Clinical Characteristics and Antibiotics Sensitivity of Culture Positive Typhoid Fever Patients in Baghdad Teaching Hospital - A Single Center Study
DOI:
https://doi.org/10.3889/oamjms.2022.9336Keywords:
Typhoid, Salmonella, Iraq, ResistanceAbstract
BACKGROUND: Enteric fever caused by Salmonella Typhi is an endemic disease in Iraq. Variations in presentations make it a diagnostic challenge. If untreated or treated inappropriately then it is a serious disease with potentially life-threatening complications. The recent emergence of drug resistant strains of S. Typhi is a rising public health problem and a clinical concern to the physician.
AIM: The objectives of the study were to assess and describe the patterns of antimicrobial resistance, clinical characteristics, epidemiological distribution, and complications of typhoid fever.
PATIENTS AND METHODS: Fifty cases of typhoid fever (culture proven) were collected during the period from February 2019 to November 2019 in the medical wards of Baghdad Teaching Hospital. Detailed history, physical examination, and laboratory investigations were conducted and statistical analysis of the results was done, prospective observational study was conducted.
RESULTS: During the study period, 50 cases of typhoid fever were documented, mean age of presentation was 30.7 ± 12.8, 60% of the cases were male gender, gastrointestinal complications were the most common (90%) followed by hematological complications (71%). Mortality of typhoid fever in our study was 2%. High percentage of resistance to third generation cephalosporins, ciprofloxacin, and azithromycin was found (96%, 56%, and 56%, respectively) while good sensitivity to trimethoprim and meropenem was found (94% and 76%, respectively). Significant association was also found between the development of typhoid fever complications and the presence of anemia, thrombocytopenia, lymphopenia, and eosinopenia. Significant association was also found between the complications and the infection with strains resistant to cephalosporins, ciprofloxacin, and azithromycin.
CONCLUSIONS: There is a concerning increase in resistance toward cephalosporins, ciprofloxacin, and azithromycin while meropenem and trimethoprim are emerging as effective drugs. There was high incidence of complications found (84%).Lymphopenia, anemia, eosinopenia, and thrombocytopenia are independent risk factors for the development of complications of typhoid fever.Downloads
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References
Pegues DA, Salmonellosis SI. Harrison Principles of Internal Medicine. 20th ed. New York: McGraw Hill Education; 2018. p. 1173-80.
Paul UK, Bandyopadhyay A. Typhoid fever: A review. Int J Adv Med. 2017;4(2):300-6. DOI: https://doi.org/10.18203/2349-3933.ijam20171035
Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002;347(22):1770-82. https://doi.org/10.1056/NEJMra020201 PMid:12456854 DOI: https://doi.org/10.1056/NEJMra020201
World Health Organizations. Background Document: The Diagnosis, Treatment and Prevention of Typhoid Fever. Department of Vaccines and Biologicals. Geneva: World Health Organizations; 2003. p. 1.
World Health Organization. Typhoid Vaccines, Who Position Paper, March 2018: Recommendations. Vaccine 2018 April 13. Geneva: World Health Organization; 2018. DOI: https://doi.org/10.1016/j.vaccine.2018.06.061
Dockrell DH, Sundar S, Angus BJ, Hopson RP. Typhoid and paratyphoid (enteric) fever. In: Davidson’s Principles and Practice of Medicine. 22nd ed. Edinburg: Churchill Livingstone, Elsevier; 2014. p. 339-40.
Richens J, Parry C. Typhoid and paratyphoid fever. In: Oxford Textbook of Medicine. Vol. 1. Oxford Academic; 2012. p. 503-7.
Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB. Relative efficacy of blood, urine, rectal swab, bonemarrow, and rose-spot cultures for recovery of Salmonella Typhi in typhoid fever. Lancet. 1975;1(7918):1211-3. https://doi.org/10.1016/s0140-6736(75)92194-7 PMid:48834 DOI: https://doi.org/10.1016/S0140-6736(75)92194-7
Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet. 2005;366(9487):749-62. https://doi.org/10.1016/S0140-6736(05)67181-4 PMid:16125594 DOI: https://doi.org/10.1016/S0140-6736(05)67181-4
Lanata CF, Levine MM, Ristori C, Black RE, Jimenez L, Salcedo M, et al. Vi serology in detection of chronic Salmonella Typhi carriers in an endemic area. Lancet. 1983;2(8347):441-3. https://doi.org/10.1016/s0140-6736(83)90401-4 PMid:6192305 DOI: https://doi.org/10.1016/S0140-6736(83)90401-4
Olsen SJ, Pruckler J, Bibb W, Nguyen TM, Tran MT, Sivapalasingam S, et al. Evaluation of rapid diagnostic tests for typhoid fever. J Clin Microbiol. 2004;42(5):1885-9. https://doi.org/10.1128/JCM.42.5.1885-1889.2004 PMid:15131144 DOI: https://doi.org/10.1128/JCM.42.5.1885-1889.2004
Andrews JR, Qamar FN, Charles RC, Ryan ET. Extensively drug-resistant typhoid are conjugate vaccines arriving just in time? N Engl J Med. 2018;379(16):1493-5. https://doi.org/10.1056/NEJMp1803926 PMid:30332569 DOI: https://doi.org/10.1056/NEJMp1803926
Kakaria A, Asgaonkar D, Narkhede M. Clinical profile of enteric fever: A prospective study of fifty enteric fever patients. Int J Res Med Sci. 2014;2:1620-5. DOI: https://doi.org/10.5455/2320-6012.ijrms20141170
Dimitrov T, Udo EE, Albaksami O, Alshehab S, Kilani A, Shehab M, et al. Clinical and microbiological investigations of typhoid fever in an infectious disease hospital in Kuwait. J Med Microbiol. 2007;56(Pt 4):538-44. https://doi.org/10.1099/jmm.0.46814-0 PMid:17374897 DOI: https://doi.org/10.1099/jmm.0.46814-0
Crump JA, Mintz ED. Global trends in typhoid and paratyphoid fever. Clin Infect Dis. 2010;50(2):241-6. https://doi.org/10.1086/649541 PMid:20014951 DOI: https://doi.org/10.1086/649541
Buch NA, Hassan MU, Kakaroo DK. Enteric fever- a changing sensitivity pattern, clinical profile and outcome. Indian Pediatr. 1994;31(8):981-5. PMid:7883352
Sur D, Ali M, von Seidlein L, Manna B, Deen JL, Acosta CJ, et al. Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India. BMC Public Health. 2007;7:289. https://doi.org/10.1186/1471-2458-7-289 PMid:17935611 DOI: https://doi.org/10.1186/1471-2458-7-289
Cabello F, Springer AD. Typhoid fever in Chile 1977-1990: An emergent disease. Rev Med Chil. 1997;125(4):474-82. PMid:9460291
Saad NJ, Lynch VD, Antillón M, Yang C, Crump JA, Pitzer VE. Seasonal dynamics of typhoid and paratyphoid fever. Sci Rep. 2018;8(1):6870. https://doi.org/10.1038/s41598-018-25234-w PMid:29720736 DOI: https://doi.org/10.1038/s41598-018-25234-w
Gupta S, Handa A, Panda RC. Profile of culture positive enteric fever from Banlore. Med J Armed Forces India. 2009;65(4):328-31. https://doi.org/10.1016/S0377-1237(09)80093-2 PMid:27408286 DOI: https://doi.org/10.1016/S0377-1237(09)80093-2
Ahmed A, Ahmed B. Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics. Ann Afr Med. 2010;9(3):135-40. https://doi.org/10.4103/1596-3519.68361 PMid:20710103 DOI: https://doi.org/10.4103/1596-3519.68361
Joshi YK. Typhoid fever clinical features. J Indian Acad Clin Med. 2001;2(1-2):13-5.
Saha AK, Hassan MK, Kundera LC, Saha SK, Begum P. Study of clinical profile and antibiotic sensitivity in typhoid fever at Faridpur medical college hospital. Faridpur Med Coll J. 2017;12(1):2-4. DOI: https://doi.org/10.3329/fmcj.v12i1.33455
Alshok M, Alamidi B. Typhoid fever complications in Babylon. Med J Babylon 2004;1(2):149-54.
Khosla SN, Anand A, Singh U, Khosla A. Hematological profile in typhoid fever. Trop Doct. 1995;25(4):156-8. https://doi.org/10.1177/004947559502500404 PMid:7502322 DOI: https://doi.org/10.1177/004947559502500404
Lokhandwala A, Athar S, Turrin NP. Role of absolute eosinopenia as marker of enteric fever: Experience from a tertiary care hospital in the United Arab Emirates. Ibnosina J Med Biomed Sci. 2012;4(6):249-53. DOI: https://doi.org/10.4103/1947-489X.210782
de Jong HK, Parry CM, van der Vaart TW, Kager LM, van den Ende SJ, Maude RR, et al. Activation of coagulation and endothelium with concurrent impairment of anticoagulant mechanisms in patients with typhoid fever. J Infect. 2018;77(1):60-7. https://doi.org/10.1016/j.jinf.2018.03.008 PMid:29746945 DOI: https://doi.org/10.1016/j.jinf.2018.03.008
Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, et al. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in cultureproven typhoid patients admitted to an urban hospital in Bangladesh. Trop Med Int Health. 2018;23(4):359-66. https://doi.org/10.1111/tmi.13037 PMid:29432657 DOI: https://doi.org/10.1111/tmi.13037
Sur D, Barkume C, Mukhopadhyay B, Date K, Ganguly NK, Garrett D. A retrospective review of hospital-based data on enteric fever in India, 2014-2015. J Infect Dis. 2018;218(Suppl 4):S206-13. https://doi.org/10.1093/infdis/jiy502 PMid:30307566 DOI: https://doi.org/10.1093/infdis/jiy502
Sharma P, Dahiya S, Manral N, Kumari B, Kumar S, Pandey S, et al. Changing trends of culture positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian hospital over the last decade. Indian J Med Microbiol. 2018;36(1):70-6. https://doi.org/10.4103/ijmm.IJMM_17_412 PMid:29735830 DOI: https://doi.org/10.4103/ijmm.IJMM_17_412
Matono T, Kato Y, Morita M, Izumiya H, Yamamoto K, Kutsuna S, et al. Case series of imported enteric fever at a referral center in Tokyo, Japan: Antibiotic susceptibility and risk factors for relapse. Am J Trop Med Hyg. 2016;95(1):19-25. https://doi.org/10.4269/ajtmh.15-0714 PMid:27162265 DOI: https://doi.org/10.4269/ajtmh.15-0714
Khan M, Coovadia Y, Connolly C, Sturm AW. Risk factors predicting complications in blood culture‐proven typhoid fever in adults. Scand J Infect Dis. 2000:32(2):201-5. https://doi.org/10.1080/003655400750045349 PMid:10826909 DOI: https://doi.org/10.1080/003655400750045349
Pegues D, Miller S. Salmonella species, including Salmonella typhi. In: Mandell G, Bennet J, Dolin R, editors. Principles of Practice of Infectious Diseases. 7th ed. New York: Churchill-Livingston; 2010. p. 2887-903. DOI: https://doi.org/10.1016/B978-0-443-06839-3.00223-X
Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M. Risk factors for enteric perforation in patients with typhoid fever. Am J Epidemiol. 2004;160(1):46-50. https://doi.org/10.1093/aje/kwh172 PMid:15229116 DOI: https://doi.org/10.1093/aje/kwh172
Everest P, Wain J, Roberts M, Rook G, Dougan G. The molecular mechanisms of severe typhoid fever. Trends Microbiol. 2001;9(7):316-20. https://doi.org/10.1016/s0966-842x(01)02067-4 PMid:11435104 DOI: https://doi.org/10.1016/S0966-842X(01)02067-4
Parry CM, Thompson C, Vinh H, Chinh NT, Phuong LT, Ho VA, et al. Risk factors for the development of severe typhoid fever in Vietnam. BMC Infect Dis. 2014;14:73. https://doi.org/10.1186/1471-2334-14-73 PMid:24512443 DOI: https://doi.org/10.1186/1471-2334-14-73
Thong KL, Goh YL, Yasin RM, Lau MG, Passey M, Winston G, et al. Increasing genetic diversity of Salmonella enterica serovar Typhi isolates from Papua New Guinea over the period from 1992 to 1999. J Clin Microbiol. 2002;40(11):4156-60. https://doi.org/10.1128/JCM.40.11.4156-4160.2002 PMid:12409390 DOI: https://doi.org/10.1128/JCM.40.11.4156-4160.2002
Holt KE, Phan MD, Baker S, Duy PT, Nga TV, Hinds J, et al. Emergence of a globally dominant IncHI1 plasmid type associated with multiple drug resistant typhoid. PLoS Negl Trop Dis. 2011;5:e1245. DOI: https://doi.org/10.1371/journal.pntd.0001245
Date KA, Newton AE, Medalla F, Blackstock A, Richardson L, McCullough A, et al. Changing patterns of enteric fever incidence and increasing antibiotic resistance of enteric fever isolate in the United States, 2008-2012. Clin Infect Dis. 2016;63(3):322-9. https://doi.org/10.1093/cid/ciw232 PMid:27090993 DOI: https://doi.org/10.1093/cid/ciw232
Capoor MR, Nair D. Quinolones and cephalosporins resistance in enteric fever. J Glob Infect Dis. 2010;2(3):258-62. https://doi.org/10.4103/0974-777X.68529 PMid:20927288 DOI: https://doi.org/10.4103/0974-777X.68529
Hussain A, Satti L, Hanif F, Zehra NM, Nadeem S, Bangash TM, et al. Typhoidal Salmonella strains in Pakistan: An impending threat of extensively drug-resistant Salmonella Typhi. Eur J Clin Microbiol Infect Dis. 2019;38(11):2145-9. https://doi.org/10.1007/s10096-019-03658-0 DOI: https://doi.org/10.1007/s10096-019-03658-0
Rowe B, Ward LR, Threlfall EJ. Ciprofloxacin-resistant Salmonella Typhi in the UK. Lancet. 1995;346(8985):1302. https://doi.org/10.1016/s0140-6736(95)91906-6 PMid:7475749 DOI: https://doi.org/10.1016/S0140-6736(95)91906-6
Medalla F, Sjölund-Karlsson M, Shin S, Harvey E, Joyce K, Theobald L, et al. Ciprofloxacin-resistant Salmonella enterica Serotype Typhi, United States, 1999-2008. Emerg Infect Dis. 2011;17(6):1095-8. https://doi.org/10.3201/eid/1706.100594 PMid:21749779 DOI: https://doi.org/10.3201/eid/1706.100594
Chitnis S, Chitnis V, Hemvani N, Chitnis DS. Ciprofloxacin therapy for typhoid fever needs reconsideration. J Infect Chemother. 2006;12:402-4. https://doi.org/10.1007/s10156-006-0472-9 PMid:17235649 DOI: https://doi.org/10.1007/s10156-006-0472-9
Britto CD, John J, Verghese VP, Pollard AJ. A systematic review of antimicrobial resistance of typhoidal Salmonella in India. Indian J Med Res. 2019;149(2):151-63. https://doi.org/10.4103/ijmr.IJMR_830_18 PMid:31219079 DOI: https://doi.org/10.4103/ijmr.IJMR_830_18
Frenck RW Jr., Mansour A, Nakhla I, Sultan Y, Putnam S, Wierzba T, et al. Short-course azithromycin for the treatment of uncomplicated typhoid fever in children and adolescents. Clin Infect Dis. 2004;38(7):951-7. https://doi.org/10.1086/382359 PMid:15034826 DOI: https://doi.org/10.1086/382359
Misra R, Prasad KN. Antimicrobial susceptibility to azithromycin among Salmonella enterica Typhi and Paratyphi A isolates from India. J Med Microbiol. 2016:65(12):1536-9. https://doi.org/10.1099/jmm.0.000390 PMid:27902389 DOI: https://doi.org/10.1099/jmm.0.000390
Lo J, Kulp SK, Chen C, Chiu H, Sensitization of intracellular Salmonella enterica serovar Typhimarinarum to aminoglycosides in vitro and in vivo by a host-targeted antimicrobial agent. Antimicrob Agents Chemother. 2014;58(12):7375-82. https://doi.org/10.1128/AAC.03778-14 PMid:25267669 DOI: https://doi.org/10.1128/AAC.03778-14
Kumar A, Pundit V, Shetty S, Rao CR, Pattanshetty S, Samarasinghe CM. Study of clinical profile and antibiotic sensitivity in culture positive typhoid fever cases. Indian J Community Med. 2012;37(4):256-8. https://doi.org/10.4103/0970-0218.103475 PMid:23293441 DOI: https://doi.org/10.4103/0970-0218.103475
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