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Indian Journal of Medical Microbiology, Vol. 25, No. 1, January-March, 2007, pp. 78-79 Correspondence A sudden rise in °Ccurrence of Salmonella paratyphi a infection in Rourkela, Orissa Bhattacharya SS, Dash Usha Department of Microbiology, Ispat General Hospital, Rourkela - 769 005, Orissa Date of Submission: 19-Aug-2005 Code Number: mb07027 Dear Editor, Enteric fever, though classically caused by Salmonella enterica, Serotype typhi , isolation of Salmonella enterica Serotype paratyphi A has also been reported.[1] Since 1996, an increasing trend in isolation of S. paratyphi A causing enteric fever has been noticed in north India.[2],[3] Between 2001 to 2003, an unusually high rate in isolation of S. paratyphi A was reported from Nagpur (46.15%)[4] and Sevagram (53.33%).[5] In 2002 and 2003, we isolated few strains of S. paratyphi A causing enteric fever. But in 2004, between March and August, a sudden and unusual rise in isolation of S. paratyphi A °Ccurred among the patients suspected to have typhoid and treated in Ispat General Hospital, Rourkela. Blood culture was carried out for 795 patients suspected to have enteric fever during March to August, 2004. Phage typing and biotyping was done at the National Salmonella Phage Typing Centre, Lady Hardinge Medical College, New Delhi. A total of 85 Salmonella isolates were obtained from 795 patients giving 10.81% positivity of which 47 (55.29%) were S. paratyphi A and 38 were S. typhi . All 47 isolates of S. paratyphi A were susceptible to ciprofloxacin, cephotaxime and ceftriaxone. Chloramphenicol sensitivity was 91.48% [Table - 1]. Only three isolates were found multi drug resistant. Phage typing was done for 24 isolates of which 21 belonged to phage type 6 and rest were type 4. Of 21 strains of phage type 6, 14 strains belonged to biotype II. In the year 2002 and 2003, we isolated 3 and 4 strains of S. paratyphi A respectively. A sudden and dramatic rise in the number of S. paratyphi A isolates was noted in 2004 over a period of six months (March to August). In our study, ampicillin sensitivity was 89.36%, whereas it was 57.1% in Pune[1] and 66.67% in Nagpur.[4] Sensitivity to chloramphenicol was 72.22% in Nagpur study compared to our sensitivity report of 91.48%. Hundred percent sensitivity shown to ciprofloxacin was similar to the reports from Nagpur and Sevagram.[4],[5] Cefotaxime sensitivity was 100% in our study as also in Nagpur. Cetriaxone showed 100% sensitivity and both gentamicin and amikacin exhibited very high susceptibility against S. paratyphi A isolates. We observed that unlike other places, majority of phage types of S. paratyphi A belonged to type 6 and the rest were type 4. Till date, ciprofloxacin is the drug of choice for enteric fever in India. A recent study from New Delhi reported that 32% isolates of S. paratyphi A showed decreased susceptibility to ciprofloxacin. As the emergence of resistance to ciprofloxacin is slowly increasing, third generation cephalosporins like cephotaxime and ceftriaxone may be tried in ciprofloxacin resistant cases. Moreover, ampicillin and chloramphenicol, because of their high susceptibility against S. paratyphi A, may be considered as first line of antibiotics to restrict the use of ciprofloxacin and thereby help prevent the emergence of drug resistance. As susceptibility pattern varies in different places of India, continuous monitoring in this regard seems to be the need of the hour. References
Copyright 2007 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb07027t1.jpg] |
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