Paratyphoid fever- Emerging problem in South India

Objective:To review the clinical profile and drug susceptibilities of Salmonella paratyphi A in a tertiary care hospital.Methods:Retrospective analyses of 113 patients with paratyphoid fever and 101 culture proven Salmonella paratyphi A infection were included in the study.The study extended over a period of 3 years(2006-2008).Diagnosis of patients were based on clinical features,serology and blood culture.The drug susceptibility testing of the isolates were performed by the disc diffusion method.Clinical presentation,laboratory parameters,susceptibility patterns of isolates,treatment and clinical response were studied.Results:Of the 113 cases,77(68.4%) were males and 36 were females(32.8%),which included 2 pediatric patients.Fever was the most common symptom(100.0%) followed by loose stools(37.2%),headache(35.4%),myalgia(31.9%), pain abdomen(29.2%),dry cough(19.5%) and vomiting(13.3%).All patients were clinically cured. Majority of the isolates(46%) were resistant to cotrimoxazole in 2006,however they became 100% sensitive in 2007 and 2008.whereas the strains became 100% sensitive to ampicillin and chloramphenicol only in 2008.In 2006 the sensitivity of organisms to ciprofloxacin was 89% but in 2007 and 2008 there has been an increasing resistance to ciprofloxacin(46% and 86%) respectively.Surprisingly 3 isolates(8.1%) were resistant to ceftriaxone in 2006,showed 100% sensitivity in 2008.Common drugs used were ceftriaxone in 100 cases(88.4%) and ciprofloxacin in 13 cases(11.6%).One patient had relapse of paratyphoid fever after treatment with ciprofloxacin which responded to ceftriaxone.Conclusions:Paratyphoid fever A is one of the emerging infections and a significant problem in India.An increasing resistance to fluoroquinolones is noted.Continuous monitoring of drug susceptibilities is mandatory in instituting appropriate therapy.