Tags

Type your tag names separated by a space and hit enter

The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015.
PLoS Negl Trop Dis. 2017 Sep; 11(9):e0005964.PN

Abstract

BACKGROUND

Enteric fever remains a major public health problem in low resource settings and antibiotic resistance is increasing. In Asia, an increasing proportion of infections is caused by Salmonella enterica serovar Paratyphi A, which for a long time was assumed to cause a milder clinical syndrome compared to Salmonella enterica serovar Typhi.

METHODOLOGY

A retrospective chart review study was conducted of 254 unique cases of blood culture confirmed enteric fever who presented at a referral adult hospital in Phnom Penh, Cambodia between 2008 and 2015. Demographic, clinical and laboratory data were collected from clinical charts and antibiotic susceptibility testing was performed. Whole genome sequence analysis was performed on a subset of 121 isolates.

RESULTS

One-hundred-and-ninety unique patients were diagnosed with Salmonella Paratyphi A and 64 with Salmonella Typhi. In the period 2008-2012, Salmonella Paratyphi A comprised 25.5% of 47 enteric fever cases compared to 86.0% of 207 cases during 2013-2015. Presenting symptoms were identical for both serovars but higher median leukocyte counts (6.8 x 109/L vs. 6.3 x 109/L; p = 0.035) and C-reactive protein (CRP) values (47.0 mg/L vs. 36 mg/L; p = 0.034) were observed for Salmonella Typhi infections. All but one of the Salmonella Typhi isolates belonged to haplotype H58 associated with multidrug resistance (MDR) (i.e. resistance to ampicillin, chloramphenicol and co-trimoxazole).;42.9% actually displayed MDR compared to none of the Salmonella Paratyphi A isolates. Decreased ciprofloxacin susceptibility (DCS) was observed in 96.9% (62/64) of Salmonella Typhi isolates versus 11.5% (21/183) of Salmonella Paratyphi A isolates (all but one from 2015). All isolates were susceptible to azithromycin and ceftriaxone.

CONCLUSIONS

In Phnom Penh, Cambodia, Salmonella Paratyphi A now causes the majority of enteric fever cases and decreased susceptibility against ciprofloxacin is increasing. Overall, Salmonella Typhi was significantly more associated with MDR and DCS compared to Salmonella Paratyphi A.

Authors+Show Affiliations

Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. Department of Microbiology & Immunology, KU Leuven, Leuven, Belgium.Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France.Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France.Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France.Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. Department of General Internal Medicine, Infectious diseases and Tropical Medicine, University Hospital Antwerp, Antwerp, Belgium.Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France.Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. Department of Microbiology & Immunology, KU Leuven, Leuven, Belgium.Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28931025

Citation

Kuijpers, Laura M F., et al. "The Clinical and Microbiological Characteristics of Enteric Fever in Cambodia, 2008-2015." PLoS Neglected Tropical Diseases, vol. 11, no. 9, 2017, pp. e0005964.
Kuijpers LMF, Phe T, Veng CH, et al. The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015. PLoS Negl Trop Dis. 2017;11(9):e0005964.
Kuijpers, L. M. F., Phe, T., Veng, C. H., Lim, K., Ieng, S., Kham, C., Fawal, N., Fabre, L., Le Hello, S., Vlieghe, E., Weill, F. X., Jacobs, J., & Peetermans, W. E. (2017). The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015. PLoS Neglected Tropical Diseases, 11(9), e0005964. https://doi.org/10.1371/journal.pntd.0005964
Kuijpers LMF, et al. The Clinical and Microbiological Characteristics of Enteric Fever in Cambodia, 2008-2015. PLoS Negl Trop Dis. 2017;11(9):e0005964. PubMed PMID: 28931025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015. AU - Kuijpers,Laura M F, AU - Phe,Thong, AU - Veng,Chhun H, AU - Lim,Kruy, AU - Ieng,Sovann, AU - Kham,Chun, AU - Fawal,Nizar, AU - Fabre,Laetitia, AU - Le Hello,Simon, AU - Vlieghe,Erika, AU - Weill,François-Xavier, AU - Jacobs,Jan, AU - Peetermans,Willy E, Y1 - 2017/09/20/ PY - 2017/04/21/received PY - 2017/09/14/accepted PY - 2017/10/02/revised PY - 2017/9/21/pubmed PY - 2017/10/7/medline PY - 2017/9/21/entrez SP - e0005964 EP - e0005964 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 11 IS - 9 N2 - BACKGROUND: Enteric fever remains a major public health problem in low resource settings and antibiotic resistance is increasing. In Asia, an increasing proportion of infections is caused by Salmonella enterica serovar Paratyphi A, which for a long time was assumed to cause a milder clinical syndrome compared to Salmonella enterica serovar Typhi. METHODOLOGY: A retrospective chart review study was conducted of 254 unique cases of blood culture confirmed enteric fever who presented at a referral adult hospital in Phnom Penh, Cambodia between 2008 and 2015. Demographic, clinical and laboratory data were collected from clinical charts and antibiotic susceptibility testing was performed. Whole genome sequence analysis was performed on a subset of 121 isolates. RESULTS: One-hundred-and-ninety unique patients were diagnosed with Salmonella Paratyphi A and 64 with Salmonella Typhi. In the period 2008-2012, Salmonella Paratyphi A comprised 25.5% of 47 enteric fever cases compared to 86.0% of 207 cases during 2013-2015. Presenting symptoms were identical for both serovars but higher median leukocyte counts (6.8 x 109/L vs. 6.3 x 109/L; p = 0.035) and C-reactive protein (CRP) values (47.0 mg/L vs. 36 mg/L; p = 0.034) were observed for Salmonella Typhi infections. All but one of the Salmonella Typhi isolates belonged to haplotype H58 associated with multidrug resistance (MDR) (i.e. resistance to ampicillin, chloramphenicol and co-trimoxazole).;42.9% actually displayed MDR compared to none of the Salmonella Paratyphi A isolates. Decreased ciprofloxacin susceptibility (DCS) was observed in 96.9% (62/64) of Salmonella Typhi isolates versus 11.5% (21/183) of Salmonella Paratyphi A isolates (all but one from 2015). All isolates were susceptible to azithromycin and ceftriaxone. CONCLUSIONS: In Phnom Penh, Cambodia, Salmonella Paratyphi A now causes the majority of enteric fever cases and decreased susceptibility against ciprofloxacin is increasing. Overall, Salmonella Typhi was significantly more associated with MDR and DCS compared to Salmonella Paratyphi A. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/28931025/The_clinical_and_microbiological_characteristics_of_enteric_fever_in_Cambodia_2008_2015_ L2 - https://dx.plos.org/10.1371/journal.pntd.0005964 DB - PRIME DP - Unbound Medicine ER -