Rapid Emergence of Multidrug Resistant, H58-Lineage <i>Salmonella</i> Typhi in Blantyre, Malawi

Feasey, Nicholas A, Gaskell, Katherine, Wong, Vanessa, Msefula, Chisomo, Selemani, George, Kumwenda, Save, Allain, Theresa J, Mallewa, Jane, Kennedy, Neil, Bennett, Aisleen
et al (show 7 more authors) (2015) Rapid Emergence of Multidrug Resistant, H58-Lineage <i>Salmonella</i> Typhi in Blantyre, Malawi. PLOS NEGLECTED TROPICAL DISEASES, 9 (4). e0003748-.

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<h4>Introduction</h4>Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).<h4>Methods</h4>Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.<h4>Results</h4>Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.<h4>Conclusions</h4>Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

Item Type: Article
Uncontrolled Keywords: Humans, Salmonella typhi, Typhoid Fever, Incidence, Prevalence, Retrospective Studies, Sequence Analysis, DNA, Phylogeny, Drug Resistance, Multiple, Bacterial, Base Sequence, Molecular Sequence Data, Adolescent, Adult, Child, Malawi, Female, Male
Subjects: ?? R1 ??
Depositing User: Symplectic Admin
Date Deposited: 15 Sep 2015 08:33
Last Modified: 05 Oct 2023 09:00
DOI: 10.1371/journal.pntd.0003748
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/2025663