and C-3 of rhamnose, thus this pattern is common and not an artefact from O-polysaccharide purification. Conjugation of the O-polysaccharide to the carrier protein had little impact on O-acetylation and therefore should not adversely affect the immunogenicity of the vaccine.

High Specific DNAzyme-Aptamer Sensor for Salmonella paratyphi A Using Single-Walled Nanotubes-Based Dual Fluorescence-Spectrophotometric Methods

In this work, single-stranded DNA aptamers that are highly specific to enterotoxigenic Salmonella paratyphi A were obtained from an enriched oligonucleotide pool using Systematic Evolution of Ligands by Exponential Enrichment (SELEX) to target the flagellin protein. The selected aptamers were confirmed to have high sensitivity and specificity to the flagellin. In addition, a probe (P0) containing the DNAzyme and fluorescein isothiocyanate-labeled aptamer3 sequences was employed as a dual probe for observing fluorescence and absorbance changes. The flagellin demonstrated low detection limits of 5 ng/mL by fluorescence and 20 ng/mL by spectrophotometry. Moreover, milk samples spiked with Salmonella paratyphi A were also detected, with the low detection limits increasing to 10(5) CFU/mL by fluorescence and 10(6)CFU/mL by spectrophotometry. The combination of fluorescence and spectrophotometry offers a specific, rapid, and sensitive way for detecting Salmonella paratyphi A and has potential for detecting other pathogens in food.

Determination of baseline widal titres amongst apparently healthy blood donors in ahmednagar, maharashtra, India

BACKGROUND

Enteric fever is endemic in all parts of India. The Widal agglutination test is widely used for its diagnosis. But the interpretation of Widal test depends upon the baseline titre which is prevalent amongst healthy individuals in a particular geographical area.

AIM

Present study was undertaken to establish the normal baseline titre in apparently healthy blood donors and also to determine cutoff values for the Widal test.

MATERIAL AND METHODS

One hundred and three (103) sera were tested by the Widal tube agglutination test from January 2012 to February 2013.

RESULTS

Eighty four (81.55%) sera were positive for agglutinins (titre ≥ 1:20) and the remaining 19 were negative. 31.64% sera were positive for agglutinins of 'O' antigen of Salmonella typhi (TO) at a titre of 1:40, 33.87% sera were positive for 'H' antigen of Salmonella typhi (TH) at a titre of 1:40 and 38.46% and 36.84% sera were positive for 'H' antigen of Salmonella paratyphi A (AH) and Salmonella paratyphi B (BH) respectively, both at a titre of 1:80.

CONCLUSION

Therefore, the baseline titre for TO and TH was noted to be 1:40 and that for AH and BH was noted to be 1:80 and therefore, the cutoff level for TO and TH was ≥ 1:80 and that for AH and BH was ≥ 1:160.

Comparison of Salmonella typhi and Paratyphi A Occurrence in a Tertiary Care Hospital

BACKGROUND

Enteric fever is an important public health problem in many underdeveloped and developing countries. In India, though Salmonella enterica serotype Typhi remains the predominant Salmonella species causing enteric fever, isolation of Salmonella enterica serotype Paratyphi A is increasing. It occurs in all age groups and more common in summer season affecting mainly children.

AIMS

To find out the isolation rate of Salmonella typhi and paratyphi A with reference to age, sex and seasonal variation attending a tertiary care hospital.

MATERIAL AND METHODS

A descriptive study was done on the Salmonella species isolated from blood cultures for 5 years. Data was collected regarding basic information like age, sex, different months and years.

RESULTS

A total of 292 Salmonellae species were included in the study during the period of 5 years. Out of 292 isolates of Salmonellae, 160 were S. typhi and 132 were S. paratyphi A. Both Salmonella species showed male preponderance in all age groups. Salmonella typhi and paratyphi A were highest in the age group 11 - 20 years followed by 21 - 30 years. Highest number of cases were isolated from July - September (123 cases) followed by October - December (81 cases).

CONCLUSION

Occurrence of S. typhi and paratyphi A are increasing which may be due to the improved diagnostics techniques or increased drug resistance. School going children and adolescents in our study were higher, requiring education classes.

Revised Ciprofloxacin Breakpoints for Salmonella: Is it Time to Write an Obituary?

OBJECTIVES

To determine the minimum inhibitory concentration of ciprofloxacin among 50 blood stream isolates of Salmonella enterica.

MATERIAL AND METHODS

A total of 50 consecutive isolates of Salmonella enterica were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Minimum inhibitory concentrations were determined using Hi-Comb strips. All results were interpreted according to the CLSI guidelines.

RESULTS

Of the 50 isolates 70%were Salmonella Typhi, 4% Salmonella paratyphi A, 2% Salmonella paratyphi B and the remaining 10% were identified only as Salmonella species. Using the CLSI 2011 breakpoints for disc diffusion, 86% (43/50) were resistant to nalidixic acid(NA), 22% (11/50) to ciprofloxacin, 12% to azithromycin, 6% to cotrimoxazole, 4% to ampicillin and 1% to chloramphenicol. The MIC50 and MIC90 of ciprofloxacin for S.Typhi were 0.181 μg/mL and 5.06 μg/mL respectively. While the same for S. paratyphi A was 0.212μg/mL and 0.228μg/mL respectively. None of the isolates were multi drug resistant and all were susceptible to ceftriaxone. Using the CLSI 2012 revised ciprofloxacin breakpoints for disc diffusion (>31mm) & MIC (<0.06 μg/mL), 90% (45/50) of these isolates were found to be resistant.

CONCLUSION

MIC's of ciprofloxacin should be reported for all salmonella isolates and should be used to guide treatment. Blindly following western guidelines for a disease which is highly endemic in the subcontinent will spell the death knell of a cheap and effective drug in our armamentarium. Therefore it will be too premature to declare that "the concept of using ciprofloxacin in typhoid fever is dead!"