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A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014.
J Infect Dis. 2018 11 10; 218(suppl_4):S201-S205.JI

Abstract

Introduction

The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan.

Methods

In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) or Salmonella Paratyphi (S. Paratyphi). Antimicrobial sensitivity patterns were characterized for all S. Typhi and S. Paratyphi isolates. Medical records were available for abstraction (demographics, clinical features, complications) only among hospitalized cases.

Results

Of the 133017 blood cultures completed during the study period, 2872 (2%) were positive-1979 (69%) for S. Typhi and 893 (31%) for S. Paratyphi. Fluoroquinolone resistance was present in >90% of both the S. Typhi and the S. Paratyphi isolates; almost none of the isolates were resistant to cephalosporins. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was observed in 1035 (52%) S. Typhi isolates and 14 (2%) S. Paratyphi isolates. Among S. Typhi and S. Paratyphi isolates, 666 (23%) were linked to hospitalized patients with medical records. Of the 537 hospitalized S. Typhi cases, 280 (52%) were aged 5-15 years, 133 (25%) were aged 2-4 years, 114 (21%) were aged >15 years, and 10 (2%) were aged 0-1 years. Among the 129 hospitalized S. Paratyphi cases, 73 (57%) were aged >15 years, 41 (32%) were aged 5-15 years, 13 (10%) were aged 2-4 years, and 2 (2%) were aged 0-1 years. Significant differences in symptomology between S. Typhi and S. Paratyphi cases were observed for nausea/vomiting, diarrhea, loss of appetite, and headache. Leukopenia, thrombocytopenia, and encephalopathy were the most commonly reported complications among enteric fever cases. No deaths were reported.

Conclusion

Evidence of high antimicrobial resistance levels and disease severity support the need for continued surveillance and improved diagnostics for typhoid. Further prospective studies on vaccination as a tool for prevention of enteric fever in Pakistan are needed to inform disease intervention strategies.

Authors+Show Affiliations

Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan. Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.Coalition Against Typhoid, Sabin Vaccine Institute, Washington, DC.Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.Coalition Against Typhoid, Sabin Vaccine Institute, Washington, DC.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30060168

Citation

Qamar, Farah Naz, et al. "A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014." The Journal of Infectious Diseases, vol. 218, no. suppl_4, 2018, pp. S201-S205.
Qamar FN, Yousafzai MT, Sultana S, et al. A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. J Infect Dis. 2018;218(suppl_4):S201-S205.
Qamar, F. N., Yousafzai, M. T., Sultana, S., Baig, A., Shakoor, S., Hirani, F., Wassay, A., Khushboo, S., Mehmood, J., Freeman, A., Date, K., & Garrett, D. (2018). A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. The Journal of Infectious Diseases, 218(suppl_4), S201-S205. https://doi.org/10.1093/infdis/jiy205
Qamar FN, et al. A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. J Infect Dis. 2018 11 10;218(suppl_4):S201-S205. PubMed PMID: 30060168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. AU - Qamar,Farah Naz, AU - Yousafzai,Mohammad Tahir, AU - Sultana,Shazia, AU - Baig,Attaullah, AU - Shakoor,Sadia, AU - Hirani,Farzeen, AU - Wassay,Abdul, AU - Khushboo,Sehrish, AU - Mehmood,Junaid, AU - Freeman,Alexander, AU - Date,Kashmira, AU - Garrett,Denise, PY - 2018/01/31/received PY - 2018/04/06/accepted PY - 2018/7/31/pubmed PY - 2019/9/20/medline PY - 2018/7/31/entrez SP - S201 EP - S205 JF - The Journal of infectious diseases JO - J Infect Dis VL - 218 IS - suppl_4 N2 - Introduction: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan. Methods: In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) or Salmonella Paratyphi (S. Paratyphi). Antimicrobial sensitivity patterns were characterized for all S. Typhi and S. Paratyphi isolates. Medical records were available for abstraction (demographics, clinical features, complications) only among hospitalized cases. Results: Of the 133017 blood cultures completed during the study period, 2872 (2%) were positive-1979 (69%) for S. Typhi and 893 (31%) for S. Paratyphi. Fluoroquinolone resistance was present in >90% of both the S. Typhi and the S. Paratyphi isolates; almost none of the isolates were resistant to cephalosporins. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was observed in 1035 (52%) S. Typhi isolates and 14 (2%) S. Paratyphi isolates. Among S. Typhi and S. Paratyphi isolates, 666 (23%) were linked to hospitalized patients with medical records. Of the 537 hospitalized S. Typhi cases, 280 (52%) were aged 5-15 years, 133 (25%) were aged 2-4 years, 114 (21%) were aged >15 years, and 10 (2%) were aged 0-1 years. Among the 129 hospitalized S. Paratyphi cases, 73 (57%) were aged >15 years, 41 (32%) were aged 5-15 years, 13 (10%) were aged 2-4 years, and 2 (2%) were aged 0-1 years. Significant differences in symptomology between S. Typhi and S. Paratyphi cases were observed for nausea/vomiting, diarrhea, loss of appetite, and headache. Leukopenia, thrombocytopenia, and encephalopathy were the most commonly reported complications among enteric fever cases. No deaths were reported. Conclusion: Evidence of high antimicrobial resistance levels and disease severity support the need for continued surveillance and improved diagnostics for typhoid. Further prospective studies on vaccination as a tool for prevention of enteric fever in Pakistan are needed to inform disease intervention strategies. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/30060168/A_Retrospective_Study_of_Laboratory_Based_Enteric_Fever_Surveillance_Pakistan_2012_2014_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiy205 DB - PRIME DP - Unbound Medicine ER -