Treatment failure in a typhoid patient infected with nalidixic acid resistant S. enterica serovar Typhi with reduced susceptibility to Ciprofloxacin: a case report from Cameroon

Njinkeng J Nkemngu,Etienne Dn Asonganyi,Anna L Njunda

doi:10.1186/1471-2334-5-49

Njinkeng J Nkemngu, Etienne Dn Asonganyi + Show 1 more

Open Access

https://doi.org/10.1186/1471-2334-5-49

Copy DOI

Abstract

BackgroundFluoroquinolones or third generation cephalosporins are the drugs of choice for the treatment of typhoid fever. Treatment failure with fluoroquinolones has been reported in Asia and Europe. We report a case of ciprofloxacin treatment failure in typhoid fever in Cameroon.Case presentationA 29-year-old female patient with suspected typhoid fever from Kumba, Cameroon, yielded growth of Salmonella enterica serovar Typhi in blood culture. The isolate was resistant to nalidixic acid but sensitive to ciprofloxacin by disc diffusion test. However, the patient did not respond to treatment with ciprofloxacin, although the isolate was apparently susceptible to ciprofloxacin.ConclusionTreatment failure with ciprofloxacin in our case indicates the presence of nalidixic acid resistant S. enterica serovar Typhi (NARST) with reduced susceptibility to ciprofloxacin in Cameroon (Central Africa).

Highlights

Fluoroquinolones or third generation cephalosporins are the drugs of choice for the treatment of typhoid fever
Treatment failure with ciprofloxacin in our case indicates the presence of nalidixic acid resistant S. enterica serovar Typhi (NARST) with reduced susceptibility to ciprofloxacin in Cameroon (Central Africa)
Our report indicates that multi-drug-resistant Salmonella enterica serovar Typhi (MDRST) and nalidixic acid resistant Salmonella enterica serovar Typhi (NARST) strains are appearing in Cameroon, Central Africa

Summary

Conclusion

The emergence of multi-drug-resistant Salmonella enterica serovar Typhi (MDRST) strains was first reported in the 80 s, in Asia. Sporadic cases of ciprofloxacin treatment failure in typhoid fever have been reported in Europe and more recently, in Asia [3,4]. Our report indicates that MDRST and nalidixic acid resistant Salmonella enterica serovar Typhi (NARST) strains are appearing in Cameroon, Central Africa. Previous studies have shown that MDRST strains in East Africa were related to earlier drugsusceptible isolates but were unrelated to MDRST isolates from Asia. MDRST and NARST isolates in Central African may be unrelated to those earlier reported in Asia, Europe and east Africa [3,4,5,6,7,8,9,10,11]. The efficacy of azithromycin, which was recently shown to be an effective

National Committee for Clinical Laboratory Standards