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Multidrug-Resistant Salmonella enterica Serotype Typhi, Gulf of Guinea Region, Africa - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC


Multidrug-Resistant Salmonella enterica Serotype Typhi, Gulf of Guinea Region, Africa - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 4—April 2015


Multidrug-Resistant Salmonella enterica Serotype Typhi, Gulf of Guinea Region, Africa


Technical Appendicies

Murielle Baltazar12, Antoinette Ngandjio1, Kathryn Elizabeth Holt, Elodie Lepillet, Maria Pardos de la Gandara3, Jean-Marc Collard, Raymond Bercion4, Ariane Nzouankeu, Simon Le Hello, Gordon Dougan, Marie-Christine Fonkoua, and François-Xavier WeillComments to Author 
Author affiliations: Institut Pasteur, Paris, France (M. Baltazar, E. Lepillet, M. Pardos de la Gandara, S. Le Hello, F.-X. Weill)Centre Pasteur du Cameroun, Yaoundé, Cameroon (A. Ngandjio, A. Nzouankeu, M.-C. Fonkoua);University of Melbourne, Melbourne, Victoria, Australia (K.E. Holt)Wellcome Trust Sanger Institute, Cambridge, UK (K.E. Holt, G. Dougan)Scientific Institute of Public Health, Brussels, Belgium (J.-M. Collard)Institut Pasteur de Bangui, Bangui, Central African Republic (R. Bercion)


We identified 3 lineages among multidrug-resistant (MDR) Salmonella enterica serotype Typhi isolates in the Gulf of Guinea region in Africa during the 2000s. However, the MDR H58 haplotype, which predominates in southern Asia and Kenya, was not identified. MDR quinolone-susceptible isolates contained a 190-kb incHI1 pST2 plasmid or a 50-kb incN pST3 plasmid.
Typhoid fever, which is caused by Salmonella enterica serotype Typhi, is endemic to the developing world; there were an estimated 26.7 million cases in 2010 (1). The incidence of typhoid fever in sub-Saharan Africa was an estimated 725 cases/100,000 persons in 2010, despite a lack of incidence studies conducted in West and central Africa (1). Antimicrobial susceptibility data are also scarce for this part of Africa. This issue is problematic because treatment with appropriate antimicrobial drugs is essential for recovery in the context of the global emergence of multidrug resistance.
In the Indian subcontinent and Southeast Asia, the multidrug-resistant (MDR) Salmonella Typhi H58 clone, which was named after its haplotype (a combination of defined chromosomal single-nucleotide polymorphisms [SNPs]) (2,3), has spread rapidly and become endemic and predominant. During the 1990s, this clone acquired a large conjugative incHI1 pST6 plasmid encoding resistance to ampicillin, chloramphenicol, and co-trimoxazole (4,5); also in the 1990s, this MDR clone became resistant to quinolones and showed decreased susceptibility to ciprofloxacin because of point mutations in the chromosomal gyrA gene (2). The H58 clone has also spread to eastern Africa, where it has been the most prevalent haplotype (87%) in Kenya since the early 2000s (6).
During 1997–2011, high incidence of MDR Salmonella Typhi was reported in some countries near the Gulf of Guinea in Africa, including Nigeria (7), Ghana (8,9), Togo (10), and the Democratic Republic of the Congo (11). During 1999–2003, a British surveillance system reported a prevalence of 19% (49/421) for MDR Salmonella Typhi isolates among imported cases of typhoid fever acquired in Africa, particularly in Ghana (12). However, nothing is known about the genotypes of these isolates, including whether they belong to the spreading MDR H58 clone.
We report data for the occurrence, genotypes, and characterization of the resistance mechanisms of MDR Salmonella Typhi isolates. These isolates were obtained from the French National Reference Center for Salmonella (FNRC-Salm), Institut Pasteur (Paris, France), and Centre Pasteur du Cameroun (Yaoundé, Cameroon).


We thank all the corresponding laboratories of the FNRC-Salm network for participating in this study.
This study was supported by the Institut Pasteur, the Réseau International des Instituts Pasteur, the Institut de Veille Sanitaire, and the French Government Investissement d'Avenir Program (Integrative Biology of Emerging Infectious Diseases, Laboratory of Excellence, grant ANR-10-LABX-62-IBEID).


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Technical Appendix

Suggested citation for this article: Baltazar M, Ngandjio A, Holt KE, Lepillet E, Pardos de la Gandara M, Collard J-M, et al. Multidrug-resistant Salmonella enterica serotype Typhi, Gulf of Guinea Region, Africa. Emerg Infect Dis. 2015 Apr [date cited]. http://dx.doi.org/10.3201/eid2104.141355
DOI: 10.3201/eid2104.141355
1These authors contributed equally to this article.
2Current affiliation: University of Limoges, Limoges, France.
3Current affiliation: Rockefeller University, New York, New York, USA.
4Current affiliation: Institute Pasteur de Dakar, Dakar, Senegal.

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