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


METHODS
The 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.


CONCLUSIONS
Most 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.
Department of Pediatrics, Songkhla Hospital, Songkhla, Thailand.
Wannee
W
Limpitikul
Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health in Songkhla, Songkhla, Thailand.
Narong
N
Henpraserttae
Department of Pediatrics, Hat Yai Education Center, Hat Yai Hospital, Hat Yai, Songkhla, Thailand.
Rachanee
R
Saksawad
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Kamolwish
K
Laoprasopwattana
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D015203:Reproducibility of Results; D012485:Salmonella typhi / Q000187:drug effects* / Q000276:immunology; D012698:Serologic Tests; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*
D000900:Anti-Bacterial Agents