Fluoroquinolone-Resistant Typhoid, South Africa | CDC EID

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Volume 16, Number 5–May 2010
Letter
Fluoroquinolone-Resistant Typhoid, South Africa
Karen H. Keddy, Anthony M. Smith, Arvinda Sooka, Husna Ismail, and Stephen Oliver
Author affiliations: National Institute of Communicable Diseases, Johannesburg, South Africa (K.H. Keddy, A.M. Smith, A. Sooka, H. Ismail); University of the Witwatersrand, Johannesburg (K.H. Keddy, A.M. Smith, H. Ismail); National Health Laboratory Service, Groote Schuur, Cape Town, South Africa (S. Oliver); and University of Cape Town, Cape Town (S. Oliver)

Suggested citation for this article

To the Editor: Salmonella enterica serotype Typhi, the causal pathogen for typhoid, is a major public health hazard in many parts of the world, with an estimated 21.6 million cases of typhoid and 217,000 deaths occurring each year (1). Most isolates in South Africa are susceptible to quinolones, and fluoroquinolones remain the treatment of choice (2). The disease is primarily water or foodborne, but person-to-person spread is well recognized (3). Travelers to disease-endemic regions may be at risk for typhoid, which may result in the importation of strains of S. Typhi with unfamiliar or unusual resistance patterns (4). Such infections present a challenge to local clinicians on optimal patient management.

S. Typhi was isolated from the blood culture of a woman 65 years of age from Cape Town; she had been in contact with a traveler to Bangladesh. The patient was treated first with ciprofloxacin, but this medication was changed to high-dose ceftriaxone combined with doxycycline for 8 days; she recovered well. Contact tracing indicated no family members had typhoid fever or carried the organism. The person who had traveled to Bangladesh was unavailable to provide further history or a stool specimen. No other potential source of infection could be elucidated: the patient lived in an urban area with safe water sources and shared meals with her family.

The isolate was referred to the Enteric Diseases Reference Unit for confirmation of identification, serotyping (Kauffman-White scheme), and antimicrobial drug susceptibility testing using the Etest (bioMérieux, Marcy l'Étoile, France) and agar dilution methods, according to criteria of the Clinical and Laboratory Standards Institute (Wayne, PA, USA) (www.clsi.org). The isolate was resistant to ampicillin, chloramphenicol, sulfamethoxazole, nalidixic acid, and ciprofloxacin, but susceptible to ceftriaxone and tetracycline.

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Suggested Citation for this Article
Keddy KH, Smith AM, Sooka A, Ismail H, Oliver S. Fluoroquinolone-resistant typhoid, South Africa [letter]. Emerg Infect Dis [serial on the Internet] 2010 May [date cited]. http://www.cdc.gov/EID/content/16/5/879.htm

DOI: 10.3201/eid1605.091917