The Clinical Course of Typhoid Fever And Resistance Pattern of Salmonella Typhi In Patients Admitted To A Tertiary Care Hospital In Pakistan
DOI:
https://doi.org/10.51253/pafmj.v74i2.8498Keywords:
Azithromycin, drug resistance, multiple, Meropenem, Pakistan, Salmonella typhi, typhoid feverAbstract
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.
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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.
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
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