Serological prevalence of tularemia in Sistan and Baluchestan Province

Abstract

Background: Enteric fever continues to remain amajor cause of morbidity and mortality in Nepal. Likewise, S. Typhi and Paratyphi have developed resistance to antibiotics used so it is required to study the current pattern of resistance to antibiotics. Om hospital has been tracking the records of laboratory confirmed S. Typhi and Paratyphi cases of both male and female cases between the ages 5 years and 55 years to assess the trend in enteric fever. Methods & Materials: In the laboratory, the blood culture containers are immediately incubated at 37◦ C for 48hours using various media like Brain Heart Infusion Browth, Blood Agar base, Muller Hinton and Mac Conkey Agar. The disk diffusion method of Kirby and Bauer is used for sensitivity testing of S. Typhi and S. Paratyphi to antibiotics. Blood culture reports are followed up to 5 days. Subculture is done when there is obvious turbidity in the broth on any day. Results: Out of 6,978 blood culture performed, 306 (4.4%) were enteric fever cases. 110 (36%) cases were S. Typhi and 196 (64%) cases were S. Paratyphi. Among 306 cases of the total S. Typhi and Paratyphi cases, 32 (10.4%), 82 (26.8%), 86 (28.1%), 54 (17.65%) and 37 (12.09%) were from less than five years, five to fifteen years, fifteen to thirty years, thirty to fifty five years and above fifty five years respectively. Similarly, 150 (49.02%) and 156 (50.98%) cases were male and female respectively. 15% of the cases were resistant to azithromycin, cephalexin and amoxicillin and 5% caseswere resistant to cefixime. Conclusion: The study of the enteric fever cases are consistent withother reports fromNepal showinghighburdenof enteric fever. However,we realized that the numbers come fromahospital based study and may not represent the population level estimates. Nevertheless, there are more cases of S. Paratyphi than S. Typhi which indicates the importance of needed intervention for control of S. Paratyphi through measures other than vaccines since there is no vaccine available for paratyphi infection. In addition it is imperative to make a case development of vaccines for preventing enteric fever.