Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: First case report from Pakistan

Authors

Seema Irfan, Aga Khan UniversityFollow
Zahra Hasan, Aga Khan UniversityFollow
Farah Qamar, Aga Khan UniversityFollow
Najia Bano Ghanchi, Aga Khan UniversityFollow
Javaria Ashraf, Aga Khan UniversityFollow
Akber Kanji, Aga Khan UniversityFollow
Safina Abdul Razzak, Aga Khan UniversityFollow
David Greig, UK Health Security Agency, United States
Satheesh Nair, Gastrointestinal Bacteria Reference Unit, United Kingdom
Rumina Hasan, Aga Khan UniversityFollow

Document Type

Case Report

Department

Paediatrics and Child Health; Pathology and Laboratory Medicine

Abstract

Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan.
Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively.
Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.

Comments

Pagination are not provided by the author/publisher.

Publication (Name of Journal)

BMC Infectious Diseases

Recommended Citation

Irfan, S., Hasan, Z., Qamar, F., Ghanchi, N., Ashraf, J., Kanji, A., Razzak, S. A., Greig, D., Nair, S., Hasan, R. (2023). Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: First case report from Pakistan. BMC Infectious Diseases, 23(267).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/1450