Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

Nicholas A Feasey; Katherine Gaskell; Vanessa Wong; Chisomo Msefula; George Selemani; Save Kumwenda; Theresa J Allain; Jane Mallewa; Neil Kennedy; Aisleen Bennett; Joram O Nyirongo; Patience A Nyondo; Madalitso D Zulu; Julian Parkhill; Gordon Dougan; Melita A Gordon; Robert S Heyderman

doi:10.1371/journal.pntd.0003748

Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

Nicholas A Feasey, Katherine Gaskell, Vanessa Wong, Chisomo Msefula, George Selemani, Save Kumwenda, Theresa J Allain, Jane Mallewa, Neil Kennedy, Aisleen Bennett, Joram O Nyirongo, Patience A Nyondo, Madalitso D Zulu, Julian Parkhill, Gordon Dougan, Melita A Gordon, Robert S Heyderman

School of Medicine, Dentistry and Biomedical Sciences

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Abstract

INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).

METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.

RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.

CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

Original language	English
Article number	e0003748
Number of pages	13
Journal	PLoS Neglected Tropical Diseases
Volume	9
Issue number	4
DOIs	https://doi.org/10.1371/journal.pntd.0003748
Publication status	Published - 24 Apr 2015

Keywords

Adolescent
Adult
Base Sequence
Child
Drug Resistance, Multiple, Bacterial
Female
Humans
Incidence
Malawi
Male
Molecular Sequence Data
Phylogeny
Prevalence
Retrospective Studies
Salmonella typhi
Sequence Analysis, DNA
Typhoid Fever

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1371/journal.pntd.0003748

Rapid Emergence of Multidrug Resistant, H58-Lineage Salmonella Typhi in Blantyre, Malawi
© 2015 Feasey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Final published version, 613 KBLicence: CC BY

Cite this

Feasey, N. A., Gaskell, K., Wong, V., Msefula, C., Selemani, G., Kumwenda, S., Allain, T. J., Mallewa, J., Kennedy, N., Bennett, A., Nyirongo, J. O., Nyondo, P. A., Zulu, M. D., Parkhill, J., Dougan, G., Gordon, M. A., & Heyderman, R. S. (2015). Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi. PLoS Neglected Tropical Diseases, 9(4), Article e0003748. https://doi.org/10.1371/journal.pntd.0003748

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title = "Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi",

abstract = "INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.",

keywords = "Adolescent, Adult, Base Sequence, Child, Drug Resistance, Multiple, Bacterial, Female, Humans, Incidence, Malawi, Male, Molecular Sequence Data, Phylogeny, Prevalence, Retrospective Studies, Salmonella typhi, Sequence Analysis, DNA, Typhoid Fever",

author = "Feasey, {Nicholas A} and Katherine Gaskell and Vanessa Wong and Chisomo Msefula and George Selemani and Save Kumwenda and Allain, {Theresa J} and Jane Mallewa and Neil Kennedy and Aisleen Bennett and Nyirongo, {Joram O} and Nyondo, {Patience A} and Zulu, {Madalitso D} and Julian Parkhill and Gordon Dougan and Gordon, {Melita A} and Heyderman, {Robert S}",

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doi = "10.1371/journal.pntd.0003748",

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Feasey, NA, Gaskell, K, Wong, V, Msefula, C, Selemani, G, Kumwenda, S, Allain, TJ, Mallewa, J, Kennedy, N, Bennett, A, Nyirongo, JO, Nyondo, PA, Zulu, MD, Parkhill, J, Dougan, G, Gordon, MA & Heyderman, RS 2015, 'Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi', PLoS Neglected Tropical Diseases, vol. 9, no. 4, e0003748. https://doi.org/10.1371/journal.pntd.0003748

TY - JOUR

T1 - Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

AU - Feasey, Nicholas A

AU - Gaskell, Katherine

AU - Wong, Vanessa

AU - Msefula, Chisomo

AU - Selemani, George

AU - Kumwenda, Save

AU - Allain, Theresa J

AU - Mallewa, Jane

AU - Kennedy, Neil

AU - Bennett, Aisleen

AU - Nyirongo, Joram O

AU - Nyondo, Patience A

AU - Zulu, Madalitso D

AU - Parkhill, Julian

AU - Dougan, Gordon

AU - Gordon, Melita A

AU - Heyderman, Robert S

PY - 2015/4/24

Y1 - 2015/4/24

N2 - INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

AB - INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

KW - Adolescent

KW - Adult

KW - Base Sequence

KW - Child

KW - Drug Resistance, Multiple, Bacterial

KW - Female

KW - Humans

KW - Incidence

KW - Malawi

KW - Male

KW - Molecular Sequence Data

KW - Phylogeny

KW - Prevalence

KW - Retrospective Studies

KW - Salmonella typhi

KW - Sequence Analysis, DNA

KW - Typhoid Fever

U2 - 10.1371/journal.pntd.0003748

DO - 10.1371/journal.pntd.0003748

M3 - Article

C2 - 25909750

SN - 1935-2727

VL - 9

JO - PLoS Neglected Tropical Diseases

JF - PLoS Neglected Tropical Diseases

IS - 4

M1 - e0003748

ER -

Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

Abstract

Keywords

UN SDGs

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