Typhoid Fever: A Massive, Single-Point Source, Multidrug-Resistant Outbreak in Nepal
Open Access
- 15 February 2005
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 40 (4), 554-561
- https://doi.org/10.1086/427503
Abstract
Background. In the summer of 2002, a total of 5963 cases of typhoid fever were recorded in Bharatpur, Nepal (population, 92,214) during a 7-week period. A team from the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand, and the CIWEC Travel Medicine Clinic (Kathmandu, Nepal) assisted the Nepal National Public Health Laboratory (Kathmandu, Nepal) in the further investigation of this large, explosive febrile disease outbreak. Methods. Investigators conducted a thorough epidemiologic and laboratory investigation to assess the size and scope of the outbreak. In addition to subculturing of previously collected samples, blood samples were obtained from 100 febrile patients, and culture and susceptibility testing were done by standard laboratory methods. Pulsed field gel electrophoresis (PFGE) and plasmid analysis were done. Results. The majority of the isolates, including 1 from the municipal water supply, were multidrug resistant. The minimum inhibitory concentrations (MICs) of ciprofloxacin ranged from 0.19 µg/mL to 0.125 µg/mL. With use of PFGE, all isolates, including isolates from the water supply, showed an analytical similarity of 96%–100%. Multidrug-resistant isolates had a plasmid encoding for resistance, and those with resistance to nalidixic acid had a single-point mutation. Conclusions. To the best of our knowledge, this outbreak is the largest single—point source outbreak of multidrug-resistant typhoid fever yet reported, and it was molecularly traced to the city's single municipal water supply. Isolates were uniformly resistant to nalidixic acid, there was a decrease in their susceptibility as measured by MIC of fluoroquinolones, and 90% of isolates obtained were resistant to >1 antibiotic.Keywords
This publication has 16 references indexed in Scilit:
- Screening Method forSalmonella entericaSerovar Typhi and Serovar Paratyphi A with Reduced Susceptibility to Fluoroquinolones by PCR-Restriction Fragment Length PolymorphismMicrobiology and Immunology, 2003
- Typhoid FeverThe New England Journal of Medicine, 2002
- DNA Sequence Analysis of DNA Gyrase and DNA Topoisomerase IV Quinolone Resistance-Determining Regions of Salmonella enterica Serovar Typhi and Serovar Paratyphi AAntimicrobial Agents and Chemotherapy, 2002
- Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan.The American Journal of Tropical Medicine and Hygiene, 1999
- A Massive Epidemic of Multidrug‐Resistant Typhoid Fever in Tajikistan Associated with Consumption of Municipal WaterThe Journal of Infectious Diseases, 1999
- Epidemic ciprofloxacin-resistant Salmonella typhi in TajikistanThe Lancet, 1998
- Modified Birnboim--Doly method for rapid detection of plasmid copy numberNucleic Acids Research, 1988
- Characterization of plasmids conferring resistance to gentamicin and apramycin in strains ofSalmonella typhimuriumphage type 204c isolated in BritainEpidemiology and Infection, 1986
- Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in childrenThe Pediatric Infectious Disease Journal, 1985
- RELATIVE EFFICACY OF BLOOD, URINE, RECTAL SWAB, BONE-MARROW, AND ROSE-SPOT CULTURES FOR RECOVERY OF SALMONELLA TYPHI IN TYPHOID FEVERThe Lancet, 1975