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J Med Microbiol 56 (2007), 538-544; DOI: 10.1099/jmm.0.46814-0
© 2007 Society for General Microbiology
ISSN 1473-5644

Clinical and microbiological investigations of typhoid fever in an infectious disease hospital in Kuwait

Tsonyo Dimitrov1, Eded E. Udo2, Ossama Albaksami3, Shehab Al-Shehab4, Abdal Kilani4, Medhat Shehab4 and Aref Al-Nakkas4

1 Department of Medical Laboratories, Microbiology Section, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

2 Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 14923, Safat 13110, Kuwait

3 Department of Pediatrics, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

4 Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

Correspondence
Tsonyo Dimitrov
dimitrov_varn90{at}hotmail.com

Received 3 July 2006
Accepted 12 December 2006

A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim–sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88 %) were treated with ceftriaxone and 27 (20 %) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 Salmonella enterica serotypes Typhi and Paratyphi A isolated from patients, 50 (37 %) were multidrug resistant (MDR) and 94 (69.6 %) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100 % of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125–1 µg ml–1). Low-level resistance to ciprofloxacin (MIC 0.125–1 µg ml–1) was also detected in 13.8 and 33.3 % of nalidixic acid-susceptible isolates of S. Typhi and S. Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant Salmonella isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR S. Typhi strains.

Abbreviations: MDR, multidrug resistant; NAR, nalidixic acid resistant; NAS, nalidixic acid susceptible.






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