The Clinical Course of Typhoid Fever And Resistance Pattern of Salmonella Typhi In Patients Admitted To A Tertiary Care Hospital In Pakistan

Authors

  • Jamal Azfar Khan Department of Medicine, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan
  • Muhammad Irfan Khattak Department of Medicine, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan
  • Fazila Sikandar Department of Medicine, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan
  • Muhammad Luqman Satti Department of Pathology, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan
  • Kashif Razzaq Department of Medicine, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan
  • Nadia Aziz Ather Department of Medicine, Pakistan Navy Ship Shifa Hospital Bahria University Medical & Dental College Karachi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i2.8498

Keywords:

Azithromycin, drug resistance, multiple, Meropenem, Pakistan, Salmonella typhi, typhoid fever

Abstract

Objective: To investigate and document the clinical course of typhoid fever and the sensitivity pattern of Salmonella typhi to
antibiotics among patients admitted to Pakistan Naval Ship Shifa Hospital.

Study Design: Cross-sectional study.

Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, from Jul to Dec 2021.

Methodology: The patients admitted with typhoid fever to the hospital during the study period were included using
consecutive sampling. After getting informed consent, the patients’ demographic characteristics, course of the disease, blood
culture sensitivity, the treatment administered, the complications that emerged, and the length of their hospital stay were
noted.

Results: There were 77 patients with culture-proven typhoid fever admitted during the study period. The mean age was
18.6±11.84 years (range 1-55 years). The most frequent presenting complaints were fever, abdominal pain, and vomiting.
Additional symptoms included a rash, bodily aches, and weariness. Out of the 77 patients, 76(99%) were extensively drugresistant (sensitive to Meropenem and Azithromycin only). The complications noted were hepatitis, myocarditis, ascites,
pleural effusion, and shock. The mean length of stay in the hospital was 16.56+3.87 days. The typical time gap between
commencing culture-specific antibiotics and fever defervescence was 4.03±2.84 days.

Conclusion: Almost all (99%) patients admitted with typhoid fever in PNS Shifa are extensively drug-resistant and require a
relatively longer hospital stay for management.

Downloads

Download data is not yet available.

References

Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK. A threeyear review of antimicrobial resistance of Salmonella enterica

serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries

; 8(8): 981-986. https://doi.org/10.3855/jidc.3817

WHO. Typhoid; 2018 [Internet]. Available at:

https://www.who.int/news-room/fact-sheets/detail/typhoid

[Accessed on September 6, 2021]

Saeed M, Rasool MH, Rasheed F, Saqalein M, Nisar MA, Imran

AA, et al. Extended-spectrum beta-lactamases producing

extensively drug-resistant Salmonella Typhi in Punjab, Pakistan.

J Infect Dev Ctries 2020; 14(2): 169-176.

https://doi.org/10.3855/jidc.12049

Munir T, Lodhi M, Ansari JK, Andleeb S, Ahmed M. Extended

spectrum beta lactamase producing cephalosporin resistant

Salmonella Typhi, reported from Rawalpindi, Pakistan. J Pak

Med Assoc 2016; 66(8): 1035-1036.

Cuypers WL, Jacobs J, Wong V, Klemm EJ, Deborggraeve S, Van

Puyvelde S. Fluoroquinolone resistance in Salmonella: insights

by whole-genome sequencing. Microb Genom 2018 ; 4(7):

e000195. https://doi.org/10.1099/mgen.0.000195

Britto CD, Wong VK, Dougan G, Pollard AJ. A systematic

review of antimicrobial resistance in Salmonella enterica serovar

Typhi, the etiological agent of typhoid. PLoS Negl Trop Dis

; 12(10): e0006779.

https://doi.org/10.1371/journal.pntd.0006779

Khan EA. XDR Typhoid: The Problem And Its Solution. J Ayub

Med Coll Abbottabad 2019; 31(2): 139-140.

Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK,

et al. Emergence of an Extensively Drug-Resistant Salmonella

enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid

Encoding Resistance to Fluoroquinolones and Third-Generation

Cephalosporins. mBio 2018 ; 9(1): e00105-118.

https://doi.org/10.1128/mBio.00105-18

Haqqi A, Khurram M, Din MSU, Aftab MN, Ali M, Ahmed H, et

al. COVID-19 and Salmonella Typhi co-epidemics in Pakistan: A

real problem. J Med Virol 2021; 93(1): 184-186.

https://doi.org/10.1002/jmv.26293

Butt MH, Saleem A, Javed SO, Ullah I, Rehman MU, Islam N, et

al. Rising XDR-Typhoid Fever Cases in Pakistan: Are We

Heading Back to the Pre-antibiotic Era? Front Public Health

; 9: 794868. https://doi.org/10.3389%2Ffpubh.2021.794868

Fatima M, Kumar S, Hussain M, Memon NM, Vighio A, Syed

MA, et al. Morbidity and Mortality Associated with Typhoid

Fever Among Hospitalized Patients in Hyderabad District,

Pakistan, 2017-2018: Retrospective Record Review. JMIR Public

Health Surveill 2021; 7(5): e27268.

https://doi.org/10.2196/27268

Akram J, Khan AS, Khan HA, Gilani SA, Akram SJ, Ahmad FJ,

et al. Extensively Drug-Resistant (XDR) Typhoid: Evolution,

Prevention, and Its Management. Biomed Res Int

;2020:6432580. https://doi.org/10.1155/2020/6432580

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): 2145-2149.

https://doi.org/10.1007/s10096-019-03658-0

Jalal K, Khan K, Hassam M, Abbas MN, Uddin R, Khusro A, et

al. Identification of a Novel Therapeutic Target against XDR

Salmonella Typhi H58 Using Genomics Driven Approach

Followed Up by Natural Products Virtual Screening.

Microorganisms 2021 ; 9(12): 2512.

https://doi.org/10.3390/microorganisms9122512

Qureshi S, Naveed AB, Yousafzai MT, Ahmad K, Ansari S,

Lohana H, et al. Response of extensively drug resistant

Salmonella Typhi to treatment with meropenem and

azithromycin, in Pakistan. PLoS Negl Trop Dis 2020; 14(10):

e0008682. https://doi.org/10.1371/journal.pntd.0008682

Basnyat B, Qamar FN, Rupali P, Ahmed T, Parry CM. Enteric

fever. BMJ 2021; 372: n437. https://doi.org/10.1136/bmj.n437

Parry CM, Ribeiro I, Walia K, Rupali P, Baker S, Basnyat B.

Multidrug resistant enteric fever in South Asia: unmet medical

needs and opportunities. BMJ 2019; 364: k5322.

https://doi.org/10.1136/bmj.k5322

Mansoor H, Ahmed K, Fida S, Uzair M, Asghar A, Iqbal J.

Gastrointestinal and Hepatobiliary Complications of Extensively

Drug-Resistant Typhoid at a Tertiary Care Hospital in Pakistan.

Cureus 2020; 12(10): e11055.

https://doi.org/10.7759/cureus.11055

Iqbal J, Dehraj IF, Carey ME, Dyson ZA, Garrett D, Seidman JC,

et al. A Race against Time: Reduced Azithromycin Susceptibility

in Salmonella enterica Serovar Typhi in Pakistan. mSphere 2020 ;

(4): e00215-220. https://doi.org/10.1128%2FmSphere.00215-2

Downloads

Published

29-04-2024

Issue

Section

Original Articles

How to Cite

1.
Khan JA, Khattak MI, Sikandar F, Satti ML, Razzaq K, Ather NA. The Clinical Course of Typhoid Fever And Resistance Pattern of Salmonella Typhi In Patients Admitted To A Tertiary Care Hospital In Pakistan. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 Nov. 24];74(2):464-8. Available from: https://pafmj.org/PAFMJ/article/view/8498