Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: first case report from Pakistan

Seema Irfan; Zahra Hasan; Farah Qamar; Najia Ghanchi; Javaria Ashraf; Akbar Kanji; Safina Razzak; David Greig; Satheesh Nair; Rumina Hasan

doi:10.1186/s12879-023-08152-9

Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: first case report from Pakistan

Seema Irfan^*
, Zahra Hasan
, Farah Qamar
, Najia Ghanchi
, Javaria Ashraf
, Akbar Kanji
, Safina Razzak
, David Greig
, Satheesh Nair
, Rumina Hasan

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.

Original language	English
Article number	267
Journal	BMC Infectious Diseases
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12879-023-08152-9
Publication status	Published - Dec 2023

Bibliographical note

Funding Information:
We acknowledge Juma Research Laboratory genomics core group and Clinical Microbiology laboratory staff of Aga Khan University Hospital, Karachi for their support.

Funding Information:
This study was supported by the Health Security Partners (HSP)-USA, as part of their collaboration with the Department of Pathology and Laboratory Medicine, Aga Khan University, for laboratory capacity building and strengthening for antimicrobial resistance surveillance.

Publisher Copyright:
© 2023, The Author(s).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Antimicrobial resistance (AMR) in Pakistan
Bla in S. Paratyphi A
Case report
Ceftriaxone resistant Salmonella Paratyphi A
Drug resistance in Salmonella
ESBL S. Para A
Enteric fever in Pakistan
S. Para A from Pakistan

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10.1186/s12879-023-08152-9

Cite this

@article{568439bbc9a7437f8e393f6a25e4a88c,

title = "Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: first case report from Pakistan",

abstract = "Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.",

keywords = "Antimicrobial resistance (AMR) in Pakistan, Bla in S. Paratyphi A, Case report, Ceftriaxone resistant Salmonella Paratyphi A, Drug resistance in Salmonella, ESBL S. Para A, Enteric fever in Pakistan, S. Para A from Pakistan",

author = "Seema Irfan and Zahra Hasan and Farah Qamar and Najia Ghanchi and Javaria Ashraf and Akbar Kanji and Safina Razzak and David Greig and Satheesh Nair and Rumina Hasan",

note = "Funding Information: We acknowledge Juma Research Laboratory genomics core group and Clinical Microbiology laboratory staff of Aga Khan University Hospital, Karachi for their support. Funding Information: This study was supported by the Health Security Partners (HSP)-USA, as part of their collaboration with the Department of Pathology and Laboratory Medicine, Aga Khan University, for laboratory capacity building and strengthening for antimicrobial resistance surveillance. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s12879-023-08152-9",

language = "English",

volume = "23",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd.",

number = "1",

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T1 - Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever

T2 - first case report from Pakistan

AU - Irfan, Seema

AU - Hasan, Zahra

AU - Qamar, Farah

AU - Ghanchi, Najia

AU - Ashraf, Javaria

AU - Kanji, Akbar

AU - Razzak, Safina

AU - Greig, David

AU - Nair, Satheesh

AU - Hasan, Rumina

N1 - Funding Information: We acknowledge Juma Research Laboratory genomics core group and Clinical Microbiology laboratory staff of Aga Khan University Hospital, Karachi for their support. Funding Information: This study was supported by the Health Security Partners (HSP)-USA, as part of their collaboration with the Department of Pathology and Laboratory Medicine, Aga Khan University, for laboratory capacity building and strengthening for antimicrobial resistance surveillance. Publisher Copyright: © 2023, The Author(s).

PY - 2023/12

Y1 - 2023/12

N2 - Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.

AB - Background: Enteric fever is an acute systemic infectious disease associated with substantial morbidity and mortality in low- and middle-income countries (LMIC), with a global burden of 14.3 million cases. Cases of enteric fever or paratyphoid fever, caused by Salmonella enterica serovar Paratyphi A (S. Para A) have been found to rise in many endemic and non-endemic countries. Drug resistance is relatively uncommon in S. Para A. Here we report a case of paratyphoid fever caused by ceftriaxone resistant S. Para A from Pakistan. Case presentation: A 29-year-old female presented with a history of fever, headache, and shivering. Her blood culture revealed a S. Para A isolate (S7), which was resistant to ceftriaxone, cefixime, ampicillin and ciprofloxacin. She was prescribed oral Azithromycin for 10 days, which resulted in resolution of her symptoms. Two other isolates of S. Para A (S1 and S4), resistant to fluoroquinolone were also selected for comparison. DST and whole genome sequencing was performed for all three isolates. Sequence analysis was performed for identification of drug resistance and phylogeny. Whole Genome Sequencing (WGS) of S7 revealed the presence of plasmids, IncX4 and IncFIB(K). blaCTX-M-15 and qnrS1 genes were found on IncFIB(K). The gyrA S83F mutation conferring fluoroquinolone resistance was also found present. Multi-locus sequence typing (MLST) showed the S7 isolate to belong to ST129. S1 and S4 had the gyrA S83Y and S83F mutations respectively. Conclusions: We highlight the occurrence of plasmid-mediated ceftriaxone resistant strain of S. Para A. This is of significance as ceftriaxone is commonly used to treat paratyphoid fever and resistance in S. Para A is not known. Continuous epidemiological surveillance is required to monitor the transmission and spread of antimicrobial resistance (AMR) among Typhoidal Salmonellae. This will guide treatment options and preventive measures including the need for vaccination against S. Para A in the region.

KW - Antimicrobial resistance (AMR) in Pakistan

KW - Bla in S. Paratyphi A

KW - Case report

KW - Ceftriaxone resistant Salmonella Paratyphi A

KW - Drug resistance in Salmonella

KW - ESBL S. Para A

KW - Enteric fever in Pakistan

KW - S. Para A from Pakistan

UR - https://www.scopus.com/pages/publications/85153921898

U2 - 10.1186/s12879-023-08152-9

DO - 10.1186/s12879-023-08152-9

M3 - Article

C2 - 37101111

AN - SCOPUS:85153921898

SN - 1471-2334

VL - 23

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 267

ER -

Ceftriaxone resistant Salmonella enterica serovar Paratyphi A identified in a case of enteric fever: first case report from Pakistan

Abstract

Bibliographical note

UN SDGs

Keywords

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