Enteric fever imported to the Czech Republic: epidemiology, clinical characteristics and antimicrobial susceptibility.
The aim of this study was to describe epidemiological and clinical characteristics of imported enteric fever in Czech travellers and to determine the antimicrobial susceptibility of isolated strains. Retrospective descriptive study included adult patients treated with enteric fever at Hospital Na Bulovce during January 2004-December 2012. A case of typhoid or paratyphoid fever was defined as isolation of Salmonella Typhi or Paratyphi from blood or stool. During the study period, there have been diagnosed 19 cases of enteric fever (12 males and 7 females) with age median of 30 years; 14 cases were caused by Salmonella Typhi and 5 cases by S. Paratyphi A. The infection has been acquired in South Asia (16 patients; 84.2 %), in Africa (Egypt, Angola) in two cases (10.5 %), and in Mexico (1; 5.3 %). Symptoms included fever (all patients), diarrhoea (16 cases; 84.2 %), headache (9; 47.4 %), and abdominal pain (7; 36.8 %). Seventeen patients (89.5 %) were treated with fluoroquinolones; however, the treatment failure was observed in seven of them (41.2 %). Decreased ciprofloxacin susceptibility was detected in eight strains (66.7 %), and one strain (8.3 %) was multidrug resistant. Sequence analysis of quinolone resistance-determining regions (QRDR) of the gyrA gene revealed the presence of amino acid substitutions in all tested isolates with decreased ciprofloxacin susceptibility. Typhoid and paratyphoid fevers represent epidemiologically important diseases that may lead to potentially life-threatening complications. Major issue in the management of enteric fever represents the non-susceptibility of Salmonella strains to fluoroquinolones and other antimicrobials.
1st Department of Infectious Diseases, 2nd Medical Faculty, Charles University in Prague and Hospital Na Bulovce, Budínova 2, 180 81, Prague, Czech Republic, milan.trojanek@bulovka.cz.
Milan
M
Trojánek
Daniela
D
Dědičová
Helena
H
Žemličková
Vladislav
V
Jakubů
Eliška
E
Malíková
Marie
M
Reisingerová
Alice
A
Gabrielová
Costas C
CC
Papagiannitsis
Jaroslav
J
Hrabák
Blanka
B
Horová
Pavla
P
Urbášková
Vilma
V
Marešová
František
F
Stejskal
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001208:Asia; D018153:Czech Republic / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010284:Paratyphoid Fever / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D019779:Salmonella enterica / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D014195:Travel; D014435:Typhoid Fever / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents