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Quaresma AJPG, Rodrigues YC, Aboim JB, Bezerra MM, Gouveia MIM, Da Costa ARF, de Oliveira Souza C, Bastos FC, Lima LNGC, de Paula Ramos FL, Valéria Batista Lima K. Molecular Epidemiology of Sporadic and Outbreak-Related Salmonella Typhi Isolates in the Brazilian North Region: A Retrospective Analysis from 1995 to 2013. Infect Dis Rep 2022; 14:569-573. [PMID: 36005262 PMCID: PMC9408587 DOI: 10.3390/idr14040060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Typhoidal salmonellosis is a global public health problem occurring in developing endemic regions. In Brazil, cases are mostly registered in the North and Northeast regions. Molecular characterization of the strains is important to understand the epidemiology of disease infections and to design control strategies. The present study retrospectively evaluates the genotyping features of sporadic and outbreak-related Salmonella Typhi isolates from the Brazilian North region. Bacterial isolates were recovered from blood and a rectal swab of patients in the states of Acre and Pará, Brazilian North region, in the period of 1995 to 2013, and were submitted to genotyping by applying Multilocus sequence typing (MLST) and Pulsed Field Gel Electrophoresis (PFGE) reference methods. MLST genotyping revealed the presence of epidemic clones ST1 and ST2, and 20 pulsotypes were identified by PFGE, including four distinct clusters (A–D), and six subclusters (A1–D1) with indistinguishable strains in different periods and locations. To conclude, the obtained data demonstrates the temporal stability, adaptation, and transmission of outbreak-related and sporadic S. Typhi strains over time, contributing to the transmission chain in the region.
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Affiliation(s)
- Ana Judith Pires Garcia Quaresma
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
- Ph.D. Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil
| | - Yan Corrêa Rodrigues
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Joseline Barbosa Aboim
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Mayza Miranda Bezerra
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Maria Isabel Montoril Gouveia
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Ana Roberta Fusco Da Costa
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Cintya de Oliveira Souza
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Flávia Corrêa Bastos
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
| | - Luana Nepomuceno Gondim Costa Lima
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
- Ph.D. Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil
| | - Francisco Lúzio de Paula Ramos
- Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil;
| | - Karla Valéria Batista Lima
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Health Surveillance Secretariat, Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.J.P.G.Q.); (Y.C.R.); (J.B.A.); (M.M.B.); (M.I.M.G.); (A.R.F.D.C.); (C.d.O.S.); (F.C.B.); (L.N.G.C.L.)
- Ph.D. Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil
- Correspondence:
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Risk factors for and management of metronidazole-refractory giardiasis in international travellers: A retrospective analysis. Travel Med Infect Dis 2021; 43:102090. [PMID: 34082086 DOI: 10.1016/j.tmaid.2021.102090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Giardia lamblia is a common cause of diarrhoea in returning travellers. Failure of the recommended first-line treatment, metronidazole, has frequently been observed. Recommendations for treatment of metronidazole-refractory giardiasis lack clarity and evidence. METHODS We conducted a retrospective data analysis of returned travellers with confirmed giardiasis at the Bernhard-Nocht-Clinic in Hamburg, Germany, between 2007 and 2016. RESULTS We identified 339 cases of giardiasis, mostly acquired in South Asia (n = 157). 308 patients received metronidazole as first-line treatment, leading to treatment failure in 93 cases. Statistical analysis suggested by far the highest risk of metronidazole treatment failure for travellers returning from South Asia (Odds Ratio 8.73). Second-line therapy consisted of various different therapy regimens. Combination therapy as second-line treatment seemed to be more effective than monotherapy. A repeat course of metronidazole proved to be futile. CONCLUSION This study reveals a strikingly low effectiveness of metronidazole, especially in patients returning from South Asia. Second-line treatment showed inconsistency of regimens and yielded unsatisfactory results. These findings require reconsideration of treatment strategies for giardiasis. Large prospective trials are urgently needed to assess new first-line treatment options and to help implement advice for effective, agreed second-line treatment strategies. Translational projects should be created to link the understanding of resistance mechanisms with epidemiological data and clinical outcome.
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Bokhary H, Pangesti KNA, Rashid H, Abd El Ghany M, Hill-Cawthorne GA. Travel-Related Antimicrobial Resistance: A Systematic Review. Trop Med Infect Dis 2021; 6:11. [PMID: 33467065 PMCID: PMC7838817 DOI: 10.3390/tropicalmed6010011] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
There is increasing evidence that human movement facilitates the global spread of resistant bacteria and antimicrobial resistance (AMR) genes. We systematically reviewed the literature on the impact of travel on the dissemination of AMR. We searched the databases Medline, EMBASE and SCOPUS from database inception until the end of June 2019. Of the 3052 titles identified, 2253 articles passed the initial screening, of which 238 met the inclusion criteria. The studies covered 30,060 drug-resistant isolates from 26 identified bacterial species. Most were enteric, accounting for 65% of the identified species and 92% of all documented isolates. High-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. International travel is a vehicle for the transmission of antimicrobial resistance globally. Health systems should identify recent travellers to ensure that adequate precautions are taken.
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Affiliation(s)
- Hamid Bokhary
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- University Medical Center, Umm Al-Qura University, Al Jamiah, Makkah, Makkah Region 24243, Saudi Arabia
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Krisna N. A. Pangesti
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Moataz Abd El Ghany
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Grant A. Hill-Cawthorne
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
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Jain P, Nandy S, Bharadwaj R, Niyogi SK, Dutta S. Salmonella enterica serovar Weltevreden ST1500 associated foodborne outbreak in Pune, India. Indian J Med Res 2016; 141:239-41. [PMID: 25900961 PMCID: PMC4418162 DOI: 10.4103/0971-5916.155595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | | | - Shanta Dutta
- Division of Bacteriology, National Institute of Cholera & Enteric Diseases (NICED), P-33, CIT Road, Scheme XM, Beliaghata, Kolkata, West Bengal, India
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Structure based in silico analysis of quinolone resistance in clinical isolates of Salmonella Typhi from India. PLoS One 2015; 10:e0126560. [PMID: 25962113 PMCID: PMC4427296 DOI: 10.1371/journal.pone.0126560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
Enteric fever is a major cause of morbidity in several parts of the Indian subcontinent. The treatment for typhoid fever majorly includes the fluoroquinolone group of antibiotics. Excessive and indiscriminate use of these antibiotics has led to development of acquired resistance in the causative organism Salmonella Typhi. The resistance towards fluoroquinolones is associated with mutations in the target gene of DNA Gyrase. We have estimated the Minimum Inhibitory Concentration (MIC) of commonly used fluoroquinolone representatives from three generations, ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin, for 100 clinical isolates of Salmonella Typhi from patients in the Indian subcontinent. The MICs have been found to be in the range of 0.032 to 8 μg/ml. The gene encoding DNA Gyrase was subsequently sequenced and point mutations were observed in DNA Gyrase in the quinolone resistance determining region comprising Ser83Phe/Tyr and Asp87Tyr/Gly. The binding ability of these four fluoroquinolones in the quinolone binding pocket of wild type as well as mutant DNA Gyrase was computationally analyzed by molecular docking to assess their differential binding behaviour. This study has revealed that mutations in DNA Gyrase alter the characteristics of the binding pocket resulting in the loss of crucial molecular interactions and consequently decrease the binding affinity of fluoroquinolones with the target protein. The present study assists in understanding the underlying molecular and structural mechanism for decreased fluoroquinolone susceptibility in clinical isolates as a consequence of mutations in DNA Gyrase.
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Abstract
Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas, especially those in Africa. The main barriers to control are vaccines that are not immunogenic in very young children and the development of multidrug resistance, which threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow surveillance and to implement control measures.
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Affiliation(s)
- John Wain
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Rene S Hendriksen
- National Food Institute, Technical University of Denmark, WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and European Union Reference Laboratory for Antimicrobial Resistance, Kongens Lyngby, Denmark
| | - Matthew L Mikoleit
- National Enteric Reference Laboratory Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Division in the National Health Laboratory Service (NHLS), Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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Intermediate susceptibility to ciprofloxacin among Salmonella enterica serovar Typhi isolates in Lima, Peru. J Clin Microbiol 2013; 52:968-70. [PMID: 24371234 DOI: 10.1128/jcm.02663-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Thirty-three Salmonella enterica serovar Typhi blood isolates from Lima, Peru (2008 to 2012), were fully susceptible to trimethoprim-sulfamethoxazole, chloramphenicol, ceftriaxone, and tetracycline; 8/33 (24.2%) showed intermediate susceptibility to ciprofloxacin carrying mutations in the quinolone resistance-determining region of the gyrA gene (Ser83-Phe and Asp87-Asn) and in the gyrB gene (Ser464-Phe).
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