Epidemiology and Antimicrobial Resistance Patterns in Enteric Fever among patients in Garissa County, a Semi-Arid Region of North Eastern Kenya

Khatra Shariff Said ,Zipporah Ng’ang’a ,Samuel Kariuki

doi:10.7176/jhmn/60-14

Abstract

Typhoid and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in developing countries where enteric fever is associated with poor sanitation and unsafe food and water. Quantification of disease burden is crucial for policy making about the deployment of enteric fever prevention measures and vaccines. This cross-sectional study was undertaken to determine the epidemiology and antimicrobial resistance pattern in bacterial aetiologies of enteric fever among patients attending Garissa County Referral Hospital, (GCRH) located in a semi-arid region of North Eastern Kenya. Blood and stool samples were obtained from 379 consenting patients and a detailed sociodemographic questionnaire was administered. Isolation and identification of Salmonella Typhi, S. Paratyphi A and S. Paratyphi B were obtained by convectional culture, PCR and Vitek-2 compact detection method. Antimicrobial susceptibility testing was done using Kirby-Bauer’s disc diffusion method. Multidrug resistance was defined as co-resistance to ampicillin, chloramphenicol and co- trimoxazole. Eight of the 379 (2.1%) participants were positive for Salmonella spp . Of the 8 Salmonella isolates were S. Typhi (n=2; 25%), S. Paratyphi A (n=2; 25%) and S. Paratyphi B (n=4; 50%). Resistance to ampicillin, tetracycline, gentamycin, chloramphenicol, nalidixic acid and trimethoprim-sulfamethoxazole was 100%, 87.5%, 75%, 50%, 25% and 25% respectively. No isolate showed resistance to ciprofloxacin. Half of all S. typhi, S. paratyphi A and B were multidrug-resistant. Risk factors including water and food (such as often eating outside homestead, family eating from a common plate, taking locally prepared cold drinks, family wash hands in common basin), low socio-economic status and availability of a previous laboratory confirmation of typhoid fever were associated with S. Typhi and S. Paratyphi infection . The isolation of a large proportion of MDR S. Typhi , S. Paratyphi A and B is worrying. Although these isolates were susceptible to fluoroquinolones, there is need for routine surveillance to monitor susceptibility to the initial first line antibiotics in clinical settings since the MDR strains have lately shown increased resistance. Addressing issues of contaminated food, water, sanitation and hygiene and low socio-economic status is likely to prevent and reduce the burden on enteric fever in this region. Keywords : Enteric Fever, Molecular Epidemiology, Antimicrobial Resistance Pattern, Semi-Arid Region of North Eastern Kenya DOI : 10.7176/JHMN/60-14 Publication date :March 31 st 2019

Highlights

The genus Salmonella comprises Salmonella enterica and Salmonella bongori
Typhoid and paratyphoid fever continue to be important causes of illness and death, among children and adolescents in developing countries where enteric fever is associated with poor sanitation and unsafe food and water
The samples were processed at Garissa County Referral hospital laboratory and only positive blood and stool specimens were characterized further for pathogenic Salmonella strains at Centre for Microbiology Research (CMR); Kenya Medical Research Institute in Nairobi

Summary

Introduction

Salmonella enterica subspecies I includes most pathogenic serotypes for humans (Pegues and Miller, 2015). The growth of S. enterica Typhi and S. enterica Paratyphi A, B, and C is limited to humans, and these organisms cause enteric fever (Pegues and Miller, 2015). Non-typhoidal Salmonella (NTS) cause acute gastroenteritis – salmonellosis – a foodborne disease that is prevalent worldwide (Harris and Brooks, 2013; Pegues and Miller, 2015). Enteric-fever is one of the major public health problems in developing countries including Kenya (Radhakrishnan et al, 2018). The incidence of enteric-fever ranges from 100 to 199.9 per 100,000 population in Kenya (Radhakrishnan et al, 2018), but these figures may be underestimates due to under re porting, as only severely ill patients seek treatment in hospitals (Breiman et al, 2012)

Methods

Results

Conclusion