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Title: Enteric fever in Cambodian children is dominated by multidrug-resistant H58 Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin
Authors: Kate Emary
Catrin E. Moore
Ngoun Chanpheaktra
Khun Peng An
Kheng Chheng
Soeng Sona
Pham Thanh Duy
Tran Vu Thieu Nga
Vanaporn Wuthiekanun
Premjit Amornchai
Varun Kumar
Lalith Wijedoru
Nicole E. Stoesser
Michael J. Carter
Stephen Baker
Nicholas P.J. Day
Christopher M. Parry
Mahidol University
Nuffield Department of Clinical Medicine
Angkor Hospital for Children
UCL Institute of Child Health
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Dec-2012
Citation: Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.106, No.12 (2012), 718-724
Abstract: Infections with Salmonella enterica serovar Typhi isolates that are multidrug resistant (MDR: resistant to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole) with intermediate ciprofloxacin susceptibility are widespread in Asia but there is little information from Cambodia. We studied invasive salmonellosis in children at a paediatric hospital in Siem Reap, Cambodia. Between 2007 and 2011 Salmonella was isolated from a blood culture in 162 children. There were 151 children with enteric fever, including 148 serovar Typhi and three serovar Paratyphi A infections, and 11 children with a non-typhoidal Salmonella infection. Of the 148 serovar Typhi isolates 126 (85%) were MDR and 133 (90%) had intermediate ciprofloxacin susceptibility. Inpatient antimicrobial treatment was ceftriaxone alone or initial ceftriaxone followed by a step-down to oral ciprofloxacin or azithromycin. Complications developed in 37/128 (29%) children admitted with enteric fever and two (1.6%) died. There was one confirmed relapse. In a sample of 102 serovar Typhi strains genotyped by investigation of a subset of single nucleotide polymorphisms, 98 (96%) were the H58 haplotype, the majority of which had the common serine to phenylalanine substitution at codon 83 in the DNA gyrase. We conclude that antimicrobial-resistant enteric fever is common in Cambodian children and therapeutic options are limited. © 2012 Royal Society of Tropical Medicine and Hygiene.
ISSN: 18783503
Appears in Collections:Scopus 2011-2015

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