Munaza Fatima1, Santosh Kumar1, Mudassar Hussain1, Naveed Masood Memon1, Anum Vighio1, Muhammad Asif Syed1, Ambreen Chaudhry2, Zakir Hussain1, Zeeshan Iqbal Baig1, Mirza Amir Baig1, Rana Jawad Asghar3, Aamer Ikram2, Yousef Khader4.
Abstract
BACKGROUND: Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.
OBJECTIVE: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.
METHODS: We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.
RESULTS: A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).
CONCLUSIONS: As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures. ©Munaza Fatima, Santosh Kumar, Mudassar Hussain, Naveed Masood Memon, Anum Vighio, Muhammad Asif Syed, Ambreen Chaudhry, Zakir Hussain, Zeeshan Iqbal Baig, Mirza Amir Baig, Rana Jawad Asghar, Aamer Ikram, Yousef Khader. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 17.05.2021.
BACKGROUND: Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.
OBJECTIVE: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.
METHODS: We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.
RESULTS: A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).
CONCLUSIONS: As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures. ©Munaza Fatima, Santosh Kumar, Mudassar Hussain, Naveed Masood Memon, Anum Vighio, Muhammad Asif Syed, Ambreen Chaudhry, Zakir Hussain, Zeeshan Iqbal Baig, Mirza Amir Baig, Rana Jawad Asghar, Aamer Ikram, Yousef Khader. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 17.05.2021.
Entities:
Keywords:
Hyderabad; Pakistan; antimicrobial resistance; complications; control drug resistance; extensive drug resistance; hospitalization; ileal perforation; medical records; microbiological; morbidity; mortality; prevention; typhoid
Year: 2021
PMID： 33999000 DOI： 10.2196/27268
Source DB: PubMed Journal: JMIR Public Health Surveill ISSN： 2369-2960