Salmonella typhi, typhoid fever, xdr, cephalosporin resistance, lahore, pakistan. Multidrug resistant salmonella typhi has been prevalent in india and the neighbouring countries since 1989. Pdf prevalence of current patterns and predictive trends. Drug resistance in salmonella has been on the rise in india with emergence of nalidixic acidresistant nar. In the past, first line antibiotics for the treatment of typhoid included chloramphenicol, ampicillin, and trimethoprimsulphamethoxazole.
Symptoms may vary from mild to severe, and usually begin 6 to 30 days after exposure. Isolation of multidrugresistant salmonella in singapore. Multi drug resistant salmonella enterica serovar typhi isolates with reduced susceptibility to ciprofloxacin in kenya winnie c. I know this because our laboratory has been sequencing the dna of s.
Salmonella enterica serovar typhi with intermediate susceptibility to. Typhi strains that infect people around the world, and we have found evidence for an accelerating evolution of resistance to antibiotics. Antimicrobial resistance of salmonella enterica serovars. Typhi, which are resistant to the firstline recommended drugs for. Drugresistant enteric fever is widespread in low and middleincome countries. Typhi and limiting the risk of treatment failure in the patient and outbreaks in the community must be prioritized. Enteric fever has persistence of great impact in sudanese public health especially during rainy season when the causative agent salmonella enterica serovar typhi possesses pan endemic patterns in most regions of sudankhartoum.
Typhi is resistant to all but two antibiotic classes recommended for treatment macrolides and carbapenems. Extensively drug resistant salmonella typhi infections emerge among travelers to or from pakistanunited states, 20162018 grace d. Genotypic analysis of multidrugresistant salmonella. To determine burden of multi drug resistance among salmonella typhi isolates of enteric fever at a tertiary care hospital. The aim of this study was to gain insight into the substrate specificity of previously uncharacterized transporters of salmonella typhi to identify their role in the development of multidrug resistance.
Typhi isolates from kenya produced an indistinguishable pfge pattern that was related to those of sensitive strains but unrelated to those of mdr s. High prevalence of multi drug resistant salmonella typhi and s. Mdr strains have also been isolated with increasing frequency from immigrant workers in. To identify the phenotypic trends in amr,833 individual s. Multidrug resistant salmonella typhi in delhi springerlink. Laboratorybased surveillance of salmonella serotype typhi. Drugresistant salmonella serotype typhi pathogen page pdf icon.
Multidrug resistance in salmonella enterica serovar typhi. The aim of this study was to determine the prevalence of salmonella enterica serovar typhi in patients with pyrexia of unknown origin puo, and antimicrobial resistance in strains isolated from patients with s. Emergence of an extensively drugresistant salmonella. A predominant pfge clone circulating in zimbabwe, south africa, zambia and tanzania, argues for crossborder cooperation in the control of this disease. Consecutive 161 children with enteric fever were included in this study. Typhi is frequently isolated in india, and highlevel cip resistant s. Although the management of typhoid fever has been effectively through antibiotic treatment, s. Pdf why is eradicating typhoid fever so challenging. Typhoid and paratyphoid fever oxford academic journals.
Article information, pdf download for drugresistant salmonella. Online supplementary document journal of global health. In 1990, we isolated 158 strains ofsalmonella typhi from blood cultures of patients suffering from typhoid fever. A case of multidrugresistant salmonella enterica serovar. Pdf multidrug resistant salmonella enterica serovar typhi. Enteric fever in cambodian children is dominated by multidrug resistant h58 salmonella enterica serovar typhi with decreased susceptibility to ciprofloxacin. Emergence of extensively drugresistant salmonella typhi. Typhoid in kenya is associated with a dominant multidrug. In early 2018, an outbreak of salmonella typhi resistant to thirdg. There are an increasing number of sporadic reports of ceftriaxone resistant s. Drugresistant enteric fever worldwide, 1990 to 2018. India is a wellknown geographical source of h58 with high cip resistance 11.
First case of typhoid fever due to extensively drugresistant. Original article from the new england journal of medicine multidrug resistant salmonella enterica serotype typhimurium associated with pet rodents. Often there is a gradual onset of a high fever over several days. Multidrugresistant salmonella enterica serotype typhi. Azithromycin, multidrug resistant salmonella typhi, nalidixic acid, salmonella. Typhi genes encoding putative members of the major facilitator superfamily were cloned and expressed in the drughypersensitive escherichia. Laboratory characterisation of salmonella enterica. We report the emergence in kenya during 19971999 of typhoid fever due to salmonella enterica serovar typhi resistant to ampicillin, tetracycline, chloramphenicol, streptomycin, and cotrimoxazole.
Typhoid and paratyphoid fever known as enteric fever pose important global public health problem, with 21. Azithromycin resistance in clinical isolates of salmonella. Multidrugresistant salmonella enterica serotype typhi, gulf of. Genotyping by pulsedfield gel electrophoresis of xbaidigested chromosomal dna yielded a single cluster. A retrospective study of multidrug resistant salmonella. The cdc first identified the multidrug resistant strain salmonella enterica serotype newport in september 2018 during an outbreak investigation. During 19892002, we studied the antimicrobial resistance of 3928 blood culture isolates of salmonella enterica serotype typhi s. This study assessed the antimicrobial susceptibility patterns of salmonella enterica serotype typhi s. Multidrug resistant salmonella enterica serovar typhi isolates with. Appiah, md louise francois watkins, md, mph division of foodborne, waterborne and environmental diseases coca call march 19, 2019. Multidrugresistant salmonella is a wellrecognised problem worldwide, especially in developing countries such as india, where nontyphoidal salmonella infections and enteric fever are endemic. This study describes the use of whole genome sequencing. It is a prevalent disease in indonesia, but data on the antimicrobial resistance pattern is limited. Increasing multidrug and fluoroquinolone resistance among salmonella typhi from sporadic outbreaks in kenya susan kavai, robert onsare, joyce mwituria, samuel kariuki centre for microbiology research, kenya medical research institute background.
Since 2016, the province of sindh is in the limelight because of its association with the emergence and spread of extensively drug resistant salmonella typhi xdr s. Multidrug resistant salmonella typhi and antimicrobial. Department of agricultures food safety and inspection service usdafsis monitored the outbreak. By 1997, 60% of salmonella enterica serotype typhi and paratyphi isolates in some parts of india had ciprofloxacin mics of. Although its global spread has been proven in several studies, our information regarding its countrywide existence is still insufficient. Antimicrobial resistance, molecular epidemiology, molecular subtyping, pfge, salmonella typhi, zimbabwe.
Typhoid fever, also known simply as typhoid, is a bacterial infection due to a specific type of salmonella that causes symptoms. Typhoid fever caused by the bacterium salmonella enterica serovar typhi s. We report the emergence in kenya during 19971999 of typhoid fever due to salmonella enterica serovar typhi resistant to ampicillin, tetracycline, chloramphenicol. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to thirdgeneration cephalosporins or azithromycin. This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting. Increasing multidrug and fluoroquinolone resistance among. Outbreak of multidrugresistant salmonella infections. Typhoid fever is a potentially severe and occasionally lifethreatening bacteraemic illness caused by salmonella enterica serovar typhi s.
Genotypic analysis of multidrugresistant salmonella enterica. Typhi causes an estimated 25 million illnesses and approximately 200,000 deaths annually mostly in developing countries. The emergence and outbreak of multidrug resistant typhoid fever in china. In the early 1990s there were many reports about the increasing frequency of multiresistant strains of salmonella typhi. In 2002, after giving a presentation at the annual convention of the society of internal medicine of nepal, a nepalese physician asked me what they could use to treat multidrug resistant typhoid. Emerging highlevel ciprofloxacinresistant salmonella. Multidrug resistant salmonella typhi and antimicrobial agent quality and bioavailability increasing incidence of multidrug resistant salmonella typhi has been a scourge for those afflicted with enteric fever all over the world. Typhi is increasingly becoming resistant to the currently recommended drugs. Cdc and public health and regulatory officials in several states investigated a multistate outbreak of multidrug resistant salmonella infections linked to raw chicken products.
Increasing resistance was also noticed to the other antibiotics, especially to the cephalosporins. Typhi, defined as strains resistant to these firstline antibiotics emerged in the late 1980s 10, 11. Ujmr, volume 1 number 1 december, 2016 umyu journal of microbiology research a retrospective study of multidrug resistant salmonella typhi in nigeria oyedum, u. In the uk, the decreased susceptibility of s typhi to ciprofloxacin had increased from 27% in 1995 to 5% in 199697, and further to 21% in 1998, and most of the. Antibiotic resistance is a major problem in salmonella enterica serovar typhi, the causative agent of typhoid. Antimicrobial resistance, particularly to fluoroquinolones, is common and leads to the frequent use of alternative agents, such as azithromycin. Ceftriaxone is the drug of choice for typhoid fever and the emergence of resistant salmonella typhi raises major concerns for treatment. Context multidrug resistant salmonella serotype typhi infections have been reported worldwide, but data on the incidence of resistant strains in the united states are lacking objectives to determine the incidence of antimicrobial resistant salmonella typhi infections and to identify risk factors for infection design crosssectional laboratorybased surveillance study. This study aim was to provide data on the antimicrobial resistance pattern of s. Rising prevalence of enteric fever due to multidrug. Vaccination before travel to countries where the disease is common may prevent typhoid fever.
Typhi lineage, h58, are responsible for multidrug resistance in kenya and parts of southeast asia, suggesting intercontinental spread of a single mdr clone. Annually, it is estimated that over 26 million people are culture positive for s. The present study aims to assess the recent state of antibiotics susceptibility of salmonella typhi with special concern to multidrug resistance strains and. Typhi paratyphi, and a significant proportion of isolates are. During the 1990s, this clone acquired a large conjugative inchi1 pst6 plasmid encoding resistance to. To a lesser extent, the prevalence of fq resistance in nontyphoidal salmonella isolates throughout the world has also been rising. Mechanisms of antibiotic resistance in salmonella typhi. Genomic signature of multidrug resistant salmonella enterica serovar typhi isolates related to a massive outbreak in zambia between 2010 and 2012. Prevalence of current patterns and predictive trends of.
Seventy nine 50% of these isolates were found to be simultaneously resistant to chloramphenicol, ampicillin and cotrimoxazole. Enteric fever is a systemic infection, caused by the gramnegative bacteria salmonella enterica subspecies enterica serovars typhi and paratyphi a, that continues to be a significant cause of morbidity and mortality in endemic regions. Ceftriaxoneresistant salmonella typhi carries an inci1. Multidrug resistant mdr salmonella enterica serotypes typhi and paratyphi a has become an emerging problem in endemic countries. This cross sectional study was done at department of pediatric medicine, nishtar medical university and hospital, multan from june 2017 to december 2018. Since 1989, strains of salmonella typhi resistant to chloramphenicol, ampicillin, and trimethoprim i. Multidrug resistance resistance to chloramphenicol, ampicillin and cotrimoxazole sequentially increased from 34 % in 1999 to 66 % in 2005. Extensively drug resistant xdr salmonella typhi causing a typhoid fever outbreak in pakistan is susceptible only to azithromycin and carbapenems. Typhi were isolated in the summer and monsoon months.
Multidrugresistant salmonella typhi in india the lancet. Typhoid fever tf caused by salmonella typhi remains a major public health problem in kenya. The occurrence of macrolide resistance in clinical salmonella enterica serovars typhi and paratyphi is of particular significance in bangladesh where azithromycin is a commonly used drug against most diseases. High prevalence of multidrug resistant salmonella typhi and s. Given the emergence of this aggressive mdr haplotype, careful selection and monitoring of antibiotic usage will be required in kenya, and potentially other regions of subsaharan africa. Multidrug resistant mdr isolates are prevalent in parts of asia and africa and are often associated with the dominant h58 haplotype. Emergence of multidrugresistant salmonella enterica. A study of the sensitivity pattern of salmonella in northern india found an increase in mdrst from. Rationale of azithromycin prescribing practices for enteric fever in. Muigai2, peter waiyaki3 and samuel kariuki3 abstract background. In the indian subcontinent and southeast asia, the multidrugresistant mdr salmonella typhi h58 clone, which was named after its haplotype a combination of.
An overview of extensively drugresistant salmonella typhi. Enteric fever continues to be a public health problem in the indian subcontinent including bangladesh. The bacteria that causes typhoid fever, salmonella typhi, is a smart one. Multidrugresistant salmonella enterica serovar typhi treated with a bench to bedside approach 149 yonsei med j vol. Multidrugresistant typhoid fever mdrtf is defined as typhoid fever caused by salmonella enterica serovar typhi strains s. Pdf characterization of class 1 integrons and antibiotic resistance. Hendriksen rs, leekitcharoenphon p, lukjancenko o, et al. Typhi was recently isolated from a domestic patient12. Multidrug resistant salmonella enterica serovar typhi. An outbreak of multidrug resistant salmonella serotype typhimurium definitive type 104 dt104 infections in humans and cattle in vermont. Emergence of resistance to fluoroquinolones and third. Why is eradicating typhoid fever so challenging mdpi.
Drugresistant salmonella typhi in pakistan christine e. Enteric fever has persistence of great impact in sudanese public health especially during rainy season when the causative agent salmonella enterica serovar typhi possesses pan endemic patterns in most regions of sudan khartoum. In total, 103 patients were included in this study, subdivided into two categories. Emergence and dissemination of multidrugresistant salmonella enterica can have a major. However, fq resistant salmonella strains were detected soon thereafter 7, 8. Plasmids were absent, but class 1 integrons were present in 80% of the isolates. Decreased susceptibility to azithromycin has been rare among nontyphoidal salmonella that cause human infections in the united states, said the reports senior author cindy friedman, md, an epidemiologist in the cdcs enteric diseases branch. Antibiotic susceptibilities of salmonella enterica serovar typhi. Analysis of trends in resistance to fluoroquinolones and. Since 2016, an ongoing outbreak of xdr typhoid fever has sickened more than 5,000 people in pakistan, and 11 children in the united states who traveled to or from pakistan. Typhi were related to earlier drugsusceptible isolates but were.