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The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015
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 syndrom...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624643/ https://www.ncbi.nlm.nih.gov/pubmed/28931025 http://dx.doi.org/10.1371/journal.pntd.0005964 |
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author | Kuijpers, Laura M. F. Phe, Thong Veng, Chhun H. Lim, Kruy Ieng, Sovann Kham, Chun Fawal, Nizar Fabre, Laetitia Le Hello, Simon Vlieghe, Erika Weill, François-Xavier Jacobs, Jan Peetermans, Willy E. |
author_facet | Kuijpers, Laura M. F. Phe, Thong Veng, Chhun H. Lim, Kruy Ieng, Sovann Kham, Chun Fawal, Nizar Fabre, Laetitia Le Hello, Simon Vlieghe, Erika Weill, François-Xavier Jacobs, Jan Peetermans, Willy E. |
author_sort | Kuijpers, Laura M. F. |
collection | PubMed |
description | 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 10(9)/L vs. 6.3 x 10(9)/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. |
format | Online Article Text |
id | pubmed-5624643 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-56246432017-10-17 The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 Kuijpers, Laura M. F. Phe, Thong Veng, Chhun H. Lim, Kruy Ieng, Sovann Kham, Chun Fawal, Nizar Fabre, Laetitia Le Hello, Simon Vlieghe, Erika Weill, François-Xavier Jacobs, Jan Peetermans, Willy E. PLoS Negl Trop Dis Research Article 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 10(9)/L vs. 6.3 x 10(9)/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. Public Library of Science 2017-09-20 /pmc/articles/PMC5624643/ /pubmed/28931025 http://dx.doi.org/10.1371/journal.pntd.0005964 Text en © 2017 Kuijpers et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kuijpers, Laura M. F. Phe, Thong Veng, Chhun H. Lim, Kruy Ieng, Sovann Kham, Chun Fawal, Nizar Fabre, Laetitia Le Hello, Simon Vlieghe, Erika Weill, François-Xavier Jacobs, Jan Peetermans, Willy E. The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title | The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title_full | The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title_fullStr | The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title_full_unstemmed | The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title_short | The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015 |
title_sort | clinical and microbiological characteristics of enteric fever in cambodia, 2008-2015 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624643/ https://www.ncbi.nlm.nih.gov/pubmed/28931025 http://dx.doi.org/10.1371/journal.pntd.0005964 |
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