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Nathania I, Nainggolan IM, Yasmon A, Nusatia ACM, Tjoa E, Gunardi WD, Moehario LH. Hotspots sequences of gyrA, gyrB, parC, and parE genes encoded for fluoroquinolones resistance from local Salmonella Typhi strains in Jakarta. BMC Microbiol 2022; 22:250. [PMID: 36253712 PMCID: PMC9578181 DOI: 10.1186/s12866-022-02666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background Infection of Salmonella enterica subsp. enterica serovar Typhi is the primary etiology of typhoid fever globally and is common in many developing countries, especially those with dense populations and poor environmental sanitation. Antibiotic fluoroquinolones were used for the treatment in the 1980s due to the resistance to the first-line antibiotics. However, many cases of treatment failure of fluoroquinolones in typhoidal patients have been reported from numerous countries in Asia, Europe, Africa, and America. Mutations in quinolone resistance determining regions (QRDR) genes, gyrA, gyrB, parC, and parE, are found in fluoroquinolone-resistant Salmonella Typhi. Contrast reports came from the S. Typhi isolates in Indonesia, mainly Jakarta and the surroundings, obtained from patients with typhoid fever, with good sensitivity to the fluoroquinolones, i.e., nalidixic acid, ciprofloxacin, moxifloxacin, and levofloxacin. The present study, therefore, aimed to identify the hotspot sequences of gyrA, gyrB, parC, and parE genes of the local S. Typhi strains based on their susceptibility to fluoroquinolones from patients with typhoid fever in Jakarta and its satellite cities. Results A total of 28 isolates were identified as S. Typhi. All isolates were susceptible to nalidixic acid, levofloxacin, and moxifloxacin. Twenty-seven isolates (96.4%) were susceptible to ciprofloxacin, with one isolate (3.6%) being intermediate. The hotspot sequences of gyrA, gyrB, parC, and parE genes from all isolates were identical to the fluoroquinolone-sensitive reference sequence Salmonella enterica subsp. enterica serovar Typhi Ty2 (NCBI GenBank AE014613.1), including the isolate with intermediate susceptibility. The mutation was not found, and amino acid deduced from all hotspots in susceptible and intermediate isolates showed no replacement in all reported codons. Conclusions This study showed that the local S. Typhi strains from Jakarta and surroundings were susceptible to fluoroquinolones (nalidixic acid, ciprofloxacin, levofloxacin, and moxifloxacin), and the hotspot sequences of the gyrA, gyrB, parC, and parE genes were all identical to the reference sequence. Thus, the hotspot sequences of the gyrA, gyrB, parC, and parE genes seemingly were conserved in Jakarta’s local S. Typhi strains and could be considered wild type. The phenotypic susceptibility was consistent with the genotypic characteristic without non-synonymous mutations associated with drug resistance. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02666-z.
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Affiliation(s)
- Ignes Nathania
- Department of Microbiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jalan Pluit Raya No. 2, North Jakarta, 14440, Indonesia
| | - Ita M Nainggolan
- Department of Clinical Pathology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jalan Pluit Raya No. 2, North Jakarta, 14440, Indonesia.,Eijkman Research Center for Molecular Biology, The National Research and Innovation Agency, Jalan Raya Jakarta Bogor No.46, Pakansari, Cibinong, Kabupaten Bogor, Jawa Barat, 16915, Indonesia
| | - Andi Yasmon
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Jalan Pegangsaan Timur 16, Jakarta, 10320, Indonesia
| | | | - Enty Tjoa
- Department of Microbiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jalan Pluit Raya No. 2, North Jakarta, 14440, Indonesia
| | - Wani D Gunardi
- Department of Microbiology, Krida Wacana Christian University, Jalan Arjuna Utara No. 6, Jakarta, 11510, Indonesia
| | - Lucky H Moehario
- Department of Microbiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jalan Pluit Raya No. 2, North Jakarta, 14440, Indonesia.
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Shi Y, Chen X, Shu J, Liu Y, Zhang Y, Lv Q, Wang J, Deng X, Liu H, Qiu J. Harmine, an inhibitor of the type III secretion system of Salmonella enterica serovar Typhimurium. Front Cell Infect Microbiol 2022; 12:967149. [PMID: 36176578 PMCID: PMC9513467 DOI: 10.3389/fcimb.2022.967149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
New therapeutic strategies for clinical Salmonella enterica serovar Typhimurium (S. Typhimurium) infection are urgently needed due to the generation of antibiotic-resistant bacteria. Inhibition of bacterial virulence has been increasingly regarded as a potential and innovative strategy for the development of anti-infection drugs. Salmonella pathogenicity island (SPI)-encoded type III secretion system (T3SS) represents a key virulence factor in S. Typhimurium, and active invasion and replication in host cells is facilitated by the secretion of T3SS effector proteins. In this study, we found that harmine could inhibit T3SS secretion; thus, its potential anti-S. Typhimurium infection activity was elucidated. Harmine inhibits the secretion and expression of T3SS effector proteins and consequently attenuates the S. Typhimurium invasion function of HeLa cells. This inhibition may be implemented by reducing the transcription of pathogenesis-related SPI-1 transcriptional activator genes hilD, hilC, and rtsA. Harmine improves the survival rate and bacterial loads of mice infected with S. Typhimurium. In summary, harmine, an effective T3SS inhibitor, could be a leading compound for the development of treatments for Salmonella infection.
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Affiliation(s)
- Yunjia Shi
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Xindi Chen
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Jingyan Shu
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Yang Liu
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Yong Zhang
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, State Key Laboratory for Zoonotic Diseases, The First Hospital of Jilin University, Changchun, China
| | - Qianghua Lv
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Jianfeng Wang
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Xuming Deng
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Hongtao Liu
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
- *Correspondence: Jiazhang Qiu, ; Hongtao Liu,
| | - Jiazhang Qiu
- Laboratory for Zoonotic Diseases, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
- *Correspondence: Jiazhang Qiu, ; Hongtao Liu,
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Shu J, Liu H, Liu Y, Chen X, Yu Y, Lv Q, Wang J, Deng X, Guo Z, Qiu J. Tannic Acid Inhibits Salmonella enterica Serovar Typhimurium Infection by Targeting the Type III Secretion System. Front Microbiol 2022; 12:784926. [PMID: 35145491 PMCID: PMC8822118 DOI: 10.3389/fmicb.2021.784926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Salmonella enterica serovar Typhimurium (S. Typhimurium) is a zoonotic pathogen that can cause food poisoning and diarrhea in both humans and animals worldwide. The Salmonella pathogenicity island (SPI) genes encoded type III secretion system (T3SS) is important for S. Typhimurium invasion and replication in host cells. Due to the increasing problem of antibiotic resistance, antibiotic treatment for clinical Salmonella infection has gradually been limited. Anti-virulence inhibitors are a promising alternative to antibiotics because they do not easily induce bacterial antibiotic resistance. Here, we systematically evaluated the therapeutic effect of tannic acid (TA) on Salmonella-infected mice and elucidated its anti-infection mechanism. TA treatment improved the survival rate of S. Typhimurium-infected mice and alleviated cecum pathological lesions. In addition, TA inhibited S. Typhimurium invasion to HeLa cells without affecting their growth. Further studies showed that TA could inhibit the expression of sipA and sipB. This inhibition may be implemented by inhibiting the transcription of key regulatory and structural genes of the T3SS. This study provides an alternative anti-virulence strategy for Salmonella infection treatment.
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Affiliation(s)
- Jingyan Shu
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Hongtao Liu
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Yang Liu
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Xindi Chen
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Yu Yu
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Qianghua Lv
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Jianfeng Wang
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Xuming Deng
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Zhimin Guo
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
- Zhimin Guo,
| | - Jiazhang Qiu
- Key Laboratory of Zoonosis, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
- *Correspondence: Jiazhang Qiu,
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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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Watkins RR, Bonomo RA. Overview: The Ongoing Threat of Antimicrobial Resistance. Infect Dis Clin North Am 2020; 34:649-658. [PMID: 33011053 DOI: 10.1016/j.idc.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The effectiveness of antibiotics continues to erode because of the relentless spread of antimicrobial resistance (AMR). Public and private foundations, professional organizations, and international health agencies recognize the threat posed by AMR and have issued calls for action. One of the main drivers of AMR is overprescription of antibiotics, both in human and in veterinary medicine. The One Health concept is a response from a broad group of stakeholders to counter the global health threat posed by AMR. In this article, we discuss current trends in AMR and suggest strategies to mitigate its ongoing dissemination.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH, USA; Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
| | - Robert A Bonomo
- Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Case VA Center for Antimicrobial Resistance and Epidemiology (Case VA-CARES), Case Western Reserve University, Cleveland, OH, USA
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6
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Andrews JR, Vaidya K, Bern C, Tamrakar D, Wen S, Madhup S, Shrestha R, Karmacharya B, Amatya B, Koju R, Adhikari SR, Hohmann E, Ryan ET, Bogoch II. High Rates of Enteric Fever Diagnosis and Lower Burden of Culture-Confirmed Disease in Peri-urban and Rural Nepal. J Infect Dis 2019; 218:S214-S221. [PMID: 28961918 PMCID: PMC6226739 DOI: 10.1093/infdis/jix221] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In South Asia, data on enteric fever are sparse outside of urban areas. We characterized enteric fever diagnosis patterns and the burden of culture-confirmed cases in peri-urban and rural Nepal. Methods We used national reports to estimate enteric fever diagnosis rates over 20 years (1994-2014) and conducted a prospective study of patients presenting with a >72-hour history of fever to 4 peri-urban and rural healthcare facilities (during August 2013-June 2016). We compared clinical characteristics of patients with culture-confirmed Salmonella Typhi or Paratyphi infection to those of patients without enteric fever. We used generalized additive models with logistic link functions to evaluate associations of age and population density with culture positivity. Results National rates of enteric fever diagnosis were high, reaching 18.8 cases per 1000 during 2009-2014. We enrolled 4309 participants with acute febrile illness. Among those with a provisional clinical diagnosis, 55% (1334 of 2412) received a diagnosis of enteric fever; however, only 4.1% of these had culture-confirmed typhoidal Salmonella infection. Culture positivity was highest among young adults and was strongly associated with higher population density (P < .001). Conclusions Enteric fever diagnosis rates were very high throughout Nepal, but in rural settings, few patients had culture-confirmed disease. Expanded surveillance may inform local enteric fever treatment and prevention strategies.
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Affiliation(s)
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Shawn Wen
- D-Lab, Massachusetts Institute of Technology, Cambridge
| | - Surendra Madhup
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Bibush Amatya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajendra Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Elizabeth Hohmann
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
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Sharma T, Sharma C, Sankhyan A, Bedi SP, Bhatnagar S, Khanna N, Gautam V, Sethi S, Vrati S, Tiwari A. Serodiagnostic evaluation of recombinant CdtB of S. Typhi as a potential candidate for acute typhoid. Immunol Res 2019; 66:503-512. [PMID: 29931558 DOI: 10.1007/s12026-018-9009-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Typhoid fever caused by human restricted Salmonella typhi presents a considerable health burden on developing South-Asian nations like India. The suboptimal sensitivity and specificity associated with culture-based isolation of etiological agent and the extensively used surface antigen-based serological assays often lead to misdiagnosis and inappropriate antimicrobial treatment. The increasing reports of the emergence of resistant strains and undefined disease burden signify the critical need for an inexpensive, reliable, easy-to-use, and highly sensitive diagnostic test for typhoid fever. Utilizing S. typhi-specific and immunogenic antigens in sero-diagnostic assays could lead to precise diagnosis of acute typhoid and prompt treatment. In this study, we report cloning, expression, and purification of recombinant Cytolethal distending toxin subunit B (CdtB) of S. typhi, which is reported to be highly specific, immunogenic, and expressed only upon S. typhi infection. We further evaluated the purified recombinant CdtB for its diagnostic potential in an IgM-based indirect ELISA format using 33 human samples. Twenty-one serum samples from blood culture confirmed cases (n = 21) of typhoid and 12 samples from healthy controls (n = 12) were tested. The assay showed sensitivity of 100% and specificity of 83.3% respectively with positive and negative predictive values of 91.3 and 100% respectively. Efficient detection of specific IgM antibodies indicates that CdtB could be highly valuable in sero-diagnosis of acute typhoid and rapid screening of clinical samples.
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Affiliation(s)
- Tarang Sharma
- Centre for Bio-design & Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Chandresh Sharma
- Centre for Bio-design & Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Anurag Sankhyan
- Centre for Bio-design & Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India.,Central Research Institute, Kasauli, Himachal Pradesh, India
| | - Sanjiv Pal Bedi
- Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shinjini Bhatnagar
- Paediatric Biology Centre, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Navin Khanna
- International Centre for Genetic Engineering & Biotechnology, New Delhi, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudhanshu Vrati
- Regional Centre for Biotechnology, Faridabad, Haryana, India
| | - Ashutosh Tiwari
- Centre for Bio-design & Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India. .,Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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8
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Tadesse G, Tessema TS, Beyene G, Aseffa A. Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis. PLoS One 2018; 13:e0192575. [PMID: 29432492 PMCID: PMC5809059 DOI: 10.1371/journal.pone.0192575] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Wide-ranging evidence on the occurrence of fluoroquinolone (FQ) resistance genetic determinants in African Salmonella strains is not available. The main objectives of this study were to assess the heterogeneity, estimate pooled proportions and describe the preponderance of FQ-resistance determinants in typhoidal and non-typhoidal Salmonella (NTS) isolates of Africa. METHODS Genetic and phenotypic data on 6103 Salmonella isolates were considered. Meta- and frequency analyses were performed depending on the number of studies by category, number of isolates and risks of bias. A random effects model was used to assess heterogeneity and estimate pooled proportions. Relative and cumulative frequencies were calculated to describe the overall preponderance of FQ-resistance determinants in quinolone resistant isolates. RESULTS The pooled proportion of gyrA mutants (Salmonella enterica serovar Typhi, Salmonella enterica serovar Typhimurium, and Salmonella enterica serovar Enteritidis) was estimated at 5.7% (95% Confidence interval (CI) = 2.6, 9.8; Tau squared (T2) = 0.1105), and was higher in S. Typhi than in S. Typhimurium (odds ratio (OR) = 3.3, 95%CI = 2, 5.7). The proportions of each of gyrB and parC mutants, and strains with Plasmid Mediated Quinolone Resistance genes (qnrA, qnrB and qnrS) were low (≤ 0.3%). Overall, 23 mutant serotypes were identified, and most strains had mutations at codons encoding Ser83 and Asp87 of gyrA (82%, 95%CI = 78, 86). CONCLUSIONS Mutations at gyrA appear to account for ciprofloxacin non-susceptibility in most clinical Salmonella strains in Africa. The estimates could be harnessed to develop a mismatch-amplification mutation-assay for the detection of FQ-resistant strains in Africa.
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Affiliation(s)
- Getachew Tadesse
- Department of Biomedical Sciences, College of Veterinary Medicine and Agriculture, Addis Ababa University, Debre Zeit, Ethiopia
| | - Tesfaye S. Tessema
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getenet Beyene
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), ALERT Campus, Addis Ababa, Ethiopia
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Samajpati S, Das S, Ray U, Dutta S. Report of Relapse Typhoid Fever Cases from Kolkata, India: Recrudescence or Reinfection? Jpn J Infect Dis 2018; 71:209-213. [DOI: 10.7883/yoken.jjid.2017.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sriparna Samajpati
- Microbiology Division, National Institute of Cholera and Enteric Diseases
| | - Surojit Das
- Microbiology Division, National Institute of Cholera and Enteric Diseases
| | | | - Shanta Dutta
- Microbiology Division, National Institute of Cholera and Enteric Diseases
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10
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Abstract
PURPOSE OF REVIEW Increasing antimicrobial resistance in Salmonella Typhi is a serious public health concern, especially in industrializing countries. Here we review recent clinical and laboratory data concerning the evolution of antimicrobial resistance, with particular reference to the emergence resistance against fluoroquinolones, third generation cephalosporins, and azithromycin. RECENT FINDINGS The last 40 years have witnessed the sequential emergence of resistance to all first-line antimicrobials used in the treatment of S. Typhi infections. Multidrug resistance (MDR), defined by resistance to chloramphenicol, amoxicillin, and co-trimoxazole, emerged in the 1990s, followed rapidly by reduced susceptibility to fluoroquinolones. In the current decade, high-level fluoroquinolone resistance has emerged in south Asia and threatens to spread worldwide. Increasing reliance is now being placed on the activity of third generation cephalosporins and azithromycin, but resistance against these agents is developing. Carbapenems and tigecycline may be alternatives, although clinical data are sparse, and in some settings reversion to chloramphenicol and co-trimoxazole susceptibility is occurring. Therefore, older drugs may yet have a role in the treatment of S. Typhi infections. SUMMARY Good surveillance, improved diagnostics, more prudent use of antimicrobials, and effective vaccines will all be critical to reducing the burden of disease caused by S. Typhi.
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Salman M, St Michael F, Ali A, Jabbar A, Cairns C, Hayes AC, Rahman M, Iqbal M, Haque A, Cox AD. First characterization of immunogenic conjugates of Vi negative Salmonella Typhi O-specific polysaccharides with rEPA protein for vaccine development. J Immunol Methods 2017; 450:27-33. [PMID: 28735760 DOI: 10.1016/j.jim.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
Efficacious typhoid vaccines for young children will significantly reduce the disease burden in developing world. The Vi polysaccharide based conjugate vaccines (Vi-rEPA) against Salmonella Typhi Vi positive strains has shown high efficacy but may be ineffective against Vi negative S. Typhi. In this study, for the first time, we report the synthesis and evaluation of polysaccharide-protein conjugates of Vi negative S. Typhi as potential vaccine candidates. Four different conjugates were synthesized using recombinant exoprotein A of Pseudomonas aeruginosa (rEPA) and human serum albumin (HSA) as the carrier proteins, using either direct reductive amination or an intermediate linker molecule, adipic acid dihydrazide (ADH). Upon injection into mice, a significantly higher antibody titer was observed in mice administrated with conjugate-1 (OSP-HSA) (P=0.0001) and conjugate 2 (OSP-rEPA) (P≤0.0001) as compared to OSP alone. In contrast, the antibody titer elicited by conjugate 3 (OSPADH-HSA) and conjugate 4 (OSPADH-rEPA) were insignificant (P=0.1684 and P=0.3794, respectively). We conclude that reductive amination is the superior method to prepare the S. Typhi OSP glycoconjugate. Moreover, rEPA was a better carrier protein than HSA. Thus OSP-rEPA conjugate seems to be efficacious typhoid vaccines candidate, it may be evaluated further and recommended for the clinical trials.
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Affiliation(s)
- M Salman
- Vaccine Program, Human Health Therapeutics Portfolio, National Research Council, Ottawa, Canada; Health Biotechnology Division, National Institute for Biotechnology, Faisalabad, Pakistan; Department of Microbiology and Biotechnology, Abasyn University, Peshawar, Pakistan.
| | - F St Michael
- Vaccine Program, Human Health Therapeutics Portfolio, National Research Council, Ottawa, Canada
| | - A Ali
- Health Biotechnology Division, National Institute for Biotechnology, Faisalabad, Pakistan
| | - A Jabbar
- Department of Biotechnology, Mirpur University of Science & Technology (MUST), Mirpur, AJK, Pakistan
| | - C Cairns
- Vaccine Program, Human Health Therapeutics Portfolio, National Research Council, Ottawa, Canada
| | - A C Hayes
- Vaccine Program, Human Health Therapeutics Portfolio, National Research Council, Ottawa, Canada
| | - M Rahman
- Health Biotechnology Division, National Institute for Biotechnology, Faisalabad, Pakistan
| | - M Iqbal
- Health Biotechnology Division, National Institute for Biotechnology, Faisalabad, Pakistan
| | - A Haque
- Faculty of Life Sciences, University of Faisalabad, Faisalabad, Pakistan
| | - A D Cox
- Vaccine Program, Human Health Therapeutics Portfolio, National Research Council, Ottawa, Canada.
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12
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Abstract
The rapid and ongoing spread of antibiotic resistance poses a serious threat to global public health. The indiscriminant use of antibiotics in agriculture and human medicine along with increasingly connected societies has fueled the distribution of antibiotic-resistant bacteria. These factors together have led to rising numbers of infections caused by multidrug-resistant and pan-resistant bacteria, with increases in morbidity and mortality. This article summarizes the trends in antibiotic resistance, discusses the impact of antibiotic resistance on society, and reviews the use of antibiotics in agriculture. Feasible ways to tackle antibiotic resistance to avert a post-antibiotic era are suggested.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General Medical Center, 224 West Exchange Street, Suite 290, Akron, OH 44302, USA; Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Robert A Bonomo
- Medicine and Research Services, Louis Stokes Cleveland, Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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13
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Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LMC, Deerin JF, Dekker DM, Fields BS, Gasmelseed N, Hertz JT, Van Minh Hoang N, Im J, Jaeger A, Jeon HJ, Kabore LP, Keddy KH, Konings F, Krumkamp R, Ley B, Løfberg SV, May J, Meyer CG, Mintz ED, Montgomery JM, Niang AA, Nichols C, Olack B, Pak GD, Panzner U, Park JK, Park SE, Rabezanahary H, Rakotozandrindrainy R, Raminosoa TM, Razafindrabe TJL, Sampo E, Schütt-Gerowitt H, Sow AG, Sarpong N, Seo HJ, Sooka A, Soura AB, Tall A, Teferi M, Thriemer K, Warren MR, Yeshitela B, Clemens JD, Wierzba TF. Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. Lancet Glob Health 2017; 5:e310-e323. [PMID: 28193398 PMCID: PMC5316558 DOI: 10.1016/s2214-109x(17)30022-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Florian Marks
- International Vaccine Institute, SNU Research Park, Seoul, South Korea.
| | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Holly M Biggs
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Robert F Breiman
- Centers for Disease Control and Prevention, Nairobi, Kenya; Global Health Institute, Emory University, Atlanta, GA, USA
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, Nairobi, Kenya; WHO-Kenya Country Office, Nairobi, Kenya
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Barry S Fields
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan; Faculty of Science, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
| | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Justin Im
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hyon Jin Jeon
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - Karen H Keddy
- National Institute for Communicable Diseases, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Konings
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Benedikt Ley
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Tübingen, Germany; Duy Tan University, Da Nang, Vietnam
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Chelsea Nichols
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Beatrice Olack
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gi Deok Pak
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ursula Panzner
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Jin Kyung Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Se Eun Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | | | | | | | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Institute of Medical Microbiology, University of Cologne, Cologne, Germany
| | - Amy Gassama Sow
- Institute Pasteur de Dakar, Dakar, Senegal; University Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Hye Jin Seo
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Arvinda Sooka
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Adama Tall
- Institute Pasteur de Dakar, Dakar, Senegal
| | | | - Kamala Thriemer
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Michelle R Warren
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - John D Clemens
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; University of California Fielding School of Public Health, Los Angeles, CA, USA
| | - Thomas F Wierzba
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
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14
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Rossi O, Grant AJ, Mastroeni P. Effect of in vivo neutralization of tumor necrosis alpha on the efficacy of antibiotic treatment in systemic Salmonella enterica infections. Pathog Dis 2017; 75:ftx002. [PMID: 28087648 PMCID: PMC5353993 DOI: 10.1093/femspd/ftx002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/13/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023] Open
Abstract
Immunity can co-operate with antibiotics, but can also antagonize drug efficacy by segregating the bacteria to areas of the body that are less accessible to antimicrobials, and by selecting for subpopulations with low division rates that are often difficult to eradicate. We studied the effect of an anti-inflammatory/immunosuppressive anti-TNFα treatment, which accelerates bacterial growth in the tissues and inhibits or reverses the formation of granulomas, on the efficacy of ampicillin and ciprofloxacin during a systemic Salmonella enterica infection of the mouse. The anti-TNFα treatment neither precluded nor enhanced the efficacy of antibiotic treatment. However, the anti-TNFα treatment rendered the animals susceptible to the rapid relapse of the infection seen after cessation of the antibiotic treatment. Reactivation of an established infection, due to late administration of anti-TNFα antibodies, could be successfully controlled by antibiotics, but full clearance of the bacterial load from the tissues was not achieved. We conclude that the lack of TNFα does not preclude the efficacy of antibiotic treatment and must be monitored with care due to post-treatment relapses. Combinations of anti-cytokine compounds and antibiotic molecules may not be the best way to treat persistent infections with intracellular bacteria like Salmonella.
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Affiliation(s)
- Omar Rossi
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
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15
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Pham Thanh D, Karkey A, Dongol S, Ho Thi N, Thompson CN, Rabaa MA, Arjyal A, Holt KE, Wong V, Tran Vu Thieu N, Voong Vinh P, Ha Thanh T, Pradhan A, Shrestha SK, Gajurel D, Pickard D, Parry CM, Dougan G, Wolbers M, Dolecek C, Thwaites GE, Basnyat B, Baker S. A novel ciprofloxacin-resistant subclade of H58 Salmonella Typhi is associated with fluoroquinolone treatment failure. eLife 2016; 5:e14003. [PMID: 26974227 PMCID: PMC4805543 DOI: 10.7554/elife.14003] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/19/2016] [Indexed: 01/22/2023] Open
Abstract
The interplay between bacterial antimicrobial susceptibility, phylogenetics and patient outcome is poorly understood. During a typhoid clinical treatment trial in Nepal, we observed several treatment failures and isolated highly fluoroquinolone-resistant Salmonella Typhi (S. Typhi). Seventy-eight S. Typhi isolates were genome sequenced and clinical observations, treatment failures and fever clearance times (FCTs) were stratified by lineage. Most fluoroquinolone-resistant S. Typhi belonged to a specific H58 subclade. Treatment failure with S. Typhi-H58 was significantly less frequent with ceftriaxone (3/31; 9.7%) than gatifloxacin (15/34; 44.1%)(Hazard Ratio 0.19, p=0.002). Further, for gatifloxacin-treated patients, those infected with fluoroquinolone-resistant organisms had significantly higher median FCTs (8.2 days) than those infected with susceptible (2.96) or intermediately resistant organisms (4.01)(p<0.001). H58 is the dominant S. Typhi clade internationally, but there are no data regarding disease outcome with this organism. We report an emergent new subclade of S. Typhi-H58 that is associated with fluoroquinolone treatment failure. Clinical trial registration: ISRCTN63006567. DOI:http://dx.doi.org/10.7554/eLife.14003.001 People who ingest a type of bacteria called Salmonella Typhi can develop the symptoms of typhoid fever. This disease is common in low-income settings in Asia and Africa, and causes a high rate of death in people who are not treated with antimicrobial drugs. During a study in Nepal, Thanh et al. tried to evaluate which of two antimicrobials was better for treating typhoid fever. One of the drugs – called gatifloxacin – did not work in some of the patients. To understand why this treatment failed, Thanh et al. decoded the entire DNA sequences of all the Salmonella Typhi bacteria isolated during the study. Comparing this genetic data to the clinical data of the patients identified a new variant of Salmonella Typhi. These bacteria have a specific combination of genetic mutations that render them resistant to the family of drugs that gatifloxacin belongs to – the fluoroquinolones. Patients infected with the variant bacteria and treated with gatifloxacin were highly likely to completely fail treatment and have longer-lasting fevers. On further investigation Thanh et al. found these organisms were likely recently introduced into Nepal from India. Fluoroquinolones are amongst the most effective and common antimicrobials used to treat typhoid fever and other bacterial infections. However, the presence of bacteria that are resistant to these compounds in South Asia means that they should no longer be the first choice of drug to treat typhoid fever in this location. DOI:http://dx.doi.org/10.7554/eLife.14003.002
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Affiliation(s)
- Duy Pham Thanh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Sabina Dongol
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Nhan Ho Thi
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne N Thompson
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom.,The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maia A Rabaa
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Amit Arjyal
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Australia
| | - Vanessa Wong
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Nga Tran Vu Thieu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phat Voong Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuyen Ha Thanh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | - Derek Pickard
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Christopher M Parry
- The London School of Hygiene and Tropical Medicine, London, United Kingdom.,School of Tropical Medicine and Global Health, Department of Clinical Research, Nagasaki University, Nagasaki, Japan
| | - Gordon Dougan
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Marcel Wolbers
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Christiane Dolecek
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom.,Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom.,The London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Yassien MAM, Elfaky MA. Overexpression of Salmonella enterica serovar Typhi recA gene confers fluoroquinolone resistance in Escherichia coli DH5α. Braz J Med Biol Res 2015; 48:990-5. [PMID: 26375447 PMCID: PMC4671525 DOI: 10.1590/1414-431x20154804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022] Open
Abstract
A spontaneous fluoroquinolone-resistant mutant (STM1) was isolated from its parent
Salmonella enterica serovar Typhi (S. Typhi)
clinical isolate. Unlike its parent isolate, this mutant has selective resistance to
fluoroquinolones without any change in its sensitivity to various other antibiotics.
DNA gyrase assays revealed that the fluoroquinolone resistance phenotype of the STM1
mutant did not result from alteration of the fluoroquinolone sensitivity of the DNA
gyrase isolated from it. To study the mechanism of fluoroquinolone resistance, a
genomic library from the STM1 mutant was constructed in Escherichia
coli DH5α and two recombinant plasmids were obtained. Only one of these
plasmids (STM1-A) conferred the selective fluoroquinolone resistance phenotype to
E. coli DH5α. The chromosomal insert from STM1-A, digested with
EcoRI and HindIII restriction endonucleases,
produced two DNA fragments and these were cloned separately into pUC19 thereby
generating two new plasmids, STM1-A1 and STM1-A2. Only STM1-A1 conferred the
selective fluoroquinolone resistance phenotype to E. coli DH5α.
Sequence and subcloning analyses of STM1-A1 showed the presence of an intact RecA
open reading frame. Unlike that of the wild-type E. coli DH5α,
protein analysis of a crude STM1-A1 extract showed overexpression of a 40 kDa
protein. Western blotting confirmed the 40 kDa protein band to be RecA. When a RecA
PCR product was cloned into pGEM-T and introduced into E. coli DH5α,
the STM1-A11 subclone retained fluoroquinolone resistance. These results suggest that
overexpression of RecA causes selective fluoroquinolone resistance in E.
coli DH5α.
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Affiliation(s)
- M A M Yassien
- Department of Natural Products and Alternative Medicine/Microbiology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M A Elfaky
- Department of Natural Products and Alternative Medicine/Microbiology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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17
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Wielding S, Scott G. Sexually acquired Salmonella Typhi urinary tract infection. Int J STD AIDS 2015; 27:494-6. [PMID: 25953964 DOI: 10.1177/0956462415585669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 11/15/2022]
Abstract
We report a case of isolated urinary Salmonella enterica serotype Typhi in an HIV-positive man who has sex with men. He was clinically well and blood and stool cultures were negative, indicating that this may have been a sexually acquired urinary tract infection.
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18
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Andrews JR, Ryan ET. Diagnostics for invasive Salmonella infections: Current challenges and future directions. Vaccine 2015; 33 Suppl 3:C8-15. [PMID: 25937611 DOI: 10.1016/j.vaccine.2015.02.030] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/03/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
Invasive Salmonellosis caused by Salmonella enterica serotype Typhi or Paratyphi A, B, C, or invasive non-typhoidal Salmonella serotypes, is an immensely important disease cluster for which reliable, rapid diagnostic tests are not available. Blood culture remains the gold standard but is insensitive, slow, and resource-intensive. Existing molecular diagnostics have poor sensitivity due to the low organism burden in bodily fluids. Commercially available serologic tests for typhoidal Salmonella have had limited sensitivity and specificity. In high burden, resource-limited settings, reliance on clinical diagnosis or inaccurate tests often results in frequent, unnecessary treatment, which contributes selective pressure for the emergence of antimicrobial resistance. This practice also results in inadequate therapy for other etiologies of acute febrile illnesses, including leptospirosis and rickettsial infections. A number of novel serologic, molecular, transcriptomic and metabolomic approaches to diagnostics are under development. Target product profiles that outline specific needs may focus development and investment, and establish benchmarks for accuracy, cost, speed, and portability of new diagnostics. Of note, a critical barrier to diagnostic assay rollout will be the low cost and low perceived harm of empiric therapy on behalf of providers and patients, which leaves few perceived incentives to utilize diagnostics. Approaches that align incentives with societal goals of limiting inappropriate antimicrobial use, such as subsidizing diagnostics, may be essential for stimulating development and uptake of such assays in resource-limited settings. New diagnostics for invasive Salmonellosis should be developed and deployed alongside diagnostics for alternative etiologies of acute febrile illnesses to improve targeted use of antibiotics.
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Affiliation(s)
- Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States.
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States.
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19
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Affiliation(s)
- Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. Centre for Tropical Medicine, Oxford University, Oxford, UK. Centre for Tropical Medicine, Oxford University, Oxford, UK.
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20
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Liang Z, Ke B, Deng X, Liang J, Ran L, Lu L, He D, Huang Q, Ke C, Li Z, Yu H, Klena JD, Wu S. Serotypes, seasonal trends, and antibiotic resistance of non-typhoidal Salmonella from human patients in Guangdong Province, China, 2009-2012. BMC Infect Dis 2015; 15:53. [PMID: 25881319 PMCID: PMC4343067 DOI: 10.1186/s12879-015-0784-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/27/2015] [Indexed: 02/02/2023] Open
Abstract
Background Non-typhoidal Salmonella is a common cause of infectious diarrhea in humans. Antimicrobial-resistant Salmonella has become a global concern. Methods Using laboratory-based surveillance system for Salmonella from September 2009 to December 2012 in Guangdong Province of China. The clinical information and samples of diarrhea patients were collected, according to the surveillance case definition. The lab tests were followed by standardized protocols, including sample isolation, isolates confirmation, serotyping, and antimicrobial susceptibility testing (AST). Results A total of 1,826 Salmonella isolates were identified from40,572 patients in 28 hospitals in11 prefectures. The isolates ratio was highest in autumn (38.8%, 708/1826) and lowest in winter (6.4%, 117/1826). Children aged <5 years were the group most affected by Salmonella in Guangdong Province accounting for 73% (1,329/1,826), of whom the infants (<1 year) were 81.5% (1084/1329) especially. A total of 108 serotypes were identified among the isolates. S. Typhimurium represented the most common serotype followed by serotype 4,5,12:i:-. S. Typhimurium was also the common serotype followed by S. Enteritidis among infants and children aged 1-3 years old. However, S. Enteritidis became the common serotype followed by S. Typhimurium among children aged 3–5 and >5 years. Resistance to at least one antimicrobial was found in 72% (1321/1,826) of the isolates. Resistance to at least three antimicrobials was found in 46% (850/1,826) of the isolates. Resistance to all 12 antimicrobials screened was observed in 8 isolates (0.44%, 8/1,826). The resistant prevalence to quinolones including nalidixic acid and ciprofloxacin was 61.9% (1131/1826), of which ciprofloxacin resistance rate was 8.05% (147/1826). The prevalence resistance to all three cephalosporin antimicrobials (cefepime, cefotaxime, and caftazidime) in <5 yr age group was accounted for 90% (89/99). Conclusions Additional data and more refined methods can improve future surveillance. The invasive Salmonella isolates should also be included to the antibiotic resistance surveillance for clinical care or public health.
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Affiliation(s)
- Zhaoming Liang
- Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China. .,Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Bixia Ke
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Xiaoling Deng
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Junhua Liang
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Lu Ran
- Office of Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Lingling Lu
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Dongmei He
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Qiong Huang
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Changwen Ke
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Zhongjie Li
- Office of Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Hongjie Yu
- Office of Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - John D Klena
- China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, U.S. Center for Disease Control and Prevention, Beijing, China. .,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Shuyu Wu
- China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, U.S. Center for Disease Control and Prevention, Beijing, China.
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21
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Tatavarthy A, Luna VA, Amuso PT. How multidrug resistance in typhoid fever affects treatment options. Ann N Y Acad Sci 2014; 1323:76-90. [PMID: 25069595 DOI: 10.1111/nyas.12490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Salmonella enterica serotype Typhi (S. Typhi) is an enteric pathogen that causes typhoid fever. The infection can be severe, with significant morbidity and mortality, requiring antimicrobial therapy. Cases of S. Typhi infection in the United States and other developed countries are often associated with travel to endemic regions. The empirical use of first-line drugs for therapy, including ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, has resulted in transmissible multidrug resistance. With the global increase in multidrug-resistant S. Typhi, use of ciprofloxacin, with excellent oral absorption, few side effects, and cost-effectiveness, has become popular for treatment. However, decreased ciprofloxacin susceptibility due to point mutations in the S. Typhi genes gyrA and/or parC has caused treatment failures, necessitating alternative therapeutic options. S. Typhi is typically genetically homogenous, with phylogenetic and epidemiological studies showing that identical clones and diverse S. Typhi types often coexist in the same geographic region. Studies investigating point mutations have demonstrated that selective pressure from empirical use of first-line drugs and fluoroquinolones has led to the global emergence of haplotype H-58. Antibiotic resistance is subject to high selective pressure in S. Typhi and thus demands careful use of antimicrobials.
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Affiliation(s)
- Aparna Tatavarthy
- Center for Biological Defense, College of Public Health, University of South Florida, Tampa, Florida
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22
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Näsström E, Vu Thieu NT, Dongol S, Karkey A, Voong Vinh P, Ha Thanh T, Johansson A, Arjyal A, Thwaites G, Dolecek C, Basnyat B, Baker S, Antti H. Salmonella Typhi and Salmonella Paratyphi A elaborate distinct systemic metabolite signatures during enteric fever. eLife 2014; 3. [PMID: 24902583 PMCID: PMC4077204 DOI: 10.7554/elife.03100] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/26/2014] [Indexed: 12/31/2022] Open
Abstract
The host-pathogen interactions induced by Salmonella Typhi and Salmonella Paratyphi A during enteric fever are poorly understood. This knowledge gap, and the human restricted nature of these bacteria, limit our understanding of the disease and impede the development of new diagnostic approaches. To investigate metabolite signals associated with enteric fever we performed two dimensional gas chromatography with time-of-flight mass spectrometry (GCxGC/TOFMS) on plasma from patients with S. Typhi and S. Paratyphi A infections and asymptomatic controls, identifying 695 individual metabolite peaks. Applying supervised pattern recognition, we found highly significant and reproducible metabolite profiles separating S. Typhi cases, S. Paratyphi A cases, and controls, calculating that a combination of six metabolites could accurately define the etiological agent. For the first time we show that reproducible and serovar specific systemic biomarkers can be detected during enteric fever. Our work defines several biologically plausible metabolites that can be used to detect enteric fever, and unlocks the potential of this method in diagnosing other systemic bacterial infections.
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Affiliation(s)
- Elin Näsström
- Department of Chemistry, Computational Life Science Cluster, Umeå University, Umeå, Sweden
| | - Nga Tran Vu Thieu
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Sabina Dongol
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Phat Voong Vinh
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tuyen Ha Thanh
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Anders Johansson
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Amit Arjyal
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Christiane Dolecek
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Henrik Antti
- Department of Chemistry, Computational Life Science Cluster, Umeå University, Umeå, Sweden
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23
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Akhtar S, Sarker MR, Jabeen K, Sattar A, Qamar A, Fasih N. Antimicrobial resistance in Salmonella enterica serovar typhi and paratyphi in South Asia-current status, issues and prospects. Crit Rev Microbiol 2014; 41:536-45. [PMID: 24645636 DOI: 10.3109/1040841x.2014.880662] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The human race owes a debt of gratitude to antimicrobial agents, penicillin and its successors that have saved people from tremendous pain and suffering in the last several decades. Unfortunately, this consideration is no more true, as millions of people are prone to the challenging threat of emergence of antimicrobial resistance worldwide and the menace is more distressing in developing countries. Comparable with other bacterial species, Salmonella enterica serovar Typhi (S. typhi) and Paratyphi (S. paratyphi) have been evolving multidrug resistance (MDR) against a wide array of antibiotics, including chloramphenicol, ampicillin and co-trimoxazole, and globally affecting 21 million people with 220,000 deaths each year. S. typhi and S. paratyphi infections are also endemic in South Asia and a series of antibiotics used to treat these infections, have been losing efficacy against enteric fever. Currently, quinolones are regarded as a choice to treat MDR Salmonella in these regions. Travel-related cases of enteric fever, especially from South Asian countries are the harbinger of the magnitude of MDR Salmonella in that region. Conclusively, the MDR will continue to grow and the available antimicrobial agents would become obsolete. Therefore, a radical and aggressive approach in terms of rational use of antibiotics during treating infections is essentially needed.
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Affiliation(s)
- Saeed Akhtar
- a Department of Food Science and Technology , Bahauddin Zakariya University Multan , Multan , Pakistan
| | - Mahfuzur R Sarker
- b Department of Microbiology , Oregon State University , Corvallis , OR , USA
| | - Kausar Jabeen
- c Department of Pathology and Microbiology , Agha Khan University Karachi , Karachi , Pakistan , and
| | - Ahsan Sattar
- d Department of Microbiology , Institute of Pure and Applied Biology, Bahauddin Zakariya University , Multan , Pakistan
| | - Aftab Qamar
- a Department of Food Science and Technology , Bahauddin Zakariya University Multan , Multan , Pakistan
| | - Naima Fasih
- c Department of Pathology and Microbiology , Agha Khan University Karachi , Karachi , Pakistan , and
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24
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Baker S, Duy PT, Nga TVT, Dung TTN, Phat VV, Chau TT, Turner AK, Farrar J, Boni MF. Fitness benefits in fluoroquinolone-resistant Salmonella Typhi in the absence of antimicrobial pressure. eLife 2013; 2:e01229. [PMID: 24327559 PMCID: PMC3857714 DOI: 10.7554/elife.01229] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Fluoroquinolones (FQ) are the recommended antimicrobial treatment for typhoid, a severe systemic infection caused by the bacterium Salmonella enterica serovar Typhi. FQ-resistance mutations in S. Typhi have become common, hindering treatment and control efforts. Using in vitro competition experiments, we assayed the fitness of eleven isogenic S. Typhi strains with resistance mutations in the FQ target genes, gyrA and parC. In the absence of antimicrobial pressure, 6 out of 11 mutants carried a selective advantage over the antimicrobial-sensitive parent strain, indicating that FQ resistance in S. Typhi is not typically associated with fitness costs. Double-mutants exhibited higher than expected fitness as a result of synergistic epistasis, signifying that epistasis may be a critical factor in the evolution and molecular epidemiology of S. Typhi. Our findings have important implications for the management of drug-resistant S. Typhi, suggesting that FQ-resistant strains would be naturally maintained even if fluoroquinolone use were reduced. DOI:http://dx.doi.org/10.7554/eLife.01229.001 The fluoroquinolones are a group of antimicrobials that are used to treat a variety of life-threatening bacterial infections, including typhoid fever. Before the introduction of antimicrobials, the mortality rate from typhoid fever was 10–20%. Prompt treatment with fluoroquinolones has reduced this to less than 1%, and has also decreased the severity of symptoms suffered by people with the disease. Now, however, the usefulness of many antimicrobials, including the fluoroquinolones, is threatened by the evolution of antimicrobial resistance within the bacterial populations being treated. Drug resistance in bacteria typically arises through specific mutations, or following the acquisition of antimicrobial resistance genes from other bacteria. It is thought that the frequent use of antimicrobials in human and animal health puts selective pressure on bacterial populations, allowing bacterial strains with mutations or genes that confer antimicrobial resistance to survive, while bacterial strains that are sensitive to the antimicrobials die out. At first it was thought that specific mutations conferring antimicrobial resistance came at a fitness cost, which would mean that such mutations would be rare in the absence of antimicrobials. Now, based on research into typhoid fever, Baker et al. describe a system in which the majority of evolutionary routes to drug resistance are marked by significant fitness benefits, even in the absence of antimicrobial exposure. Typhoid is caused by a bacterial pathogen known as Salmonella Typhi, and mutations in two genes—gyrA and parC—result in resistance to fluoroquinolones. Baker et al. show that mutations in these genes confer a measurable fitness advantage over strains without these mutations, even in the absence of exposure to fluoroquinolones. Moreover, strains with two mutations in one of these genes exhibited a higher than predicted fitness, suggesting that there is a synergistic interaction between the two mutations. This work challenges the dogma that antimicrobial resistant organisms have a fitness disadvantage in the absence of antimicrobials, and suggests that increasing resistance to the fluoroquinolones is not solely driven by excessive use of this important group of drugs. DOI:http://dx.doi.org/10.7554/eLife.01229.002
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Affiliation(s)
- Stephen Baker
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
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25
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Park SE, Marks F. A conjugate vaccine against typhoid fever. THE LANCET. INFECTIOUS DISEASES 2013; 14:90-1. [PMID: 24290842 DOI: 10.1016/s1473-3099(13)70292-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Se Eun Park
- International Vaccine Institute, Development and Delivery Unit, Department of Epidemiology, Seoul 151-600, Korea
| | - Florian Marks
- International Vaccine Institute, Development and Delivery Unit, Department of Epidemiology, Seoul 151-600, Korea.
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26
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Karki S, Shakya P, Cheng AC, Dumre SP, Leder K. Trends of etiology and drug resistance in enteric fever in the last two decades in Nepal: a systematic review and meta-analysis. Clin Infect Dis 2013; 57:e167-76. [PMID: 23985342 DOI: 10.1093/cid/cit563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.
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Affiliation(s)
- Surendra Karki
- Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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27
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Evaluation of an electricity-free, culture-based approach for detecting typhoidal Salmonella bacteremia during enteric fever in a high burden, resource-limited setting. PLoS Negl Trop Dis 2013; 7:e2292. [PMID: 23853696 PMCID: PMC3694822 DOI: 10.1371/journal.pntd.0002292] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In many rural areas at risk for enteric fever, there are few data on Salmonella enterica serotypes Typhi (S. Typhi) and Paratyphi (S. Paratyphi) incidence, due to limited laboratory capacity for microbiologic culture. Here, we describe an approach that permits recovery of the causative agents of enteric fever in such settings. This approach involves the use of an electricity-free incubator based upon use of phase-change materials. We compared this against conventional blood culture for detection of typhoidal Salmonella. METHODOLOGY/PRINCIPAL FINDINGS Three hundred and four patients with undifferentiated fever attending the outpatient and emergency departments of a public hospital in the Kathmandu Valley of Nepal were recruited. Conventional blood culture was compared against an electricity-free culture approach. Blood from 66 (21.7%) patients tested positive for a Gram-negative bacterium by at least one of the two methods. Sixty-five (21.4%) patients tested blood culture positive for S. Typhi (30; 9.9%) or S. Paratyphi A (35; 11.5%). From the 65 individuals with culture-confirmed enteric fever, 55 (84.6%) were identified by the conventional blood culture and 60 (92.3%) were identified by the experimental method. Median time-to-positivity was 2 days for both procedures. The experimental approach was falsely positive due to probable skin contaminants in 2 of 239 individuals (0.8%). The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% (95% CI: 80.0%-97.0%) and 96.0% (92.7%-98.1%), respectively. After initial incubation, Salmonella isolates could be readily recovered from blood culture bottles maintained at room temperature for six months. CONCLUSIONS/SIGNIFICANCE A simple culture approach based upon a phase-change incubator can be used to isolate agents of enteric fever. This approach could be used as a surveillance tool to assess incidence and drug resistance of the etiologic agents of enteric fever in settings without reliable local access to electricity or local diagnostic microbiology laboratories.
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28
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Shen X, Ou L, Chen X, Zhang X, Tan X. The application of the grey disaster model to forecast epidemic peaks of typhoid and paratyphoid fever in China. PLoS One 2013; 8:e60601. [PMID: 23565260 PMCID: PMC3614922 DOI: 10.1371/journal.pone.0060601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/28/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objectives of this study were to forecast epidemic peaks of typhoid and paratyphoid fever in China using the grey disaster model, to evaluate its feasibility of predicting the epidemic tendency of notifiable diseases. METHODS According to epidemiological features, the GM(1,1) model and DGM model were used to build the grey disaster model based on the incidence data of typhoid and paratyphoid fever collected from the China Health Statistical Yearbook. Model fitting accuracy test was used to evaluate the performance of these two models. Then, the next catastrophe date was predicted by the better model. RESULTS The simulation results showed that DGM model was better than GM(1,1) model in our data set. Using the DGM model, we predicted the next epidemic peak time will occur between 2023 to 2025. CONCLUSION The grey disaster model can predict the typhoid and paratyphoid fever epidemic time precisely, which may provide valuable information for disease prevention and control.
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Affiliation(s)
- Xuejun Shen
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Limin Ou
- Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xiaojun Chen
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xin Zhang
- Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xuerui Tan
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- * E-mail:
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29
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Cho IJ, Yim J, Lee Y, Kim MS, Seo Y, Chung HS, Yong D, Jeong SH, Lee K, Chong Y. Trends in Isolation and Antimicrobial Susceptibility of Enteropathogenic Bacteria in 2001-2010 at a Korean Tertiary Care Hospital. ANNALS OF CLINICAL MICROBIOLOGY 2013. [DOI: 10.5145/acm.2013.16.1.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- In Joo Cho
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Jisook Yim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Myung Sook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Youkyung Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Sun Chung
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Yunsop Chong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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30
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Solez K, Karki A, Rana S, Bjerland H, Cujec B, Aaron S, Morrish D, Walker M, Gowrishankar M, Bamforth F, Satkunam L, Glick N, Stevenson T, Ross S, Dhakal S, Allain D, Konkin J, Zakus D, Nichols D. Multifaceted support for a new medical school in Nepal devoted to rural health by a Canadian Faculty of Medicine and Dentistry. Glob J Health Sci 2012; 4:109-18. [PMID: 23121747 PMCID: PMC4777003 DOI: 10.5539/gjhs.v4n6p109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/22/2012] [Indexed: 11/24/2022] Open
Abstract
Nepal and Alberta are literally a world apart. Yet they share a common problem of restricted access to health services in remote and rural areas. In Nepal, urban-rural disparities were one of the main issues in the recent civil war, which ended in 2006. In response to the need for improved health equity in Nepal a dedicated group of Nepali physicians began planning the Patan Academy of Health Sciences (PAHS), a new health sciences university dedicated to the education of rural health providers in the early 2000s. Beginning with a medical school the Patan Academy of Health Sciences uses international help to plan, deliver and assess its curriculum. PAHS developed an International Advisory Board (IAB) attracting international help using a model of broad, intentional recruitment and then on individuals’ natural attraction to a clear mission of peace-making through health equity. Such a model provides for flexible recruitment of globally diverse experts, though it risks a lack of coordination. Until recently, the PAHS IAB has not enjoyed significant or formal support from any single international institution. However, an increasing number of the international consultants recruited by PAHS to its International Advisory Board are from the University of Alberta in Edmonton, Alberta, Canada (UAlberta). The number of UAlberta Faculty of Medicine and Dentistry members involved in the project has risen to fifteen, providing a critical mass for a coordinated effort to leverage institutional support for this partnership. This paper describes the organic growth of the UAlberta group supporting PAHS, and the ways in which it supports a sister institution in a developing nation.
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Affiliation(s)
- Kim Solez
- University of Alberta, Alberta, Canada.
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