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Multi-drug resistance and reduced susceptibility to ciprofloxacin among Salmonella enterica serovar Typhi isolates from the Middle East and Central Asia.
[typhoid]
Typhoid
fever
is
common
in
developing
countries
,
with
an
estimated
120
million
infections
and
700
000
annual
deaths
,
worldwide
.
Fluoroquinolones
have
been
the
treatment
of
choice
for
infection
with
multidrug-resistant
(
MDR
)
Salmonella
enterica
serovar
Typhi
(
S
.
Typhi
)
.
However
,
alarming
reports
of
fluoroquinolone-resistance
and
failure
of
typhoid
fever
treatment
have
recently
been
published
.
To
determine
the
proportion
of
S
.
Typhi
isolates
with
reduced
susceptibility
to
ciprofloxacin
(
RSC
)
from
six
countries
in
the
Middle
East
and
Central
Asia
,
968
S
.
Typhi
isolates
collected
between
2002
and
2007
from
Egypt
,
Uzbekistan
,
Pakistan
,
Qatar
,
Jordan
and
Iraq
were
tested
for
antibiotic
susceptibility
to
five
antibiotics
using
the
disc-diffusion
method
.
MDR
was
defined
as
resistance
to
amicillin
,
chloramphenicol
and
trimethoprim-sulfamethoxazole
.
The
E
-
test
was
employed
to
determine
the
MIC
of
ciprofloxacin
only
.
Nalidixic
acid
resistance
was
evaluated
as
a
marker
for
RSC
.
Interpretations
were
made
according
to
CLSI
guidelines
.
MDR
strains
were
considerably
more
prevalent
in
Iraq
(
83
%
)
and
Pakistan
(
52
%
)
compared
with
the
other
countries
studied
(
13
-
52
%
)
.
Nearly
all
isolates
were
susceptible
(
99
.
7
%
)
to
ceftriaxone
.
RSC
was
detected
in
a
total
of
218
isolates
(
22
%
)
,
mostly
from
Iraq
(
54
/
59
,
92
%
)
,
Uzbekistan
(
98
/
123
,
80
%
)
,
Qatar
(
23
/
43
,
54
%
)
and
Pakistan
(
31
/
65
,
47
%
)
.
Many
of
these
(
21
%
)
were
also
MDR
.
Use
of
nalidixic
acid
resistance
as
an
indicator
for
RSC
was
99
%
sensitive
and
98
%
specific
.
This
study
reinforces
the
need
for
routine
antimicrobial
susceptibility
surveillance
of
enteric
fever
isolates
and
close
review
of
current
therapeutic
policies
in
the
region
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated