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First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy.
Pathogens. 2020 Feb 24; 9(2)P

Abstract

Typhoid fever is a potentially severe and occasionally life-threatening bacteraemic illness caused by Salmonella enterica serovar Typhi (S. Typhi). In Pakistan, an outbreak of extensively drug-resistant (XDR) S. Typhi cases began in November 2016. We report on a five-year-old boy who contracted enteric fever while travelling in Pakistan and was diagnosed after returning to Italy in September 2019. Blood culture isolated Salmonella enterica serovar Typhi that was XDR to all first-line antibiotics, including ceftriaxone and fluoroquinolones. Empiric therapy was switched to meropenem, and the patient recovered completely. Whole-genome sequencing showed that this isolate was of haplotype H58. The XDR S. Typhi clone encoded a chromosomally located resistance region and harbored a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum β-lactamase and the qnrS fluoroquinolone resistance gene. This is the first case of typhoid fever due to XDR S. Typhi detected in Italy and one of the first paediatric cases reported outside Pakistan, highlighting the need to be vigilant for future cases. While new vaccines against typhoid are in development, clinicians should consider adapting their empiric approach for patients returning from regions at risk of XDR S. Typhi outbreak with typhoid symptoms.

Authors+Show Affiliations

Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.Paediatric Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy.Infectious Diseases Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy.Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.Paediatric Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy.Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32102428

Citation

Procaccianti, Michela, et al. "First Case of Typhoid Fever Due to Extensively Drug-resistant Salmonella Enterica Serovar Typhi in Italy." Pathogens (Basel, Switzerland), vol. 9, no. 2, 2020.
Procaccianti M, Motta A, Giordani S, et al. First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy. Pathogens. 2020;9(2).
Procaccianti, M., Motta, A., Giordani, S., Riscassi, S., Guidi, B., Ruffini, M., Maffini, V., Esposito, S., & Dodi, I. (2020). First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy. Pathogens (Basel, Switzerland), 9(2). https://doi.org/10.3390/pathogens9020151
Procaccianti M, et al. First Case of Typhoid Fever Due to Extensively Drug-resistant Salmonella Enterica Serovar Typhi in Italy. Pathogens. 2020 Feb 24;9(2) PubMed PMID: 32102428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy. AU - Procaccianti,Michela, AU - Motta,Alice, AU - Giordani,Stefano, AU - Riscassi,Sara, AU - Guidi,Battista, AU - Ruffini,Monica, AU - Maffini,Valentina, AU - Esposito,Susanna, AU - Dodi,Icilio, Y1 - 2020/02/24/ PY - 2020/01/31/received PY - 2020/02/18/revised PY - 2020/02/21/accepted PY - 2020/2/28/entrez PY - 2020/2/28/pubmed PY - 2020/2/28/medline KW - Salmonella Typhi KW - XDR Salmonella enterica serovar Typhi KW - blaCTX-M-15 extended-spectrum β-lactamase gene KW - carbapenem KW - typhoid fever JF - Pathogens (Basel, Switzerland) JO - Pathogens VL - 9 IS - 2 N2 - Typhoid fever is a potentially severe and occasionally life-threatening bacteraemic illness caused by Salmonella enterica serovar Typhi (S. Typhi). In Pakistan, an outbreak of extensively drug-resistant (XDR) S. Typhi cases began in November 2016. We report on a five-year-old boy who contracted enteric fever while travelling in Pakistan and was diagnosed after returning to Italy in September 2019. Blood culture isolated Salmonella enterica serovar Typhi that was XDR to all first-line antibiotics, including ceftriaxone and fluoroquinolones. Empiric therapy was switched to meropenem, and the patient recovered completely. Whole-genome sequencing showed that this isolate was of haplotype H58. The XDR S. Typhi clone encoded a chromosomally located resistance region and harbored a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum β-lactamase and the qnrS fluoroquinolone resistance gene. This is the first case of typhoid fever due to XDR S. Typhi detected in Italy and one of the first paediatric cases reported outside Pakistan, highlighting the need to be vigilant for future cases. While new vaccines against typhoid are in development, clinicians should consider adapting their empiric approach for patients returning from regions at risk of XDR S. Typhi outbreak with typhoid symptoms. SN - 2076-0817 UR - https://www.unboundmedicine.com/medline/citation/32102428/First_Case_of_Typhoid_Fever_due_to_Extensively_Drug_resistant_Salmonella_enterica_serovar_Typhi_in_Italy_ L2 - https://www.mdpi.com/resolver?pii=pathogens9020151 DB - PRIME DP - Unbound Medicine ER -
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