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1 June 2008

Volume 46, Number 11
Clinical Infectious Diseases 2008;46:1656–1663
This article is in the public domain, and no copyright is claimed.
1058-4838/2008/4611-0003
DOI: 10.1086/587894
MAJOR ARTICLE

Laboratory‐Based Surveillance of Paratyphoid Fever in the United States: Travel and Antimicrobial Resistance

Sundeep K. Gupta,

Felicita Medalla,

Michael W. Omondi,

Jean M. Whichard,

Patricia I. Fields,

Peter Gerner‐Smidt,

Nehal J. Patel,

Kara L. F. Cooper,

Tom M. Chiller, and

Eric D. Mintz

Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.The incidence of paratyphoid fever, including paratyphoid fever caused by antimicrobial‐resistant strains, is increasing globally. However, the epidemiologic and laboratory characteristics of paratyphoid fever in the United States have never been studied.

Methods.We attempted to interview all patients who had been infected with laboratory‐confirmed Salmonella serotypes Paratyphi A, Paratyphi B, or Paratyphi C in the United States with specimens collected from 1 April 2005 through 31 March 2006. At the Centers for Disease Control and Prevention (CDC), isolates underwent serotype confirmation, antimicrobial susceptibility testing, and pulsed‐field gel electrophoresis typing.

Results.Of 149 patients infected with Salmonella Paratyphi A, we obtained epidemiologic information for 89 (60%); 55 (62%) of 86 were hospitalized. Eighty‐five patients (96%) reported having travel internationally, and 80 (90%) had traveled to South Asia. Of the 146 isolates received at the CDC, 127 (87%) were nalidixic acid resistant; nalidixic acid resistance was associated with travel to South Asia (odds ratio, 17.0; 95% confidence interval, 3.8–75.9). All nalidixic acid–resistant isolates showed decreased susceptibility to ciprofloxacin (minimum inhibitory concentration, 0.12 μg/mL). Of 49 patients infected with Salmonella Paratyphi B, only 12 (24%) were confirmed to have Paratyphi B when tested at the CDC. Four (67%) of 6 patients were hospitalized, and 5 (83%) reported travel (4 to the Andean region of South America). One case of Salmonella Paratyphi C infection was reported in a traveler to West Africa with a urinary tract infection.

Conclusions.Physicians should be aware of the increasing incidence of infection due to Salmonella Paratyphi A and treatment options given its widespread antimicrobial resistance. A paratyphoid fever vaccine is urgently needed. Continued surveillance for paratyphoid fever will help guide future prevention and treatment recommendations.

Received 19 November 2007; accepted 14 January 2008; electronically published 18 April 2008.

Reprints or correspondence: Dr. Sundeep K. Gupta, 2190 Kampala Place, Dulles, VA 20189 ().

Cited by

David K. Byers, Kyle Petersen. (2009) A Case of Salmonella enterica Serotype Typhi in a Patient Without a History of International Travel. Journal of Travel Medicine 16:3, 223-225
Online publication date: 1-Jun-2009.
CrossRef
S. Hume, T. Schulz, P. Vinton, T. Korman, J. Torresi. (2009) Increasing rates and clinical consequences of nalidixic acid-resistant isolates causing enteric fever in returned travellers: an 18-year experience. European Journal of Clinical Microbiology & Infectious Diseases
Online publication date: 9-May-2009.
CrossRef
Christopher M Parry, EJ Threlfall. (2008) Antimicrobial resistance in typhoidal and nontyphoidal salmonellae. Current Opinion in Infectious Diseases 21:5, 531-538
Online publication date: 1-Nov-2008.
CrossRef
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