Title: Repeated Outbreaks of Paratyphoid Fever– An Ongoing Threat in North Kerala
Authors: Pushpa Kizhakkekarammel, Ajithkumar V T, Rekha Rachel Philip, Geetha Raveendran
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.65
Abstract
Two major episodes of Salmonella Paratyphi A outbreaks had occurred in different localities of a same Muncipality panchayath following wedding feasts- the first episode in April 2016 and the second one in January 2017. Patients presented with fever and abdominal discomfort, 10-14 days after the suspected exposure.
Objective: To identify the magnitude and source of two different food borne outbreaks of Salmonella Pparatyphi A.
Methods: A team from the local tertiary care centre which included personnel from Departments of Microbiology, Community Medicine and Paediatrics had visited the places, conducted medical camps and field visits. Blood samples were collected from symptomatic patients for culture and serological tests. Stool samples were subjected to culture. Drinking water sources and food samples were collected for microbiological analysis.
Results: Blood cultures yielded Salmonella Paratyphi A in 5 out of 34 patients during the first episode and 7 out of 59 patients in the second episode. The isolates were sensitive to Ampicillin, Ceftriaxone, Ciprofloxacin and Chloramphenicol. Significant levels of Salmonella Paratyphi A antibody were demonstrated in 53% (18/34) and 27% (18/59) of patients during first and second episodes respectively. Stool cultures and environment samples were negative for Salmonella species.
Conclusion: All identified patients were treated with Ceftriaxone or Ciprofloxacin for 2 weeks and no relapse was noted. Intensive health awareness programs were conducted all over the panchayath, along with chlorination of drinking water sources and health education. Salmonella Paratyphi A infection, which was once thought to be rare compared to Salmonella Typhi enteric fever, is being reported more frequently associated with outbreaks.
Keywords: Paratyphoid fever, Widal test.
References
- Clinical infectious disease. 2014 Feb;58(3):359-64. doi: 10.1093/cid/cit723. Epub 2013 Nov 5.A large outbreak of Salmonella Paratyphi A infection among israeli travelers to Nepal. Meltzer E, Stienlauf S, Leshem E, Sidi Y, Schwartz E.
- The Ecological Dynamics of Fecal Contamination and Salmonella Typhi and Salmonella Paratyphi A in Municipal Kathmandu Drinking Water. PLoS Negl Trop Dis. 2016 Jan 6;10 :e0004346. Karkey A , Jombart T
- Kapil A, Dash N, Das BK, Goel V, Seth P. (1999) Paratyphoid fever in India: An emerging problem. (letter) Emerg Infect Dis 1999; 5: 483-4.
- Epidemiology of typhoid and paratyphoid fever in India ,Suman Kanungo, Shanta Dutta, J Infect Developing Countries 2008; 2(6):454-460.
- Calicut Medical Journal ISSN 0972-9518 Volume: 2; Issue: 4; Date: 2004; Lathi Nair, Sudarsana J Pushpa KK
- Micoli F, Rondini S, Gavini M, Lanzilao L, Medaglini D, Saul A, et al.O:2-CRM (197) conjugates against Salmonella Paratyphi A. PLoS One 2012;7:e47039.
- Thong KL, Nair S, Chaudhry R, Seth P, Kapil A, Kumar D, et al.Molecular analysis of Salmonella Paratyphi A from an outbreak in New Delhi, India. Emerg Infect Dis 1998;4:507-8. [PUBMED]
- Jackson BR, Griffin PM, Cole D, Walsh KA, Chai SJ. Outbreak-associated Salmonella entericaserotypes and food commodities, United States, 1998-2008. Emerg Infect Dis 2013;19:1239-44.
- J Clin Pathol 1983;36:471-475 Significance and value of the Widal test in the diagnosis of typhoid fever in an endemic area TIKKY PANG, SAVITHRI D PUTHUCHEARY From the Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Grunbaum A S. Preliminary note on the use of the agglutinative action of human serum for the diagnosis of enteric fever. 1896;ii:806–807.
- Schroeder S A. Interpretation of serological tests for typhoid fever. J Am Med Assoc. 1968;206:839–840. [PubMed]