TY - JOUR
T1 - Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever
T2 - first case report from Pakistan
AU - Irfan, Seema
AU - Hasan, Zahra
AU - Qamar, Farah
AU - Ghanchi, Najia
AU - Ashraf, Javaria
AU - Kanji, Akbar
AU - Razzak, Safina
AU - Greig, David
AU - Nair, Satheesh
AU - Hasan, Rumina
N1 - Funding Information:
We acknowledge Juma Research Laboratory genomics core group and Clinical Microbiology laboratory staff of Aga Khan University Hospital, Karachi for their support.
Funding Information:
This study was supported by the Health Security Partners (HSP)-USA, as part of their collaboration with the Department of Pathology and Laboratory Medicine, Aga Khan University, for laboratory capacity building and strengthening for antimicrobial resistance surveillance.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.
AB - Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.
KW - Antimicrobial resistance (AMR) in Pakistan
KW - Bla in S. Paratyphi A
KW - Case report
KW - Ceftriaxone resistant Salmonella Paratyphi A
KW - Drug resistance in Salmonella
KW - ESBL S. Para A
KW - Enteric fever in Pakistan
KW - S. Para A from Pakistan
UR - http://www.scopus.com/inward/record.url?scp=85153921898&partnerID=8YFLogxK
U2 - 10.1186/s12879-023-08152-9
DO - 10.1186/s12879-023-08152-9
M3 - Article
C2 - 37101111
AN - SCOPUS:85153921898
SN - 1471-2334
VL - 23
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 267
ER -
