Upsurging Paratyphoid Fever: A Study from Southern India

Year 2020, Volume: 10 Issue: 01, 18 - 23, 15.03.2020

Chaitra Govardhan Christi Dominic Savio Susan Verghese

https://doi.org/10.5799/jmid.700507

Abstract

Objectives: Enteric fever is still a major public health problem in an endemic country like India. Studies project that Salmonella Typhi is the most common cause in the pediatric population but with a recent rising trend in the number of cases due to Salmonella Paratyphi A with increased morbidity and mortality.
Methods: A retrospective analysis of children who had been infected with laboratory-confirmed Salmonella serotypes of Typhi or Paratyphi A collected from November 2016 to October 2018, isolates underwent serotype confirmation, antimicrobial susceptibility testing.
Results: A total of 29 isolates of Salmonella species were studied, which revealed an emergence of Salmonella Paratyphi A as predominant serotype accounting for 55.2% (16) cases with remaining 44.8% (13) cases being Salmonella Typhi.
Conclusions: Physicians should be aware of the increasing incidence of infection due to Salmonella Paratyphi A and treatment options given its widespread antimicrobial resistance. A paratyphoid fever vaccine is urgently needed. Continued surveillance for paratyphoid fever will help guide future prevention and treatment recommendations. J Microbiol Infect Dis 2020; 10(1):18-23.

Keywords

Salmonella Paratyphi A, Enteric fever, Drug resistance, Rising trend

References

• 1. Kliegman R, Stanton B, St. Geme J, Schor N, Behrman R, Nelson W. Nelson Textbook of Pediatrics. Philadelphia: Elsevier; 2016; 198:1388-1393. 2. Chandel D. Drug-Resistant Salmonella enterica Serotype Paratyphi A in India. Emerg Infect Dis 2000; 6(4):420-421. 3. Maskey A, Day J, Tuan P, et al. Salmonella enterica Serovar Paratyphi A and S. enterica Serovar Typhi Cause Indistinguishable Clinical Syndromes in Kathmandu, Nepal. Clin Infect Dis 2006; 42(9):1247-1253. 4. Chowta N, Chowta M. Study of Clinical Profile and Antibiotic Response in Typhoid Fever. Indian Journal of Medical Microbiology 2005; 23(2):125. 5. Bekur R, Vandana K, Shivashankara K, Valsalan R, Sathyanarayanan V. Paratyphoid fever– Emerging problem in South India. Asian Pacific J Trop Med 2010; 3(10):815-817. 6. Bhattacharya SS, Dash U. Sudden rise in the occurrence of Salmonella Paratyphi infection in Rourkela, Orissa. Indian J Med Microbiol 2007; 25(1): 78-79. 7. Bhan M, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. The Lancet 2005; 366 (9487):749-762. 8. Threlfall E, Fisher I, Berghold C, et al. Trends in antimicrobial drug resistance in Salmonella enterica serotypes Typhi and Paratyphi A isolated in Europe, 1999–2001. Intern J Antimicrob Agent 2003; 22(5):487-491. 9. Vollaard A, Ali S, Widjaja S, et al. Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia. Trans R Soc Trop Med Hyg 2005; 99(6):440-450. 10. Chaudhry R, Chandel D, Pandey A, Dhawan B, Gulati V, Sood R. Utility of PCR in diagnosing complicated cases of unusual clinical manifestations of Salmonella enterica var. paratyphi A. Amer J Med 2005; 118(7):799-800. 11. Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M. Age-related clinical and microbiological characteristics of enteric fever in India. Trans R Soc Trop Med Hyg 2006; 100(10):942-948. 12. Parry C, Hien T, Dougan G, White N, Farrar J. Typhoid Fever. N Eng J Med 2002; 347(22):1770-1782. 13. Tankhiwale SS, Agrawal G, Jalgaonkar SV. An unusually high occurrence of Salmonella enterica serotype Paratyphi A in patients with enteric fever. Ind J Med Res 2003; 117: 10-12. 14. Joshi S, Amarnath S. Fluoroquinolone resistance in Salmonella Typhi and S. Paratyphi A in Bangalore, India. Trans R Soc Trop Med Hyg 2007; 101(3):308-310. 15. Joshi S, Wattal C, Sharma A, Oberoi JK, Prasad KJ. Quinolones drug of choice for enteric fever? Indian Journal of Medical Microbiology. 2004; 22(4): 271-2. 16. Madhulika U, Harish BN, Parija SC. Current pattern in antimicrobial susceptibility of Salmonella Typhi isolates in Pondicherry. Ind J Med Research. 2004; 120(8): 111-114. 17. Thaver D, Zaidi AK, Critchley J, Madni SA, Bhutta ZA. Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database Systematic Reviews 2005; 2. 18. Kadhiravan T, Wig N, Kapil A, Kabra S, Renuka K, Misra A. Clinical outcomes in typhoid fever: adverse impact of infection with nalidixic acid-resistant Salmonella Typhi. BMC Infect Dis 2005;5(1). 19. Thisyakorn U, Mansuwan P, Taylor DN. Typhoid and paratyphoid fever in 192 hospitalized children in Thailand. Am J Dis Child 1987; 141: 862–5.