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Dhara D, Baliban SM, Huo CX, Rashidijahanabad Z, Sears KT, Nick ST, Misra AK, Tennant SM, Huang X. Syntheses of Salmonella Paratyphi A Associated Oligosaccharide Antigens and Development towards Anti-Paratyphoid Fever Vaccines. Chemistry 2020; 26:15953-15968. [PMID: 32578281 PMCID: PMC7722144 DOI: 10.1002/chem.202002401] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/21/2020] [Indexed: 01/08/2023]
Abstract
With the emergence of multidrug resistant Salmonella strains, the development of anti-Salmonella vaccines is an important task. Currently there are no approved vaccines against Salmonella Paratyphi A, the leading cause of paratyphoid fever. To fill this gap, oligosaccharides corresponding to the O-polysaccharide repeating units from the surface of Salmonella Paratyphi A have been synthesized through convergent stereoselective glycosylations. The synthetic glycan antigen was conjugated with a powerful immunogenic carrier system, the bacteriophage Qβ. The resulting construct was able to elicit strong and long-lasting anti-glycan IgG antibody responses, which were highly selective toward Salmonella Paratyphi A associated glycans. The availability of well-defined glycan antigen enabled the determination that one repeating unit of the polysaccharide is sufficient to induce protective antibodies, and the paratose residue and/or the O-acetyl modifications on the backbone are important for recognition by antibodies elicited by a Qβ-tetrasaccharide conjugate. Immune sera provided excellent protection to mice from lethal challenge with Salmonella Paratyphi A, highlighting the potential of the synthetic glycan-based vaccine.
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Affiliation(s)
- Debashis Dhara
- Division of Molecular Medicine; Bose Institute, P-1/12, C.I.T. Scheme VII M; Kolkata 700054, India
| | - Scott M. Baliban
- Center for Vaccine Development and Global Health; University of Maryland School of Medicine; Baltimore, MD, USA
| | - Chang-Xin Huo
- Department of Chemistry, Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science & Engineering; Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
| | - Zahra Rashidijahanabad
- Department of Chemistry, Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science & Engineering; Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
| | - Khandra T. Sears
- Center for Vaccine Development and Global Health; University of Maryland School of Medicine; Baltimore, MD, USA
| | - Setare Tahmasebi Nick
- Department of Chemistry, Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science & Engineering; Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
| | - Anup Kumar Misra
- Division of Molecular Medicine; Bose Institute, P-1/12, C.I.T. Scheme VII M; Kolkata 700054, India
| | - Sharon M. Tennant
- Center for Vaccine Development and Global Health; University of Maryland School of Medicine; Baltimore, MD, USA
| | - Xuefei Huang
- Department of Chemistry, Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science & Engineering; Michigan State University; 578 South Shaw Lane, East Lansing, MI 48824, USA
- Department of Biomedical Engineering; Michigan State University; East Lansing, MI 48824, USA
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Qian H, Cheng S, Liu G, Tan Z, Dong C, Bao J, Hong J, Jin D, Bao C, Gu B. Discovery of seven novel mutations of gyrB, parC and parE in Salmonella Typhi and Paratyphi strains from Jiangsu Province of China. Sci Rep 2020; 10:7359. [PMID: 32355184 PMCID: PMC7193621 DOI: 10.1038/s41598-020-64346-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/15/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To investigate the prevalence of Salmonella Typhi and Paratyphi resistance to quinolones and characterize the underlying mechanism in Jiangsu Province of China. Methods: Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion system. Quinolone resistance-determining region (QRDR), plasmid-mediated quinolone resistance (PMQR) determinant genes were detected by PCR and sequencing. Results: Out of 239 Salmonella isolates, 164 were S. Typhi and 75 were S. Paratyphi. 128 (53.6%) Salmonella isolates were resistant to nalidixic acid; 11 (4.6%) isolates to ciprofloxacin and 66 (27.6%) isolates were intermediate to ciprofloxacin. QRDR were present in 69 S. Typhi isolates, among which mutation at codon 83 (n = 45) and 133 (n = 61) predominated. In S. Paratyphi, the most common mutations were detected in gyrA at codon 83(n = 24) and parC: T57S (n = 8). Seven mutations were first reported in Salmonella isolates including gyrB: S426G, parC: D79G and parE: [S498T, E543K, V560G, I444S, Y434S]. PMQR genes including qnrD1, qnrA1, qnrB4, aac (6′)-Ib-cr4 and qnrS1 were detected in 1, 2, 3, 7 and 9 isolates, relatively. Conclusions: High resistance to quinolones in Salmonella remains a serious problem in Jiangsu, China. The presence of the novel mutations increases the complexity of quinolone-resistant genotypes and poses a threat to public health. Subject terms: Salmonella Typhi, Salmonella Paratyphi, antimicrobial resistance, QRDR, PMQR.
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Affiliation(s)
- Huimin Qian
- Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, 210029, China
| | - Siyun Cheng
- Xuzhou Medical University School of Medical Technology, Xuzhou, 221004, China
| | - Guoye Liu
- Xuzhou Medical University School of Medical Technology, Xuzhou, 221004, China
| | - Zhongming Tan
- Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, 210029, China
| | - Chen Dong
- Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, 210029, China
| | - Jinfeng Bao
- Xuzhou Medical University School of Medical Technology, Xuzhou, 221004, China
| | - Jie Hong
- Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, 210029, China
| | - Dazhi Jin
- Centre of Laboratory Medicine, Zhejiang Provincial People Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.,School of Laboratory Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, 310053, China
| | - Changjun Bao
- Department of Acute Infectious Disease Prevention and Control, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, 210029, China.
| | - Bing Gu
- Xuzhou Medical University School of Medical Technology, Xuzhou, 221004, China. .,Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
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Britto CD, John J, Verghese VP, Pollard AJ. A systematic review of antimicrobial resistance of typhoidal Salmonella in India. Indian J Med Res 2019; 149:151-163. [PMID: 31219079 PMCID: PMC6563740 DOI: 10.4103/ijmr.ijmr_830_18] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background & objectives: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India. Methods: To identify trends in AMR in India, resistance patterns among 4611 individual S. Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases. Results: The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons). Interpretation & conclusions: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.
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Affiliation(s)
- Carl D Britto
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jacob John
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - Valsan P Verghese
- Department of Paediatrics, Christian Medical College, Vellore, India
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
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Patil N, Mule P. Sensitivity Pattern Of Salmonella typhi And Paratyphi A Isolates To Chloramphenicol And Other Anti-Typhoid Drugs: An In Vitro Study. Infect Drug Resist 2019; 12:3217-3225. [PMID: 31686872 PMCID: PMC6800285 DOI: 10.2147/idr.s204618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the antimicrobial sensitivity pattern of commonly prescribed antimicrobials (chloramphenicol, cefixime, ofloxacin, azithromycin, and ceftriaxone) against Salmonella enterica isolates. Methods Blood culture positive isolates of S. typhi and S. paratyphi A (N = 251) received at Metropolis Healthcare Limited (Mumbai, India) from four zones of India (North, South, West, and East) between April and August 2018 were tested for antimicrobial susceptibility by E-test method. Based on the minimum inhibitory concentration (MIC), the organism was categorized as sensitive, intermediate, and resistant against the respective antibiotics as per Clinical and Laboratory Standards Institute criteria 2018. Results Out of 251 Salmonella isolates, 192 (76.5%) were S. typhi and 59 (23.5%) were S. paratyphi A. All 251 (100%) Salmonella isolates were sensitive to cefixime, ceftriaxone, and azithromycin; 237/251 (94.4%) isolates to chloramphenicol and only 9/251 (3.6%) isolates were sensitive to ofloxacin. Based on average MIC and MIC breakpoints, Salmonella isolates were found to be sensitive to chloramphenicol (MIC: 3.89±6.94 µg/mL), cefixime (MIC: 0.13±0.11 µg/mL), azithromycin (MIC: 3.32±2.19 µg/mL), and ceftriaxone (MIC: 0.11±0.18 µg/mL) and resistant to ofloxacin (MIC: 2.95±6.06 µg/mL). More than 20% of Salmonella isolates had MICs of chloramphenicol as 1.5 µg/mL (27.85% isolates) and 2 µg/mL (29.53% isolates). Conclusion Our study confirms the re‑emergence of susceptibility of Salmonella isolates to chloramphenicol. Further, the concern about fluoroquinolone-decreased susceptibility as indicated by the intermediate susceptibility or resistance was reiterated in this study. Though cefixime, azithromycin, and ceftriaxone showed susceptibility, the possibility of antibiotic resistance with the irrational use of these antibiotics cannot be deterred. This study thus emphasizes the need for continuous evaluation and judicious use of antimicrobials, considering the ever-changing landscape.
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Affiliation(s)
- Niranjan Patil
- Microbiology and Molecular Biology Department, Metropolis Healthcare Limited, Mumbai, India
| | - Prashant Mule
- Microbiology and Molecular Biology Department, Metropolis Healthcare Limited, Mumbai, India
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Joshi S, Adhikary R, Beena HB, Bhavana MV, Bhalwar R. Trends in antibiotic susceptibility of enteric fever isolates from South India, 2002–2013. Med J Armed Forces India 2019; 75:81-85. [DOI: 10.1016/j.mjafi.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
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Ahmedullah H, Khan FY, Al Maslamani M, Al Soub H, Chacko K, Abu Khattab M, Mahmoud S, Howaidy F, Thapur M, Al Madhoun E, Hamed M, Doiphode S, Al Khal A, Deshmukh A. Epidemiological and Clinical Features of Salmonella Typhi Infection Among Adult Patients in Qatar: A Hospital-based Study. Oman Med J 2018; 33:468-472. [PMID: 30410688 DOI: 10.5001/omj.2018.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives We sought to describe the epidemiological and clinical features of typhoid fever in Qatar. Methods We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012. Results The mean age of the 354 patients enrolled in the study was 28.4±9.3 years; 296 (83.6%) were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 (96.9%) patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain (38.1%), diarrhea (35.6%), and headache (33.1%). Salmonella typhi, showed high resistance to ciprofloxacin (n = 163; 46.0%), and low resistance to ceftriaxone (n = 2; 0.6%). Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients (0.6%) died. Conclusions Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality.
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Affiliation(s)
- Hasan Ahmedullah
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | | | - Muna Al Maslamani
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Hussam Al Soub
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Kadavil Chacko
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Mohammed Abu Khattab
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Samar Mahmoud
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Faraj Howaidy
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Maliha Thapur
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Eyad Al Madhoun
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Manal Hamed
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Sanjay Doiphode
- Department of Microbiology, Hamad General Hospital, Doha, Qatar
| | - Abdulatif Al Khal
- Department of Medicine, Infectious Disease Division, Hamad General Hospital, Doha, Qatar
| | - Anand Deshmukh
- Department of Microbiology, Hamad General Hospital, Doha, Qatar
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Typhoid Fever due to Extended Spectrum β-Lactamase-Producing Salmonella enterica Serovar Typhi: A Case Report and Literature Review. Case Rep Infect Dis 2018; 2018:4610246. [PMID: 29666727 PMCID: PMC5832104 DOI: 10.1155/2018/4610246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/25/2017] [Accepted: 01/14/2018] [Indexed: 11/18/2022] Open
Abstract
Emergence of cephalosporin-resistant strains of Salmonella enterica serovar Typhi is a cause of concern in the management of enteric fever. Cephalosporin resistance in Salmonella species is mainly due to the production of extended-spectrum β-lactamases (ESBLs). The majority of ESBLs in Salmonella enterica serovar Typhi are derivatives of the TEM, SHV, and CTX-M β-lactamase families. Of these, CTX-M appears to be predominant. This paper discusses the detection and molecular characterization of an ESBL-producing Salmonella enterica serovar Typhi strain isolated from a patient who was admitted to a private hospital in Sri Lanka. The three main types of β-lactamases such as TEM, SHV, and CTX-M were identified in this isolate. This case report from Sri Lanka contributes to the knowledge of the increasingly reported cases of typhoid fever due to Salmonella enterica serovar Typhi resistant to β-lactamase by ESBL production.
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Chowdhury R, Ilyas H, Ghosh A, Ali H, Ghorai A, Midya A, Jana NR, Das S, Bhunia A. Multivalent gold nanoparticle-peptide conjugates for targeting intracellular bacterial infections. NANOSCALE 2017; 9:14074-14093. [PMID: 28901372 DOI: 10.1039/c7nr04062h] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Although nanoparticle-tagged antimicrobal peptides have gained considerable importance in recent years, their structure-function correlation has not yet been explored. Here, we have studied the mechanism of action of a designed antimicrobial peptide, VG16KRKP (VARGWKRKCPLFGKGG), delivered via gold nanoparticle tagging against Salmonella infection by combining biological experiments with high- and low-resolution spectroscopic techniques. In comparison with the free VG16KRKP peptide or gold nanoparticle alone, the conjugated variant, Au-VG16KRKP, is non-cytotoxic to eukaryotic cells, but exhibits strong bacteriolytic activity in culture. Au-VG16KRKP can penetrate host epithelial and macrophage cells as well as interact with intracellular S. Typhi LPS under both in vitro and in vivo conditions. Treatment of mice with Au-VG16KRKP post-infection with S. Typhi resulted in reduced intracellular bacterial recovery and highly enhanced protection against S. Typhi challenge. The three-dimensional high resolution structure of nanoparticle conjugated VG16KRKP depicted the generation of a well-separated amphipathic structure with slight aggregation, responsible for the increase of the local concentration of the peptide, thus leading to potent activity. This is the first report on the structural and functional characterization of a nanoparticle conjugated synthetic antimicrobial peptide that can kill intracellular pathogens and eventually protect against S. Typhi challenge in vivo.
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Affiliation(s)
- Rimi Chowdhury
- Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, P-33 CIT Road Scheme XM, Beliaghata, Kolkata-700010, India.
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Veeraraghavan B, Anandan S, Muthuirulandi Sethuvel DP, Puratchiveeran N, Walia K, Devanga Ragupathi NK. Molecular Characterization of Intermediate Susceptible Typhoidal Salmonella to Ciprofloxacin, and its Impact. Mol Diagn Ther 2017; 20:213-9. [PMID: 26951258 DOI: 10.1007/s40291-016-0191-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Extensive use of ciprofloxacin to treat Salmonella typhi infections has led to the emergence of resistance, resulting in clinical failure and delayed treatment response. Interpretative breakpoints for ciprofloxacin were revised by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2012. Since the majority of S. typhi isolates fall under the category of 'intermediate susceptible' as per CLSI criteria, we undertook molecular characterization to better define the susceptibility of these isolates. METHODS Of 113 typhoidal Salmonella isolates collected during 2014, 33 (27 S. typhi and 6 S. paratyphi A) were randomly selected to determine the presence of chromosomal (gyrA, gyrB and parC), plasmid (qnrA, qnrB, qnrS and aac(6')-lb-cr), and efflux-mediated fluoroquinolone resistance. RESULTS To the best of our knowledge, the parC mutation Glu(84)-Gly was observed for the first time in S. typhi in India. Of 33 isolates, only one harbored the qnrB gene, which is responsible for plasmid-mediated resistance. No significant change in efflux pump activity was observed for ciprofloxacin, except one that showed a fivefold decrease. Ninety-six percent of isolates with intermediate minimum inhibitory concentration to ciprofloxacin (CLSI) had mutations in the gyrA and parC genes, which might translate to possible/probable clinical failure in patients if treated with ciprofloxacin. In contrast, the EUCAST criteria define these isolates as resistant and may result in appropriate therapy with reduced morbidity. CONCLUSION It was clear that the molecular mechanism of ciprofloxacin resistance correlates better with the EUCAST criteria than the CLSI criteria, which is also in agreement with the pefloxacin results, suggesting it as a surrogate marker for identifying fluoroquinolone susceptibility.
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Affiliation(s)
- Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, 8th Floor, Asha Building, Vellore, 632 004, Tamil Nadu, India.
| | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, 8th Floor, Asha Building, Vellore, 632 004, Tamil Nadu, India
| | | | - Nivetha Puratchiveeran
- Department of Clinical Microbiology, Christian Medical College, 8th Floor, Asha Building, Vellore, 632 004, Tamil Nadu, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110 029, India
| | - Naveen Kumar Devanga Ragupathi
- Department of Clinical Microbiology, Christian Medical College, 8th Floor, Asha Building, Vellore, 632 004, Tamil Nadu, India
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Harichandran D, Dinesh KR. Antimicrobial susceptibility profile, treatment outcome and serotype distribution of clinical isolates of Salmonella enterica subspecies enterica: a 2-year study from Kerala, South India. Infect Drug Resist 2017; 10:97-101. [PMID: 28352198 PMCID: PMC5358982 DOI: 10.2147/idr.s126209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/purpose Typhoid and paratyphoid fever continue to be important causes of illness and death in parts of Asia, being associated with poor sanitation and consumption of unsafe food and water. Antimicrobial resistance has emerged to traditional first-line drugs, namely, the fluoroquinolones, as well as to third-generation cephalosporins, posing challenges to treatment. Azithromycin has proven to be an effective alternative for treatment of uncomplicated typhoid fever. The purpose of this study was to determine the antimicrobial susceptibility, clinical outcome and serotype distribution pattern of clinical isolates belonging to Salmonella enterica subspecies enterica. Methodology All clinical isolates of S. enterica obtained from blood, sterile body fluids, as well as stool and urine samples at Amrita Institute of Medical Sciences and Research Centre, Kerala, India, between August 2011 and July 2013 were included in the study and processed based on standard microbiology protocols. Results A total of 118 isolates of Salmonella were obtained during the study period. Out of these, 79 were of S. Typhi (66.95%), followed by isolates of S. Paratyphi A (22; 18.64%) and S. Typhimurium 12 (10.17%). Five isolates could not be identified further. There was 100% susceptibility to ceftriaxone in all S. enterica subspecies. Ciprofloxacin susceptibility was 32.91% for S. Typhi and 40.90% for S. Paratyphi A as determined by the disk diffusion method. The susceptibility profile of S. Typhi isolates to different antimicrobials was as follows: chloramphenicol (94.93%), ampicillin (77.21%), cotrimoxazole (75.94%) and azithromycin (78.48%). For S. Typhi, the minimum inhibitory concentration (MIC) of ciprofloxacin required to inhibit the growth of 50% of organisms was 0.5 μg/mL (intermediate) and MIC required to inhibit the growth of 90% of organisms was 1 μg/mL (resistant). S. Typhimurium was 100% susceptible to cotrimoxazole, ampicillin, ceftriaxone, chloramphenicol, ofloxacin and azithromycin. Susceptibility to ciprofloxacin was 66.66%. Patients from whom S. Typhimurium was isolated had comorbidities with documented risk. Of the 118 patients, 3 expired. Two had typhoid fever and were in sepsis at admission. One had S. Typhimurium and was suffering from multiple myeloma. Conclusion S. Typhi was the predominant isolate. All isolates were susceptible to ceftriaxone. Chloramphenicol susceptibility was >90%. No multidrug-resistant Salmonella strains were isolated. Susceptibility to ciprofloxacin for S. Typhi was 33%. Recovery rate was 97%.
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Affiliation(s)
- Deepa Harichandran
- Department of Microbiology, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Kavitha Radhakrishnan Dinesh
- Department of Microbiology, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
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Chiyangi H, Muma JB, Malama S, Manyahi J, Abade A, Kwenda G, Matee MI. Identification and antimicrobial resistance patterns of bacterial enteropathogens from children aged 0-59 months at the University Teaching Hospital, Lusaka, Zambia: a prospective cross sectional study. BMC Infect Dis 2017; 17:117. [PMID: 28152988 PMCID: PMC5290660 DOI: 10.1186/s12879-017-2232-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bacterial diarrhoeal disease is among the most common causes of mortality and morbidity in children 0-59 months at the University Teaching Hospital in Lusaka, Zambia. However, most cases are treated empirically without the knowledge of aetiological agents or antimicrobial susceptibility patterns. The aim of this study was, therefore, to identify bacterial causes of diarrhoea and determine their antimicrobial susceptibility patterns in stool specimens obtained from the children at the hospital. METHODS This hospital-based cross-sectional study involved children aged 0-59 months presenting with diarrhoea at paediatrics wards at the University Teaching Hospital in Lusaka, Zambia, from January to May 2016. Stool samples were cultured on standard media for enteropathogenic bacteria, and identified further by biochemical tests. Multiplex polymerase chain reaction was used for characterization of diarrhoeagenic Escherichia coli strains. Antimicrobial susceptibility testing was performed on antibiotics that are commonly prescribed at the hospital using the Kirby-Bauer disc diffusion method, which was performed using the Clinical Laboratory Standards International guidelines. RESULTS Of the 271 stool samples analysed Vibrio cholerae 01 subtype and Ogawa serotype was the most commonly detected pathogen (40.8%), followed by Salmonella species (25.5%), diarrhoeagenic Escherichia coli (18%), Shigella species (14.4%) and Campylobacter species (3.5%). The majority of the bacterial pathogens were resistant to two or more drugs tested, with ampicillin and co-trimoxazole being the most ineffective drugs. All diarrhoeagenic Escherichia coli isolates were extended spectrum β-lactamase producers. CONCLUSION Five different groups of bacterial pathogens were isolated from the stool specimens, and the majority of these organisms were multidrug resistant. These data calls for urgent revision of the current empiric treatment of diarrhoea in children using ampicillin and co-trimoxazole, and emphasizes the need for continuous antimicrobial surveillance as well as the implementation of prevention programmes for childhood diarrhoea.
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Affiliation(s)
- Harriet Chiyangi
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
- Tanzania Field Epidemiology and Laboratory Management Program, Ministry of Health, Dar es Salaam, Tanzania
| | - John B Muma
- Department of Disease Control, School of Veterinary, University of Zambia, Lusaka, Zambia
| | - Sydney Malama
- Health Promotions Research Program, Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia.
| | - Joel Manyahi
- Health Promotions Research Program, Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | - Ahmed Abade
- Tanzania Field Epidemiology and Laboratory Management Program, Ministry of Health, Dar es Salaam, Tanzania
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mecky I Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
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Menezes GA, Harish BN, Khan MA, Goessens W, Hays JP. Antimicrobial resistance trends in blood culture positive Salmonella Paratyphi A isolates from Pondicherry, India. Indian J Med Microbiol 2016; 34:222-7. [PMID: 27080779 DOI: 10.4103/0255-0857.180352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Enteric fever is a public health problem with the upsurge in the occurrence of Salmonella isolates that are resistant to ciprofloxacin. In this study, a total of 284 blood culture isolates of S. Paratyphi A were investigated. Of these isolates, 281 (98.9%) were nalidixic acid resistant. A high rate (6.3%) of high-level resistance (≥ 4 μg/mL) was found to ciprofloxacin. The isolates with ciprofloxacin minimum inhibitory concentrations (MICs) of ≥ 12 μg/mL had 4 mutations, 2 mutations within the quinolone resistance-determining region of gyrA and 2 mutations also in parC. According to the Clinical Laboratory Standards Institute 2012 MIC breakpoints, 75.0% of isolates were resistant to ciprofloxacin. Finally, 3 major pulsed-field gel electrophoresis patterns were observed among the S. Paratyphi A isolates. The spread of fluoroquinolone resistant S. Paratyphi A necessitates a change toward 'evidence-based' treatment for enteric fever. The research provides a perspective on the increasing prevalence of antimicrobial resistant S. Paratyphi A isolates in this region of India.
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Affiliation(s)
- G A Menezes
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Molecular Diagnostics and Personalised Therapeutics Unit, Ha'il University, Hail, Kingdom of Saudi Arabia; Department of Microbiology, Institute of National Importance, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India,
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Divyashree S, Nabarro LEB, Veeraraghavan B, Rupali P. Enteric fever in India: current scenario and future directions. Trop Med Int Health 2016; 21:1255-1262. [DOI: 10.1111/tmi.12762] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Divyashree
- Department of Infectious Disease; Christian Medical College; Vellore India
| | - L. E. B. Nabarro
- Department of Infectious Disease; Christian Medical College; Vellore India
- Public Health England; London UK
| | - B. Veeraraghavan
- Department of Microbiology; Christian Medical College; Vellore India
| | - P. Rupali
- Department of Infectious Disease; Christian Medical College; Vellore India
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Verma S, Sharma V, Mokta K, Thakur C, Angrup A, Singh D, Kanga A. Outbreak of enteric fever due to Salmonella Paratyphi A variety durazzo (2,12:a:-) in a hilly region of North India: A report of 43 cases. Indian J Med Microbiol 2016; 34:387-9. [PMID: 27514969 DOI: 10.4103/0255-0857.188366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Enteric fever due to Salmonella Paratyphi A (SPA) is a global problem occurring as outbreaks at times. An unusual SPA (2,12:a:-) variety durazzo has been reported rarely. We report an outbreak of enteric fever due to this variety affecting 43 individuals. The blood samples grew unusual mucoid, lactose non-fermenting colonies with atypical biochemical reactions in sugar fermentation and amino acid decarboxylation. Isolates had sensitivity to ceftriaxone, chloramphenical, cotrimoxazole, intermediate susceptibility to ciprofloxacin and resistance to ampicillin and nalidixic acid. Identification was confirmed as SPA (2,12:a:-) at the National Salmonella Centre.
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Affiliation(s)
- S Verma
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - V Sharma
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - K Mokta
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - C Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - A Angrup
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - D Singh
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - A Kanga
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Date KA, Newton AE, Medalla F, Blackstock A, Richardson L, McCullough A, Mintz ED, Mahon BE. Changing Patterns in Enteric Fever Incidence and Increasing Antibiotic Resistance of Enteric Fever Isolates in the United States, 2008-2012. Clin Infect Dis 2016; 63:322-9. [PMID: 27090993 DOI: 10.1093/cid/ciw232] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Enteric fever in the United States has been primarily associated with travel and with worrisome changes in global patterns of antimicrobial resistance. We present the first comprehensive report of National Typhoid and Paratyphoid Fever Surveillance System (NTPFS) data for a 5-year period (2008-2012). METHODS We reviewed data on laboratory-confirmed cases reported to NTPFS, and related antimicrobial susceptibility results of Salmonella Typhi and Paratyphi A isolates sent for testing by participating public health laboratories to the Centers for Disease Control and Prevention's National Antimicrobial Resistance Monitoring System laboratory. RESULTS During 2008-2012, 2341 enteric fever cases were reported, 80% typhoid and 20% paratyphoid A. The proportion caused by paratyphoid A increased from 16% (2008) to 22% (2012). Foreign travel within 30 days preceding illness onset was reported by 1961 (86%) patients (86% typhoid and 92% paratyphoid A). Travel to southern Asia was common (82% for typhoid, 97% for paratyphoid A). Among 1091 (58%) typhoid and 262 (56%) paratyphoid A isolates tested for antimicrobial susceptibility, the proportion resistant to nalidixic acid (NAL-R) increased from 2008 to 2012 (Typhi, 60% to 68%; Paratyphi A, 91% to 94%). Almost all NAL-R isolates were resistant or showed decreased susceptibility to ciprofloxacin. Resistance to at least ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug resistant [MDR]) was limited to Typhi isolates, primarily acquired in southern Asia (13%). Most MDR isolates were also NAL-R. CONCLUSIONS Enteric fever in the United States is primarily associated with travel to southern Asia, and increasing resistance is adding to treatment challenges. A bivalent typhoid and paratyphoid vaccine is needed.
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Affiliation(s)
- Kashmira A Date
- Epidemic Intelligence Service, Office of Workforce and Career Development Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna E Newton
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Felicita Medalla
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Blackstock
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LaTonia Richardson
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andre McCullough
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara E Mahon
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Antimicrobial resistance, virulence profiles and molecular subtypes of Salmonella enterica serovars Typhi and Paratyphi A blood isolates from Kolkata, India during 2009-2013. PLoS One 2014; 9:e101347. [PMID: 25098613 PMCID: PMC4123848 DOI: 10.1371/journal.pone.0101347] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 06/05/2014] [Indexed: 11/19/2022] Open
Abstract
Enteric fever, caused by Salmonella enterica, remains an unresolved public health problem in India and antimicrobial therapy is the main mode of treatment. The objective of this study was to characterize the Salmonella enterica isolates from Kolkata with respect to their antimicrobial resistance (AMR), virulence profiles and molecular subtypes. Salmonella enterica blood isolates were collected from clinically suspected enteric fever patients attending various hospitals in Kolkata, India from January 2009 to June 2013 and were tested for AMR profiles by standard protocols; for resistance gene transfer by conjugation; for resistance and virulence genes profiles by PCR; and for molecular subtypes by Pulsed Field Gel Electrophoresis (PFGE). A total of 77 Salmonella enterica serovar Typhi (S. Typhi) and 25 Salmonella enterica serovar Paratyphi A (S. Paratyphi A) from Kolkata were included in this study. Although multidrug resistance (resistance to chloramphenicol, ampicillin, co-trimoxazole) was decreasing in S. Typhi (18.2%) and absent in S. Paratyphi A, increased resistance to fluoroquinolone, the current drug of choice, caused growing concern for typhoid treatment. A single, non-conjugative non-IncHI1 plasmid of 180 kb was found in 71.4% multidrug resistant (MDR) S. Typhi; the remaining 28.6% isolates were without plasmid. Various AMR markers (blaTEM-1, catA, sul1, sul2, dfrA15, strA-strB) and class 1 integron with dfrA7 gene were detected in MDR S. Typhi by PCR and sequencing. Most of the study isolates were likely to be virulent due to the presence of virulence markers. Major diversity was not noticed among S. Typhi and S. Paratyphi A from Kolkata by PFGE. The observed association between AMR profiles and S. Typhi pulsotypes might be useful in controlling the spread of the organism by appropriate intervention. The study reiterated the importance of continuous monitoring of AMR and molecular subtypes of Salmonella isolates from endemic regions for better understanding of the disease epidemiology.
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Elumalai S, Muthu G, Selvam REM, Ramesh S. Detection of TEM-, SHV- and CTX-M-type β-lactamase production among clinical isolates of Salmonella species. J Med Microbiol 2014; 63:962-967. [DOI: 10.1099/jmm.0.068486-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Enteric fever is a major public health problem in developing countries. Due to the problem of resistance to first-line drugs and fluoroquinolone, cephalosporins are currently used for treatment of enteric fever. Cephalosporin resistance in Salmonella spp. is mainly due to production of extended-spectrum β-lactamases (ESBLs). The majority of ESBLs in Salmonella are derivatives of the TEM and SHV β-lactamase families. The objectives of this study were to detect antibiotic susceptibility patterns, ESBL production and TEM-, SHV- and CTX-M-encoding genes (bla
TEM, bla
SHV and bla
CTX-M) among clinical isolates of Salmonella spp. A total of 134 Salmonella isolates [Salmonella Typhi (n = 101), Salmonella Paratyphi A (n = 31), Salmonella Paratyphi B (n = 1) and Salmonella Typhimurium (n = 1)] were included in this study. Multidrug resistance was seen in 5/134 (3.73 %) isolates, all of which belonged to serotype S. Typhi. A better susceptibility profile was observed for first-line drugs (ampicillin, chloramphenicol, co-trimoxazole and tetracycline) and cephalosporins (cefotaxime, ceftazidime, ceftriaxone, cefixime and cefepime). However, 131 (97.76 %) of the 134 isolates were resistant to nalidixic acid and one (0.75 %) was resistant to ciprofloxacin. TEM-1-type β-lactamase (bla
TEM-1) was detected in six (4.47 %) of the 134 isolates, which belonged to the serotype S. Typhi. All six TEM-positive isolates were negative for the bla
SHV gene and none of the isolates was positive for the bla
CTX-M gene. The presence of the bla
TEM gene encoding TEM-1 β-lactamase is believed to confer resistance only to penicillins and early cephalosporins; however, the resistance spectrum of TEM-1 descendants may extend to second-, third- and fourth-generation cephalosporins. The ESBLs derived from TEM-1 differ from their progenitors by as few as 1 aa, and have the ability to hydrolyse third-generation cephalosporins. Therefore, appropriate selection and rotation of antibiotics as well as continuous monitoring of antibiotic susceptibility profiles could help to control the emergence and spread of resistant strains.
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Affiliation(s)
- Sathishkumar Elumalai
- Department of Microbiology, Dr ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, Tamil Nadu, India
| | - G. Muthu
- Central Research Laboratory, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Pondicherry 605 107, India
| | - R. Esther Mary Selvam
- Department of Microbiology, ESIC Hospital, K. K. Nagar, Chennai 600078, Tamil Nadu, India
| | - Srivani Ramesh
- Department of Microbiology, Dr ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, Tamil Nadu, India
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Kaushik D, Mohan M, Borade DM, Swami OC. Ampicillin: rise fall and resurgence. J Clin Diagn Res 2014; 8:ME01-3. [PMID: 24995206 DOI: 10.7860/jcdr/2014/8777.4356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Abstract
Antimicrobial resistance (AMR) is a global problem. AMR has posed new challenges in treatment of infectious diseases. Antimicrobials are losing efficacy due to development of resistant pathogens. It has lead to re-emergence of certain infectious diseases. Treatment of such diseases has undergone changes with use of alternative antimicrobials and drug combinations. Pathogens are likely to develop resistance to alternative antimicrobials also and risk of infections with nonexistent treatment is real. Salmonella showed widespread resistant to ampicillin which resulted in use of alternative antimicrobials like fluroquinolones and cephalosporins in the treatment of enteric fever in last two decades. Unfortunately there are growing reports of resistance to these antimicrobials. Interestingly there are numerous reports of ampicillin regaining activity against Salmonella. Speculatively lack of exposure of Salmonella to ampicillin for long time resulted in the loss of plasmid mediated resistance in the pathogen. There may have been emergence of de novo ampicillin susceptible strains. This is assuring in the era where problem of AMR is compounded by the scarcity of new antimicrobial development.
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Affiliation(s)
- Dwarikadhish Kaushik
- Consultant Physician, Department of Critical Care Medicine, St Joseph Hospital , Mariyam Nagar, Nandgram Ghaziabad-201003, UP, India
| | - Mudit Mohan
- Consultant Physician, Department of Medicine, Yashoda Hospital , Ghaziabad, UP, India
| | - Dhammraj M Borade
- Assistant Manager, Department of Medical Service, Unichem Laboratories Ltd , Unichem Bhavan, Prabhat Estate, S.V. Road, Jogeshwari (W), Mumbai, Maharashtra, India
| | - Onkar C Swami
- Head, Department of Medical Services, Unichem Laboratories Ltd , Unichem Bhavan, Prabhat Estate, S.V. Road, Jogeshwari (W), Mumbai, Maharashtra, India
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Teh CSJ, Chua KH, Thong KL. Paratyphoid fever: splicing the global analyses. Int J Med Sci 2014; 11:732-41. [PMID: 24904229 PMCID: PMC4045793 DOI: 10.7150/ijms.7768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/05/2014] [Indexed: 11/24/2022] Open
Abstract
The incidence of enteric fever caused by Salmonella enterica serovar Paratyphi A (S. Paratyphi A) is increasing in many parts of the world. Although there is no major outbreak of paratyphoid fever in recent years, S. Paratyphi A infection still remains a public health problem in many tropical countries. Therefore, surveillance studies play an important role in monitoring infections and the emergence of multidrug resistance, especially in endemic countries such as India, Nepal, Pakistan and China. In China, enteric fever was caused predominantly by S. Paratyphi A rather than by Salmonella enterica serovar Typhi (S. Typhi). Sometimes, S. Paratyphi A infection can evolve into a carrier state which increases the risk of transmission for travellers. Hence, paratyphoid fever is usually classified as a "travel-associated" disease. To date, diagnosis of paratyphoid fever based on the clinical presentation is not satisfactory as it resembles other febrile illnesses, and could not be distinguished from S. Typhi infection. With the availability of Whole Genome Sequencing technology, the genomes of S. Paratyphi A could be studied in-depth and more specific targets for detection will be revealed. Hence, detection of S. Paratyphi A with Polymerase Chain Reaction (PCR) method appears to be a more reliable approach compared to the Widal test. On the other hand, due to increasing incidence of S. Paratyphi A infections worldwide, the need to produce a paratyphoid vaccine is essential and urgent. Hence various vaccine projects that involve clinical trials have been carried out. Overall, this review provides the insights of S. Paratyphi A, including the bacteriology, epidemiology, management and antibiotic susceptibility, diagnoses and vaccine development.
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Affiliation(s)
- Cindy Shuan Ju Teh
- 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
| | - Kek Heng Chua
- 2. Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur
| | - Kwai Lin Thong
- 3. Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur
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Sahastrabuddhe S, Carbis R, Wierzba TF, Ochiai RL. Increasing rates of Salmonella Paratyphi A and the current status of its vaccine development. Expert Rev Vaccines 2014; 12:1021-31. [PMID: 24053396 DOI: 10.1586/14760584.2013.825450] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enteric fever caused by Salmonella enterica serovar Typhi and Salmonella enterica serovar Paratyphi is still a major disease burden mainly in developing countries. Previously, S. Typhi was believed to be the major cause of enteric fever. The real situation is now becoming clear with reports emerging from many Asian countries of S. Paratyphi, mostly S. Paratyphi A, causing a substantial number of cases of enteric fever. Although there have been advances in the use of the currently available typhoid vaccines and in the development of newer typhoid vaccines, paratyphoid vaccine development is lagging behind. Since the disease caused by S. Typhi and S. Paratyphi are clinically indistinguishable and are commonly termed 'enteric' fever, it will be necessary to have a vaccine available against both S. Typhi and S. Paratyphi A as a bivalent 'enteric fever vaccine'.
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Affiliation(s)
- Sushant Sahastrabuddhe
- International Vaccine Institute, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul, 151-919, Korea
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Garg A, Verma S, Kanga A, Singh D, Singh B. Antimicrobial resistance pattern and in-vitro activity of azithromycin in Salmonella isolates [corrected]. Indian J Med Microbiol 2013; 31:287-9. [PMID: 23883718 DOI: 10.4103/0255-0857.115641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We evaluated antimicrobial susceptibility pattern of 42 Salmonella isolates from February 2012 through January 2013. We also determined the minimum inhibitory concentrations (MICs) of azithromycin against Salmonella isolates and compared them with corresponding disc diffusion sizes. Entire 42 isolates were sensitive to chloramphenicol, 41 (97.6%) were sensitive to cotrimoxazole and amoxicillin each. MICs for azithromycin ranged from 2 μg/ml to 24 μg/ml, corresponding zone diameters ranged from 15 mm to 33 mm and the two were significantly correlated (P = 0.001). Our results indicate that whereas, azithromycin is a potential therapeutic option, the sensitivity to the first line drugs and absence of multidrug resistance reinforce the concept of antimicrobial recycling.
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Affiliation(s)
- A Garg
- Department of Microbiology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
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Analysis of characteristics of paratyphoid A in 157 Chinese inpatients between 1998 and 2009. Eur J Clin Microbiol Infect Dis 2010; 30:71-5. [PMID: 20827496 DOI: 10.1007/s10096-010-1055-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 08/20/2010] [Indexed: 10/19/2022]
Abstract
The objectives of this study were to understand the epidemic rules, clinical characteristics, and drug resistance of paratyphoid A by analyzing 157 cases in the Wenzhou area of China during a 12-year period. The subjects included in the present study were patients with paratyphoid A who were admitted to the First Affiliated Hospital of Wenzhou Medical College (Wenzhou, ZJ, China) between 1998 and 2009. The disease mainly occurred in persons aged 20 to 50 years. The peak incidence was between 2001 and 2003 (n = 85). Paratyphoid A was more likely to occur in winter and spring in this area. In many cases (33.8%), the condition was complicated by underlying diseases. The length of hospital stay was relatively long, averaging 17.68 days. The white blood cell (WBC) count was 2-8 × 10(9)/L in 88.5% of cases. Eosinophils disappeared in 51.7% of cases. The erythrocyte sedimentation rate (ESR) was not significant and lower than 60 mm/h in 88.5% of cases. Alanine aminotransferase (ALT) was ≤3-fold greater than the normal value in 84.3% of cases. The Widal test was positive in only 7.7% of our cases. The sensitivity of many antibiotics was over 90%. Paratyphoid A in the Wenzhou area has unique epidemic rules, clinical characteristics, and drug resistance. The results of our retrospective analysis are instructive for the early diagnosis and rational treatment of paratyphoid A.
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