title: Bacteraemia with pleural effusions complicating typhoid fever caused by high-level ciprofloxacin-resistant Salmonella enterica serotype Typhi.
abstract: An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 μg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83→Phe and Asp87→Asn in gyrA and Ser80→Ile in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India. srujana_micro@yahoo.co.in
authors.forename: S
authors.initials: S
authors.lastname: Mohanty
authors.forename: R
authors.initials: R
authors.lastname: Gaind
authors.forename: B
authors.initials: B
authors.lastname: Paglietti
authors.forename: P
authors.initials: P
authors.lastname: Paul
authors.forename: S
authors.initials: S
authors.lastname: Rubino
authors.forename: M
authors.initials: M
authors.lastname: Deb
mesh_terms: D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000382:microbiology*; D001426:Bacterial Proteins / Q000235:genetics; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002939:Ciprofloxacin / Q000494:pharmacology*; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D004322:Drainage; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D020125:Mutation, Missense; D010996:Pleural Effusion / Q000150:complications / Q000382:microbiology* / Q000601:surgery; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000382:microbiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002939:Ciprofloxacin; D002443:Ceftriaxone; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase