Enteric fever in India: current scenario and future directions

Abstract

SummaryEnteric fever is a major cause of morbidity and mortality in tropical areas worldwide. The Indian subcontinent bears the brunt of the disease, both in terms of absolute case numbers and drugresistant strains. Recent phylogenetic studies suggest that the multidrug-resistant clade H58 originated in India and subsequently expanded through Asia and Africa. In Africa, it caused unrecognised outbreaks in areas previously considered free of the disease. In this study, we discuss the current status of enteric fever in India, the factors preventing its control and its future directions in this rapidly developing nation.

Epidemiological Profile and Antimicrobial Resistance Pattern of Enteric Fever in a Tertiary Care Hospital of North India – a Seven Year Ambispective Study

“…In this study, we found 58.4% and 0.84% of DCS and 37% and 89.9% of CiR strains among S. typhi and S. paratyphi respectively. Similar to our findings, several studies from India have reported high rate of resistance to Ciprofloxacin (23,26,28).…”

“…DCS strains are associated with delayed clinical response and increase in complications. Accumulation of further mutations with or without added efflux pumps, lead to CiR (26). In this study, we found 58.4% and 0.84% of DCS and 37% and 89.9% of CiR strains among S. typhi and S. paratyphi respectively.…”

“…Outbreaks of MDR typhoid have occurred in Kerala, Mumbai and Delhi frequently affecting the pediatric age group. However in the present decade reversal in the resistance trends in Salmonella is reported by many Indian centres (24,25,26). A recent surveillance study conducted by ICMR across four tertiary care centres in India have also reported MDR rate less than 3% (27).…”

“…Though with reduced MDR rates and increased susceptibility with first line drugs, it is tempting to recycle old drugs but due to the several reasons it is unlikely in India in near future. Loss of confidence in first line antibiotics amongst clinicians due to occurrence of more cases of recurrence and relapse and severe complications like aplastic anaemia associated with these chloramphenicol marks the top most reasons (26).…”

“…Azithromycin is indicated for MDR, NaR and empirical therapy as it attains high concentrations for intracellular Salmonella. It is also helpful in treating many other etiologies of undifferentiated fever like leptospirosis, scrub typhus, lower respiratory tract infections (LRTI) which has a definite advantage in areas where there is lack of accurate diagnosis (26). Studies conducted on susceptibility pattern of Azithromycin against Salmonella serotypes in Delhi and Lucknow found susceptibility rate to be 92% and 92.6% respectively (28,29).…”