Typhoid outbreak in Songkhla, Thailand 2009-2011: clinical outcomes, susceptibility patterns, and reliability of serology tests.

Wannee Limpitikul,Rachanee Saksawad,Kamolwish Laoprasopwattana,Narong Henpraserttae

doi:10.1371/journal.pone.0111768

Wannee Limpitikul, Rachanee Saksawad + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0111768

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Abstract

ObjectiveTo determine the clinical manifestations and outcomes, the reliability of Salmonella enterica serotype Typhi (S ser. Typhi) IgM and IgG rapid tests, and the susceptibility patterns and the response to treatment during the 2009–2011 typhoid outbreak in Songkhla province in Thailand.MethodThe medical records of children aged <15 years with S ser. Typhi bacteremia were analysed. The efficacy of the typhoid IgM and IgG rapid tests and susceptibility of the S ser. Typhi to the current main antibiotics used for typhoid (amoxicillin, ampicillin, cefotaxime, ceftriaxone, co-trimoxazole, and ciprofloxacin), were evaluated.Results S ser. Typhi bacteremia was found in 368 patients, and all isolated strains were susceptible to all 6 antimicrobials tested. Most of the patients were treated with ciprofloxacin for 7–14 days. The median time (IQR) of fever before treatment and duration of fever after treatment were 5 (4, 7) days and 4 (3, 5) days, respectively. Complications of ascites, lower respiratory symptoms, anemia (Hct <30%), and ileal perforation were found in 7, 7, 22, and 1 patients, respectively. None of the patients had recurrent infection or died. The sensitivities of the typhoid IgM and IgG tests were 58.3% and 25.6% respectively, and specificities were 74.1% and 50.5%, respectively.ConclusionMost of the patients were diagnosed at an early stage and treated with a good outcome. All S ser. Typhi strains were susceptible to standard first line antibiotic typhoid treatment. The typhoid IgM and IgG rapid tests had low sensitivity and moderate specificity.

Highlights

Enteric fever is an important cause of morbidity in developing countries, among children and adolescents in Africa and South and Southeast Asia
Typhi bacteremia was found in 368 patients, and all isolated strains were susceptible to all 6 antimicrobials tested
Typhi strains were susceptible to standard first line antibiotic typhoid treatment

Summary

Introduction

Enteric fever (typhoid or paratyphoid fever) is an important cause of morbidity in developing countries, among children and adolescents in Africa and South and Southeast Asia. The incidence in some counties is as high as 800/100,000 people/ year. In Thailand, where enteric fever is endemic, the incidence varies according to region (central, northern, north-eastern, and southern), and whether or not there is a current outbreak. In 2013 the incidence among the different regions of Thailand varied from 0.9 to 83.6/100,000 people [5], while during 2009–2011, during a typhoid fever outbreak in Songkhla province in the south of Thailand, the estimated incidence increased from 1.8 (the average incidence in the 5 years before the outbreak) to 25.2/100,000 people [6]

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