Details:

Alternative Title:
PLoS Negl Trop Dis
Personal Author:
Walters, Maroya Spalding ; Routh, Janell ; Mikoleit, Matthew ; Kadivane, Samuel ; Ouma, Caroline ; ... More +
Walters, Maroya Spalding ; Routh, Janell ; Mikoleit, Matthew ; Kadivane, Samuel ; Ouma, Caroline ; Mubiru, Denis ; Mbusa, Ben ; Murangi, Amos ; Ejoku, Emmanuel ; Rwantangle, Absalom ; Kule, Uziah ; Lule, John ; Garrett, Nancy ; Halpin, Jessica ; Maxwell, Nikki ; Kagirita, Atek ; Mulabya, Fred ; Makumbi, Issa ; Freeman, Molly ; Joyce, Kevin ; Hill, Vince ; Downing, Robert ; Mintz, Eric Less -
Description:
Background

Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo.

Methodology/Principal Findings

A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates.

Conclusions/Significance

Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.


Subjects:
[+]
Adolescent Adult Aged Aged, 80 And Over Anti-Bacterial Agents Biology Blood Child Child, Preschool Cluster Analysis Disease Outbreaks Drug Resistance, Bacterial Electrophoresis, Gel, Pulsed-Field Feces Female Humans Infant Male Medicine Microbial Sensitivity Tests Middle Aged Molecular Typing Research Article Salmonella Typhi Topography, Medical Typhoid Fever Uganda Young Adult
Source:
PLoS Negl Trop Dis. 2014; 8(3)
Pubmed ID:
24603860
Pubmed Central ID:
PMC3945727
Document Type:
Journal Article
Funding:
T32 AI007610/AI/NIAID NIH HHSUnited States/
Collection(s):
Stephen B. Thacker CDC Library collection
Main Document Checksum:
[+]
urn:sha256:2006b4dc42654ce48d087dbc9755756cf6ea1046688450c87b78f5d3e3816a62
Download URL:
https://stacks.cdc.gov/view/cdc/27691/cdc_27691_DS1.pdf
File Type:

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