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CORRESPONDENCE
Year : 2004  |  Volume : 22  |  Issue : 3  |  Page : 196
 

Enteric fever due to S.paratyphia - An emerging problem


Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram - 442 102, Maharashtra, India

Date of Submission15-Nov-2003
Date of Acceptance02-Dec-2003

Correspondence Address:
Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram - 442 102, Maharashtra, India



How to cite this article:
Mendiratta D K, Deotale V, Thamke D, Narang R, Narang P. Enteric fever due to S.paratyphia - An emerging problem. Indian J Med Microbiol 2004;22:196


How to cite this URL:
Mendiratta D K, Deotale V, Thamke D, Narang R, Narang P. Enteric fever due to S.paratyphia - An emerging problem. Indian J Med Microbiol [serial online] 2004 [cited 2019 Jul 20];22:196. Available from: http://www.ijmm.org/text.asp?2004/22/3/196/11220


Dear Editor,
 Salmonella More Details enterica serotype Typhi classically causes enteric fever in India.  Salmonella More Details enterica serotype paratyphi A, which had earlier been reported less frequently (1-15%,[1] 3-17%[2] from cases of enteric fever, has shown an increasing trend since 1996 in north India.[1] Recently an unusually high rate of isolation of S.paratyphi A (46.15% of all  Salmonella More Detailse isolated) has also been reported from Nagpur, central India (2001-02).[3] The Kasturba Hospital, Sevagram, a rural hospital (over 70% of its total OPD attendance is from rural area) situated 75 km. from Nagpur and attached to the first rural medical college, observed an emergence of S.paratyphi-A as a cause of enteric fever in the year 2000. During the last decade only one strain of S.paratyphi-A was isolated from a case of enteric fever and that too in 1996. In the year 2000 we isolated this serotype from five cases and in 2001 from two. However, in 2002 the isolations increased to 15 and till September 2003, eight cases had tested positive. In the year 2002, 45.45% of the all  Salmonella More Detailse isolated were S.paratyphi-A, whereas till September 2003, 53.33% of the  Salmonella More Detailse isolated were S.paratyphi-A. Chandel et al attribute this dramatic increase in incidence of enteric fever by S.paratyphi-A to wide spread use of vaccines and quinolones against S.typhi in the past decade.[1]
The strains isolated from Nagpur[3] showed resistance to chloramphenicol (27.78%), ampicillin (33.33%) and cotrimoxazole (27.78%) and two of the 18 strains (11.11%) were multi drug resistant (MDR). However, only one of the 31 S.paratyphi-A isolates from Sevagram during the last decade was resistant to ampicillin only. This probably reflects indiscriminate use of antibiotics in the urban areas in contrast to rural. The study from Delhi[1] also observed an increase in MDR strains from 10% in 1966 to 45% till July 1999. All our strains, as also those from Nagpur[3] showed 100% sensitivity to ciprofloxacin, the drug of choice for enteric fever in India, though 32% of the isolates from New Delhi[1] showed low susceptibility to ciprofloxacin (MIC>2.0 mg/L).
The present communication endorses the observation of S.paratyphi-A as rapidly emerging pathogen of enteric fever in central India and though all strains at present are 100% sensitive to ciprofloxacin, the low susceptibility to this drug and increase in incidence of MDR strains reported from north India[1] definitely warrants the judicious use of ciprifloxacin and emphasizes the need for continuous monitoring of susceptibility pattern in order to avoid outbreaks of drug resistant S.paratyphi-A in India. 

 ~ References Top

1.Chandel DS, Chaudhry R, Dhawan R, Pandey A, Dey AB. Drug resistant Salmonella enterica Serotype Paratyphi A in India. Emer Infec Dis 2000;6(4):420-421.  Back to cited text no. 1    
2.Sood S, Kapil A, Dash N, Das BK, Goel V, Seth P. Paratyphoid fever in India. Emer Infec Dis 1999;5:483-484.  Back to cited text no. 2    
3.Tankhiwale SS, Agrawal G, Jalgaonkar SV. An unusually high occurrence of Salmonella enterica serotype Paratyphi A in patients with enteric fever. Indian J Med Res 2003;117:10-12.  Back to cited text no. 3    
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2004 - Indian Journal of Medical Microbiology
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