Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan

M. Imran Khan, Sajid Bashir Soofi, R. Ochiai Leon, Mohammad Jawed Khan, Shah Muhammad Sahito, Mohammad Atif Habib, Mahesh K. Puri, Lorenz von Seidlein, Jin Kyung Park, Young Ae You, Mohammad Ali, S. Nizami Qamaruddin, Camilo J. Acosta, R. Sack Bradley, John D. Clemens, Zulfiqar A. Bhutta

Research output: Contribution to journalArticle

Abstract

Introduction: Enteric fever remains a major public health problem in Asia. Planning appropriate preventive measures such as immunization requires a clear understanding of disease burden. We conducted a community-based surveillance for Salmonella Typhi infection in children in Karachi, Pakistan. Methodology: A de jure household census was conducted at baseline in the study setting to enumerate all individuals. A health-care facility-based passive surveillance system was used to capture episodes of fever lasting three or more 3 days in children 2 to 16 years old. Results: A total of 7,401 blood samples were collected for microbiological confirmation, out of which 189 S. Typhi and 32 S. Paratyphi A isolates were identified with estimated annual incidences of 451/100,000 (95% CI: 446 - 457) and 76/100,000 (95% CI: 74 - 78) respectively. At the time of presentation, after adjusting for age, there was an association between the duration of fever and temperature at presentation, and being infected with multidrug-resistant S. Typhi. Of 189 isolates 83 were found to be resistant to first-line antimicrobial therapy. There was no statistically significant difference in clinical presentation of blood culture sensitive and resistant S. Typhi isolates. Conclusion: Incidence of S. Typhi in children is high in urban squatter settlements of Karachi, Pakistan. Findings from this study identified duration of fever and temperature at the time of presentation as important symptoms associated with blood culture-confirmed typhoid fever. Preventive strategies such as immunization and improvements in water and sanitation conditions should be the focus of typhoid control in urban settlements of Pakistan.

Original languageEnglish (US)
Pages (from-to)704-714
Number of pages11
JournalJournal of Infection in Developing Countries
Volume6
Issue number10
StatePublished - Oct 2012

Fingerprint

Salmonella typhi
Pakistan
Drug Resistance
Epidemiology
Typhoid Fever
Fever
Immunization
Temperature
Sanitation
Salmonella Infections
Health Facilities
Incidence
Censuses
Public Health
Delivery of Health Care
Water

Keywords

  • Drug resistance
  • Pakistan
  • Population-based incidence
  • S. Typhi

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology
  • Parasitology
  • Virology

Cite this

Khan, M. I., Soofi, S. B., Ochiai Leon, R., Khan, M. J., Sahito, S. M., Habib, M. A., ... Bhutta, Z. A. (2012). Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan. Journal of Infection in Developing Countries, 6(10), 704-714.

Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan. / Khan, M. Imran; Soofi, Sajid Bashir; Ochiai Leon, R.; Khan, Mohammad Jawed; Sahito, Shah Muhammad; Habib, Mohammad Atif; Puri, Mahesh K.; von Seidlein, Lorenz; Park, Jin Kyung; You, Young Ae; Ali, Mohammad; Nizami Qamaruddin, S.; Acosta, Camilo J.; Sack Bradley, R.; Clemens, John D.; Bhutta, Zulfiqar A.

In: Journal of Infection in Developing Countries, Vol. 6, No. 10, 10.2012, p. 704-714.

Research output: Contribution to journalArticle

Khan, MI, Soofi, SB, Ochiai Leon, R, Khan, MJ, Sahito, SM, Habib, MA, Puri, MK, von Seidlein, L, Park, JK, You, YA, Ali, M, Nizami Qamaruddin, S, Acosta, CJ, Sack Bradley, R, Clemens, JD & Bhutta, ZA 2012, 'Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan', Journal of Infection in Developing Countries, vol. 6, no. 10, pp. 704-714.
Khan, M. Imran ; Soofi, Sajid Bashir ; Ochiai Leon, R. ; Khan, Mohammad Jawed ; Sahito, Shah Muhammad ; Habib, Mohammad Atif ; Puri, Mahesh K. ; von Seidlein, Lorenz ; Park, Jin Kyung ; You, Young Ae ; Ali, Mohammad ; Nizami Qamaruddin, S. ; Acosta, Camilo J. ; Sack Bradley, R. ; Clemens, John D. ; Bhutta, Zulfiqar A. / Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan. In: Journal of Infection in Developing Countries. 2012 ; Vol. 6, No. 10. pp. 704-714.
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abstract = "Introduction: Enteric fever remains a major public health problem in Asia. Planning appropriate preventive measures such as immunization requires a clear understanding of disease burden. We conducted a community-based surveillance for Salmonella Typhi infection in children in Karachi, Pakistan. Methodology: A de jure household census was conducted at baseline in the study setting to enumerate all individuals. A health-care facility-based passive surveillance system was used to capture episodes of fever lasting three or more 3 days in children 2 to 16 years old. Results: A total of 7,401 blood samples were collected for microbiological confirmation, out of which 189 S. Typhi and 32 S. Paratyphi A isolates were identified with estimated annual incidences of 451/100,000 (95{\%} CI: 446 - 457) and 76/100,000 (95{\%} CI: 74 - 78) respectively. At the time of presentation, after adjusting for age, there was an association between the duration of fever and temperature at presentation, and being infected with multidrug-resistant S. Typhi. Of 189 isolates 83 were found to be resistant to first-line antimicrobial therapy. There was no statistically significant difference in clinical presentation of blood culture sensitive and resistant S. Typhi isolates. Conclusion: Incidence of S. Typhi in children is high in urban squatter settlements of Karachi, Pakistan. Findings from this study identified duration of fever and temperature at the time of presentation as important symptoms associated with blood culture-confirmed typhoid fever. Preventive strategies such as immunization and improvements in water and sanitation conditions should be the focus of typhoid control in urban settlements of Pakistan.",
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T1 - Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella Typhi in Karachi, Pakistan

AU - Khan, M. Imran

AU - Soofi, Sajid Bashir

AU - Ochiai Leon, R.

AU - Khan, Mohammad Jawed

AU - Sahito, Shah Muhammad

AU - Habib, Mohammad Atif

AU - Puri, Mahesh K.

AU - von Seidlein, Lorenz

AU - Park, Jin Kyung

AU - You, Young Ae

AU - Ali, Mohammad

AU - Nizami Qamaruddin, S.

AU - Acosta, Camilo J.

AU - Sack Bradley, R.

AU - Clemens, John D.

AU - Bhutta, Zulfiqar A.

PY - 2012/10

Y1 - 2012/10

N2 - Introduction: Enteric fever remains a major public health problem in Asia. Planning appropriate preventive measures such as immunization requires a clear understanding of disease burden. We conducted a community-based surveillance for Salmonella Typhi infection in children in Karachi, Pakistan. Methodology: A de jure household census was conducted at baseline in the study setting to enumerate all individuals. A health-care facility-based passive surveillance system was used to capture episodes of fever lasting three or more 3 days in children 2 to 16 years old. Results: A total of 7,401 blood samples were collected for microbiological confirmation, out of which 189 S. Typhi and 32 S. Paratyphi A isolates were identified with estimated annual incidences of 451/100,000 (95% CI: 446 - 457) and 76/100,000 (95% CI: 74 - 78) respectively. At the time of presentation, after adjusting for age, there was an association between the duration of fever and temperature at presentation, and being infected with multidrug-resistant S. Typhi. Of 189 isolates 83 were found to be resistant to first-line antimicrobial therapy. There was no statistically significant difference in clinical presentation of blood culture sensitive and resistant S. Typhi isolates. Conclusion: Incidence of S. Typhi in children is high in urban squatter settlements of Karachi, Pakistan. Findings from this study identified duration of fever and temperature at the time of presentation as important symptoms associated with blood culture-confirmed typhoid fever. Preventive strategies such as immunization and improvements in water and sanitation conditions should be the focus of typhoid control in urban settlements of Pakistan.

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KW - Drug resistance

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KW - Population-based incidence

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