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Poonia, B., Khan, I., Makkar, A., Rajmohan, K., Kumar, D., Malik, A., Gupta, S., Banerjee, P., Panda, P., Gupta, R. (2018). Typhoidal Salmonella and Emerging Resistance in Outbreak Proportions. International Journal of Travel Medicine and Global Health, 6(2), 64-68. doi: 10.15171/ijtmgh.2018.12
Bindu Poonia; Inam Danish Khan; Anuradha Makkar; KS Rajmohan; Deepak Kumar; Amandeep Malik; Shilpi Gupta; Priyanka Banerjee; Pragyan Swagatika Panda; Rajiv Mohan Gupta. "Typhoidal Salmonella and Emerging Resistance in Outbreak Proportions". International Journal of Travel Medicine and Global Health, 6, 2, 2018, 64-68. doi: 10.15171/ijtmgh.2018.12
Poonia, B., Khan, I., Makkar, A., Rajmohan, K., Kumar, D., Malik, A., Gupta, S., Banerjee, P., Panda, P., Gupta, R. (2018). 'Typhoidal Salmonella and Emerging Resistance in Outbreak Proportions', International Journal of Travel Medicine and Global Health, 6(2), pp. 64-68. doi: 10.15171/ijtmgh.2018.12
Poonia, B., Khan, I., Makkar, A., Rajmohan, K., Kumar, D., Malik, A., Gupta, S., Banerjee, P., Panda, P., Gupta, R. Typhoidal Salmonella and Emerging Resistance in Outbreak Proportions. International Journal of Travel Medicine and Global Health, 2018; 6(2): 64-68. doi: 10.15171/ijtmgh.2018.12

Typhoidal Salmonella and Emerging Resistance in Outbreak Proportions

Article 4, Volume 6, Issue 2, Spring 2018, Page 64-68  XML PDF (257 K)
Document Type: Original Article
DOI: 10.15171/ijtmgh.2018.12
Authors
Bindu Poonia1; Inam Danish Khan 1; Anuradha Makkar1; KS Rajmohan1; Deepak Kumar1; Amandeep Malik1; Shilpi Gupta2; Priyanka Banerjee1; Pragyan Swagatika Panda1; Rajiv Mohan Gupta3
1Army College of Medical Sciences and Base Hospital, New Delhi, India
2Graded Specialist Microbiology, Military Hospital Bhopal, New Delhi, India
3Army Hospital Research and Referral, New Delhi, India
Receive Date: 10 December 2017,  Revise Date: 03 February 2018,  Accept Date: 04 February 2018 
Abstract
Introduction: Typhoidal Salmonella causes an invasive infection resulting in 200 000 deaths among 20 million patients annually. Typhoid remains a public health problem in Southeast Asia, the Indian subcontinent, Africa, and South America. Traveler’s diarrhea caused by Salmonella is common in Asia. Outbreaks of typhoidal Salmonella resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole in the 1990s pushed therapy to ciprofloxacin which was replaced by ceftriaxone due to fluoroquinolone resistance.
Methods: This prospective study characterizes demographical, etiological, and resistance patterns in typhoidal Salmonella at a 1000-bed teaching hospital in New Delhi, India. Two hundred inpatients in pediatrics, obstetrics-gynecology, medicine, intensive care, and OPD in whom Salmonella bacteremia was detected were characterized by routine and automated microbiology techniques.
Results: The mean age of patients in this study was 21.4 years. Overall, 71% of patients suffered from Salmonella Typhi followed by 26% from Salmonella Paratyphi A. Four cases of Salmonella resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol were encountered. A high degree of partial and complete resistance to fluoroquinolones was seen among Salmonella Typhi, Salmonella Paratyphi A, and Salmonella Paratyphi B cases. Resistance to ciprofloxacin was 48% among Salmonella Typhi and 100% among Salmonella Paratyphi A cases. Only 18% of Salmonella Typhi cases were completely resistant to quinolones, while 79% were partially resistant. A total of 92% of Salmonella Paratyphi A cases were partially resistant to quinolones. Four Salmonella cases were resistant to ceftriaxone.
Conclusion: Salmonella Typhi remains the predominant serotype, followed by Salmonella Paratyphi A. The high prevalence of quinolone resistance in Salmonella Typhi and Salmonella Paratyphi A is a serious problem limiting empirical therapy to non-quinolone-based therapy such as ceftriaxone. Multidrug-resistant Salmonella is an emerging problem requiring active surveillance among residents and travelers presenting with tropical fever.
Keywords
Salmonella; Typhoid; Multidrug Resistance; Fluoroquinolone Resistance; Traveler’s Diarrhea
References
  1. Kariuki S, Revathi G, Muyodi J, et al. Characterization of multidrug-resistant typhoid outbreaks in Kenya. J Clin Microbiol. 2004;42(4):1477-1482. doi:10.1128/JCM.42.4.1477-1482.2004.
  2. Salve A, Pichel M, Wiesner M, et al. Molecular subtyping of Salmonella enterica serovar Typhi isolates from Colombia and Argentina. Foodborne Pathog Dis. 2006;3(1):142-152. doi:10.1089/fpd.2006.3.142.
  3. Sinha A, Sazawal S, Kumar R, et al. Typhoid fever in children aged less than 5 years. Lancet. 1999;354(9180):734-737. doi:10.1016/S0140-6736(98)09001-1.
  4. Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL. Typhoid fever. Lancet. 2015;385(9973):1136-1145. doi:10.1016/S0140-6736(13)62708-7.
  5. Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012;2(1):010401. doi:10.7189/jogh.02.010401.
  6. Mogasale V, Maskery B, Ochiai RL, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health. 2014;2(10):e570-580. doi:10.1016/S2214-109X(14)70301-8
  7. Black RE. Epidemiology of travelers’ diarrhea and relative importance of various pathogens. Rev Infect Dis. 1990;12 Suppl 1:S73-79. doi:10.1093/clinids/12.Supplement_1.S73.
  8. Farthing M, Salam MA, Lindberg G, et al. Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol. 2013;47(1):12- 20. doi:10.1097/MCG.0b013e31826df662.
  9. Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine. J Infect Public Health. 2017. doi:10.1016/j.jiph.2017.06.004.
  10. Masyeni S, Sukmawati H, Paramasatiari L, et al. Diarrhea Among International Travelers in Bali-Indonesia: Clinical and Microbiological Finding. Int J Travel Med Glob Health. 2017;5(3):84-88. doi:10.15171/ijtmgh.2017.18.
  11. Paniker CK, Vimala KN. Transferable chloramphenicol resistance in Salmonella typhi. Nature. 1972;239(5367):109-110. doi:10.1038/239109b0.
  12. Olarte J, Galindo E. Salmonella typhi resistant to chloramphenicol, ampicillin, and other antimicrobial agents: strains isolated during an extensive typhoid fever epidemic in Mexico. Antimicrob Agents Chemother. 1973;4(6):597-601. doi:10.1128/AAC.4.6.597.
  13. Arora RK, Gupta A, Joshi NM, Kataria VK, Lall P, Anand AC. Multidrug resistant typhoid fever: study of an outbreak in Calcutta. Indian Pediatr. 1992;29(1):61-66.
  14. Mishra S, Patwari AK, Anand VK, et al. Multidrug resistant typhoid fever: therapeutic considerations. Indian Pediatr. 1992;29(4):443- 448.
  15. Sharma A, Gathwala G. Clinical profile and outcome in enteric fever. Indian Pediatr. 1993;30(1):47-50.
  16. Raman TS, Krishnamurthy L, Menon PK, Singh D, Jayaprakash DG. Clinical profile and therapy in enteric fever. Indian Pediatr. 1994;31(2):196-199.
  17. Butt T, Ahmad RN, Salman M, Kazmi SY. Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan. East Mediterr Health J. 2005;11(5-6):1038-1044.
  18. Chandel DS, Chaudhry R, Dhawan B, Pandey A, Dey AB. Drug-resistant Salmonella enterica serotype paratyphi A in India. Emerg Infect Dis. 2000;6(4):420-421. doi:10.3201/eid0604.000420.
  19. Qureshi AH, Mushahid N, Ijaz A, et al. Changing drug susceptibility pattern of Salmonella Paratyphi A. J Coll Physicians Surg Pak. 2001;11(7):449-451.
  20. Woods CW, Murdoch DR, Zimmerman MD, et al. Emergence of Salmonella enterica serotype Paratyphi A as a major cause of enteric fever in Kathmandu, Nepal. Trans R Soc Trop Med Hyg. 2006;100(11):1063-1067. doi:10.1016/j.trstmh.2005.12.011.
  21. Chau PY, Ng WS, Ling J, Arnold K. In vitro susceptibility of Salmonella to various antimicrobial agents, including a new cephalosporin, Ro 13-9904. Antimicrob Agents Chemother. 1981;19(1):8-11. doi: 10.1128/AAC.19.1.8.
  22. Singh L, Cariappa MP. Blood culture isolates and antibiogram of Salmonella: Experience of a tertiary care hospital. Med J Armed Forces India. 2016;72(3):281-284. doi:10.1016/j.mjafi.2015.07.007.
  23. Spika JS, Waterman SH, Hoo GW, et al. Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms. A major persisting source of human salmonellosis in California. N Engl J Med. 1987;316(10):565-570. doi:10.1056/NEJM198703053161001.
  24. DuPont HL, Ericsson CD, Farthing MJ, et al. Expert review of the evidence base for prevention of travelers’ diarrhea. J Travel Med. 2009;16(3):149-160. doi:10.1111/j.1708-8305.2008.00299.x.
  25. Khan ID, Sahni AK. Rapid Diagnosis of Dengue Outbreaks in Resource Limited Facilities. West Indian Med J. 2017;66(1):4-9. doi:10.7727/wimj.2016.095.
  26. Khan ID. Challenges and Opportunities in Diagnosis and Management of Infectious Diseases in Developing Country Healthcare System. J Basic Clin Med. 2016;5(1):1.
  27. Kendall ME, Crim S, Fullerton K, et al. Travel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009. Clin Infect Dis. 2012;54 Suppl 5:S480-487. doi:10.1093/cid/cis052.
  28. Punjabi NH, Agtini MD, Ochiai RL, et al. Enteric fever burden in North Jakarta, Indonesia: a prospective, community-based study. J Infect Dev Ctries. 2013;7(11):781-787. doi:10.3855/jidc.2629.
  29. Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK. A three-year review of antimicrobial resistance of Salmonella enterica serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries. 2014;8(8):981- 986. doi:10.3855/jidc.3817.
  30. Chand HJ, Rijal KR, Neupane B, Sharma VK, Jha B. Re-emergence of susceptibility to conventional first line drugs in Salmonella isolates from enteric fever patients in Nepal. J Infect Dev Ctries. 2014;8(11):1483-1487. doi:10.3855/jidc.4228.
  31. Chiou CS, Lauderdale TL, Phung DC, et al. Antimicrobial resistance in Salmonella enterica Serovar Typhi isolates from Bangladesh, Indonesia, Taiwan, and Vietnam. Antimicrob Agents Chemother. 2014;58(11):6501-6507. doi:10.1128/AAC.03608-14.
  32. Alam A. Pola resistensi Salmonella enterica Serotipe typhi, departement Ilmu Kesehatan anak RSHS, Tahun 2006–2010. Sari Pediatri. 2011;12(5):296-301. doi:10.14238/sp12.5.2011.2 96 -301.
  33. Moehario LH. The molecular epidemiology of Salmonella Typhi across Indonesia reveals bacterial migration. J Infect Dev Ctries. 2009;3(8):579-584. doi:10.3855/jidc.548.
  34. Bhutta ZA. Impact of age and drug resistance on mortality in typhoid fever. Arch Dis Child. 1996;75(3):214-217. doi:10.1136/adc.75.3.214.
  35. Khan ID, Sahni AK, Bharadwaj R, Lall M, Jindal AK, Sashindran VK. Emerging organisms in a tertiary healthcare set up. Med J Armed Forces India. 2014;70(2):120-128. doi:10.1016/j.mjafi.2013.09.005.
  36. Khan ID, Basu A, Kiran S, Trivedi S, Pandit P, Chattoraj A. Device- Associated Healthcare-Associated Infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit. Med J Armed Forces India. 2017;73(3):222-231. doi:10.1016/j.mjafi.2016.10.008.
  37. Jindal AK, Pandya K, Khan ID. Antimicrobial resistance: A public health challenge. Med J Armed Forces India. 2015;71(2):178-181. doi:10.1016/j.mjafi.2014.04.011.
  38. Khan ID, Gupta RM, Sen S, et al. Emerging Antimicrobial Resistance and Evolving Healthcare: Dangerous Crossroads for the Community and the Military. J Arch Mil Med. 2017;5(3):e12097. doi:10.5812/jamm.12097.
  39. Khan ID, Gupta N, Rangan NM, et al. Evaluation Of Pre and Post Analytical Variables in Clinical Microbiology Services in Multidisciplinary ICU of a Medical College And Tertiary Care Hospital. J Basic Clin Med. 2016;5(1):2-4.
  40. Khan ID, Sahni AK, Sen S, Gupta RM, Basu A. Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit. Med J Armed Forces India. 2017. doi:10.1016/j.mjafi.2017.07.012.
  41. Khan ID, Lall M, Sen S, Ninawe SM, Chandola P. Multiresistant Elizabethkingia meningoseptica infections in tertiary care. Med J Armed Forces India. 2015;71(3):282-286. doi:10.1016/j.mjafi.2014.02.002.
  42. Khan ID, Khan S, Khan MA, et al. Indian Medical Mission at Hajj- 2016: Mass-Gathering Medicine Perspectives, Challenges, and Opportunities in a Mission Posture. Int J Travel Medicine Glob Health. 2017;5(3):94-101. doi:10.15171/ijtmgh.2017.20.
  43. Khan ID, Hussaini SB, Khan S, et al. Emergency Response of Indian Hajj Medical Mission to Heat Illness Among Indian Pilgrims in Tent- Clinics at Mina and Arafat During Hajj, 2016. Int J Travel Med Glob Health. 2017;5(4):135-139. doi:10.15171/ijtmgh.2017.26.
  44. Ismayl G, Abdel Hadi H, Hussein A, et al. Practices and Attitudes to Prevention of Travel-related Infectious Diseases in United Arab Emirates. Int J Travel Med Glob Health. 2016;4(1):13-18. doi:10.20286/ijtmgh-040113.
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