ro13-9904 and Typhoid-Fever

Typhoid and paratyphoid (enteric fever) are febrile bacterial illnesses common in many low- and middle-income countries. The World Health Organization (WHO) currently recommends treatment with azithromycin, ciprofloxacin, or ceftriaxone due to widespread resistance to older, first-line antimicrobials. Resistance patterns vary in different locations and are changing over time. Fluoroquinolone resistance in South Asia often precludes the use of ciprofloxacin. Extensively drug-resistant strains of enteric fever have emerged in Pakistan. In some areas of the world, susceptibility to old first-line antimicrobials, such as chloramphenicol, has re-appeared. A Cochrane Review of the use of fluoroquinolones and azithromycin in the treatment of enteric fever has previously been undertaken, but the use of cephalosporins has not been systematically investigated and the optimal choice of drug and duration of treatment are uncertain.. To evaluate the effectiveness of cephalosporins for treating enteric fever in children and adults compared to other antimicrobials.. We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the WHO ICTRP and ClinicalTrials.gov up to 24 November 2021. We also searched reference lists of included trials, contacted researchers working in the field, and contacted relevant organizations.. We included randomized controlled trials (RCTs) in adults and children with enteric fever that compared a cephalosporin to another antimicrobial, a different cephalosporin, or a different treatment duration of the intervention cephalosporin. Enteric fever was diagnosed on the basis of blood culture, bone marrow culture, or molecular tests.. We used standard Cochrane methods. Our primary outcomes were clinical failure, microbiological failure and relapse. Our secondary outcomes were time to defervescence, duration of hospital admission, convalescent faecal carriage, and adverse effects. We used the GRADE approach to assess certainty of evidence for each outcome.. We included 27 RCTs with 2231 total participants published between 1986 and 2016 across Africa, Asia, Europe, the Middle East and the Caribbean, with comparisons between cephalosporins and other antimicrobials used for the treatment of enteric fever in children and adults. The main comparisons are between antimicrobials in most common clinical use, namely cephalosporins compared to a fluoroquinolone and cephalosporins compared to azithromycin. Cephalosporin (cefixime) versus fluoroquinolones Clinical failure, microbiological failure and relapse may be increased in patients treated with cefixime compared to fluoroquinolones in three small trials published over 14 years ago: clinical failure (risk ratio (RR) 13.39, 95% confidence interval (CI) 3.24 to 55.39; 2 trials, 240 participants; low-certainty evidence); microbiological failure (RR 4.07, 95% CI 0.46 to 36.41; 2 trials, 240 participants; low-certainty evidence); relapse (RR 4.45, 95% CI 1.11 to 17.84; 2 trials, 220 participants; low-certainty evidence). Time to defervescence in participants treated with cefixime may be longer compared to participants treated with fluoroquinolones (mean difference (MD) 1.74 days, 95% CI 0.50 to 2.98, 3 trials, 425 participants; low-certainty evidence). Cephalosporin (ceftriaxone) versus azithromycin Ceftriaxone may result in a decrease in clinical failure compared to azithromycin, and it is unclear whether ceftriaxone has an effect on microbiological failure compared to azithromycin in two small trials published over 18 years ago and in one more recent trial, all conducted in participants under 18 years of age: clinical failure (RR 0.42, 95% CI 0.11 to 1.57; 3 trials, 196 participants; low-certainty evidence); microbiological failure (RR 1.95, 95% CI 0.36 to 10.64, 3 trials, 196 participants; very low-certainty evidence). It is unclear whether ceftriaxone increases or decreases relapse compared to azithromycin (RR 10.05, 95% CI 1.93 to 52.38; 3 trials, 185 participants; very low-certainty evidence). Time to defervescence in participants treated with ceftriaxone may be shorter compared to participants treated with azithromycin (mean difference of -0.52 days, 95% CI -0.91 to -0.12; 3 trials, 196 participants; low-certainty evidence). Cephalosporin (ceftriaxone) versus fluoroquinolones It is unclear whether ceftriaxone has an effect on clinical failure, microbiological failure, relapse, and time to defervescence compared to fluoroquinolones in three trials published over 2. Based on very low- to low-certainty evidence, ceftriaxone is an effective treatment for adults and children with enteric fever, with few adverse effects. Trials suggest that there may be no difference in the performance of ceftriaxone compared with azithromycin, fluoroquinolones, or chloramphenicol. Cefixime can also be used for treatment of enteric fever but may not perform as well as fluoroquinolones.  We are unable to draw firm general conclusions on comparative contemporary effectiveness given that most trials were small and conducted over 20 years previously. Clinicians need to take into account current, local resistance patterns in addition to route of administration when choosing an antimicrobial.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cefixime; Ceftriaxone; Cephalosporins; Child; Chloramphenicol; Ciprofloxacin; Fluoroquinolones; Humans; Monobactams; Ofloxacin; Pakistan; Paratyphoid Fever; Recurrence; Typhoid Fever

The rarity of acute psychosis in typhoid fever can result in delayed and misdiagnosis of the condition. We report a case of a 20-year-old man who presented with fever and acute psychotic symptoms. This was associated with headache, dizziness, and body weakness. There were no other significant symptoms. Neurological examination revealed reduced muscle tone of bilateral lower limbs but otherwise unremarkable. The computed tomography (CT) scan of his brain showed no abnormality. Blood specimens for microbiological culture grew Salmonella Typhi. This isolate was susceptible to chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. He was treated with intravenous ceftriaxone for one week and responded well. He was discharged with oral ciprofloxacin for another week. The repeated blood and stool for bacterial culture yielded no growth of Salmonella Typhi.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Humans; Male; Psychotic Disorders; Salmonella typhi; Typhoid Fever; Young Adult

Recent attempts at mapping Typhoid epidemiology have revealed an enormous burden of disease in developing countries. Countries hitherto believed to have a low incidence, such as the African subcontinent, on accurate mapping were found to have a significant burden of disease. Drug resistance, because of rampant overuse of antibiotics, has driven selection pressure to extensively drug-resistant typhoid becoming a reality in the Indian subcontinent. With widespread travel, importation of this variety of typhoid to nonendemic countries is likely to lead to outbreaks in a nonimmune population.. A strain of extensively drug-resistant Salmonella Typhi isolated in Pakistan in 2016 has been responsible for multiple outbreaks in Pakistan and multiple travel-related cases all over the world in United States, UK, and Australia. This novel strain belongs to H58 lineage harbouring a plasmid encoding additional resistance elements like blaCTX-M-15 and a qnrS fluoroquinolone resistance gene. This resistance pattern has rendered many therapeutic options like Ceftriaxone and Fluoroquinolones clinically inactive impacting care in endemic and traveller populations alike.. Changing epidemiology and drug resistance in typhoid indicates that it may be prudent to vaccinate nonimmune travellers travelling to typhoid endemic areas, especially the Indian subcontinent.

Topics: Anti-Bacterial Agents; Asia; Azithromycin; Ceftriaxone; Communicable Diseases, Imported; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Genes, Bacterial; Humans; Pakistan; Public Health; Salmonella typhi; Travel; Typhoid Fever

Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication.. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data.. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases.. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases.

Topics: Abdominal Abscess; Abdominal Pain; Age Distribution; Appendicitis; Asia; Ceftriaxone; Child; Developed Countries; Diagnosis, Differential; Endemic Diseases; Fever; Hepatomegaly; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Methylprednisolone; Middle East; Sex Distribution; Spain; Splenomegaly; Typhoid Fever

Enteric fever, a systemic illness, is caused by Salmonella enterica serovar Typhi or S. enterica serovar Paratyphi A, B or C. The organism is transmitted to humans by the faecal oral route and is endemic in countries with poor sanitation and lacking clean drinking water. There are around 27 million individuals infected with S. Typhi worldwide annually. Enteric fever is a particular problem in travellers to endemic areas, especially those visiting friends and relatives. Currently, the two main vaccines recommended for travellers are the Vi polysaccharide vaccine and the oral Ty21a vaccine. These internationally licensed vaccines are safe and effective against S. Typhi. However, there is currently no commercially available vaccine against S. Paratyphi, which is increasingly reported as a cause of enteric fever. Vaccine uptake and taking appropriate precautions are poor in travellers visiting friends and relatives abroad; this problem requires addressing. Ciprofloxacin is no longer recommended for empirical treatment of infection because of increasing reports of resistance, especially from South Asia. Ceftriaxone and azithromycin are currently the most commonly used antimicrobials for empirical treatment of enteric fever but resistance to both these agents is emerging.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Drug Resistance; Humans; Paratyphoid Fever; Salmonella paratyphi A; Salmonella paratyphi B; Salmonella paratyphi C; Salmonella typhi; Travel; Typhoid Fever; Typhoid-Paratyphoid Vaccines

Emergence of multidrug resistance and decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi in South Asia have rendered older drugs, including ampicillin, chloramphenicol, trimethoprim-sulphamethoxazole, ciprofloxacin, and ofloxacin, ineffective or suboptimal for typhoid fever. Ideally, treatment should be safe and available for adults and children in shortened courses of 5 days, cause defervescence within 1 week, render blood and stool cultures sterile, and prevent relapse. In this review of 20 prospective clinical trials that enrolled more than 1600 culture-proven patients, azithromycin meets these criteria better than other drugs. Among fluoroquinolones, which are more effective than cephalosporins, gatifloxacin appears to be more effective than ciprofloxacin and ofloxacin for patients infected with bacteria showing DCS. Ceftriaxone continues to be useful as a back-up choice, and chloramphenicol, despite its toxicity for bone marrow and history of plasmid-mediated resistance, is making a comeback in developing countries that show their bacteria to be susceptible to it.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Clinical Trials as Topic; Drug Resistance, Bacterial; Fluoroquinolones; Gatifloxacin; Humans; Salmonella typhi; Treatment Outcome; Typhoid Fever

We report a case of typhoid rhabdomyolysis with acute renal failure and acute pancreatitis in a 23-year-old Vietnamese male who was admitted to the intensive care unit with a 15-day history of fever followed by severe abdominal pain. On examination, the patient was febrile and his abdomen was diffusely tender. Serum creatinine was 533 micromol/L, pancreatic amylase 1800 U/L and lipase 900 U/L; the myoglobin blood level was high, which is associated with significant myoglobinuria. Blood, urine and stool culture yielded Salmonella enterica serovar typhi, which was sensitive to ceftriaxon, ampicillin and ciprofloxacin. Ceftriaxon was initiated for a total of 14 days. Subsequently, the patient maintained a good urine output with improved renal parameters and accordingly was discharged. In this report, we review the literature and discuss the pathogenesis of the disease thoroughly.

Topics: Acute Disease; Acute Kidney Injury; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Pancreatitis; Rhabdomyolysis; Salmonella typhi; Typhoid Fever; Young Adult

Salmonella are a rare cause of infective endocarditis. This report describes a case where Salmonella typhi was isolated from the blood and urine of a patient with echocardiographically documented aortic valve disease and endocarditis. The patient was treated with two weeks of ceftriaxone (3 g/day) and amikacin (15 mg/kg/day), followed by a further two weeks of ceftriaxone (3 g/day) alone. He made a complete recovery.

Topics: Adult; Amikacin; Aortic Valve; Ceftriaxone; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Male; Salmonella typhi; Typhoid Fever

Typhoid fever is rare in Europe, but well-recognized endemic disease in tropical zones. We report our findings in a series of 25 cases of typhoid fever during pregnancy observed in French Guiana and reviewed the literature on clinical signs, diagnosis and treatment. Salmonellea typhi causes septicemia of digestive origin that can cross the placenta resulting in chorioamniotitis. Maternal-fetal infection with S. typhi can lead to miscarriage, fetal death, neonatal infection, as well as diverse maternal complications. In order to avoid maternal complications and possible fetal transmission, treatment with ceftriaxone should be initiated as early as possible

Topics: Abortion, Spontaneous; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Microbial; Endemic Diseases; Female; Fetal Death; French Guiana; Humans; Infectious Disease Transmission, Vertical; Microbial Sensitivity Tests; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Retrospective Studies; Typhoid Fever

Topics: Aged; Aged, 80 and over; Ceftriaxone; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Humans; Liver Abscess; Male; Metronidazole; Salmonella typhi; Typhoid Fever

We report a child with typhoid glomerulonephritis who presented with fever, gastrointestinal symptoms, edema, hypertension and abnormal urine findings including microscopic hematuria and proteinuria. Salmonella typhi resistant to ampicillin and cotrimoxazole was isolated from a blood culture. Renal biopsy was not performed. The child successfully treated with ceftriaxone.

Topics: Adolescent; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Female; Glomerulonephritis; Humans; Male; Thailand; Typhoid Fever

Emerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic resistance and the chronic carriage of the pathogens. The aim of our study was to assess the efficacy of combining third-generation cephalosporin therapy with azithromycin on the outcomes of TF in patients living in an endemic region.. An open-label, comparative trial was conducted at Dhulikhel Hospital, Nepal, between October 2012 and October 2014. Only culture-confirmed TF cases were eligible. Patients were alternately allocated to one of four study arms: hospitalized patients received either intravenous ceftriaxone or a combination of ceftriaxone and oral azithromycin, while outpatients received either oral azithromycin or a combination of oral azithromycin and cefexime. The primary outcome evaluated was FCT and the secondary outcomes included duration of bacteremia.. 105 blood culture-confirmed patients, of whom 51 were treated as outpatients, were eligible for the study. Of the 88 patients who met the inclusion criteria for FCT analysis 41 patients received a single-agent regimen, while 47 patients received a combined regimen. Results showed that FCT was significantly shorter for the latter (95 versus 88 hours, respectively, p = 0·004), and this effect was exhibited in both the hospitalized and the outpatient sub-groups. Repeat blood cultures, drawn on day 3, were positive for 8/47 (17%) patients after monotherapy, versus 2/51 (4%) after combination therapy (p = 0·045). No severe complications or fatalities occurred in any of the groups.. Combined therapy of third-generation cephalosporins and azithromycin for TF may surpass monotherapy in terms of FCT and time to elimination of bacteremia.. Trial registration number: NCT02224040.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Male; Middle Aged; Nepal; Typhoid Fever; Young Adult

Enteric fever, caused by Salmonella Typhi and Salmonella Paratyphi A, is the leading cause of bacterial febrile disease in South Asia.. Individual data from 2092 patients with enteric fever randomized into 4 trials in Kathmandu, Nepal, were pooled. All trials compared gatifloxacin with 1 of the following comparator drugs: cefixime, chloramphenicol, ofloxacin, or ceftriaxone. Treatment outcomes were evaluated according to antimicrobial if S. Typhi/Paratyphi were isolated from blood. We additionally investigated the impact of changing bacterial antimicrobial susceptibility on outcome.. Overall, 855 (41%) patients had either S. Typhi (n = 581, 28%) or S. Paratyphi A (n = 274, 13%) cultured from blood. There were 139 (6.6%) treatment failures with 1 death. Except for the last trial with ceftriaxone, the fluoroquinolone gatifloxacin was associated with equivalent or better fever clearance times and lower treatment failure rates in comparison to all other antimicrobials. However, we additionally found that the minimum inhibitory concentrations (MICs) against fluoroquinolones have risen significantly since 2005 and were associated with increasing fever clearance times. Notably, all organisms were susceptible to ceftriaxone throughout the study period (2005-2014), and the MICs against azithromycin declined, confirming the utility of these alternative drugs for enteric fever treatment.. The World Health Organization and local government health ministries in South Asia still recommend fluoroquinolones for enteric fever. This policy should change based on the evidence provided here. Rapid diagnostics are urgently required given the large numbers of suspected enteric fever patients with a negative culture.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Gatifloxacin; Humans; Male; Microbial Sensitivity Tests; Nepal; Ofloxacin; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Treatment Failure; Treatment Outcome; Typhoid Fever; Young Adult

Because treatment with third-generation cephalosporins is associated with slow clinical improvement and high relapse burden for enteric fever, whereas the fluoroquinolone gatifloxacin is associated with rapid fever clearance and low relapse burden, we postulated that gatifloxacin would be superior to the cephalosporin ceftriaxone in treating enteric fever.. We did an open-label, randomised, controlled, superiority trial at two hospitals in the Kathmandu valley, Nepal. Eligible participants were children (aged 2-13 years) and adult (aged 14-45 years) with criteria for suspected enteric fever (body temperature ≥38·0°C for ≥4 days without a focus of infection). We randomly assigned eligible patients (1:1) without stratification to 7 days of either oral gatifloxacin (10 mg/kg per day) or intravenous ceftriaxone (60 mg/kg up to 2 g per day for patients aged 2-13 years, or 2 g per day for patients aged ≥14 years). The randomisation list was computer-generated using blocks of four and six. The primary outcome was a composite of treatment failure, defined as the occurrence of at least one of the following: fever clearance time of more than 7 days after treatment initiation; the need for rescue treatment on day 8; microbiological failure (ie, blood cultures positive for Salmonella enterica serotype Typhi, or Paratyphi A, B, or C) on day 8; or relapse or disease-related complications within 28 days of treatment initiation. We did the analyses in the modified intention-to-treat population, and subpopulations with either confirmed blood-culture positivity, or blood-culture negativity. The trial was powered to detect an increase of 20% in the risk of failure. This trial was registered at ClinicalTrials.gov, number NCT01421693, and is now closed.. Between Sept 18, 2011, and July 14, 2014, we screened 725 patients for eligibility. On July 14, 2014, the trial was stopped early by the data safety and monitoring board because S Typhi strains with high-level resistance to ciprofloxacin and gatifloxacin had emerged. At this point, 239 were in the modified intention-to-treat population (120 assigned to gatifloxacin, 119 to ceftriaxone). 18 (15%) patients who received gatifloxacin had treatment failure, compared with 19 (16%) who received ceftriaxone (hazard ratio [HR] 1·04 [95% CI 0·55-1·98]; p=0·91). In the culture-confirmed population, 16 (26%) of 62 patients who received gatifloxacin failed treatment, compared with four (7%) of 54 who received ceftriaxone (HR 0·24 [95% CI 0·08-0·73]; p=0·01). Treatment failure was associated with the emergence of S Typhi exhibiting resistance against fluoroquinolones, requiring the trial to be stopped. By contrast, in patients with a negative blood culture, only two (3%) of 58 who received gatifloxacin failed treatment versus 15 (23%) of 65 who received ceftriaxone (HR 7·50 [95% CI 1·71-32·80]; p=0·01). A similar number of non-serious adverse events occurred in each treatment group, and no serious events were reported.. Our results suggest that fluoroquinolones should no longer be used for treatment of enteric fever in Nepal. Additionally, under our study conditions, ceftriaxone was suboptimum in a high proportion of patients with culture-negative enteric fever. Since antimicrobials, specifically fluoroquinolones, are one of the only routinely used control measures for enteric fever, the assessment of novel diagnostics, new treatment options, and use of existing vaccines and development of next-generation vaccines are now a high priority.. Wellcome Trust and Li Ka Shing Foundation.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Female; Fluoroquinolones; Gatifloxacin; Humans; Male; Nepal; Salmonella enterica; Salmonella typhi; Treatment Failure; Typhoid Fever; Young Adult

The interplay between bacterial antimicrobial susceptibility, phylogenetics and patient outcome is poorly understood. During a typhoid clinical treatment trial in Nepal, we observed several treatment failures and isolated highly fluoroquinolone-resistant Salmonella Typhi (S. Typhi). Seventy-eight S. Typhi isolates were genome sequenced and clinical observations, treatment failures and fever clearance times (FCTs) were stratified by lineage. Most fluoroquinolone-resistant S. Typhi belonged to a specific H58 subclade. Treatment failure with S. Typhi-H58 was significantly less frequent with ceftriaxone (3/31; 9.7%) than gatifloxacin (15/34; 44.1%)(Hazard Ratio 0.19, p=0.002). Further, for gatifloxacin-treated patients, those infected with fluoroquinolone-resistant organisms had significantly higher median FCTs (8.2 days) than those infected with susceptible (2.96) or intermediately resistant organisms (4.01)(pS. Typhi clade internationally, but there are no data regarding disease outcome with this organism. We report an emergent new subclade of S. Typhi-H58 that is associated with fluoroquinolone treatment failure.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Ceftriaxone; Ciprofloxacin; Fluoroquinolones; Gatifloxacin; Genotype; Humans; Nepal; Salmonella typhi; Sequence Analysis, DNA; Treatment Failure; Typhoid Fever

To study the epidemiological pattern, clinical picture, the recent trends of multidrug-resistant typhoid fever (MDRTF), and therapeutic response of ofloxacin and ceftriaxone in MDRTF.. The present prospective randomized controlled parallel study was conducted on 93 blood culture-proven Salmonella typhi children. All MDRTF cases were randomized to treatment with ofloxacin or ceftriaxone.. Of 93 children, 62 (66.6%) were MDRTF. 24 cases were below 5 years, 26 between 5-10 years and 12 were above 10 years. Male to female ratio was 1.85: 1. Majority of cases came from lower middle socio-economic classes with poor personal hygiene. Fever was the main presenting symptom. Hepatomegaly and splenomegaly was present in 88% and 46% cases respectively. 19 (30.6%) cases developed complications. Mean defervescence time with ceftriaxone and ofloxacin was 4.258 and 4.968 days respectively.. MDRTF is still emerging as serious public and therapeutic challenge. Ceftriaxone is well-tolerated and effective drug but expensive whereas ofloxacin is safe, cost-effective and therapeutic alternative in treatment of MDRTF in children with comparable efficacy to ceftriaxone.

Topics: Administration, Oral; Blood; Ceftriaxone; Chi-Square Distribution; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; Humans; India; Infant; Infusions, Intravenous; Male; Microbial Sensitivity Tests; Ofloxacin; Probability; Prognosis; Prospective Studies; Risk Factors; Salmonella typhi; Severity of Illness Index; Survival Rate; Treatment Outcome; Typhoid Fever

Although the efficacy of ceftriaxone in typhoid fever is well documented, the precise duration of ceftriaxone therapy in children with typhoid fever is not established and varies from 3 to 14 days in the literature. In a prospective, randomized study ceftriaxone was compared with chloramphenicol for treatment of 72 children who had bacteriologically confirmed typhoid fever. Ceftriaxone was given at a dose of 75 mg/kg per day (maximally 2 g/day) intravenously, in two doses until defervescence and continued 5 days after that time. Chloramphenicol was given at a dose of 75 mg/kg per day (maximally 2 g/day) in four doses for 14 days. Mean defervescence time was in 5.4 days in the ceftriaxone group and 4.2 days in the chloramphenicol group (P=0.04). Clinical cure without complications was achieved in all patients in both groups. No patient relapsed in the ceftriaxone group, and four patients relapsed in the chloramphenicol group (P=0.048). The overall results of this study suggest that a flexible-duration of ceftriaxone therapy given until defervescence time, followed by an additional 5 days of therapy is a reasonable alternative to conventional 14-day chloramphenicol treatment in children with typhoid fever.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Administration Schedule; Female; Humans; Male; Prospective Studies; Randomized Controlled Trials as Topic; Typhoid Fever

The precise duration of therapy of multidrug-resistant (MDR) typhoid with broad-spectrum cephalosporins is uncertain. We prospectively randomized 57 children with culture-proven MDR typhoid to receive treatment with intravenous ceftriaxone (CRO) (65 mg/kg of body weight/day) for 7 days (short course; n = 29) or 14 days (conventional; n = 28). The response to therapy, as evaluated by the serial monitoring of the typhoid morbidity score and bacteriological clearance, was comparable between groups. In contrast to the conventional therapy, 14% of the children receiving CRO for 7 days had a confirmed bacteriological relapse within 4 weeks of stopping therapy.

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Drug Resistance, Multiple; Humans; Pakistan; Recurrence; Treatment Outcome; Typhoid Fever

A total of 108 children aged 4-17 years were randomized to receive 7 days of azithromycin (10 mg/kg/day; maximum, 500 mg/day) or ceftriaxone (75 mg/kg/day; maximum, 2.5 g/day), to assess the efficacy of the agents for the treatment of uncomplicated typhoid fever. Salmonella typhi was isolated from the initial cultures of blood samples from 64 patients. A total of 31 (91%) of the 34 patients treated with azithromycin and 29 (97%) of the 30 patients treated with ceftriaxone were cured (P>.05). All 64 isolates were susceptible to azithromycin and ceftriaxone. Of the patients treated with ceftriaxone, 4 subsequently had relapse of their infection. No serious side effects occurred in any study subject. Oral azithromycin administered once daily appears to be effective for the treatment of uncomplicated typhoid fever in children. If these results are confirmed, the agent could be a convenient alternative for the treatment of typhoid fever, especially in individuals in developing countries where medical resources are scarce.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Child, Preschool; Female; Humans; Male; Salmonella typhi; Treatment Outcome; Typhoid Fever

We evaluated the clinical profile, outcome and serial plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) concentrations in 38 consecutive children (aged 6 months-14 years) admitted with culture-proven multidrug-resistant typhoid. All children received therapy for 14 days with either i.v. ceftriaxone or oral cefixime, with comparable outcome. Concentrations of IL-6 and TNF-alpha were significantly elevated in over 50% of the cases and correlated with clinical severity of illness as quantitated by the typhoid morbidity score. Sequential measurements revealed a significant decrease in IL-6 and TNF-alpha concentrations within 7 days of initiation of therapy (P<0.05). While no clear relationship was seen with time-to-defervescence, the failure rate was significantly higher in children with baseline serum IL-6 values >400 pg/ml (P<0.05). Our data suggest that plasma cytokine activity is frequently elevated in children with typhoidal salmonellosis, and IL-6 concentrations show a correlation with clinical severity and recovery from the illness.

Topics: Adolescent; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cohort Studies; Drug Resistance, Multiple; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Interleukin-6; Male; Morbidity; Salmonella typhi; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha; Typhoid Fever

We evaluated the response to therapy in a series of 876 children consecutively admitted to The Aga Khan University Hospital with culture-proven typhoid, including 281 cases infected with multi-drug-resistant (MDR) strains. Among sensitive isolates there was no significant difference in cure rates, failure rates and time to defervescence with either ampicillin or chloramphenicol. Of the 217 children with MDR typhoid who received therapy with third-generation cephalosporins, the outcome was significantly better with intravenous ceftriaxone compared with cefotaxime. Despite comparable cure rates, the time to defervescence was significantly longer among MDR strains treated with ceftriaxone versus sensitive strains (mean (SD): 7.2 (3.4) versus 6.3 (29) days; p < 0.05). Earlier recognition and introduction of appropriate second-line therapy has allowed us to reduce the case fatality rates of typhoid to under 1%. Although a 14-day course of ceftriaxone can be used successfully to treat most children hospitalized with MDR typhoid, there is a need to evaluate the role of short-course therapy or alternative therapeutic agents.

Topics: Algorithms; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child, Preschool; Chloramphenicol; Drug Resistance, Multiple; Hospitalization; Humans; Microbial Sensitivity Tests; Pakistan; Penicillins; Prospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of alternative drugs. Children with positive blood cultures were treated with cefixime, ceftriaxone or aztreonam, and the efficacy, safety and cost of these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and aztreonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 children. Children in the 3 groups were comparable with regard to age, sex, duration and severity of illness before admission. All children were cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days). During the 4-week follow-up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam group. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone was most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatient basis, because of drug cost.

Topics: Adolescent; Anti-Bacterial Agents; Aztreonam; Bacteremia; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cost-Benefit Analysis; Drug Resistance, Multiple; Egypt; Female; Humans; Male; Monobactams; Salmonella typhi; Treatment Outcome; Typhoid Fever

To compare the efficacy of a short course of ceftriaxone with a standard course of chloramphenicol for typhoid fever, a randomized trial was conducted in 46 patients (30 adults and 16 children) who were blood culture-positive for Salmonella typhi or S. paratyphi. Ceftriaxone was given intravenously once a day for three days to 15 adults at a dose of 2 g/day and to eight children at a dose of 50 mg/kg/day. Chloramphenicol was given orally four times a day to an equal number of patients at a dose of 60 mg/kg/day until defervescence, followed by 40 mg/kg/day for a total of 14 days. Clinical cure without complications or relapse occurred in 19 patients (83%) treated with ceftriaxone and in 20 patients (87%) treated with chloramphenicol (P > 0.05). Four patients with clinical failures in the ceftriaxone group included two with fever lasting six days or more, one with altered sensorium, and one with relapse; three patients treated with chloramphenicol developed leukopenia and thrombocytopenia and were switched to amoxicillin therapy. Bacteriologically, blood cultures of all 46 patients were sterile three days after the start of treatment, and remained so through day 15 of follow-up. These results extend previous observations on the efficacy of ceftriaxone in short courses for both adults and children with typhoid fever.

Topics: Administration, Oral; Adult; Ceftriaxone; Child; Chloramphenicol; Drug Administration Schedule; Female; Humans; Infusions, Intravenous; Male; Typhoid Fever

We randomly allocated 80 children with suspected multidrug-resistant tyhpoid fever to therapy with either cefixime or ceftriaxone. Of these, an alternative diagnosis was subsequently made in 10 children and another 10 were excluded because cultures were negative. In 9 cases the typhoidal organisms isolated were susceptible to first-line drugs. In all, 50 children were randomly allocated to receive therapy with either intravenous ceftriaxone (65 mg/kg/day once daily, Group A, n = 25) or oral cefixime (10 mg/kg/day divided every 12 hours, Group B, n = 25) for 14 days. The two groups were comparable in their clinical characteristics, duration and severity of illness at the time of admission. The time to defervescence was comparable in both groups (8.3 +/- 3.7 vs. 8.0 +/- 4.1 days, P = not significant). An equal number (3 in each group) failed to respond and underwent a change in therapy. Three children in Group A and one in Group B relapsed. No adverse effects were seen in either group during the course of therapy. Our data suggest that oral cefixime can be used as effectively as parenterally administered ceftriaxone for management of typhoid fever in children.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftriaxone; Child, Preschool; Drug Resistance, Multiple; Female; Humans; Infant; Injections, Intravenous; Male; Salmonella typhi; Typhoid Fever

An open, randomized comparison of ofloxacin (200 mg, every 12 h) given orally for 5 days and ceftriaxone (3 g, once daily) given intravenously for 3 days in the treatment of uncomplicated enteric fever was conducted in Ho Chi Minh City, Vietnam. Salmonella paratyphi type A was isolated from six patients. Salmonella typhi was isolated from 41 patients; 63% of these isolates were resistant to multiple antibiotics: ampicillin, chloramphenicol, sulfamethoxazole, trimethoprim, and tetracycline. Of the culture-confirmed cases, treatment with ofloxacin resulted in complete cure of all 22 patients, whereas 18 of 25 patients treated with ceftriaxone were completely cured (P < 0.01). In the ceftriaxone group, there were six acute treatment failures and one relapse. Mean +/- standard deviation fever clearance times were 81 +/- 25 h for ofloxacin and 196 +/- 87 h for ceftriaxone (P < 0.0001). Short-course treatment with oral ofloxacin (5 days) is significantly better than that with ceftriaxone (3 days) and will be of particular benefit in areas where multiresistant strains of S. typhi are encountered.

Topics: Adolescent; Adult; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Ofloxacin; Typhoid Fever

A randomized trial comparing ceftriaxone (3 g given parenterally per day for 7 days) to ciprofloxacin (500 mg given orally twice a day for 7 days) in the treatment of blood culture positive typhoid fever was conducted. Twenty patients were openly randomized to receive ciprofloxacin and 22 to receive ceftriaxone. The outcome was classified as clinical failure in 6 patients (27%) in the ceftriaxone group, but in none in the ciprofloxacin group (p = 0.01). The mean duration of fever was four days in the ciprofloxacin group and about five days in the ceftriaxone group (p = 0.04). In the six patients in the ceftriaxone group who experienced failure, therapy was switched to ciprofloxacin and the patients became afebrile and asymptomatic within 48 hours. Patients with resistant strains of Salmonella typhi and patients with sensitive strains responded equally well to ciprofloxacin therapy. Analysis of a subset of 12 of the multiresistant strains revealed that resistance was encoded for by a transferable 180 kilobase plasmid. Ciprofloxacin represents a useful treatment option in areas where multiresistant strains are likely to be encountered.

Topics: Bacteriophage Typing; Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; Humans; Treatment Outcome; Typhoid Fever

To compare the therapeutic efficacy of ceftriaxone given once daily for 5 days and chloramphenicol given four times daily for 14 days, a controlled trial was carried out with 59 patients who were culture positive for Salmonella typhi. Ceftriaxone was given to 28 patients in once-daily intravenous doses of 75 mg/kg of body weight to children and 4 g to adults for 5 days; chloramphenicol was given to 31 patients at a dosage of 60 mg/kg/day until defervescence and then at 40 mg/kg/day to complete 14 days of treatment. All Salmonella isolates were susceptible to both antibiotics. Clinical cures (defervescence without complications, no relapse, and no need for further treatment) occurred in 79% of the patients treated with ceftriaxone and 90% of those treated with chloramphenicol (P = 0.37). On the third day of treatment, blood cultures were positive for S. typhi for 60% of the patients in the chloramphenicol group and 0% of the ceftriaxone group (P = 0.001). Defervescence occurred in half the patients in both groups during the first 7 days, but on days 9 to 13 after the start of treatment, nine patients in the ceftriaxone group, compared with six patients in the chloramphenicol group, remained febrile (P = 0.4). The median hematocrit and total leukocyte counts at day 14 were significantly lower for the chloramphenicol group than those for the ceftriaxone group (P = 0.01 and P = 0.02, respectively). These results indicate that the effects of therapy with ceftriaxone for typhoid fever differed from those of chloramphenicol therapy in that blood cultures became negative earlier, prolonged fever persisted in some patients, and bone marrow suppression was reduced. We conclude that a short, 5-day course of ceftriaxone is a useful alternative to conventional 14-day chloramphenicol therapy in the treatment of typhoid fever.

Topics: Adolescent; Adult; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Administration Schedule; Female; Hematocrit; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Microbial; Female; Humans; In Vitro Techniques; Infant; Male; Recurrence; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Fifty-nine adult Filipino patients suffering from typhoid fever documented by blood culture were randomly allocated to one of three different drug regimens. Nineteen patients received 3 g ceftriaxone iv once daily for three days. Twenty patients received 4 g ceftriaxone iv once daily for three days and 20 patients received oral chloramphenicol 3 g daily in divided doses for two days followed by 2 g daily for 12 days. Eighteen patients were cured (95%) with 3 g of ceftriaxone for three days. All patients receiving 4 g ceftriaxone per day for three days or chloramphenicol for 14 days were cured. In the ceftriaxone groups two patients developed typhoid fever 30 and 45 days respectively after completion of treatment and one further patient had evidence of reinfection. Three patients relapsed within 15 to 17 days in the chloramphenicol group. Fever subsided in most patients between six and eight days, with three patients having a prolonged and moderate fever for 11 days in the ceftriaxone groups. This study suggests that a short treatment of three days of typhoid fever with ceftriaxone (3 or 4 g once daily) is adequate and not hazardous as far as relapses are concerned.

Topics: Adolescent; Adult; Ceftriaxone; Chloramphenicol; Female; Humans; Male; Middle Aged; Paratyphoid Fever; Recurrence; Typhoid Fever

Fifty-five patients with culture-proven Salmonella typhi and paratyphi enteric fever were assigned to one of two therapeutic regimens. Group I received ceftriaxone 60-80 mg/kg/day intramuscularly for 5-7 days, those in group II received chloramphenicol 50-80 mg/kg/day orally in 4 divided doses for 12-14 days. both groups were comparable as regards age, sex, severity and duration of symptoms prior to admission. A significant reduction in the mean number of days taken for patients to become afebrile, disappearance of clinical signs and symptoms, duration of therapy and hospital stay were observed in patients receiving ceftriaxone as compared to those receiving chloramphenicol. None of the patients receiving ceftriaxone relapsed, while three patients receiving chloramphenicol relapsed. No major reactions were seen with either drug.

Topics: Adolescent; Adult; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Humans; Male; Prospective Studies; Salmonella typhi; Typhoid Fever

Due to mass tourism and the exodus of refugees from Africa and Asia, typhoid fever, common in the tropics, has reappeared in the more temperate climates. The clinical signs of prolonged fever, headache, general malaise, anorexia and abdominal pain are not specific enough to allow diagnosis and only a blood culture will prove the presence of the disease. Unless there is resistance, which is in fact rare in Southeast Asia, chloramphenicol, an effective, well tolerated and cheap antibiotic, remains the treatment of choice for typhoid. In the search for an alternative treatment a cephalosporin, ceftriaxone (Rocephin) seems promising. It has a low MIC of 0.05 micrograms/ml for S. typhi and a high level of biliary excretion which destroys S. typhi in the bile and thus prevents relapse. In Southeast Asia three consecutive studies, of which two were randomised and comparative with chloramphenicol given for 14 days, showed that treatment for two or three days, 3 or 4 g per day of ceftriaxone was as effective as chloramphenicol and was not followed by relapse. In 46 adults there was one failure with ceftriaxone (in an immunocompromised patient) and none in the 30 patients treated with chloramphenicol, three of which, however, relapsed in the 15 days after completion of treatment. Defervescence was a little more rapid with chloramphenicol (six to seven days) than with ceftriaxone (seven to ten days) even though blood, urine and stool cultures were all negative from the third or fourth day of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bile; Ceftriaxone; Chloramphenicol; Humans; Recurrence; Salmonella typhi; Typhoid Fever

In a prospective, randomized, open study ceftriaxone was compared with chloramphenicol for treatment of 59 children who had bacteriologically confirmed acute typhoid fever. Ceftriaxone was administered intramuscularly in a once a day dose of approximately 80 mg/kg body weight for 5 days. Chloramphenicol was given orally for 3 weeks in a daily dosage of 50 to 100 mg/kg body weight divided into 4 doses. In the ceftriaxone group 23 of 29 patients were cured, 2 improved, 1 failed and 2 relapsed. For those who received chloramphenicol 22 of the 30 patients were cured, 5 improved, 1 failed and 2 relapsed. In none of the patients in either group were adverse effects recorded. The overall results of this comparative study suggest that short term treatment of typhoid fever with ceftriaxone is as effective and safe as conventional treatment with chloramphenicol.

Topics: Acute Disease; Administration, Oral; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Humans; Injections, Intramuscular; Male; Prospective Studies; Random Allocation; Typhoid Fever

Sixty-three patients with Salmonella typhi infections were randomly assigned to receive either ceftriaxone iv in single daily doses of 75 mg/kg for children and 3-4 g for adults for seven days or to receive 60 mg of chloramphenicol/kg a day orally or iv in four divided doses until defervescence and then 40 mg/kg a day to complete 14 d. In the ceftriaxone group, one death occurred, and two of seven patients still febrile 11 d after starting treatment were given chloramphenicol. In the chloramphenicol group, one death and one gastrointestinal perforation occurred. The probability of remaining febrile was similar for both groups during the first seven days but was significantly greater for patients receiving ceftriaxone during the 14-d period. Patients in the chloramphenicol group were more likely to be bacteremic on day 3. These results suggest that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.

Topics: Adolescent; Adult; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Feces; Female; Hematocrit; Humans; Infant; Leukocyte Count; Male; Middle Aged; Platelet Count; Random Allocation; Salmonella typhi; Typhoid Fever

Topics: Adult; Ceftriaxone; Female; Humans; Male; Middle Aged; Typhoid Fever

The epidemiology and treatment of typhoid fever are complicated by the emergence and spread of Salmonella enterica subsp.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Ontario; Retrospective Studies; Salmonella enterica; Serogroup; Typhoid Fever

To calculate the frequency of positive blood culture in clinically diagnosed cases of enteric fever and antibiotic sensitivity patterns in culture-positive cases of S.typhi Study Design: Observational Study. Place and Duration of the Study: Department of Paediatrics Medicine, Services Hospital Lahore, from November 15th 2020 to May 15th 2021.. A total of 246 patients, fulfilling the definition of a suspected case of enteric fever were enrolled. Blood cultures were drawn on the spot. Antimicrobial sensitivity for 8 antimicrobial agents-Ampicillin, amoxicillin, chloramphenicol, cefixime, ceftriaxone, cefotaxime, ciprofloxacin, meropenem, and Azithromycin, were performed. A p-value of <0.05 was considered statistically significant.. Blood cultures were positive in 62 (25.2%), patients out of which 34 (54.9%) were females and 28 (45.1%) were males, of which, 58 were S. typhi and 4 were S. Paratyphi A or B. Cefixime was sensitive in 27.4% of patients and intermediate sensitivity was found in 3.2% of cases and 69.4% of cases were resistant, ceftriaxone was sensitive in 38.7% of cases and Azithromycin was sensitive in 96.7% of cases, whereas meropenem showed 100% sensitivity. Chloramphenicol and Ciprofloxacin were resistant in 80.6% and 27.3% of the cases respectively. Among isolates, 32.3% (20) were categorised as sensitive enteric fever; 64.5% (40) as MDR, and 3.2% (2) as XDR enteric fever.. MDR and XDR enteric fever are a major concern. For such cases, Azithromycin remains the best oral antibiotic with a sensitivity of up to 96.7%. Meropenem was sensitive in 100% of cases and was the only antibiotic with no documented resistance in this study.. Enteric fever, Salmonella, Antibiotic sensitivity, Blood culture, MDR, XDR, Azithromycin, Meropenem.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cefixime; Ceftriaxone; Child; Chloramphenicol; Ciprofloxacin; Drug Resistance, Bacterial; Female; Humans; Male; Meropenem; Microbial Sensitivity Tests; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan.. A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively.. We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Multilocus Sequence Typing; Pakistan; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

We performed whole-genome sequencing of 174

Topics: Anti-Bacterial Agents; Bayes Theorem; Ceftriaxone; Drug Resistance, Bacterial; Genotype; Humans; India; Microbial Sensitivity Tests; Prospective Studies; Salmonella typhi; Typhoid Fever; Vaccines, Conjugate

Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of Salmonella Typhi, which causes typhoid. Hence, with rising drug resistance in Salmonella Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. However, unlike for typhoid, there is no vaccine to prevent paratyphoid. Here, we report 23-year AMR trends of Salmonella Paratyphi A in Bangladesh.. From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines.. Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and >99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but the current average MIC is 32-fold lower than the resistance cut-off. Over 99% of the isolates exhibited decreased susceptibility to ciprofloxacin.. Salmonella Paratyphi A has remained susceptible to most antibiotics, unlike Salmonella Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever, especially in the post typhoid vaccine era, and with the availability of new paratyphoid diagnostics.

Topics: Anti-Bacterial Agents; Azithromycin; Bangladesh; Ceftriaxone; Child; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

Invasive Salmonella infections result in a significant burden of disease including morbidity, mortality, and financial cost in many countries. Besides typhoid fever, the clinical impact of non-typhoid Salmonella infections is increasingly recognized with the improvement of laboratory detection capacity and techniques. A retrospective multicenter study was conducted to analyze the clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in hospitalized children in China during 2016-2018. A total of 130 children with invasive Salmonella infections were included with the median age of 12 months (range: 1-144 months). Seventy-nine percent of cases occurred between May and October. Pneumonia was the most common comorbidity in 33 (25.4%) patients. Meningitis and septic arthritis caused by nontyphoidal Salmonella (NTS) infections occurred in 12 (9.2%) patients and 5 (3.8%) patients. Patients < 12 months (OR: 16.04) and with septic shock (OR: 23.4), vomit (OR: 13.33), convulsion (OR: 15.86), C-reactive protein (CRP) ≥ 40 g/L (OR: 5.56), and a higher level of procalcitonin (PCT) (OR: 1.05) on admission were statistically associated to an increased risk of developing meningitis. Compared to 114 patients with NTS infections, 16 patients with typhoid fever presented with higher levels of CRP and PCT (P < 0.05). The rates of resistance to ampicillin, sulfamethoxazole/trimethoprim, ciprofloxacin, and ceftriaxone among Salmonella Typhi and NTS isolates were 50% vs 57.3%, 9.1% vs 24.8%, 0% vs 11.2%, and 0% vs 9.9%, respectively. NTS has been the major cause of invasive Salmonella infections in Chinese children and can result in severe diseases. Antimicrobial resistance among NTS was more common.

Topics: Ampicillin; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Child; Child, Preschool; China; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Infant; Microbial Sensitivity Tests; Procalcitonin; Salmonella; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

To determine the current antibiotic resistance patterns and identification of quinolone and ceftriaxone resistant genes among Salmonella enterica subspecies serovar Typhi.. The prospective study was conducted from September 2018 to March 2019 and comprised samples collected from major hospitals and laboratories in Karachi, Quetta, Lahore, Kharia, Rawalpindi, Islamabad and Peshawar after approval from the institutional ethics review board of Hazara University, Mansehra, Pakistan. Antimicrobial susceptibility of isolates collected from the health facilities was checked using the Kirby Bauer disc diffusion method in line with the Clinical and Laboratory Standards Institute guidelines at the Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan. All isolates were subjected for identification of genes responsible for quinolone and ceftriaxone resistance using polymerase chain reaction followed by gel-electrophoresis.. Among the 96 isolates, phenotypically, ceftriaxone was found resistant in 31(32.29%) and ciprofloxacin in 95(99%). Genotypically, blaCTX-M-15 (beta lactamase, CTX as its acronym, -M from Munich) gene for ceftriaxone resistance was found in all phenotypically resistant 31(32.29%) isolates, while QnrS (Quinolone resistance, S group), GyrA (DNA gyrase subunit A), and GyrB (DNA gyrase subunit B) genes responsible for ciprofloxacin resistance were found in different frequencies (percentages given in table 2).. The spread of extensively drug-resistant Salmonella enterica subspecies serovar Typhi strain to many big cities calls for urgent preventive measures.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; DNA Gyrase; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Pakistan; Prospective Studies; Quinolones; Salmonella typhi; Typhoid Fever

In view of widespread isolation of fluoroquinolone (FQ) resistant Salmonella enterica serovar Typhi globally, third generation cephalosporins (ceftriaxone) are used as alternative drugs for treatment of typhoid fever in recent years. But reports on emergence of third generation cephalosporin resistant S. Typhi have been documented from various countries including India posing threat in future use of this drug for typhoid treatment. Here, we report on genomic analysis of a third generation cephalosporin resistant S. Typhi strain isolated for the first time from Eastern India, Kolkata during 2019. The study strain was phenotypically resistant to ceftriaxone, ampicillin. Whole genome sequencing revealed the presence of conjugative IncX3 plasmid carrying bla

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Haplotypes; India; Microbial Sensitivity Tests; Phylogeny; Salmonella typhi; Typhoid Fever; Whole Genome Sequencing

Systematic studies to estimate the disease burden of typhoid and paratyphoid in India are limited. Therefore, a multicenter study on the Surveillance of Enteric Fever in India was carried out to estimate the incidence, clinical presentation, and antimicrobial resistance (AMR) trend. The data presented here represent the national burden of AMR in Salmonella Typhi and Salmonella Paratyphi A.. Antimicrobial susceptibility testing was performed for S. Typhi and S. Paratyphi A (n = 2373) isolates collected prospectively during a 2-year period from November 2017 to January 2020.. Of 2373 Salmonella isolates, 2032 (85.6%) were identified as S. Typhi and 341 (14.4%) were S. Paratyphi A. Approximately 2% of S. Typhi were multidrug-resistant (MDR), whereas all 341 (100%) of S. Paratyphi A isolates were sensitive to the first-line antimicrobials. Among 98% of ciprofloxacin nonsusceptible isolates, resistance (minimum inhibitory concentration [MIC] >0.5 µg/mL) was higher in S. Typhi (37%) compared with S. Paratyphi A (20%). Azithromycin susceptibility was 99.9% and 100% with a mean MIC of 4.98 μg/mL for S. Typhi and 7.39 μg/mL for S. Paratyphi A respectively. Ceftriaxone was the only agent that retained 100% susceptibility. Moreover, beta-lactam/beta-lactamase inhibitors showed potent in vitro activity against the study isolates.. Data obtained from this systematic surveillance study confirms the declining trend of MDR Salmonella isolates from India. The higher prevalence of ciprofloxacin nonsusceptibility enforces to limit its use and adhere to the judicious usage of azithromycin and ceftriaxone for enteric fever management.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Humans; India; Microbial Sensitivity Tests; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

Typhoid fever in the United States is acquired primarily through international travel by unvaccinated travelers. There is currently no typhoid vaccine licensed in the United States for use in children <2 years.. We reviewed Salmonella enterica serotype Typhi infections reported to the Centers for Disease Control and Prevention (CDC) and antimicrobial-resistance data on Typhi isolates in CDC's National Antimicrobial Resistance Monitoring System from 1999 through 2015.. 5131 cases of typhoid fever were diagnosed and 5004 Typhi isolates tested for antimicrobial susceptibility. Among 1992 pediatric typhoid fever patients, 1616 (81%) had traveled internationally within 30 days of illness onset, 1544 (81%) of 1906 were hospitalized (median duration, 6 days; range, 0-50), and none died. Forty percent (799) were <6 years old; 12% were <2 years old. Based on age and travel destination, 1435 (83%) of 1722 pediatric patients were vaccine-eligible; only 68 (5%) of 1361 were known to be vaccinated. Of 2003 isolates tested for antimicrobial susceptibility, 1216 (61%) were fluoroquinolone-nonsusceptible, of which 272 (22%) were also resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant [MDR]). All were susceptible to ceftriaxone and azithromycin. MDR and fluoroquinolone-nonsusceptible isolates were more common in children than adults (16% vs 9%, P < .001, and 61% vs 54%, P < .001, respectively). Fluoroquinolone nonsusceptibility was more common among travel-associated than domestically acquired cases (70% vs 17%, P < .001).. Approximately 95% of currently vaccine-eligible pediatric travelers were unvaccinated, and antimicrobial-resistant infections were common. New public health strategies are needed to improve coverage with currently licensed vaccines. Introduction of an effective pretravel typhoid vaccine for children <2 years could reduce disease burden and prevent drug-resistant infections.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Humans; Microbial Sensitivity Tests; Salmonella typhi; Travel; Typhoid Fever; United States

Salmonellas enterica serovar Typhi (S.typhi) causes typhoid fever and is a global health problem, especially in developing countries like Ethiopia. But there is a little information about prevalence and factors association with S.typhi and its antimicrobial susceptibility pattern in Ethiopia especially in the study area. The aim of this study was to determine the prevalence of S.typhi infection, its associated factors and antimicrobial susceptibility pattern among patient with a febrile illness at Adare General Hospital, Hawassa, Southern Ethiopia.. Hospital based cross sectional study was conducted among 422 febrile patients from May 23, 2018 to October 20, 2018. A 5 ml venous blood was collected from each febrile patient. Culture and biochemical test were performed for each isolate. Antimicrobial susceptibility testing was performed for each isolate using modified Kirby-Bauer disk diffusion techniques.. In this study, the prevalence of S.typhi among febrile illness patients at Adare General Hospital was 1.6% [95% confidence interval (CI): 0.5-2.9]. The age of the study subjects were ranged from 15 to 65 years (mean age 32 years). It was observed that participants who came from rural area had 8 times (AOR 8.27: 95% CI: 1.33, 51.55) more likely to had S. typhi infection when compared with urban dwellers. The microbial susceptibility testing revealed that all six of S.typhi isolates showed sensitive to Ceftriaxone and all 6 isolates showed resistant to nalidixic acid and Cefotaxime and 5(83.3%) susceptible to Chloramphenicol and Ciprofloxaciline. Multidrug resistance (resistance to three or more antibiotics) was observed among most of the isolates.. S. typhi bacteraemia is an uncommon but important cause of febrile illness in our study population. Ceftriaxone therapy is a suitable empirical antibiotic for those that are unwell and suspected of having this illness. Further surveillance is required to monitor possible hanging antibiotic resistant patterns in Ethiopia.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Chloramphenicol; Cross-Sectional Studies; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Ethiopia; Female; Hospitals, General; Humans; Hygiene; Male; Prevalence; Risk Factors; Salmonella typhi; Typhoid Fever; Young Adult

Pakistan is experiencing the first known outbreak of extensively drug-resistant (XDR) Salmonella enterica serotype Typhi (resistant to third-generation cephalosporins). The outbreak originated in Hyderabad in 2016 and spread throughout the Sindh Province. Whereas focus has remained on Sindh, the burden of XDR typhoid in Punjab, the most populous province, and the rest of the country is understudied. Using laboratory data from Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore (Punjab Province) and its network of more than 100 collection centers across the country, we determined the frequency of blood culture-confirmed XDR typhoid cases from 2017 to 2019. We observed an increase in XDR typhoid cases in Punjab, with the percent of ceftriaxone resistance among Salmonella Typhi cases increasing from no cases in 2017, to 30% in 2018, and to 50% in 2019, with children bearing the largest burden. We also observed spread of XDR typhoid to the two other provinces in Pakistan. To assess prevailing knowledge and practices on XDR typhoid, we surveyed 321 frontline healthcare workers. Survey results suggested that inappropriate diagnostic tests and antibiotic practices may lead to underdiagnosis of XDR typhoid cases, and potentially drive resistance development and spread. Of those surveyed, only 43.6% had heard of XDR typhoid. Currently, serological tests are more routinely used over blood culture tests even though blood culture is imperative for a definitive diagnosis of typhoid fever. We recommend stronger liaisons between healthcare providers and diagnostic laboratories, and increased promotion of typhoid vaccination among healthcare workers and the general population.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Infant; Pakistan; Prevalence; Salmonella enterica; Salmonella typhi; Serogroup; Typhoid Fever

Enteric fever caused by Salmonella enterica continues to be a major public health problem worldwide. In the last decade, ceftriaxone and azithromycin have become the drugs of choice for treating enteric fever caused by Nalidixic acid resistant Salmonella (NARS) enterica. This has led to reports of drug resistance to both drugs. Since enteric fever is endemic in India, accurate drug susceptibility surveillance is crucial to ensure empiric management of enteric fever is appropriate. The aim of this study is to evaluate the minimum inhibitory concentration (MIC) of ceftriaxone and azithromycin for blood culture isolates of NARS isolated at our centre.. This is a retrospective study conducted in a tertiary care center in Mumbai for blood culture isolates of NARS from 2016 to 2018. Isolates were tested for antimicrobial susceptibility testing (AST) against ceftriaxone and azithromycin using a manual broth microdilution method (BMD).. Of 155 blood culture isolates of NARS: S. Typhi (n = 112) and S. Paratyphi A (n = 43) were included in the study. 81.9% (127 / 155) isolates were susceptible, 6.4% (10 / 155) isolates were intermediate while 11.6% (18 / 155) isolates were resistant to ceftriaxone. 100% susceptibility of NARS was observed to azithromycin.. This study documents an alarming increase in resistance to ceftriaxone among NARS in Mumbai while azithromycin continues to be susceptible in vitro. It is essential to know MICs to understand epidemiological trends and choose appropriate treatment regimens for treating enteric fever.

Topics: Azithromycin; Ceftriaxone; Drug Resistance, Bacterial; Humans; India; Microbial Sensitivity Tests; Retrospective Studies; Salmonella enterica; Typhoid Fever

To see the efficacy of rapid colour test for the sensitivity of ceftriaxone against clinical isolates of salmonella typhi.. The cross-sectional validation study was conducted at the Department of Microbiology, Pakistan Navy Ship Shifa Hospital, Karachi, from Nov 2018 to April 2019, and comprised clinical isolates of salmonella typhi that were obtained from five different hospitals in Karachi and Hyderabad. The isolates were tested using the rapid colour test. All the isolates were also tested using the conventional disc diffusion method and minimum inhibitory concentrations on the Vitek-2 version 8.01.. Of the 97 isolates, 83(85.5%) were ceftriaxone-resistant and 14(14.4%) were ceftriaxone-sensitive. Sensitivity and specificity of the rapid colour test were 100% when compared with the results of the other methods. All the results were readable within 2 hours on the colour test.. The colour test was found to be a rapid, accurate and inexpensive tool to screen for ceftriaxone resistance in typhoid-endemic areas.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cross-Sectional Studies; Humans; Microbial Sensitivity Tests; Pakistan; Pharmaceutical Preparations; Salmonella typhi; Typhoid Fever

Two MDR Salmonella Typhi isolates from India were found by whole genome sequencing to be closely related to the 2016 XDR S. Typhi outbreak strain from Pakistan. The Indian isolates have no chromosomal antimicrobial resistance cassette but carry the IncY plasmid p60006. Both isolates are susceptible to chloramphenicol, azithromycin, and carbapenems.

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; India; Microbial Sensitivity Tests; Pakistan; Salmonella typhi; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Humans; Infectious Encephalitis; Magnetic Resonance Imaging; Male; Paraspinal Muscles; Typhoid Fever

Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints.. A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection.. The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7-21.1) of them, 83.7, 95% CI: 70.9-91.5 were NTS while 16.3, 95% CI: 8.5-29.0 were Typhoid Salmonella species. All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53-9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07-4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21-5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28-8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81-39.78) and diarrhea (AOR 2.3, 95% CI, 1.12-4.68) were independent symptoms that predict Salmonella infection.. There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Gastrointestinal Diseases; Hospitals; Humans; Infant; Male; Middle Aged; Prevalence; Salmonella; Salmonella Infections; Tanzania; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Young Adult

Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infection (BSI) in sub-Saharan Africa. This study aimed to assess its longitudinal evolution as cause of BSI, its serotype distribution and its antibiotic resistance pattern in Kisantu, DR Congo.. As part of a national surveillance network, blood cultures were sampled in patients with suspected BSI admitted to Kisantu referral hospital from 2015-2017. Blood cultures were worked-up according to international standards. Results were compared to similar data from 2007 onwards.. In 2015-2017, NTS (n = 896) represented the primary cause of BSI. NTS were isolated from 7.6% of 11,764 suspected and 65.4% of 1371 confirmed BSI. In children <5 years, NTS accounted for 9.6% of suspected BSI. These data were in line with data from previous surveillance periods, except for the proportion of confirmed BSI, which was lower in previous surveillance periods. Salmonella Typhimurium accounted for 63.1% of NTS BSI and Salmonella Enteritidis for 36.4%. Of all Salmonella Typhimurium, 36.9% did not express the O5-antigen (i.e. variant Copenhagen). O5-negative Salmonella Typhimurium were rare before 2013, but increased gradually from then onwards. Multidrug resistance was observed in 87.4% of 864 NTS isolates, decreased ciprofloxacin susceptibility in 7.3%, ceftriaxone resistance in 15.7% and azithromycin resistance in 14.9%. A total of 14.2% of NTS isolates, that were all Salmonella Typhimurium, were multidrug resistant and ceftriaxone and azithromycin co-resistant. These Salmonella isolates were called extensively drug resistant. Compared to previous surveillance periods, proportions of NTS isolates with resistance to ceftriaxone and azithromycin and decreased ciprofloxacin susceptibility increased.. As in previous surveillance periods, NTS ranked first as the cause of BSI in children. The emergence of O5-negative Salmonella Typhimurium needs to be considered in the light of vaccine development. The high proportions of antibiotic resistance are worrisome.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Congo; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Salmonella; Salmonella enteritidis; Salmonella Infections; Salmonella typhimurium; Serogroup; Typhoid Fever; Young Adult

Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Child; Child, Preschool; Disease Outbreaks; Drug Resistance, Microbial; Female; Humans; Infant; Iraq; Male; Middle Aged; Pakistan; Salmonella typhi; Travel-Related Illness; Typhoid Fever; United States; Young Adult

In contrast to enteric fever, reports of secondary hemophagocytic lymphohistiocytosis (HLH) in invasive non-typhoidal salmonellosis are scarce. We report a child with ceftriaxone-resistant invasive

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Drug Resistance, Bacterial; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Meropenem; Salmonella enteritidis; Salmonella Infections; Typhoid Fever

Typhoid fever is usually a mild clinical disease, but it can have potentially serious complications. Here, we describe a case of an adolescent male who presented with severe illness and multi-organ involvement from typhoid fever. He required follow-up after discharge but eventually recovered. Clinicians should be aware of the spectrum of clinical manifestations as early recognition will improve monitoring and management of typhoid disease.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Confusion; Humans; Hypotension; Male; Meningism; Pancytopenia; Paratyphoid Fever; Pneumonia; Salmonella typhi; Typhoid Fever

The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.. The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.. Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29-84) months. The majority (60% [61/101]) of the cases were 6-60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.. Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned.

Topics: Adolescent; Ceftriaxone; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Infant; Male; Pakistan; Salmonella typhi; Sanitation; Typhoid Fever; Typhoid-Paratyphoid Vaccines; Water Microbiology; Water Quality; Water Supply; Young Adult

Topics: Case-Control Studies; Ceftriaxone; Disease Outbreaks; Humans; Pakistan; Risk Factors; Salmonella enterica; Salmonella typhi; Serogroup; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteria; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Feces; Genome, Bacterial; Humans; Medication Adherence; Plasmids; Recurrence; Salmonella typhi; Typhoid Fever

Topics: Case-Control Studies; Ceftriaxone; Disease Outbreaks; Humans; Iraq; Microbial Sensitivity Tests; Pakistan; Risk Factors; Salmonella enterica; Salmonella typhi; Serogroup; Typhoid Fever

We describe a ceftriaxone-resistant

Topics: Abdominal Pain; Adult; Agglutination Tests; Anti-Bacterial Agents; Azithromycin; Bacteremia; Carbapenem-Resistant Enterobacteriaceae; Ceftriaxone; Denmark; Drug Resistance; Escherichia coli; Female; Fever; Humans; Meropenem; Microbial Sensitivity Tests; Pakistan; Plasmids; Polymerase Chain Reaction; Pregnancy; Salmonella typhi; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Travel; Typhoid Fever; Whole Genome Sequencing

Antimicrobial resistance is a major challenge in the treatment of typhoid fever with limited choices left to empirically treat these patients. The present study was undertaken to determine the current practices of antibiotic use in children attending a tertiary care hospital in north India.. This was a descriptive observational study in children suffering from enteric fever as per the case definition including clinical and laboratory parameters. The antibiotic audit in hospitalized children was measured as days of therapy per 1000 patient days and in outpatient department (OPD) as antibiotic prescription on the treatment card.. A total of 128 children with enteric fever were included in the study, of whom, 30 were hospitalized and 98 were treated from OPD. The mean duration of fever was 9.5 days at the time of presentation. Of these, 45 per cent were culture positive with Salmonella Typhi being aetiological agent in 68 per cent followed by S. Paratyphi A in 32 per cent. During hospitalization, the average length of stay was 10 days with mean duration of defervescence 6.4 days. Based on antimicrobial susceptibility ceftriaxone was given to 28 patients with mean duration of treatment being six days. An additional antibiotic was needed in six patients due to clinical non-response. In OPD, 79 patients were prescribed cefixime and additional antibiotic was needed in five during follow up visit.. Based on our findings, ceftriaxone and cefixime seemed to be the first line of antibiotic treatment for typhoid fever. Despite susceptibility, clinical non-response was seen in around 10 per cent of the patients who needed combinations of antibiotics.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Humans; India; Male; Microbial Sensitivity Tests; Salmonella enterica; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

Extra-intestinal complications of Salmonella Typhi (S. Typhi) infections usually occur in endemic countries and in patients with underlying risk conditions. A 14-year-old immunocompetent girl was admitted with respiratory distress owing to S. Typhi pneumonia and pleural empyema. She was a native of Ivory Coast but had lived in France for 4 years and had not travelled abroad for several years. There were no gastro-intestinal symptoms and no S. Typhi carriage was detected in her family. She recovered completely with ceftriaxone and ciprofloxacin and pleural drainage was not required. An atypical presentation of S. Typhi should be considered even in settings where there are no risk factors.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drainage; Empyema, Pleural; Female; France; Humans; Pneumonia, Bacterial; Salmonella typhi; Treatment Outcome; Typhoid Fever

Ceftriaxone is the drug of choice for typhoid fever and the emergence of resistant Salmonella Typhi raises major concerns for treatment. There are an increasing number of sporadic reports of ceftriaxone-resistant S. Typhi and limiting the risk of treatment failure in the patient and outbreaks in the community must be prioritized. This study describes the use of whole genome sequencing to guide outbreak identification and case management.. An isolate of ceftriaxone-resistant S. Typhi from the blood of a child taken in 2000 at the Popular Diagnostic Center, Dhaka, Bangladesh was subjected to whole genome sequencing, using an Illumina NextSeq 500 and analysis using Geneious software.Results/Key findings. Comparison with other ceftriaxone-resistant S. Typhi revealed an isolate from the Democratic Republic of the Congo in 2015 as the closest relative but no evidence of an outbreak. A plasmid belonging to incompatibility group I1 (IncI1-ST31) which included blaCTX-M-15 (ceftriaxone resistance) associated with ISEcp-1 was identified. High similarity (90 %) was seen with pS115, an IncI1 plasmid from S. Enteritidis, and with pESBL-EA11, an incI1 plasmid from E. coli (99 %) showing that S. Typhi has access to ceftriaxone resistance through the acquisition of common plasmids.. The transmission of ceftriaxone resistance from E. coli to S. Typhi is of concern because of clinical resistance to ceftriaxone, the main stay of typhoid treatment. Whole genome sequencing, albeit several years after the isolation, demonstrated the success of containment but clinical trials with alternative agents are urgently required.

Topics: Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Cephalosporin Resistance; Child; Disease Outbreaks; Drug Resistance, Bacterial; Humans; Phylogeny; Plasmids; Salmonella typhi; Typhoid Fever; Whole Genome Sequencing

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Topics: Artesunate; Azithromycin; Ceftriaxone; Child; Communicable Diseases; Critical Care; Dengue; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Geography; Humans; Intensive Care Units; Leptospirosis; Malaria; Male; Nervous System Diseases; Pregnancy; Shock, Hemorrhagic; Syndrome; Travel; Tropical Medicine; Typhoid Fever

Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture-confirmed enteric fever patients and purposively selected key informants. Informants were theoretically sampled based on initial themes identified using abductive analysis. Nvivo 11 was used for thematic coding. An urgent need to address health literacy concerning the transmission of enteric fever was identified, as lay informants did not link the disease and its symptoms to bacterial contamination of foods and drinks but rather to foods considered "bad" following humoral illness interpretations. As a result, lay informants considered recurrence of enteric fever preventable with appropriate dietary restrictions and Khmer traditional medicines. This study also reveals pluralistic health-care-seeking behavior. For initial and mild symptoms, patients preferred home treatment or traditional healing practices; limited household finances delayed treatment seeking. When symptoms persisted, patients first visited drug outlets or private practitioners, where they received a mix of nonessential medicines and one or more antibiotics often without prescription or confirmation of diagnosis. Inappropriate use of antibiotics was common and was related to diagnostic uncertainty and limited finances, factors which should be addressed during future efforts to improve the uptake of appropriate diagnostics and treatment of enteric fever.

Topics: Adult; Anti-Bacterial Agents; Cambodia; Ceftriaxone; Community Participation; Family Characteristics; Female; Gentamicins; Health Knowledge, Attitudes, Practice; Humans; Male; Medicine, Traditional; Middle Aged; Patient Acceptance of Health Care; Qualitative Research; Salmonella paratyphi A; Salmonella typhi; Social Perception; Surveys and Questionnaires; Typhoid Fever

Typhoid fever remains a public health concern in developing countries especially among the poor who live in informal settlements devoid of proper sanitation and clean water supply. In addition antimicrobial resistance poses a major challenge in management of the disease. This study assessed the antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi (S. Typhi) isolated from typhoid fever cases (2004-2007).. A cross sectional study was conducted on 144 archived S. Typhi isolates (2004-2007) tested against 11 antimicrobial agents by quality controlled disk diffusion technique. Isolates resistant to ampicillin, chloramphenicol, and cotrimoxazole were considered Multidrug resistant (MDR). Thirty MDR isolates were selected randomly and further tested using minimum inhibitory concentration (MIC) E-test.. Sixteen percent (23/144) of the isolates were susceptible to all the antibiotics tested while 68% were resistant to three or more of the 11 antibiotics tested. The isolates showed a high susceptibility to ceftriaxone (94%) and gentamicin (97%). A high percentage of resistance was observed for the conventional first-line antibiotics; ampicillin (72%), chloramphenicol (72%), and cotrimoxazole (70%). Sixty-nine percent of the isolates (100/144) showed reduced susceptibility to ciprofloxacin. All the 30 (100%) isolates selected for MIC test were susceptible to amoxicillin-clavulanic acid. All except one of the 30 isolates were susceptible to ceftriaxone while majority 21 (70%) recorded an intermediate susceptibility to ciprofloxacin with MIC of 0.12-0.5 μg/mL.. A large proportion of S. Typhi isolates were MDR and also showed reduced susceptibility to ciprofloxacin. Fluoroquinolone resistance is emerging and this may pose a challenge in treatment of typhoid in future. There is need for routine surveillance to monitor this phenotype in clinical settings.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Humans; Kenya; Microbial Sensitivity Tests; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Case-Control Studies; Ceftriaxone; Disease Outbreaks; Humans; Pakistan; Risk Factors; Salmonella enterica; Serogroup; Typhoid Fever

Pakistan is currently facing the largest outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi described to date. Here we aimed to report the outbreak investigation done in Hyderabad, Pakistan, and identify disease risk factors.. We did an age-matched case-control (1:4) study, in which cases of ceftriaxone-resistant S Typhi were identified from active sentinal sites (three hospitals in Hyderabad, Pakistan), community, and laboratory-based surveillance. Ceftriaxone-resistant S Typhi infection (ie, resistance to ampicillin, chloramphenicol, co-trimoxazole, fluoroquinole, and ceftriaxone) was confirmed using blood culture. Healthy participants (controls) were enrolled for the first 200 people (cases) with ceftriaxone-resistant S Typhi. A structured questionnaire was administered to identify exposures 4 weeks before the illness (cases) or enrolment (controls). Cases were included if written informed consent was provided. Four controls were selected from the same community as the corresponding case, matched on age, being healthy at the time of enrolment, and with no febrile illness in the 4 weeks before enrolment. Samples of drinking water from households and community water sources (ie, hand pumps or taps in common areas outside households) were collected for testing. Conditional logistic regression analysis was used to assess the risk factors for ceftriaxone-resistant S Typhi outbreak in Hyderabad.. Between Nov 30, 2016, and Dec 30, 2017, 486 people with ceftriaxone-resistant S Typhi were identified from Hyderabad. Of the 486 cases, 296 (61%) were male and 447 (92%) were aged 15 years or younger. Several factors were significantly associated with acquisition of ceftriaxone-resistant S Typhi, including male sex (adjusted odds ratio [aOR] 1·53, 95% CI 1·06-2·21), eating outside of the house (aOR 1·48, 1·01-2·19), exposure to a patient with S Typhi infection (aOR 3·81, 2·21-6·83), and a history of antimicrobial use (aOR 4·25, 2·53-7·13). Nine (69%) of 13 water samples taken from the households of people with ceftriaxone-resistant S Typhi infection were positive for Escherichia coli, indicating faecal contamination. S Typhi DNA was detected in 12 (22%) of 55 water samples from community water sources. Geospatial mapping showed clustering of cases around sewerage lines.. Hyderabad faces the largest reported outbreak of ceftriaxone-resistant S Typhi. The outbreak is suspected to be attributed to the contaminated drinking water, especially the mixing of sewage with drinking water. The risk of ceftriaxone-resistant S Typhi infection is increased among children aged 15 years and younger, male individuals, and those eating outside the house. Vaccination and chlorination of water are recommended for the containment of the outbreak.. None.

Topics: Adolescent; Adult; Age Factors; Anti-Bacterial Agents; beta-Lactam Resistance; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Disease Outbreaks; Disease Transmission, Infectious; Drinking Water; Female; Humans; Infant; Pakistan; Risk Factors; Salmonella typhi; Serogroup; Sex Factors; Surveys and Questionnaires; Typhoid Fever; Young Adult

To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae.. Descriptive cross-sectional study.. The study was carried out in the Department of Microbiology, PNS Shifa Hospital, Karachi, from January 2014 to December 2015.. Blood culture samples received from the wards and outpatient departments were included. Isolates of Salmonella were dealt with standard microbiological procedures. The antimicrobial sensitivity against the typhoidal Salmonellaewas determined using Kirby-Bauer disc diffusion method as per the guidelines of Clinical and Laboratory Standards Institute (2013).. Atotal of 460 typhoidal Salmonellaewere isolated; out of which 270 were Salmonella typhiand 190 were Salmonella paratyphiA. The percentage of MDR isolates of S. typhiwas 57% and that of S. paratyphiAwas 42%. None of the isolates were resistant to ceftriaxone, while sensitivity to ciprofloxacin (07% and 0% for S. typhiand S. paratyphiA, respectively) was very low.. There is high percentage of MDR isolates of typhoidal Salmonellaein our region. The antimicrobial sensitivity of typhoidal Salmonellaeto conventional agent has not improved enough to recommend their empirical use. There is almost complete resistance to fluoroquinolones as well, leaving very limited available treatment options.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Cross-Sectional Studies; Disk Diffusion Antimicrobial Tests; Humans; Pakistan; Salmonella typhi; Tertiary Care Centers; Typhoid Fever

Enteric fever (typhoid and paratyphoid) remains a threat to British troops overseas and causes significant morbidity and mortality. We report the case of a soldier who developed typhoid despite appropriate vaccination and field hygiene measures, which began 23 days after returning from a deployment in Sierra Leone. The incubation period was longer than average, symptoms started 2 days after stopping doxycycline for malaria chemoprophylaxis and initial blood cultures were negative. The Salmonella enterica serovar Typhi eventually isolated was resistant to amoxicillin, co-amoxiclav, co-trimoxazole and nalidixic acid and had reduced susceptibility to ciprofloxacin. He was successfully treated with ceftriaxone followed by azithromycin, but 1 month later he remained fatigued and unable to work. The clinical and laboratory features of enteric fever are non-specific and the diagnosis should be considered in troops returning from an endemic area with a febrile illness. Multiple blood cultures and referral to a specialist unit may be required.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cecum; Ceftriaxone; Humans; Lymphatic Diseases; Male; Mesentery; Military Personnel; Sierra Leone; Tomography, X-Ray Computed; Treatment Failure; Typhoid Fever; Typhoid-Paratyphoid Vaccines; United Kingdom

Topics: Adult; Ceftriaxone; Female; Humans; Occupational Exposure; Salmonella typhi; Treatment Outcome; Typhoid Fever

Invasive non-typhoidal Salmonella (iNTS) infections are now a well-described cause of morbidity and mortality in children and HIV-infected adults in sub-Saharan Africa. In contrast, the epidemiology and clinical manifestations of iNTS disease in Asia are not well documented. We retrospectively identified >100 cases of iNTS infections in an infectious disease hospital in Southern Vietnam between 2008 and 2013. Clinical records were accessed to evaluate demographic and clinical factors associated with iNTS infection and to identify risk factors associated with death. Multi-locus sequence typing and antimicrobial susceptibility testing was performed on all organisms. Of 102 iNTS patients, 71% were HIV-infected, >90% were adults, 71% were male and 33% reported intravenous drug use. Twenty-six/92 (28%) patients with a known outcome died; HIV infection was significantly associated with death (p = 0.039). S. Enteritidis (Sequence Types (ST)11) (48%, 43/89) and S. Typhimurium (ST19, 34 and 1544) (26%, 23/89) were the most commonly identified serovars; S. Typhimurium was significantly more common in HIV-infected individuals (p = 0.003). Isolates from HIV-infected patients were more likely to exhibit reduced susceptibility against trimethoprim-sulfamethoxazole than HIV-negative patients (p = 0.037). We conclude that iNTS disease is a severe infection in Vietnam with a high mortality rate. As in sub-Saharan Africa, HIV infection was a risk factor for death, with the majority of the burden in this population found in HIV-infected adult men.

Topics: Adult; Aged; Anti-Infective Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; HIV Infections; Hospitals; Humans; Logistic Models; Male; Middle Aged; Multilocus Sequence Typing; Multivariate Analysis; Retrospective Studies; Salmonella enterica; Salmonella Infections; Serogroup; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Vietnam

An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Colombia; Diagnosis, Differential; Doxycycline; Female; Fever; France; Humans; Leptospirosis; Malaria; Male; Rickettsia Infections; Travel; Treatment Outcome; Typhoid Fever

Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania, yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients.. The present study was conducted at Korogwe District Hospital in north-eastern Tanzania. Patients aged between 2 and 59 months with a history of fever or measured axillary temperature ≥37.5°C attending the outpatient clinic were screened for enrolment into the study. Blood culturing was performed using the BACTEC 9050® system. A biochemical analytical profile index and serological tests were used for identification and confirmation of bacterial isolates. In-vitro antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. The identification of Plasmodium falciparum malaria was performed by microscopy with Giemsa stained blood films.. A total of 808 blood cultures were collected between January and October 2013. Bacterial growth was observed in 62/808 (7.7%) of the cultured samples. Pathogenic bacteria were identified in 26/808 (3.2%) cultures and the remaining 36/62 (58.1%) were classified as contaminants. Salmonella typhi was the predominant bacterial isolate detected in 17/26 (65.4%) patients of which 16/17 (94.1%) were from patients above 12 months of age. Streptococcus pneumoniae was the second leading bacterial isolate detected in 4/26 (15.4%) patients. A high proportion of S. typhi 11/17 (64.7%) was isolated during the rainy season. S. typhi isolates were susceptible to ciprofloxacin (n = 17/17, 100%) and ceftriaxone (n = 13/17, 76.5%) but resistant to chloramphenicol (n = 15/17, 88.2%). P. falciparum malaria was identified in 69/808 (8.5%) patients, none of whom had bacterial infection.. Bloodstream bacterial infection was not found to be a common cause of fever in outpatient children; and S. typhi was the predominant isolate. This study highlights the need for rational use of antimicrobial prescription in febrile paediatric outpatients presenting at healthcare facilities in rural Tanzania.

Topics: Acute Disease; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Ciprofloxacin; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Malaria, Falciparum; Male; Microbial Sensitivity Tests; Microscopy; Outpatients; Plasmodium falciparum; Pneumonia, Pneumococcal; Rural Population; Salmonella typhi; Streptococcus pneumoniae; Tanzania; Typhoid Fever

Malaria and salmonella infections are endemic especially in developing countries, however malaria and salmonella co-infection is a rare entity with high mortality. The basic mechanism in developing salmonella co-infection is the impaired mobilization of granulocytes through heme and heme oxygenase which are released from haemoglobin due to the breakdown of erythrocytes during malaria infection. Thus, a malaria infected person becomes more susceptible to develop infection with Salmonella spp. In this report a case with Plasmodium falciparum and Salmonella Typhi co-infection was presented. A 23-year-old male patient was admitted to hospital with the complaints of diarrhea, nausea, vomiting, abdominal pain, fatigue and fever. Laboratory findings yielded decreased number of platelets and increased ALT, AST and CRP levels. Since he had a history of working in Pakistan, malaria infection was considered in differential diagnosis, and the diagnosis was confirmed by the detection of P.falciparum trophozoites in the thick and thin blood smears. As he came from a region with chloroquine-resistant Plasmodium, quinine (3 x 650 mg) and doxycycline (2 x 100 mg/day) were started for the treatment. No erythrocytes, parasite eggs or fungal elements were seen at the stool microscopy of the patient who had diarrhoea during admission. No pathogenic microorganism growth was detected in his stool culture. The patient's blood cultures were also taken in febrile periods starting from the time of his hospitalization. A bacterial growth was observed in his blood cultures, and the isolate was identified as S. Typhi. Thus, the patient was diagnosed with P.falciparum and Salmonella Typhi coinfection. Ceftriaxone (1 x 2 g/day, 14 days) was added to the therapy according to the results of antibiotic susceptibility test. With the combined therapy (quinine, doxycycline, ceftriaxone) the fever was taken under control, his general condition improved and laboratory findings turned to normal values. However, on the fifth day of his anti-malaria therapy sudden bilateral hearing loss developed due to quinine use. Thus, the treatment was replaced with an artemisinin-based (arthemeter/lumefantrine) combination therapy. No adverse effects were detected due to artemisinin-based therapy, and the patient completely recovered. In conclusion, if a patient is diagnosed with malaria, he/she should be closely monitored in terms of having co-infections and appropriate diagnostic methods including blood cul

Topics: Anti-Bacterial Agents; Antimalarials; Artemether, Lumefantrine Drug Combination; Artemisinins; Bacteremia; Ceftriaxone; Coinfection; Diagnosis, Differential; Doxycycline; Drug Combinations; Drug Therapy, Combination; Ethanolamines; Fluorenes; Hearing Loss, Bilateral; Humans; Malaria, Falciparum; Male; Plasmodium falciparum; Quinine; Salmonella typhi; Treatment Outcome; Typhoid Fever; Young Adult

Typhoid fever is caused by enteroinvasive Gram-negative organism Salmonella typhi. The well-known complications of typhoid fever are intestinal haemorrhage and perforation. In the pre-antibiotic era, these complications were quite common, but in the current antibiotic era the incidence of these complications is on the decline. We report a case of a patient with typhoid fever who developed haematochezia during the hospital stay and was found to have caecal ulcer with an adherent clot on colonoscopy. He was managed successfully with conservative measures without endotherapy and there was no rebleed.

Topics: Anti-Bacterial Agents; Blood Transfusion; Cecal Diseases; Ceftriaxone; Colonoscopy; Gastrointestinal Hemorrhage; Humans; Male; Typhoid Fever; Ulcer; Young Adult

Septic arthritis is a rare complication of typhoid fever. A 12-year-old boy without pre-existing disease attended a paediatric hospital in Cambodia with fever and left hip pain. A hip synovial fluid aspirate grew multidrug-resistant Salmonella enterica ser. Typhi with intermediate susceptibility to ciprofloxacin. Arthrotomy, 2 weeks of intravenous ceftriaxone and 4 weeks of oral azithromycin led to resolution of symptoms. The optimum management of septic arthritis in drug-resistant typhoid is undefined.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Azithromycin; Cambodia; Ceftriaxone; Child; Debridement; Drug Resistance, Multiple, Bacterial; Hip Joint; Humans; Male; Microbial Sensitivity Tests; Salmonella typhi; Synovial Fluid; Treatment Outcome; Typhoid Fever

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Cholecystitis; Female; Gallbladder; Hepatomegaly; Humans; Liver Function Tests; Salmonella Infections; Salmonella typhi; Treatment Outcome; Typhoid Fever; Ultrasonography

This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever. Due to ambiguous clinical findings, which were suggestive of either abdominal tuberculosis, or a lymphoma, the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region. The blood culture reports, however, were reported to grow colonies of Salmonella paratyphi A; thus the diagnosis of the patient was changed to enteric fever, and the patient improved on the subsequently started therapy of ceftriaxone 2,000 mg bid. To the best of our knowledge, this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Ceftriaxone; Diagnosis, Differential; Fever; Humans; Lymphatic Diseases; Male; Microbial Sensitivity Tests; Salmonella Infections; Salmonella paratyphi A; Tuberculosis; Typhoid Fever

Infections with Salmonella enterica serovar Typhi isolates that are multidrug resistant (MDR: resistant to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole) with intermediate ciprofloxacin susceptibility are widespread in Asia but there is little information from Cambodia. We studied invasive salmonellosis in children at a paediatric hospital in Siem Reap, Cambodia. Between 2007 and 2011 Salmonella was isolated from a blood culture in 162 children. There were 151 children with enteric fever, including 148 serovar Typhi and three serovar Paratyphi A infections, and 11 children with a non-typhoidal Salmonella infection. Of the 148 serovar Typhi isolates 126 (85%) were MDR and 133 (90%) had intermediate ciprofloxacin susceptibility. Inpatient antimicrobial treatment was ceftriaxone alone or initial ceftriaxone followed by a step-down to oral ciprofloxacin or azithromycin. Complications developed in 37/128 (29%) children admitted with enteric fever and two (1.6%) died. There was one confirmed relapse. In a sample of 102 serovar Typhi strains genotyped by investigation of a subset of single nucleotide polymorphisms, 98 (96%) were the H58 haplotype, the majority of which had the common serine to phenylalanine substitution at codon 83 in the DNA gyrase. We conclude that antimicrobial-resistant enteric fever is common in Cambodian children and therapeutic options are limited.

Topics: Adult; Age Distribution; Anti-Infective Agents; Azithromycin; Cambodia; Ceftriaxone; Child; Child Mortality; Child, Preschool; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Female; Haplotypes; Hospitals, Pediatric; Humans; Male; Microbial Sensitivity Tests; Polymorphism, Single Nucleotide; Retrospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

To report a patient with typhoid fever who presented with fulminant hepatitis and was found to have a co-infection with hepatitis A.. An 11-year-old girl presented with fever and jaundice after arrival from India. Her blood culture was positive for Salmonella typhi. While on treatment with ceftriaxone, she had worsening of her jaundice with abrupt elevation of liver transaminases associated with coagulopathy. She was found to have an associated hepatitis A infection. Liver enzymes all reverted back to normal upon follow up.. The association of typhoid fever with hepatitis A can result in fulminant hepatitis but in this case, is associated with complete recovery.

Topics: Anti-Bacterial Agents; Blood; Ceftriaxone; Child; Female; Hepatitis A; Humans; India; Kuwait; Salmonella typhi; Transaminases; Travel; Typhoid Fever

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Humans; Male; Mitral Valve; Salmonella typhi; Typhoid Fever; Ultrasonography; Young Adult

Fluoroquinolone-resistant Salmonella enterica subspecies enterica serotype Typhi are being increasingly reported from the Asian subcontinent. This has been hypothesised to be due to a double mutation in the gyrA gene. A total of 113 S. Typhi strains isolated during 1987-2006 in a tertiary-level hospital of North India were monitored for their antibiotic susceptibility by the disk diffusion and minimum inhibitory concentration (MIC) methods. The study period was arbitrarily divided into four equal parts, each comprising 5 years. The antibiotics tested showed an extremely wide range of MICs during all four periods except for ceftriaxone, which showed no resistance during the study period. However, a gradual increase in the MIC of this drug was observed, i.e. 0.047 mg/L, 0.098 mg/L, 0.211 mg/L and 0.3652 mg/L during the four study periods. Ninety-one percent of the strains isolated in the final study period were observed to have MIC levels > or = 0.125 mg/L to ciprofloxacin. Furthermore, gyrA restriction analysis showed no mutation at the two reported sites of the gene, suggesting that the double mutation theory in the development of ciprofloxacin resistance may not be the only mechanism responsible for fluoroquinolone resistance.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Ceftriaxone; Ciprofloxacin; Cluster Analysis; DNA Gyrase; DNA, Bacterial; Drug Resistance, Bacterial; Hospitals; Humans; India; Microbial Sensitivity Tests; Restriction Mapping; Salmonella typhi; Typhoid Fever

The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; India; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Ofloxacin; Randomized Controlled Trials as Topic; Recurrence; Salmonella paratyphi A; Salmonella typhi; Travel; Typhoid Fever

An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 μg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83→Phe and Asp87→Asn in gyrA and Ser80→Ile in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Ceftriaxone; Child; Ciprofloxacin; DNA Gyrase; DNA Topoisomerase IV; Drainage; Drug Resistance, Bacterial; Female; Humans; Microbial Sensitivity Tests; Mutation, Missense; Pleural Effusion; Salmonella typhi; Treatment Outcome; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Early Diagnosis; Gastrointestinal Hemorrhage; Humans; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

A six-year-old boy with high-grade fever and abdominal pain in the epigastric region was examined with ultrasonogram of the abdomen. Hematology-cell analysis, serology (Widal test), urine analysis, and blood cultures were also performed. The ultrasonogram was helpful for the identification of multiple organ involvement with Salmonella typhi. The results revealed mild hepatosplenomegaly, minimal ascitis, and mesenteric lympoadenopathy. Hematological analysis showed a white blood count of 6,300 cells mL-1; a red blood cell count of 4.54 million/cu mm. The erythrocyte sedimentation rate (ESR) was 24 mm/1 hr; hemoglobin level of 11.5 g/dl; and a platelet count of 206,000 cells/mL. The patient's serum was agglutinated with lipopolysaccharide (TO), the titre value was 1:320 dilution, and flagellar antigen (TH) titre was 1:640. The patient was diagnosed with typhoid fever. Ceftriaxone was given intravenously for five days and the patient fully recovered.

Topics: Abdomen; Abdominal Pain; Anti-Bacterial Agents; Antibodies, Bacterial; Ascites; Ceftriaxone; Child; Hematologic Tests; Hepatomegaly; Humans; Lymphatic Diseases; Male; Salmonella typhi; Serologic Tests; Splenomegaly; Treatment Outcome; Typhoid Fever; Ultrasonography

Guillian-Barré Syndome is a very rare neurological complication of typhoid. We report a young girl with blood culture proven typhoid septicaemia that developed this very rare neurological complication of the disease. Following treatment with intravenous antibiotics she improved but developed the complications during the third week of her illness while admitted in hospital. To our knowledge this neurological complication of typhoid has never been reported in Fiji.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cloxacillin; Female; Fiji; Guillain-Barre Syndrome; Humans; Typhoid Fever

Enteric fever is associated with a variety of clinical presentations and complications. Although central nervous system involvement is not uncommon in enteric fever, acute cerebellar ataxia as a presenting feature is rare. A 7-year-old boy with enteric fever who presented with acute cerebellar ataxia is reported.

Topics: Ceftriaxone; Cerebellar Ataxia; Child; Humans; Male; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Hepatitis A; Humans; Liver Failure, Acute; Male; Microbial Sensitivity Tests; Quinolones; Salmonella typhi; Typhoid Fever

A case of typhoidal acalculous cholecystitis is described in a 31-year-old Indian man, who was admitted with 4-day fever, abdominal pain, diarrhea and vomiting. On examination, he looked ill, but was conscious and febrile with icteric sclera. The right upper quadrant of the abdomen was tender. Investigations showed high liver enzymes with high total bilirubin. Abdominal ultrasound findings were consistent with the diagnosis of acalculous cholecystitis and Salmonella enterica serovar typhi was isolated from the blood. After a 2-week course of ceftriaxone (2g once daily) the patient made an uneventful recovery and was discharged. In this report the literature is reviewed and the pathogenesis of the disease is discussed.

Topics: Acalculous Cholecystitis; Adult; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Conjunctival Diseases; Eye Hemorrhage; Humans; Male; Treatment Outcome; Typhoid Fever

The mortality and morbidity of salmonella infections is seriously underestimated. Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days. Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure, features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Multiple Organ Failure; Myocarditis; Pulmonary Edema; Rhabdomyolysis; Salmonella typhi; Treatment Outcome; Typhoid Fever

A 42-year-old German woman presented in hospital with a high temperature (40 degrees C) after visiting Pakistan. She had manifest psychomotor retardation but no signs of meningitis, bradycardia and some pale circular erythematous skin lesions on the abdomen, which disappeared on pressure.. The C-reactive protein (CRP) was 39.27 mg/dl, but the white cell count was normal. Screening tests for malaria were negative, but the blood culture grew Salmonella typhi.. As typhoid fever was suspected and finally confirmed, the patient was treated with oral ciprofloxacin for 14 days. Four days after admission she had to be resuscitated, although the CRP had fallen. The underlying course of the disease was an acute myocarditis with pulmonary edema. Under intensive care complete regression of symptoms was achieved within six days. But after the antibiotic therapy had been completed the patient developed a typhoid relapse with similar but less pronounced signs and symptoms. The antibiotic treatment was changed to ceftriaxon for 14 days and complete remission of clinical, chemical and echocardiographic findings was achieved.. Symptoms of high fever after visiting countries with sometimes poor hygiene should make one suspect typhoid fever, particularly when bradycardia and a normal leukocyte cell count are documented. Because of the pathophysiology of this infection different systemic complications are possible, such as acute myocarditis. Relapses are also a frequent problem: they may occur despite antibiotic treatment given according to the results of microbiological tests.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Anti-Infective Agents; C-Reactive Protein; Ceftriaxone; Ciprofloxacin; Female; Humans; Myocarditis; Pakistan; Pulmonary Edema; Recurrence; Salmonella typhi; Travel; Treatment Outcome; Typhoid Fever

A case of childhood enteric fever complicated by transient dysautonomia and cerebellitis is reported. The child was treated with intravenous antibiotics, and the complications were managed conservatively. Dysautonomia and cerebellitis resolved by day 5 and day 8 after admission, respectively. Results of a neurologic examination at the end of 6 months were normal. Dysautonomia complicating the course of childhood enteric fever is previously unreported.

Topics: Anti-Bacterial Agents; Ataxia; Autonomic Nervous System; Ceftriaxone; Cerebellar Diseases; Cerebellum; Child; Gait Disorders, Neurologic; Humans; Hypotension; Male; Ofloxacin; Primary Dysautonomias; Salmonella typhi; Tachycardia; Treatment Outcome; Typhoid Fever

Typhoid fever is a systemic disease not endemic to South Dakota. We report a case of a young child, living in South Dakota since immigrating with his family as a refugee, who developed typhoid fever. Contact investigation failed to identify a source, suggesting that the infection was acquired abroad. The clinical presentation of typhoid is discussed, and the literature relevant to diagnosis, treatment and prevention is reviewed.

Topics: Analgesics, Non-Narcotic; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child, Preschool; Emigrants and Immigrants; Humans; Male; Salmonella typhi; Typhoid Fever

Intracranial haemorrhage in typhoid fever is very rare. We report another case of non-traumatic intracranial hemorrhage in a 6-year-old boy suffering from typhoid fever, unconsciousness, seizure and non-coherent speech. Investigations revealed severe thrombocytopenia and prolonged prothrombin time. CT scan of brain showed intraparenchymal haemorrhage in frontal regions bilaterally with perilesional oedema, subarachnoid bleed and extension into the lateral ventricles. No aneurysm or arterio-venous malformation was seen on MR angiography. The patient recovered without any neurological deficit.

Topics: Anti-Bacterial Agents; Antifibrinolytic Agents; Blood Transfusion; Ceftriaxone; Child, Preschool; Humans; Intracranial Hemorrhages; Male; Risk Factors; Typhoid Fever; Vitamin K

In the present case series report we describe seven recent cases of typhoid fever. All the patients were travellers returning from Pakistan, where typhoid is endemic. Salmonella typhi isolated from the patients by blood culture were reported as intermediary susceptible to fluoroquinolones in six out of seven cases. We recommend that empiric treatment of suspected cases of typhoid fever includes a third generation cephalosporin such as ceftriaxon. Furthermore, the present report stresses the importance of typhoid vaccination of travellers to areas where typhoid is endemic.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; Denmark; Female; Fluoroquinolones; Humans; Male; Pakistan; Salmonella typhi; Travel; Typhoid Fever; Typhoid-Paratyphoid Vaccines

A total of 50 cases of blood culture proved enteric fever were studied for clinical response to the treatment and compared with in vivo antibiotic sensitivity pattern. Out of 50 Salmonella strains isolated, 37 were S typhi and 13 S paratyphi A. All S typhi isolates were sensitive in vitro to gentamicin and ceftriaxone while sensitivity to ciprofloxacin was 73%, ampicillin 29.7%, chloromphenicol 27%, tetracycline 27% and co-trimoxazole 13.5%. Multidrug resistance (Ampicillin, Chloramphenicol, Cotrimoxazale and Tetracycline) was observed in 62% isolates. All Sparatyphi A isolates were sensitive to all the antibiotics. Clinical response to the antibiotic therapy was as follows: Group I--Ampicillin + Gentamicin: 15 cases, clinical response (CR), 9.1% (S typhi) and 75% (S paratyphi A), mean day of defervescence 5.33 days. Group II--Ciprofloxacin: 29 cases, clinical response 47.6% (S typhi) and 75% (S paratyphi A), mean day of defervescence--5.22 days. Group--III Ceftriaxone: 30 cases, clinical response 100% in all, mean day of defervescence--4.93 days. Thus we observed highly significant discrepancy in antibiotic sensitivity pattern of the isolates and clinical response. Most importantly we observed significantly delayed clinical response to the ceftriaxone. This may be indicative of evolving resistance to ceftriaxone.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Humans; In Vitro Techniques; India; Male; Microbial Sensitivity Tests; Middle Aged; Typhoid Fever; Young Adult

Topics: Abdominal Abscess; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Metronidazole; Ofloxacin; Salmonella typhi; Spleen; Splenic Diseases; Typhoid Fever; Young Adult

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever; United Kingdom

Ultrasonography and computed tomography scan with hypo echoic areas diagnosed a splenic infarction in a Salmonella typhi infected 30-year-old man with painful hypochondrium and epigastrium. An antibiotic recipe of ceftriaxone and amikacin resulted in recovery. Imaging techniques contribute remarkably to a rapid diagnosis and rational management of the extra intestinal lesions attributable to the Salmonella typhi/paratyphi group of organisms.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Ceftriaxone; Follow-Up Studies; Humans; Male; Risk Assessment; Salmonella typhi; Severity of Illness Index; Splenic Infarction; Tomography, X-Ray Computed; Treatment Outcome; Typhoid Fever; Ultrasonography, Doppler

Acute pancreatitis is a pancreatic inflammation that recognises Salmonella typhi among its aetiological agents. In this article the authors describe two cases of acute pancreatitis secondary to typhoid fever, evolving towards complete recovery. These two cases, besides confirming that Salmonella typhi can be responsible for acute pancreatitis, remind us that during typhoid fever, amylase enzyme test should be always assessed. Moreover, salmonella infection must also be considered in cases of non-alcoholic or non-lithiasic pancreatitis.

Topics: Abdominal Pain; Acute Disease; Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Ceftriaxone; Female; Gabexate; Humans; Male; Octreotide; Omeprazole; Pancreatitis; Serine Proteinase Inhibitors; Typhoid Fever

With the global spread of enteric fever, the emergence of Salmonella enterica serovar Paratyphi as a major pathogen (particularly in Asia), the spread of drug resistance, and the global increase in the incidence of non-Typhi salmonella, particularly in patients coinfected with human immunodeficiency virus, there is now more than ever a need for clinical research in enteric fever. The work of Ted Woodward 60 years ago remains relevant today, and his holistic approach to clinical research inspired many of us to follow in his footsteps. There remains healthy discussion among clinicians about the best treatment for enteric fever, and pragmatic, well-designed, randomized controlled trials are required to provide clear evidence. Vaccines and public health measures will have the greatest impact on the overall burden of disease; however, while we wait for these measures, prompt diagnosis and early treatment with the best available and affordable drug will help patients, reduce transmission within the community, and potentially help to contain the spread of drug resistance. Better integration of clinical medicine with epidemiology, public health, vaccine development, and modern laboratory science will help to yield tangible benefits for the vast number of people who have this disease.

Topics: Adolescent; Adult; Age Factors; Anti-Bacterial Agents; Biomedical Research; Ceftriaxone; Child; Chloramphenicol; Developing Countries; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; History, 20th Century; History, 21st Century; Humans; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Research Design; Typhoid Fever

A 12-year-old male presented with osteomyelitis and poliarthritis; after hospitalisation he developed subcutaneous abscesses, endocarditis and pericarditis. The diagnosis of typhoid fever was made when blood cultures grew Salmonella typhi. The patient was cured with a regimen of ceftriaxone and ciprofloxacin.

Topics: Arthritis; Ceftriaxone; Child; Ciprofloxacin; Humans; Male; Osteomyelitis; Salmonella typhi; Typhoid Fever

Fluoroquinolones or third generation cephalosporins are the drugs of choice for the treatment of typhoid fever. Treatment failure with fluoroquinolones has been reported in Asia and Europe. We report a case of ciprofloxacin treatment failure in typhoid fever in Cameroon.. A 29-year-old female patient with suspected typhoid fever from Kumba, Cameroon, yielded growth of Salmonella enterica serovar Typhi in blood culture. The isolate was resistant to nalidixic acid but sensitive to ciprofloxacin by disc diffusion test. However, the patient did not respond to treatment with ciprofloxacin, although the isolate was apparently susceptible to ciprofloxacin.. Treatment failure with ciprofloxacin in our case indicates the presence of nalidixic acid resistant S. enterica serovar Typhi (NARST) with reduced susceptibility to ciprofloxacin in Cameroon (Central Africa).

Topics: Adult; Anti-Bacterial Agents; Cameroon; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Salmonella typhi; Treatment Failure; Typhoid Fever

Salmonella osteomyelitis of the rib is a rare clinical entity. In our case, a muhidrug resistant Salmonella enterica serotype Typhi was isolated from an immuno-competent patient with osteomyclitis of the ribs, who was treated earlier with ciprotloxacin for typhoid fever. The patient was successfully treated for osteomyclitis with intravenous ceftriaxone.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Male; Osteomyelitis; Ribs; Salmonella typhi; Typhoid Fever

Typhoid fever continues to remain a health problem as the causative organism Salmonella Typhi has developed resistance to many of the antibiotics used. This study was undertaken to determine the current pattern of resistance to antimicrobial agents and phage types of S.Typhi isolates obtained in a tertiary health care hospital in Pondicherry. Blood culture was done for 1296 suspected cases of enteric fever and 157 strains of S. Typhi were isolated. Sensitivity to ampicillin, chloramphenicol, gentamicin, ciprofloxacin and ceftriaxone was determined by disc diffusion, and the minimum inhibitory concentration (MIC) of ciprofloxacin determined. There were 61 multidrug resistant (MDR) isolates. The MIC of ciprofloxacin for 147 isolates was >0.5 mg/l; of these, 131 were resistant to nalidixic acid. Phage typing was done for 123 isolates and 115 were found to be of phage type E1, biotype 1. A decline in the number of MDR isolates was noted. Concurrently, there has been an increase in the number of isolates sensitive to all antibiotics except nalidixic acid, and all these isolates showed reduced susceptibility to ciprofloxacin. Nalidixic acid susceptibility could be a useful screening test for the detection of decreased susceptibility of S. Typhi to ciprofloxacin. The clinicians should be advised to use ceftriaxone selectively in cases showing non-responsiveness to ciprofloxacin.

Topics: Anti-Infective Agents; Bacteriophage Typing; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Humans; India; Microbial Sensitivity Tests; Salmonella typhi; Typhoid Fever

Thrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed.

Topics: Adult; Ceftriaxone; Humans; Male; Platelet Count; Salmonella typhi; Thrombocytopenia; Typhoid Fever

Multidrug resistance among Salmonella typhi is well known. Reports of treatment failure in enteric fever with Ciprofloxacin made us undertake this study to determine the antibiotic susceptibility pattern of S. typhi and S. paratyphi A isolated from typhoid bacteremia cases, by disc diffusion and MIC by broth dilution method. A total of 50 strains were tested, 48 of Salmonella typhi and 2 of S. paratyphi A. The disc diffusion method was done using ampicillin, chloramphenicol, cotrimoxazole, tetracycline, ciprofloxacin, ofloxacin, cefuroxime and ceftriaxone as antibiotics. The MIC was performed using ciproloxacin, ofloxacin and ceftriaxone based on standard procedure. ACCOT resistance as determined by disc diffusion method was seen in 68% of isolates. All the strains remained susceptible to flouroquinolones cephalosporins and aminoglycosides. The MIC of ciprofloxacin, ofloxacin and ceftriaxone were in the recommended range of susceptibility as given by NCCLS, 14 (28%) strains had MIC of ciprofloxacin greater than 0.5 ug/ml with 4 strains having an MIC of 1.56 ug/ml; 25 (50%) strains had MIC of ofloxacin greater than 0.5 ug/ml and 20 (40%) strains had MIC of ceftriaxone greater than 0.5 ug/ml. The high levels of MIC of ciprofloxacin may account for treatment failure cases. The rising levels of MIC of ofloxacin and ceftriaxone in S. typhi and S. paratyphi is also of concern. We document here the emergence of high levels of MIC not only to ciprofloxacin, but also ofloxacin and ceftriaxone in S. typhi and S. paratyphi A. We recommend that MIC levels of ofloxacin and ceftriaxone should be monitored along with ciprofloxacin in treatment failure cases of enteric fever.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever

Though typhoid fever is quite common, typhoid hepatitis is a very rare entity which may have a variety of presenting features similar to other more common conditions. One case of typhoid hepatitis is reported here because of its ratity.

Topics: Adolescent; Ceftriaxone; Cephalosporins; Female; Hepatitis; Humans; Jaundice; Liver; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Drug Resistance, Bacterial; Drug Resistance, Multiple; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Salmonella typhi; Typhoid Fever

The emergence of multi drug-resistant Salmonella typhi (MDRST) in many developing countries including Pakistan, has led to a search for suitable alternatives to conventional therapy. Quinolones have been found to be an effective alternative for the treatment of MDRST, in adults as well as in children.. The efficacy of various therapeutic regimens currently used for the treatment of Typhoid was analysed. Children 1 month to 12 years of age admitted to the Children's Hospital from 1990 to 1993 with fever and Salmonella typhi isolated from blood cultures were included in this retrospective analysis.. The cumulative prevalence of Multiple Drug Resistant Salmonella typhi (MDRST) was 67.2%. Only 32.8% of isolated Salmonella typhi were susceptible to chloramphenicol and amoxicillin. The cumulative cure rate with conventional therapy (chloramphenicol or amoxicillin) was 47.4% and 53.6% children needed a change of therapy. The average hospital stay for the non-responders to conventional therapy was 9.2 days as compared to 7.7 days for the responders. The average hospital stay of the patients treated with a third generation cephalosporin was 12.7 days. Patients treated with ofloxacin, a flouroquinolone drug, did not need a change of therapy. The average hospital stay of the patients treated with flouroquinolones was 6.2 days.. There was a high prevalence of multiple drug resistant typhoid fever in hospitalized children, leading to a high failure rate with conventional therapy. This resulted in frequent change of therapy, delayed defervesence and prolonged hospital stay. The flouroquinolones were found to be the most effective drug against MDRST.

Topics: Amoxicillin; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Male; Microbial Sensitivity Tests; Ofloxacin; Pakistan; Prognosis; Retrospective Studies; Salmonella typhi; Treatment Failure; Treatment Outcome; Typhoid Fever

We describe septic arthritis of the hip in a child with typhoid fever. The aetiological diagnosis was confirmed by a positive Widal test as well as by isolation of Salmonella typhi from joint aspirate. Treatment with ceftriaxone along with surgical drainage was successful.

Topics: Arthritis, Infectious; Ceftriaxone; Cephalosporins; Child, Preschool; Drainage; Hip Joint; Humans; Male; Salmonella typhi; Typhoid Fever; Ultrasonography

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Microbial; Humans; India; Microbial Sensitivity Tests; Salmonella typhi; Treatment Failure; Typhoid Fever

Multidrug resistant Salmonella infections in India have been encountered since 1990, for which Quinolones were introduced at that time. However, with indiscriminate use of Quinolones, the sensitivity of these drugs when used alone, to treat S. typhi and S. paratyphi are decreasing. From 1997 to 1999, we have noted a gradual decrease in clinical efficacy of Quinolone monotherapy in enteric fever (9.3% in 1997, 20% in 1998 and 34.88% in 1999). Hence we recommend the use of multidrug therapy for Quinolone resistant and complicated enteric fever. Addition of Ceftriaxone and/or Aminoglycoside is recommended.

Topics: 4-Quinolones; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Drug Resistance, Bacterial; Drug Therapy, Combination; Humans; Typhoid Fever

The rapid spread of multidrug resistant (MDR) typhoid fever has posed a great challenge for the treatment of these cases the world over. After the emergence of chloramphenicol resistant Salmonella typhi strains, ciprofloxacin has become the drug of choice for the treatment of typhoid fever even in the paediatric age group. This study evaluated the role of ceftriaxone therapy in bacteriologically confirmed MDR typhoid cases who did not respond to 12-14 days of ciprofloxacin therapy. Attempts have also been made to investigate the in vitro susceptibility of isolated S. typhi strains to chloramphenicol, ciprofloxacin and ceftriaxone.. A total of 140 children, aged 3-10 yr, clinically diagnosed as having typhoid fever, without any clinical response after 12-14 days of ciprofloxacin therapy were screened for S. typhi by blood culture. In the bacteriologically positive children the treatment was changed to intravenous ceftriaxone for 14 days. The isolated strains of S. typhi were tested for in vitro antimicrobial susceptibility.. Clinical and bacteriological cure was observed with intravenous ceftriaxone therapy in all the 32 bacteriologically positive patients. All isolated S. typhi strains were uniformly (100%) susceptible to ciprofloxacin and ceftriaxone but 50 per cent of the strains were resistant to chloramphenicol. The MIC values of chloramphenicol, ciprofloxacin and ceftriaxone ranged between 125-500, 0.0625-0.5 and < 0.0625 microgram/ml respectively.. The study indicates that although the S. typhi strains were susceptible to ciprofloxacin in vitro, the patients did not respond clinically and bacteriologically to ciprofloxacin therapy. Hence, ciprofloxacin may not represent a reliable and useful option for treating MDR typhoid fever; ceftriaxone may be an effective alternative for the treatment of such cases.

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Humans; Typhoid Fever

A 64 years diabetic man presented with recurrent episodes of fever and abdominal pain. Ultrasonography revealed the presence of an abscess in the right lobe of the liver and a distended gall bladder with multiple calculi. Salmonella typhi was grown from the liver aspirate. Cholelithiasis may act as a predisposing factor for hepatic abscess formation in Salmonella carriers.

Topics: Ceftriaxone; Cephalosporins; Cholelithiasis; Diabetes Complications; Follow-Up Studies; Humans; Liver Abscess; Male; Middle Aged; Salmonella typhi; Time Factors; Typhoid Fever; Ultrasonography

A Fifteen years girl belonging to a low socioeconomic status was admitted with peritonsillar abscess caused by methicillin resistant Staphylococcus aureus (MRSA), high fever, diarrhoea and septicaemic shock. Initial blood cultures and widal test, stool cultures and routine stool examination were non-contributory to the diagnosis. A bone marrow culture in the second week confirmed the diagnosis of Salmonella typhi infection. Examination of a fresh stool sample showed cysts of Entamoeba histolytica. She was treated with ciprofloxacin, metronidazole, augmentin and ceftriaxone. She had no clinical evidence of immunosuppression prior to this episode and her HIV test was negative. This case report highlights the presence of community acquired MRSA infection causing perititonsillar abscess, and the diagnostic dilemma of fever and diarrhoea due to coinfection with Salmonella typhi and Entamobea histolytica.

Topics: Adolescent; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Ciprofloxacin; Entamoebiasis; Female; Humans; Methicillin Resistance; Peritonsillar Abscess; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Typhoid Fever

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; Ceftibuten; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; Quinolones; Time Factors; Typhoid Fever

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Ciprofloxacin; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Humans; Recurrence; Salmonella typhi; Typhoid Fever

Forty five positive blood culture acute typhoid cases were studied during a 2 years period (1997-1999) in Abbassia Fever hospital, Cairo, Egypt. Their ages ranged between 4-23 (12 +/- 2.5) years. Male: Female ratio was 1:1. Three of the 4 classical signs namely: toxic look (84%), bronchitic chest (47%), tumid tympanitic abdomen (84%) and just palpable receding spleen (69%) were found in almost all cases and offer a good bed side clinical diagnostic test. Blood picture revealed anaemia, within normal white blood count and thrombocytopenia. Liver function tests showed within normal total serum bilirubin, two or more folds increase of ALT and within normal serum alkaline phosphatase. Comparing the 3 tests, namely significant Widal titre (56%), modified Widal test (89%) and bright spleen (78%), it was found that modified Widal test is the most sensitive serological test. Ultrasonographic finding of bright spleen is an easy, safe, noninvasive and sensitive technique which is relatively cheap. Each of the 3 drugs in our study namely chloramphenicol, quinolones and ceftriaxone resulted in improvement of general condition, drop of fever, increase in haemoglobin, white blood count and platelet count. Also, there was a significant improvement of liver function tests by either of the 3 drugs. Ceftriaxone is the best drug from the clinical and laboratory points of view followed by quinolones in multidrug resistant (MDR) acute typhoid cases. Chloramphenicol is still the drug of choice in chloramphenicol sensitive salmonellae.

Topics: Acute Disease; Adolescent; Adult; Agglutination Tests; Anti-Bacterial Agents; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Resistance, Bacterial; Egypt; Female; Humans; Leukopenia; Liver Function Tests; Male; Quinolones; Sensitivity and Specificity; Treatment Outcome; Typhoid Fever; Urban Health

Topics: Bangladesh; Ceftriaxone; Cephalosporin Resistance; Humans; Infant; Male; Salmonella typhi; Typhoid Fever

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Ciprofloxacin; Drug Resistance, Microbial; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Salmonella typhi; Typhoid Fever

Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases.. A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock. Vomiting and abdominal pain were followed by headache, prostration, fever and diarrhea. Leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis and hepatitis were present. Clotting tests were normal. The thick peripheral blood film was negative. Salmonella typhi was isolated from 6 blood cultures. Treatment associated ceftriaxone 4 g per day for 5 days, colloid and crystalloid fluids and dopamine. The patient was discharged 2 weeks later.. Typhoid fever should be considered as a diagnosis in patients with sepsis who come from endemic zones. Abdominal symptoms, prolonged fever, coma and delayed headache are particularly contributive signs. Specific treatment should be instituted.

Topics: Adult; Ceftriaxone; Coma; Critical Care; Diagnosis, Differential; Dopamine; Female; Fluid Therapy; Humans; Korea; Salmonella typhi; Shock, Septic; Typhoid Fever

Typhoid fever, which is endemic in Malaysia, affects all age groups and it has been stated that classical features described in textbooks were absent in children. The aim of this study was to find out whether this was true in the local setting and hence a retrospective study was undertaken.. Fifty-four paediatric patients satisfied the inclusion criteria and all were seen consecutively during the study period of 10 years. Patients' records were reviewed for demographic data such as age, sex, ethnicity, clinical features, therapy and results of laboratory tests.. Fever was the most common presenting symptom and diarrhoea was more common than constipation. Isolation of S typhi from blood and/or stools was the most important diagnostic tool *85.2%) and of these 99% had significant Widal titres. Clinical and bacteriological relapse occurred in 5 children (3%) who were successfully treated with ceftriaxone. The absence of mortality and low level of complications indicates either a mild nature of the disease or to early recognition or prompt and appropriate therapy.

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Constipation; Diarrhea; Disease Progression; Female; Humans; Infant; Malaysia; Male; Retrospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

Multidrug-resistant Salmonella typhi has become a major public health problem. In this study, typhoid fever was diagnosed by isolation of Salmonella typhi from blood or by a positive Widal's reaction in 170 Pakistani children. There were 111 boys (65%) and 59 girls (35%). The average age was 6.2 years; 4 (2%) were less than 1 year old, 78 (46%) were 1 to 5 years old, and 88 (52%) were more than 5 years old. All patients were pretreated with antibiotics. Salmonella typhi was detected by culture in 109 cases (64%), by Widal's test in 84 (49%), and by both in 23 (14%). All 79 isolates that were multidrug resistant were sensitive to ofloxacin, cefotaxime, and ceftriaxone. Clinical features of infections due to resistant S typhi did not differentiate these from other cases of typhoid. Fifty-five infections (70%) due to resistant S typhi were treated with ofloxacin and 24 (30%) with ceftriaxone. Sixteen patients had complications, and all recovered.

Topics: Ampicillin Resistance; Anti-Infective Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Multiple; Female; Humans; Infant; Male; Ofloxacin; Pakistan; Salmonella typhi; Trimethoprim Resistance; Typhoid Fever

To determine the changing spectrum of typhoid fever, a study was conducted on 240 cases of typhoid fever, admitted over a period of 4 years. The classical 'Stepladder fever' and 'relative bradycardia' were less commonly seen. Presentation as hepatitis, psychosis, meningism, myocarditis, polyneuropathy and diarrhea were encountered in a small number of patients. Reversible proximal myopathy occurred in four patients and all of them recovered completely over a period of 2-3 weeks. The total leukocyte counts were within normal range in most of the cases. Bone marrow cultures were positive in all untreated and partially treated patients. All strains of Salmonella typhi in this study were sensitive to ofloxacin ceftriaxone and ciprofloxacin.

Topics: Adolescent; Adult; Anti-Infective Agents; Bone Marrow Examination; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Female; Humans; Male; Sensitivity and Specificity; Typhoid Fever

Topics: Adolescent; Ceftriaxone; Cephalosporins; Humans; Male; Recurrence; Typhoid Fever

Topics: Ceftriaxone; Cephalosporins; Drug Resistance, Multiple; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Male; Pregnancy; Salmonella typhi; Typhoid Fever

In Mexico typhoid fever (TF) is still a disease of major importance. The reports of TF complicating pregnancy are few in number, nevertheless the majority of authors agree than pregnancy does not alter the clinical presentation or the laboratory findings of the patient with TF. In these cases data suggest unfavorable perinatal outcome with a greater frequency of abortions and premature delivery. We report five cases of TF complicating pregnancy; one patient aborted, one had a preterm labor with neonatal dead of the product, and the other three had a normal pregnancy without abnormalities of the newborns. An improved outcome of the pregnant women complicated with TF is associated with a proper diagnosis and early treatment with ampicillin of ceftriaxone. Chloramphenicol is contraindicated during pregnancy.

Topics: Abortion, Spontaneous; Adult; Ampicillin; Ceftriaxone; Chloramphenicol; Contraindications; Female; Humans; Infant, Newborn; Male; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Typhoid Fever

Ceftriaxone in short courses has emerged as an effective alternative to chloramphenicol for the treatment of typhoid fever. To study the pharmacokinetics of ceftriaxone in acute typhoid fever, 10 febrile Nepalese adolescents and young adults with blood culture-positive illness were treated with 3 g of ceftriaxone (intravenous infusion for 30 min) daily for 3 days. On the 1st and 3rd day of treatment, blood and urine samples were collected at defined intervals for measurements of drug concentrations. Kinetic parameters including concentrations at the end of infusion (Cmax) and 24 h after the end of infusion (Cmin), elimination half-life (t1/2), area under the plasma concentration-time curve (AUC), total plasma clearance, renal clearance, percentage excreted in urine, and volume of distribution were estimated. On day 1, mean values were as follows: Cmax, 291 micrograms/ml; Cmin, 21.7 micrograms/ml; plasma t1/2, 5.2 h; AUC, 1,428 micrograms.h/ml; total plasma clearance, 37 ml/min; renal clearance, 19 ml/min; percentage excreted in urine, 49.7%; and volume of distribution, 16.1 liters. Mean values on day 3 were not significantly different from those on day 1. Compared with published values for healthy volunteers who received the same dose, our mean t1/2s and AUCs were lower and our mean total plasma clearances, renal clearances, and volumes of distribution were higher. The good clinical responses of these patients to therapy and the adequate Cmins support the use of ceftriaxone once daily for the treatment of typhoid fever.

Topics: Adolescent; Adult; Ceftriaxone; Female; Humans; Male; Metabolic Clearance Rate; Typhoid Fever

Topics: Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Salmonella typhi; Typhoid Fever

Enteric fever caused by Salmonella typhi resistant to all the standard first-line antibiotics is emerging as a major problem in developing countries. Fifteen such culture-proven cases were treated with ceftriaxone (6), cefotaxime (5) or ciprofloxacin (4). The earliest defervescence occurred with ceftriaxone (mean 3.3 days). Clinical cures were obtained with all three drugs with only one child having a relapse. Ciprofloxacin, by virtue of its cost and an oral route of administration, is the ideal choice in a developing country.

Topics: Cefotaxime; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Microbial; Female; Follow-Up Studies; Humans; Infant; Male; Salmonella typhi; Typhoid Fever

A rare case of acute acalculous cholecystitis caused by Salmonella typhi in a 6-year-old child is presented. The clinical signs were fulminant, with diffuse peritonitis being suspected. Cholecystostomy and i.v. ceftriaxone proved efficacious and the girl was discharged in less than two weeks. The appropriate literature is reviewed.

Topics: Ceftriaxone; Child; Cholecystitis; Cholecystostomy; Female; Humans; Salmonella typhi; Typhoid Fever

Treatment of children with infections caused by Salmonella typhi strains resistant to the commonly used oral antimicrobials is a special problem. As children cannot be treated with quinolones, there is no form of oral therapy. Third generation cephalosporins, which have been shown to be effective against typhoid caused by ampicillin sensitive strains of S. typhi were effective against typhoid caused by ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim-resistant strains. We treated 28 children with ceftriaxone and 8 with cefotaxime. We found ceftriaxone to be more effective than cefotaxime with significantly lower relapse rate. Antibiotic therapy of 19 other children, initially treated in a similar manner, was altered for ease of therapy or due to poor response to therapy. The high cost of this parenteral therapy and the problems in its delivery point to the need for safe, effective oral therapy.

Topics: Adolescent; Ampicillin Resistance; Aztreonam; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Ofloxacin; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ceftriaxone; Child; Child, Preschool; Female; Humans; Male; Time Factors; Typhoid Fever

Eight children, seriously ill with bacteriologically proven Salmonella typhi septicemia, were successfully treated with a single daily intramuscular injection of 2 g ceftriaxone given for 5-7 days. All children improved clinically within 48 h of starting therapy and all except 1 became afebrile within 5 days. None relapsed during the 4-week follow-up study.

Topics: Ceftriaxone; Child; Female; Humans; Injections, Intramuscular; Male; Typhoid Fever

Pharmacokinetic properties of ceftriaxone, such as sustained tissue drug levels over 24 hours after a single injection; good penetration of the antibiotic into cells; significant biliary excretion as active unchanged compound and high potency against S. typhi, should make it possible to significantly shorten the treatment of typhoid fever. To test this hypothesis a pilot, open study was initiated. 17 adult patients suffering from uncomplicated typhoid or paratyphoid fever, documented by blood culture, were treated with 4g ceftriaxone once daily for three days (4 patients) or two days (15 patients). The cure rate of 17 assessable patients was 94.2% (one failure). One possible relapse was observed two months after treatment. It is to be noted that no patient in the study suffered from a severe form of the disease.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Female; Humans; Kinetics; Male; Middle Aged; Paratyphoid Fever; Salmonella paratyphi A; Salmonella paratyphi B; Typhoid Fever

Following intravenous administration of 2 g ceftriaxone, concentrations of the drug were assayed in serum, in thoracic duct lymph from dogs, and in mesenteric lymph nodes in patients. Antibacterial activity of lymph against S. typhi was also studied. Results show that ceftriaxone concentrations in serum and lymph are comparable; with a satisfactory antibacterial activity of both fluids against S. typhi. In mesenteric lymph nodes, mean ceftriaxone concentration was approximately 1000 times the MIC for S. typhi. Our data contribute to explain the successful clinical results achieved with ceftriaxone in patients with typhoid fever.

Topics: Animals; Blood Bactericidal Activity; Ceftriaxone; Chromatography, High Pressure Liquid; Dogs; Humans; Lymph; Lymph Nodes; Typhoid Fever

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Meningitis; Respiratory Tract Infections; Sepsis; Sexually Transmitted Diseases; Typhoid Fever; Urinary Tract Infections

The efficacy and safety of ceftriaxone in the treatment of bacteremic typhoid fever was studied in 14 patients. Ceftriaxone at a dosage of 50 to 60 mg/kg per day was administered intravenously in two divided doses in 13 patients and as a single dose in 1 patient. When the two patients with medical complications causing persistent fever and the patient who was febrile during therapy were excluded from the calculations, the mean period of defervescence was 4 days. Five to eight days of ceftriaxone therapy was adequate for the patients who were cured. The 14 patients treated with ceftriaxone included 13 patients who were considered cured, although 1 was a convalescent carrier, and one patient who was a treatment failure. There were no relapses in the 11 patients who were monitored for 1 to 8 months. Both peak and trough concentrations of ceftriaxone were well above the ceftriaxone MICs for the Salmonella typhi strains isolated from the patients. We have demonstrated that ceftriaxone can be used successfully in the treatment of typhoid fever in some patients. The advantages of its use include rapid clinical response, short course of treatment, and lack of serious adverse drug reactions.

Topics: Adolescent; Adult; Body Temperature; Ceftriaxone; Child; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Salmonella typhi; Sepsis; Typhoid Fever