Scatid J Infect Dis 24:
819-820, 1992
SHORT COMMUNICATION
Chloramphenicol-resistant Typhoid Fever: An Emerging Problem in Oman SlTrANA SHAMSELDIN ELSHAFIE and AKBAR MOHAMED RAFAY h o r n the
Deportmen/ of Medico1 Microbiology, c'ollc,gr7 oj Metlicinc,. Sulturl
Qtrhoos
Scand J Infect Dis Downloaded from informahealthcare.com by McMaster University on 12/17/14 For personal use only.
U/iitw.si/y, Sirltnriutr of Omun
Until recently multiply drug-resistant Salmonella typhi was uncommon in the Sultanate of Oman. In 1990 the first isolate of chloramphenicol-resistant S. typhi from an Indian expatriate was reported. In 1991, 58 cases of typhoid fever were diagnosed, of whom 19 (33%)were resistant to chloramphenicol. All patients with chloramphenicol-resistant S. typhi are either Indians or Omani with a history of recent travel to India. Chloramphenicol may not he the appropriate blind therapy for such patients. Ciprofloxacin may he the alternative. Dr. S . S. Elshafe, Sultan Qaboos UniversiQ, College of Medicine. P.O. Box 3248.5, Al-Khod. Muscat, Sultanate of Oman
INTRODUCTION Chloramphenicol-resistant Salmonella typhi were first rcported in 1950 ( 1 ). Since then outbreaks of typhoid fever due t o S. typhi resistant to chloramphenicol and/or ampicillin have been reported from various parts of the world (2-4). We have reviewed the incidence of chloramphenicol-resistant S. typhi in the Sultanate of Oman during the year 1991.
MATERIALS AND METHODS 58 strains of S. typhi were isolated in 1991 from patients with typhoid fever treated at the Royal Hospital and Sultan Qaboos University Hospital. These strains were either isolated from hlood cultures and/or stool cultures using conventional laboratory techniques for isolating S. tvphi All isolates were then identified biochemically either by the API 2OE (Royal Hospital) o r Sceptor machine (Sultan Qaboos University Hospital). Further confirmatory test was done by slide agglutination against specific antisera. Susceptibility to antimicrohial agents was tested hy Stokes method using Oxoid DST agar ( 5 ) . A resistant strain was identified hy ahsence of zone o f inhihition around the antihiotic disc or reduced zone compared to the control.
RE SU LTS Out of 58 isolates of S. typhi, 19 (33%) were found 10 he resistant to chlorarnphenicol, 28 (48%) resistant to ampicillin. 28 (48%) resistant to co-trimoxazole. I ( 2 % ) resistant t o ciprofloxncin and none resistant to cefotaxime o r cetriaxone.
DISCUSSION Typhoid fever is endemic in Sultanate of Oman. Chloramphenicol has hcen the mainstay of therapy in both adults and children. Occasionally ampicillin and co-trimoxazole are also h a n g used. The first case of typhoid fever resistant to chloramphenicol was reported in Oman in 1Y90. All our patients infected with chlorarnphenicol-resistant strains were either Indians o r Omani, with recent history of travel t o the Indian subcontinent. In a recent report from India 76% o f S . typhi isolated /hew were resistant to chloramphenicol ( 6 ) . Hence. it may not he appropriate to use chloramphenicol empirically in the treatment of patients coming from India. Ciprofloxacin o r ceftriaxone may be the alternative.
820 S. S. Elshafie and A . M . Rafay
Scand J Infect DI\ 24
Treatment of multiresistant typhoid fever in children may be a problem (7). Parenteral third generation cephalosporins (i.e. cefotaxime, ceftriaxone) are safe. Ciprofloxacin can be administered orally and its use in the treatment of typhoid fever in childhood with resistant strains may be the only available drug and thus justifiable. These resistant strains can easily spread among family contacts and we are currently investigating this possibility.
Scand J Infect Dis Downloaded from informahealthcare.com by McMaster University on 12/17/14 For personal use only.
REFERENCES I . Colquhoun J, Weetch RS. Chloramphenicol resistant S. typhi. Lancet 2: 621-623. 1950. 2. Panikar CKJ. Vimala KN. Transferable chloramphenicol resistance in S. typhi. Nature 10: 239. 1972. 3. Agdrwal KC, Panhorta BR. Manhata J , Arya VK, Gang RK. Typhoid fever due t o chloramphenicolresistant S. typhi. Indian J Med Res 73: 484-488, 1981. 4. Olarte J , Galindo E. S. typhi resistant to chloramphenicol, ampicillin and other antimicrobial agents: strains isolated during an extensive typhoid fever epidemic in Mexico. Antimicrob Agents Chemother 4: 57(M01, 1973. 5. Stokes EJ. Ridgway GL. Clinical Bacteriology, 5th ed. London: Arnold, 205-219, 1980. 6 . Mandal BK. Treatment of multiresistant typhoid fever. Lancet 336: 1383, 1989. 7. Adam D. Use of quinolones in paediatric patients. Rev Infect Dis 11, Suppl5: S 11 13-S I 1 16, 1989.
819-820, 1992
SHORT COMMUNICATION
Chloramphenicol-resistant Typhoid Fever: An Emerging Problem in Oman SlTrANA SHAMSELDIN ELSHAFIE and AKBAR MOHAMED RAFAY h o r n the
Deportmen/ of Medico1 Microbiology, c'ollc,gr7 oj Metlicinc,. Sulturl
Qtrhoos
Scand J Infect Dis Downloaded from informahealthcare.com by McMaster University on 12/17/14 For personal use only.
U/iitw.si/y, Sirltnriutr of Omun
Until recently multiply drug-resistant Salmonella typhi was uncommon in the Sultanate of Oman. In 1990 the first isolate of chloramphenicol-resistant S. typhi from an Indian expatriate was reported. In 1991, 58 cases of typhoid fever were diagnosed, of whom 19 (33%)were resistant to chloramphenicol. All patients with chloramphenicol-resistant S. typhi are either Indians or Omani with a history of recent travel to India. Chloramphenicol may not he the appropriate blind therapy for such patients. Ciprofloxacin may he the alternative. Dr. S . S. Elshafe, Sultan Qaboos UniversiQ, College of Medicine. P.O. Box 3248.5, Al-Khod. Muscat, Sultanate of Oman
INTRODUCTION Chloramphenicol-resistant Salmonella typhi were first rcported in 1950 ( 1 ). Since then outbreaks of typhoid fever due t o S. typhi resistant to chloramphenicol and/or ampicillin have been reported from various parts of the world (2-4). We have reviewed the incidence of chloramphenicol-resistant S. typhi in the Sultanate of Oman during the year 1991.
MATERIALS AND METHODS 58 strains of S. typhi were isolated in 1991 from patients with typhoid fever treated at the Royal Hospital and Sultan Qaboos University Hospital. These strains were either isolated from hlood cultures and/or stool cultures using conventional laboratory techniques for isolating S. tvphi All isolates were then identified biochemically either by the API 2OE (Royal Hospital) o r Sceptor machine (Sultan Qaboos University Hospital). Further confirmatory test was done by slide agglutination against specific antisera. Susceptibility to antimicrohial agents was tested hy Stokes method using Oxoid DST agar ( 5 ) . A resistant strain was identified hy ahsence of zone o f inhihition around the antihiotic disc or reduced zone compared to the control.
RE SU LTS Out of 58 isolates of S. typhi, 19 (33%) were found 10 he resistant to chlorarnphenicol, 28 (48%) resistant to ampicillin. 28 (48%) resistant to co-trimoxazole. I ( 2 % ) resistant t o ciprofloxncin and none resistant to cefotaxime o r cetriaxone.
DISCUSSION Typhoid fever is endemic in Sultanate of Oman. Chloramphenicol has hcen the mainstay of therapy in both adults and children. Occasionally ampicillin and co-trimoxazole are also h a n g used. The first case of typhoid fever resistant to chloramphenicol was reported in Oman in 1Y90. All our patients infected with chlorarnphenicol-resistant strains were either Indians o r Omani, with recent history of travel t o the Indian subcontinent. In a recent report from India 76% o f S . typhi isolated /hew were resistant to chloramphenicol ( 6 ) . Hence. it may not he appropriate to use chloramphenicol empirically in the treatment of patients coming from India. Ciprofloxacin o r ceftriaxone may be the alternative.
820 S. S. Elshafie and A . M . Rafay
Scand J Infect DI\ 24
Treatment of multiresistant typhoid fever in children may be a problem (7). Parenteral third generation cephalosporins (i.e. cefotaxime, ceftriaxone) are safe. Ciprofloxacin can be administered orally and its use in the treatment of typhoid fever in childhood with resistant strains may be the only available drug and thus justifiable. These resistant strains can easily spread among family contacts and we are currently investigating this possibility.
Scand J Infect Dis Downloaded from informahealthcare.com by McMaster University on 12/17/14 For personal use only.
REFERENCES I . Colquhoun J, Weetch RS. Chloramphenicol resistant S. typhi. Lancet 2: 621-623. 1950. 2. Panikar CKJ. Vimala KN. Transferable chloramphenicol resistance in S. typhi. Nature 10: 239. 1972. 3. Agdrwal KC, Panhorta BR. Manhata J , Arya VK, Gang RK. Typhoid fever due t o chloramphenicolresistant S. typhi. Indian J Med Res 73: 484-488, 1981. 4. Olarte J , Galindo E. S. typhi resistant to chloramphenicol, ampicillin and other antimicrobial agents: strains isolated during an extensive typhoid fever epidemic in Mexico. Antimicrob Agents Chemother 4: 57(M01, 1973. 5. Stokes EJ. Ridgway GL. Clinical Bacteriology, 5th ed. London: Arnold, 205-219, 1980. 6 . Mandal BK. Treatment of multiresistant typhoid fever. Lancet 336: 1383, 1989. 7. Adam D. Use of quinolones in paediatric patients. Rev Infect Dis 11, Suppl5: S 11 13-S I 1 16, 1989.
