Browsing by Subject "Enteric fever"
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Item Antibiogram Of Salmonella serovars From The Blood of Clinically Suspected Enteric Fever Patients Visiting Alka Hospital(Department of Microbiology, 2013) Chand, Hari JungEnteric fever is endemic in Nepal having a significant public health burden and includes typhoid fever caused by Salmonella sero type Typhi and paratyphoid fever caused by Salmonell a sero types Paratyphi A, B, and C. Across sectional study was carried out in clinically suspected enteric fever patients visiting Alka Hospital during July 2011 to February 2012 to determine the prevalence of enteric fever and antibiogram pattern of Salmonella isolates. Out of 1202 blood samples collected, only 86 (7.2%) showed positive blood culture result amongwhich56(65.1%) isolates were Salmonella Typhi and 30(34.9%) isolates were Salmonella Paratyphi A. Prevalence of enteric fever was higher in female patients (40/542;7.4%) than in male patients (46/660;7.0%), in age group 11-21years (28/220; 12.7%), and in the months of July and August.Salmonella Typhi isolates were 100% sensitive to chloramphenicol, cotrimoxazole, cefixime, ceftriaxone, ciprofloxacin and gentamicin followed by98.2%sensitive to amoxycillin,ofloxacinand89.3%sensitive to azithromycin. Similarly Salmonella Paratyphi A isolates were100%sensitive to amoxycillin, cotrimoxazole, ceftriaxone and gentamicin followed by 96.7% sensitive to chloramphenicol, ciprofloxacin, ofloxacin, cefixime and 86.7% sensitive to azithromycin.None of the Salmonella isolates were multi drug resistant(MDR).About91.1% S. Typhi and90.0% S. Paratyphi A isolates were nalidixic acid resistant(NAR).None of the nalidixic acid resistant S.Typhi were ciprofloxacin resistant whereas 1 (3.7%) nalidixic acid resistant S. Paratyphi A isolate was resistant to ciprofloxacin. This study revealed the increasing frequency ofnalidixic acid resistant Salmonella isolates andre-emergence of susceptibility to conventionalfirst linedrugs. Keywords: Enteric fever, Multi drug resistant (MDR), Nalidixic acid resistant,SalmonellaItem Antibiotic Susceptibility Pattern of Salmonella from Blood of Suspected Enteric Fever Patients Attending Patan Hospital(Department of Microbiology, 2009) Prajapati, Krishna GovindaIn the present study blood samples were collected from 25,470 suspected of enteric fever patients who visited Patan Hospital during January 2007 to December 2008. The blood samples were cultured to isolate Salmonella using selective enrichment technique. Salmonella isolates were serotyped and their antibiotic sensitivity test was studied using modified Kirby-Bauer method recommended by Clinical and Laboratory Standards Institute. In all the 25,470 blood samples, 3,131(12.29%) patients were culture positive and among the culture positive 1,640 (52.38%) were Salmonella isolates. In all the Salmonella isolates, 1135 (69.20%) were Salmonella Typhi, 503 (30.67%) Salmonella paratyphi A, 1 (0.06%) Salmonella Paratyphi B and 1 (0.06%) Salmonella Paratyphi C. Salmonella Typhi were most prevalent causative organism of enteric fever. High prevalence of Salmonella was found during summer season. Salmonella Typhi (N=1,135) were found to be sensitive to Cephotaxime 1,128 (99.38%), Gentamicin 1,121 (98.77%), Chloramphenicol 1,120 (98.68%), Ofloxacin 1,117 (98.41%), Amoxycillin 1,113 (98.06%), Cotrimoxazole 1,107 (97.53%), Ciprofloxacin 1,063(93.66%) and Nalidixic acid 359 (31.63%). In all the Salmonella Paratyphi A (N=503) was found sensitive to Gentamicin 501 (99.60%), Cephotaxime 499 (99.20%), Amoxycillin 497 (98.81%) and Cotrimoxazole 496 (98.61%) and resistant to Nalidixic acid 477 (94.83%) and Ciprofloxacin 38 (7.55%). Salmonella Paratyphi B was sensitive to Amoxycillin, Ciprofloxacin, Cotrimoxazole, Chloramphenicol, Gentamicin Cephotaxime, Nalidixic acid and Ofloxacin. Salmonella Paratyphi C was resistant to Gentamicin, Chloramphenicol and Cotrimoxazole and sensitive to Amoxycillin, Nalidixic acid, Cephotaxime and Ofloxacin. In all the Nalidixic acid resistant Salmonella isolates (N=1,251), 55(4.39%) isolates were resistant to Ciprofloxacin.Item Fluoroquinolone Susceptibility Pattern of the Salmonella Isolates From Enteric Fever Patients Visiting to National Public Health Laboratory Nepal(Department of Microbiology, 2009) Acharya, DhirajEnteric fever caused by Salmonella enterica serovar Typhi and Paratyphi A is the most common clinical diagnosis among febrile patients presenting to hospital in Nepal. The aim of this study was to evaluate the fluoroquinolone susceptibility pattern in S. Typhi and S. Paratyphi A Salmonella enterica serovar Typhi and Paratyphi A. During the study period, 41 isolates of S. enterica serovar Typhi (59.54%) and Paratyphi A (41.46%) were grown from 443 blood samples from clinically diagnosed enteric fever patients visiting to NPHL. All isolates were identified by conventional biochemical tests and serotyping with Salmonella antisera (Denka Seiken Co. Ltd., Japan). Antibiotic susceptibility testing to 8 antibiotics (Ampicillin, chloramphenicol, cotrimoxazole, tetracycline, nalidixic acid, ciprofloxacin, ofloxacin and ceftriaxone) was performed by Kirby Bauer disc diffusion method and CLSI recommended interpretive criteria. MIC to ciprofloxacin, ofloxacin and nalidixic acid were determined by agar dilution method. Thirty three (80.49%) isolates were resistant to nalidixic acid, with S. Paratyphi A showing higher rate (88.23%) of resistance compared to S. Typhi (75%). Two S. Typhi isolates (4.88%) were MDR (one showing resistance to ampicillin, chloramphenicol, cotrimoxazole and nalidixic acid and other to cotrimoxazole, tetracycline nalidixic acid, ciprofloxacin, ofloxacin) while none of S. Paratyphi A were MDR. The isolates with full resistance to ciprofloxacin and ofloxacin with additional resistance to cotrimoxazole and tetracycline has not previously been characterized from Nepal. Ceftriaxone was the most sensitive (100%) drug. Despite this, one encouraging trend reported is the re-emergence of strains sensitive to ampicillin, chloramphenicol, cotrimoxazole and tetracycline (95.12%). Difference in both MIC and inhibition zone diameter in nalidixic acid sensitive and nalidixic acid resistant isolates was statistically significant (P < 0.001). S. Paratyphi A with reduced susceptibility to fluoroquinolones had higher MIC value compared to that of S. Typhi (P < 0.001). The decreased susceptibility to fluoroquinolones of S. Typhi and S. Paratyphi A was strongly correlated (sensitivity and specificity of 100%) with resistance to nalidixic acid. Ciprofloxacin and ofloxacin can no longer be considered as the drug of choice in treating enteric fever due to the high level resistant in nalidixic acid and increasing report of full fluoroquinolone resistant. Due to the re-emergence of susceptibility, conventional drug may play important role in the treatment of enteric fever.Item Isolation and Characterization of Salmonella Serovars from Enteric Fever Suspected Patients Attending Birhospital(Department of Microbiology, 2012) Dahal, SubhaEnteric fever is a multi-systemic illness caused primarily by Salmonella Typhi. A similar but less severe disease is caused by S. Paratyphi A,and less commonly by S. Paratyphi Band S. Paratyphi C. A study was conducted at Microbiology Unit, Bir Hospital,Kathmandu from June 2011 to September 2011 with the objective to isolate and characterize Salmonella serovars from enteric fever suspected patients. During the study period, 1542 blood samples were collected from patients suspected of enteric fever of which 126 (8.17%)showed positive culture result and among the culture positive, 87(69.05%) were Salmonella isolates and remaining were other bacterial species.The other bacterial species isolated were Acinetobacter spp. (15.87%), Enterobacter spp. (3.97%),Staphylococcus aureus(3.97%),Pseudomonas aeruginosa(3.17%),Escherichia coli(2.38%) and Klebsiellaspp. (1.59%). Among Salmonella isolates, 48 (38.10%) isolates were Salmonella Typhi and 39(30.95%) isolates were Salmonella Paratyphi A. Typhoid fever was more prevalent causative organism of enteric fever than paratyphoid fever.Prevalence of enteric fever was seen higher in male patients (58/87; 66.67%) than in female patients (29/87;33.33%) and it was statistically insignificant (χ²=0.2517, P>0.05). Salmonella Typhi was found to be 100% sensitive to Ofloxacin and Ceftriaxone, followed by Ciprofloxacin (95.83%), Chloramphenicol (95.83%), Amoxycillin (93.75%) and Cotrimoxazole (91.67%).Similarly,S. Paratyphi A was found to be 100% sensitive to Ofloxacin, Ceftriaxone and Chloramphenciol, followed by Ciprofloxacin (94.87%),Cotrimoxazole (94.87%) and Amoxycillin (92.31%). Out of 48S. Typhi isolates, two(4.17%) were found to be Multi Drug Resistant (MDR).No MDR strains of S. Paratyphi A were isolated. Out of 36 Nalidixic acid resistant Salmonella Typhi two isolates were intermediately sensitive to Ciprofloxacin and out of 29 Nalidixic acid resistant Salmonella Paratyphi A two isolates were intermediately sensitive to Ciprofloxacin. Keywords: Enteric fever, Salmonella serovars, Multidrug resistant(MDR), Nalidixic acid resistantItem Nalidixic Acid Resistant Salmonella with Decreased Ciprofloxacin Susceptibility(Department of English, 2007) Kunwor, Rup BahadurA total of 534 patients suspected of enteric fever were studied in Kathmandu ModelHospital from May 2006 to August 2006. Among them 19.28percentpatientswereculture positive. Theprevalence of culture positive was highest among the age groupof 0-10 years (31.42%) and the result was statistically significant (p > 0.05). Among103 culture positive cases, the incidence rate was more in female (23.15) than male(17.15%) and it was statistically insignificant (p<0.05). The culture positive rate wasfound maximum from out patients (19.76%) than inpatients (12.12%). Among 103 isolates, 67(65.04%) were Salmonella typhi and 36(34.95%) wereSalmonella paratyphi A. The most sensitive drugs for Salmonella typhi were found to be Amoxycillin,Ceftriaxone, Chloramphenicol and CotrimoxazoleandleastsensitivebeingOfloxacin.The same pattern ofsusceptibility was shown bySalmonella paratyphi A. Among 73 Nalidixic acid resistant isolates 45(61.64%) wereSalmonella typhiand28(38.35%) were Salmonella paratyphi A. In contrast, among 30 Nalidixic andsusceptible isolates 22(73.33%) were Salmonella typhi and 8(26.66%) wereSalmonella paratyphi A. In thisstudy, none of the nalidixic acid resistance isolates were found Ciprofloxacinresistance, but all Nalidixic acid susceptible isolates were also susceptible toCiprofloxacin. Among 72 bacterial isolates with increased susceptibility to Ciprofloxacin (0.125g/ml), 67 isolates showed Nalidixic acid resistance in disc diffusion method. Andamong 31 isolates with MIC value < 0.125g/ml (Ciprofloxacin) 25 isolates were Nalidixic acid susceptible in disc diffusion method.The sensitivity and specificity of Nalidixic acid resistance test by disc diffusion method to screen for isolates having MICs of Ciprofloxacin0.125g/ml were91.98% and 83.33% respectively.Item Study on Incidence of Nalidixic Acid Resistant Salmonella Enterica Serovar Typhi and Salmonella Entrica Serovar Paratyphi A and Their Antibiotic Susceptibilities(Department of Microbiology, 2013) Giri, ShudijA total of 949 blood specimen from patients suspected of enteric fever were included in this study. Among them 66 (6.95 percent) blood specimen were culture positive. The incidence of S. Typhi and S. Paratyphi A among total suspected enteric fever patient was 3.2% (30) and 3.8% (36) respectively. The incidence of culture positive case was highest among the age group of 10-20 years (12.4%). Among 66 culture positive cases, the incidence rate was more in male patient (8.9%) than female patient (4.7%).The culture positive rate was found maximum from out patients (7.5%) than inpatients (5.4%). The incidence of Nalidixic acid resistant Salmonella isolates among outpatient and inpatient was 7.2% and 4.6% respectively. The incidence of Nalidixic acid resistant S.Typhi and S. Paratyphi A among total population was 2.7% and 3.8% respectively. The incidence of Nalidixic acid resistant Salmonella isolates among male and female was 8.1% and 4.7% respectively. Among 66 isolates, 30 (45.5%) were Salmonella Typhi and 36 (54.5%) were Salmonella Paratyphi A. The most sensitive antibiotics for Salmonella Typhi were found to be ciprofloxacin and ceftriaxone. Similarly the most sensitive antibiotics for Salmonella Paratyphi A were found to be ciprofloxacin, ceftriaxone, cotrimoxazole and chloramphenicol. Among 62 Nalidixic acid resistant isolates 26(41.94%) were Salmonella Typhi and 36 (58.1%) were Salmonella Paratyphi A. In contrast, among 4 Nalidixic acid susceptible isolates all 4 (100%) were Salmonella Typhi and non were Salmonella Paratyphi A. In this study, none of the nalidixic acid resistance isolates were found Ciprofloxacin resistance. Key words: Enteric fever, Salmonella, Nalidixic acid resistance