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Salmonella Infections in Asir Region, Southern Saudi Arabia: Expatriate Implications

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Mehreen Gull Malik at Superior University
Mehreen Gull Malik
Abdul Hameed A. Al-Wabel
Abdul Hameed A. Al-Wabel
Abdul Hameed A. Al-Wabel
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M M El Bagir Khalafalla Ahmed
M M El Bagir Khalafalla Ahmed
M M El Bagir Khalafalla Ahmed
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Naser Bilal at University of Khartoum
Naser Bilal
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One hundred forty-two cases of salmonella infection seen in Asir region, Southern Saudi Arabia, during the period of 1989-1991 inclusive, were analyzed. Ninety-four cases were found to have enteric fever and 48 cases were found to have, Salmonella enteritidis gastroenteritis. Enteric fever is more common in non-Saudis (64%) than in the indigenous Saudi population (34%). Salmonella enteriditis gastroenteritis is more common among the Saudi population (75%) than non-Saudis (25%). The clinical presentation of both types of salmonella infection is outlined. Enteric fever is more common among expatriates who recently came from India (40.5%), Egypt (10.6%), Pakistan (6.4%), and Syria (4.3%). Salmonella typhi resistant to tetracycline, ampicillin, and chloramphenicol are more common among Indian patients (75% of resistant cases) and Syrian patients (12.5-28% of resistant cases). Resistance to cotrimoxazole is commonly encountered in Indians (50% of resistant cases) and Egyptians (33.3%). Salmonella enteriditis resistant to tetracycline, ampicillin, and chloramphenicol is more common among Saudis (66.7% of resistant cases) and Filipinos (16.7-33.3% of resistant cases). Recommendations regarding screening of expatriates for enteric fever and proper drug therapy of possible resistant cases are outlined.
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Salmonella Infections in Asir Region, Southern
Saudi Arabia: Expatriate Implications
Gaafar M. Malik, MRCP; Abdul Hameed A. Al-Wabel, MPH, MD; Mohamed M. El Bagir Khalafalla Ahmed,
FRCP; Naser E. Bilal, MD; Ashock Shenoy, MD; Mohamed Abdalla, MD; Tag Elsir Mekki, MBBS
From the Department of Medicine (Drs. Malik, Al-Wabel, Ahmed, Abdalla, Mekki), and Department of Microbiology (Drs. Shenoy and Bilal), College of
Medicine, Asir Central Hospital, Abha.
Address reprint requests and correspondence to Dr. Malik: Assistant Professor of Medicine, King Saud University - Abha Branch, P.O. Box 641, Abha,
Saudi Arabia.
Accepted for publication 20 September 1992.
One hundred forty-two cases of salmonella infection seen in Asir region, Southern Saudi Arabia, during the period
of 1989-1991 inclusive, were analyzed. Ninety-four cases were found to have enteric fever and 48 cases were found
to have Salmonella enteritidis gastroenteritis. Enteric fever is more common in non-Saudis (64%) than in the
indigenous Saudi population (34%). Salmonella enteritidis gastroenteritis is more common among the Saudi
population (75%) than non-Saudis (25%). The clinical presentation of both types of salmonella infection is outlined.
Enteric fever is more common among expatriates who recently came from India (40.5%), Egypt (10.6%), Pakistan
(6.4%), and Syria (4.3%). Salmonella typhi resistant to tetracycline, ampicillin, and chloramphenicol are more
common among Indian patients (75% of resistant cases) and Syrian patients (12.5-28% of resistant cases).
Resistance to cotrimoxazole is commonly encountered in Indians (50% of resistant cases) and Egyptians (33.3%).
Salmonella enteritidis resistant to tetracycline, ampicillin, and chloramphenicol is more common among Saudis
(66.7% of resistant cases) and Filipinos (16.7-33.3% of resistant cases). Recommendations regarding screening of
expatriates for enteric fever and proper drug therapy of possible resistant cases are outlined. Ann Saudi Med
1993;13(3):242-245.
GM Malik, AHA Al-Wabel, MMEBK Ahmed, NE Bilal, A Shenoy, M Abdalla, TE Mekki, Salmonella Infections in
Asir Region, Southern Saudi Arabia: Expatriate Implications. 1993; 13(3): 242-245
Salmonella infections are still a major health problem in many developing countries [1]. The clinical spectrum
of salmonella infection varies greatly with different geographical regions. These differences were related to
environmental and nutritional factors [2] as well as differences in the virulence of the organisms [3]. The Kingdom
of Saudi Arabia is served by a large number of expatriates from different countries in which salmonella infection is
endemic. In our clinical practice, we have observed that enteric fever is not so common among the indigenous Saudi
population, while cases are frequently seen among foreigners who have traveled recently to their countries where
typhoid is endemic. Reviewing the literature, no published reports about salmonella infection in the southern part of
Saudi Arabia could be found. This study was undertaken to assess the magnitude of the problem in the Asir region
and the influence of the large number of expatriates on the disease pattern.
Material and Methods
The case records of 142 patients diagnosed as having salmonella infection in both Asir Central Hospital and
Lassan Fever Hospital in Abha over the period of 1989-1991 inclusive were reviewed. Asir Central Hospital is the
main referral hospital of Asir region while Lassan Hospital is the referral hospital for fevers and infectious diseases.
The cases diagnosed by a positive blood, stool, urine, or bone marrow culture were selected for analysis. Typhoid
and paratyphoid fevers which were suspected on clinical grounds with negative culture were included only if there
was evidence of a rising Widal agglutination titer for the O antigen on two or more occasions, a week or more apart.
Results
One hundred forty-two patients were identified to have salmonella infection. Ninety-four cases had enteric fever
and 48 had Salmonella enteritidis gastroenteritis. The average age of the patients was 21.9 years (range of two
months to 60 years). Fifty percent of the cases of Salmonella enteritidis gastroenteritis were found among children
below the age of 14 years. Eighty-six were males (60.6%) and 56 were females (39.4%). This male predominance
might be a reflection of the fact that the majority of cases of enteric fever were foreign male laborers as shown in
Table 1.
Table 1 shows the distribution of the cases according to nationalities. Enteric fever is found to be more common
Salmonella Infections in Asir Region, Southern Saudi Arabia: Expatriate Implications
Annals of Saudi Medicine, Vol 13 No. 3; 1993
in foreigners (66%) than in the indigenous Saudi population (34%). Salmonella enteritidis gastroenteritis is more
common among Saudis (75%) than among foreigners (25%). All the expatriates who presented with enteric fever
gave a history of travel to their home country during the eight weeks prior to the illness. Among foreigners, enteric
fever is more common in Indians (40.5%), Egyptians (10.6%), Pakistanis (6.4%) and Syrians (4.3%). Foreigners
who commonly presented with Salmonella enteritidis gastroenteritis were Filipinos (12.4%).
Table 2 summarizes the clinical features of both enteric fever and Salmonella enteritidis. The most common
presenting symptoms of enteric fever were fever (100%), headache (55.3%), vomiting (42.5%), abdominal pain
(40.5%), and diarrhea (34%). Rare symptoms include constipation (4.3%), dry cough (4.3%), and arthralgia (2.1%).
The most common physical signs of enteric fever were a temperature above 37.5°C (74.5%), anemia (23.4%),
hepatomegaly (21.3%), splenomegaly (19.1%), and abdominal tenderness in 12.8%. Rare signs include
lymphadenopathy (6.4%), lung crepitations (4.3%), and skin rash (2.1%). The most common symptoms of
Salmonella enteritidis infections are diarrhea (91.7%), abdominal pain (87.5%), fever (79.2%), and vomiting in
62.5%. Headache is a rare symptom (4.2%). The most common findings in Salmonella enteritidis infection are
abdominal tenderness (79.2%) and a temperature above 37.5°C (37.5%). All cases of Salmonella enteritidis were
isolated from the stool except four cases: two from discharging bone sinuses in a sicklemic and a patient with an
infected compound fracture; the other two from infected skin lesions in a sicklemic and a patient with splenectomy.
Table 3 shows the pattern of antibiotic resistance of salmonella isolates in relation to different nationalities.
Resistant salmonella typhi or paratyphi to tetracycline, ampicillin and chloramphenicol is more common in isolates
from Indian patients (75% of resistance isolated to each antibiotic). Isolates from Syrian patients show resistance to
ampicillin (18.8%) and chloramphenicol (25%). Resistance to cotrimoxazole is also more common among Indians
(50%) and Egyptians (33.3%). Regarding Salmonella enteritidis isolates, resistance to tetracycline, ampicillin, and
chloramphenicol is more common in isolates from Saudi patients. Resistant isolates (66.7%) to each antibiotic were
found in Saudi patients. Isolates from Filipino patients also showed resistance to tetracycline (16.65%), ampicillin
(33.3%), and chloramphenicol (33.3%).
Table 1. Distribution of 142 cases of Salmonella typhi, Salmonella paratyphians and Salmonella enteritidis in the Asir
region, according to nationality.
Nationality
Salmonella typhi
& paratyphi
Salmonella
enteritidis
Total
No.
(%)
No.
(%)
(%)
Saudi
32
(34)
36
(75)
(47.9)
Indian
38
(40.5)
-
-
(26.8)
Egyptian
10
(10.6)
-
-
( 7.1)
Pakistani
6
( 6.4)
2
( 4.2)
( 5.6)
Filipino
-
-
6
( 12.4)
( 4.2)
Syrian
4
( 4.3)
-
( 2.8)
Sudanese
2
( 2.1)
2
( 4.2)
( 2.8)
Sri Lankan
-
-
2
( 4.2)
( 1.4)
Palestinian
2
( 2.1)
-
-
( 1.4)
Total
94
(100)
48
(100)
(100)
Salmonella Infections in Asir Region, Southern Saudi Arabia: Expatriate Implications
Annals of Saudi Medicine, Vol 13 No. 3; 1993
Table 2. Symptoms and signs of 142 patients diagnosed as having enteric fever or Salmonella enteritidis gastroenteritis in
the Asir region.
Salmonella typhi &
paratyphi
Salmonella
enteritidis
No.
(%)
No.
(%)
Symptoms
Fever
94
(100)
38
(79.2)
Headache
52
(55.3)
2
( 4.2)
Vomiting
40
(42.5)
30
(62.5)
Abdominal pain
& distention
38
(40.4)
42
(87.5)
Diarrhea
32
(34.0)
44
(91.7)
Constipation
4
( 4.3)
-
-
Dry cough
4
( 4.3)
-
-
Arthralgia
2
( 2.1)
-
-
Signs
Temp. > 37.5°C
70
(74.5)
18
(37.5)
Anemia
(pale conjunctivae)
22
(23.4)
-
-
Hepatomegaly
20
(21.3)
-
-
Splenomegaly
18
(19.1)
-
-
Abdominal tenderness
12
(12.8)
38
(79.2)
Cervical lymph-
adenopathy
6
( 6.4)
-
-
Lung crepitations
4
( 4.3)
-
-
Skin rash
2
( 2.1)
-
-
Discharging bone sinus
-
-
2
( 4.2)
Skin infection
-
-
2
( 4.2)
Table 3. Pattern of antibiotic resistance to Salmonella infection according to nationality in the Asir region.
Antibiotics
Salmonella typhi or paratyphi
Salmonella enteritidis
Resistance
(%)
Nationality
No.
(%)
Resistance
(%)
Nationality
No.
(%)
Tetracycline
16/40
(40)
Indian
=
12
(75)
12/44
(24.3)
Saudi
=
8
(66.7)
Sudanese
=
2
(12.5)
Sudanese
=
2
(16.65)
Syrian
=
2
(12.5)
Filipino
=
2
(16.65)
Ampicillin
16/52
(38.8)
Indian
=
12
(75)
6/44
(13.6)
Saudi
=
4
(66.7)
Syrian
=
3
(18.8)
Filipino
=
2
(33.3)
Saudi
=
1
(16.2)
Co-trimoxazole
6/16
(37.5)
Indian
=
3
(50)
-
-
-
-
Egyptian
=
2
(33.3)
Saudi
=
1
(16.7)
Chloramphenicol
16/50
(32)
Indian
=
12
(75)
6/36
(16.7)
Saudi
=
4
(66.7)
Syrian
=
4
(25)
Filipino
=
2
(33.3)
Carbenicillin
2/8
(25)
Sudanese
=
2
-
-
-
-
-
Nalidixic acid
2/2
(100)
Sudanese
=
2
-
-
-
-
-
Cefoxitin
0/40
(0)
-
2/26
(7.7)
Filipino
=
2
Salmonella Infections in Asir Region, Southern Saudi Arabia: Expatriate Implications
Annals of Saudi Medicine, Vol 13 No. 3; 1993
Discussion
The results of this retrospective study confirmed our observation that enteric fever is more common among
foreigners than in the indigenous Saudi population.
All the non-Saudis gave a history of recent travel to their respective countries, which implies that they had
probably contracted the infection from their home countries. Similar observations have been reported from other
Gulf countries, particularly Kuwait, which is also served by a large number of foreign laborers [4,5]. Salmonella
enteritidis gastroenteritis is found to be more common among Saudis than non-Saudis, in agreement with reports
from the Riyadh area [6], Eastern Province [7], and Western Province [8] of Saudi Arabia.
Regarding the clinical findings of enteric fever, results are similar to those reported from other countries like
India [9], Kuwait [5], and Canada [10]. The disease is generally mild with no serious complications or fatalities seen
in this series. This is similar to what has been found in studies from Singapore [11]. The clinical features of
Salmonella enteritidis gastroenteritis in the Asir region are similar to those reported from other parts of the Kingdom
[6,7]. Salmonella typhi and paratyphi isolates which are resistant to ampicillin, chloramphenicol, tetracycline, and
cotrimoxazole are common in patients coming from the Indian subcontinent. Similar reports of resistant Salmonella
to the standard chemotherapy are now accumulating from Southeast Asia and other parts of the world [4,12-14].
Isolates from Syrian patients have exhibited some resistance to tetracycline, ampicillin, and chloramphenicol, while
isolates from Egyptians have shown resistance to cotrimoxazole.
Practicing physicians in Saudi Arabia should be alerted to the possibility of encountering organisms resistant to
the standard enteric fever chemotherapy in patients coming from these countries. Since there is a large number of
laborers moving between these countries and the Kingdom, there is a chance of importing the resistant enteric fever
organism to the Kingdom. Public health measures should be enforced to ensure the proper evaluation of laborers
before employment by using stool cultures and agglutination tests for salmonella, especially for food handlers.
Alternative antibiotics should be used in cases of enteric fever coming from Southeast Asia in which resistance is
suspected. Reports have shown that the third generation cephalosporins, aminoglycosides, and quinolones are a
better alternative [4,15-17]. Salmonella enteritidis organism, which is more common among the Saudi population,
exhibited some resistance to tetracycline, ampicillin, and chloramphenicol. This observation has also been reported
in the Jeddah region [8]. Other antibiotics should be used if antibiotic treatment is required for severe cases.
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Salmonella Infections in Asir Region, Southern Saudi Arabia: Expatriate Implications
Annals of Saudi Medicine, Vol 13 No. 3; 1993
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A variety of health issues have been investigated in the Hajj pilgrims (HPs) in KSA. However, it is still obscure to decide which meals contribute to health related issues specifically gastrointestinal disorders and allergies. Hence present study was planned to compare the effect of using different meals on GIT disorders and allergies. The data was categorized into two groups. Group 1 of age matched HPs comprised a Functional Digestive System Questionnaire (FDSQ) to study digestive disorders. Group 2 HPs were compared for those received Toafa Corporation Meals (TCM) and those did not received Toafa Corporation Meals (NTCM). The FDSQ showed some of the gastrointestinal symptoms in male and female Hajj pilgrims differing significantly (p<0.05). The efficacy of the treatment was evaluated by subject recovery scoring (SRS). The 61.7% HPs taking TCM revealed various discomforts and food allergy and the 50.6% HPs using NTCM did not suffer from any disorders. However, the pilgrims taking the meals provided by the Toafa corporation but not showing allergy were more significant in number (p=0.0002). The existing study presents a new method (construction of a FDSQ) for comparing gastrointestinal and other disorders. The present study recommends that Toafa Corporation should provide suitable meals for the pilgrims to meet their actual needs during Hajj and health situation.
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... A few studies have investigated Salmonella incidence in the clinical and environmental settings of Saudi Arabia along with their antibiotic resistance patterns. These studies were conducted in Riyadh (Alghoribi et al. 2020;Al-Hindi et al. 2023;Al-Nakhli et al. 1999;El-Tayeb et al. 2017;Moussa et al. 2010Moussa et al. , 2011Nabbut et al. 1982;Somiley et al. 2012), Southern Asir region (Malik et al. 1993), Jeddah (Al-Humam and Mohammad 2022), and Eastern province (Al-Tawfiq 2007;Elhadi et al. 2013). However, little is known about Salmonella incidence in Makkah's environmental and clinical settings. ...
Diversity and antimicrobial susceptibility patterns of clinical and environmental Salmonella enterica serovars in Western Saudi Arabia
Article
  • May 2024
  • FOLIA MICROBIOL
The diverse environmental distribution of Salmonella makes it a global source of human gastrointestinal infections. This study aimed to detect Salmonella spp. and explore their diversity and antimicrobial susceptibility patterns in clinical and environmental samples. Pre-enrichment, selective enrichment, and selective plating techniques were adopted for the Salmonella detection whereas the API 20E test and Vitek Compact 2 system were used to confirm the identity of isolates. Salmonella serovars were subjected to molecular confirmation by 16S rDNA gene sequencing. Disc diffusion method and Vitek 2 Compact system determined the antibiotic susceptibility of Salmonella serovars. Multiple antibiotic resistance index (MARI) was calculated to explore whether Salmonella serovars originate from areas with heavy antibiotic usage. Results depicted low Salmonella prevalence in clinical and environmental samples (3.5%). The main detected serovars included Salmonella Typhimurium, S. enteritidis, S. Infantis, S. Newlands, S. Heidelberg, S. Indian, S. Reading, and S. paratyphi C. All the detected Salmonella serovars (27) exhibited multidrug resistance to three or more antimicrobial classes. The study concludes that the overall Salmonella serovars prevalence was found to be low in environmental and clinical samples of Western Saudi Arabia (Makkah and Jeddah). However, antimicrobial susceptibility patterns of human and environmental Salmonella serovars revealed that all isolates exhibited multidrug-resistance (MDR) patterns to frequently used antibiotics, which might reflect antibiotic overuse in clinical and veterinary medicine. It would be suitable to apply and enforce rules and regulations from the One Health approach, which aim to prevent antibiotic resistance infections, enhance food safety, and improve human and animal health, given that all Salmonella spp. detected in this investigation were exhibiting MDR patterns.
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... However, gastrointestinal complaints (gId) were found to be one of the most typical disorders during Hajj (Khamis, 2008). The occurrence of foodborne diseases comprising food poisoning in Hajj in Saudi Arabia is commonly recognized just after or a certain period after taking the meal (jaralla et al., 1993;Malik et al., 1993;Kurdi, 1995;Al-Awaidy and Fontaine, 1996;gaulin et al., 2002;Al-Mazrou, 2004;Heymann, 2004). The outbreak of food poisoning directly or indirectly relates to food handlers (Angelillo et al., 2000;Maguire et al., 2000). ...
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... Foodborne disease outbreaks (FBDO) are recognized by the illness of individuals usually within a short but variable period of time after a common meal.1 A national policy for reporting, notifying, and recording incidents of bacterial food poisoning in Saudi Arabia was established in 1984.23 Since then, food poisoning outbreaks exhibiting seasonal and regional variations have been reported from different regions of the Kingdom.245 Food poisoning outbreaks associated with mass catering are not rare, and have been reported even from developed countries.6 ...
An outbreak of foodborne diarrheal illness among soldiers in mina during Hajj: The role of consumer food handling behaviors
Article
  • Mar 2007
An investigation of the outbreak was initiated as a result of the number of cases of gastroenteritis reporting to a general hospital in Mina during the pilgrimage to Makkah (HAJJ). This study was conducted to identify the source of the outbreak, assess its extent, and make recommendations to prevent similar outbreaks in the future. A case was defined as any individual who developed diarrhea with or without abdominal pain after eating at the camp in Mina on 3(rd) January 2006. A retrospective cohort study was conducted to identify food items and circumstances responsible for this outbreak. Laboratory tests included stool cultures of all diarrhea patients, and rectal swabs from all food handlers were cultured for enteric pathogens. A total of 50 Saudi Male Soldiers were interviewed. Out of these, 16 (39%) had developed gastroenteritis, most commonly manifested by diarrhea (100%), and abdominal colic (87.5%). The mean incubation period was 12.6 ± 4.9 hours and the epidemic curve suggested a common point source outbreak. Out of three served meals, lunch was found to have a statistically significant association with illness (p=0.0230). Out of five food items served, rice was the only food item found to have a statistically significant association with illness (p=0.0230). No food remnants were found for sampling. All results of stool cultures of all diarrhea patients, and rectal swabs from all food handlers were inconclusive. This outbreak was most likely caused by eating contaminated rice served at lunch on 3(rd) January. The most likely organisms were Bacillus cereus, and/or Clostridium perfringens. Consuming food that was kept at an unsafe temperature wihout being reheated was the most probable important factor leading to this outbreak.
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Antimicrobial resistance and genomic characterization of Salmonella enterica isolates from chicken meat
Article
Full-text available
  • Mar 2023
This study investigated genotypic and phenotypic antimicrobial resistance profiles, phylogenic relatedness, plasmid and virulence composition of 39 Salmonella enterica strains isolated from chicken meat samples using whole genome sequencing (WGS) technology. Four distinct serotypes were identified; Salmonella Minnesota (16/39, 41%), Salmonella Infantis (13/39, 33.3%), Salmonella Enteritidis (9/39, 23.1%), and one isolate was detected for Salmonella Kentucky (1/39, 2.6%), with sequence types (STs) as followed: ST548, ST32, ST11, and ST198, respectively. Phenotypic resistance to tetracycline (91.2%), ampicillin (82.4%), sulfisoxazole (64.7%), and nalidixic acid (61.6%) was the most observed. Resistome analysis revealed the presence of resistance genes to aminoglycosides, β-lactamase, sulfonamides, trimethoprim, phenicol, lincosamide, macrolides, and tetracyclines. Plasmidome showed the presence of eight incompatibility groups, including IncA/C2, IncFIB(K)_1_Kpn3, Col440I_1, IncR, IncX1, IncI1_1_Alpha, IncFIB(S)/IncFII(S), IncHI2/IncHI2A, IncX2 and ColpVC plasmids across the 39 genomes. Three resistance genes, sul2, tetA and blaCMY-2, were predicted to be located on IncA/C2 plasmid in S. Minnesota isolates, whereas all S. Infantis isolates were positive to IncFIB(K)_1_Kpn3 plasmid that carries blaCTX-M-65 gene. Eleven Salmonella pathogenicity islands and up to 131 stress and/or virulence genes were identified in the evaluated genomes. Phylogenetic analysis showed four phylogroups that were consistent with the identified ST profiles with a high level of inter-diversity between isolates. This is the first genomic characterization of Salmonella isolates from retail chicken meat in Saudi Arabia using WGS technology. The availability of Salmonella genomes from multiple geographic locations, including Saudi Arabia, would be highly beneficial in future source-tracking, especially during epidemiological surveillance and outbreak investigations.
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Antimicrobial resistance of gram-negative bacteria in Saudi Arabia
Article
  • Jan 2012
Much of the focus of today's media is directed on multidrug-resistant gram-positive bacteria. However, resistance within gram-negative bacilli continues to rise, occasionally creating situations in which few or no antibiotics that retain activity are available. Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, hospital-and healthcare-associated pneumonias, and various intra-abdominal infections. In Saudi Arabia, among Escherichia coli isolates from outpatients, 50% are resistant to ampicillin, 33% are resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% are resistant to ciprofloxacin. Among isolates from inpatients, 63% of E. coli are resistant to ampicillin, 44% are resistant to TMP-SMZ, and 33% are resistant to ciprofloxacin. Multidrug resistance is detected in 2-28% of outpatient isolates and 7.4-39.6% of inpatient isolates. For Pseudomonas aeruginosa, the resistance rates of outpatient and inpatient isolates to piperacillin, ceftazidime, imipenem, and ciprofloxacin are 4.6% and 11.5%, 2.4% and 10%, 2.6% and 5.8%, and 3% and 6%, respectively. Multi-drug resistance is observed in 1-2% of inpatient isolates. Acinetobacter calcoaceticus-baumannii has high rates of resistance to ampicillin (86%), cefoxitin (89%), and nitrofurantoin (89%). The rate of resistance to imipenem is 3%; to ticarcillin-clavulanic acid, 16.5%; to gentamicin, 26%; and to ceftazidime, 38%. Multidrug resistance is observed in 14%-35.8%. Acinetobacter calcoaceticus-baumannii complex were recovered. The organism showed high rates of resistance to ampicillin (86%), cefoxitin (89%), and nitrofurantoin (89%). The rate of resistance to imipenem was 3%; to ticarcillin-clavulanic acid, 16.5%; to gentamicin, 26%; and to ceftazidime, 38%. Multidrug resistance is observed in 14%-35.8%.
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Epidemiological Typing of Salmonellla enterica Isolates Causing Acute Food Poisoning in Saudi Arabia Based on Plasmid Profiles and Antibiograms
Article
Full-text available
A total of 41 Salmonellla enterica isolates, 23 serotype Typhimurium and 18 serotype Enteritidis isolated in Saudi Arabia were epidemiologically studied. All isolates of both serotypes were resistant to at least one antibiotic of the 15 tested. Multi-drug resistance was prevalent in the majority of isolates of Salmonellla serotype Typhimurium and more than 70% of these isolates were resistant to 6-8 antibiotics. It was possible to recognize 10 resistance patterns. Salmonellla serotype Enteritidis isolates were mostly resistant to streptomycin, neomycin and Sulfamethoxazole and 3 resistant patterns were dtected. Isolates of both serotypes harbored a sero-specific high molecular weight plasmid; 90 kb in Salmonellla serotype Typhimurium and 60 or 65 kb in Salmonellla serotype Enteritidis. In addition in Salmonellla serotype Typhimurium and serotype Enteritidis, 82.6% and 33.3% of the isolates harbored one or more low molecular weight plasmids. It was possible to recognize 7 and 5 plasmid profiles in serotype Typhimurium and Enteritidis respectively. Dice coefficient analysis of plasmids revealed 4 clusters in serotype Typhimurium and 3 clusters in serotype Enteritidis. Cluster A in serotype Typhimurium was more prominent (69.6% of isolates) and cluster E was more prominent in serotype Enteritidis (61.1% of isolates). Isolates of cluster A were further divided into 4 sub-clones and those of cluster E were divided into 2 sub-clones according to their plasmid profiles. When both plasmid profiles and antibiograms were combined the sub-clones were further divided into several new sub-clones. Data obtained suggest that the misuse of antibiotics resulted in the development and the dissemination of new sub-clones of both serotypes in the community. This fact necessitates the control of antibiotic use both in humans and animals.
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Epidemiologic and clinical features of sporadic Salmonella enteric fever
Article
Full-text available
  • Dec 1978
  • Can Med Assoc J
Twenty-seven cases of enteric fever were diagnosed between January 1961 and February 1977 at a medium-sized urban hospital. Nineteen of the patients had recently travelled abroad. Fever was the only constant finding, and four patients noted fever and headache as their only symptoms. Splenomegaly was present in 30% and rose spots in just 11%. Enteric fever was initially suspected in only 63% of cases, and a mean of 4.8 days elapsed after admission before specific therapy was instituted. Salmonella was cultured from blood samples in 19 of 24 patients and from stool specimens in 21 of 27, but was never isolated from the urine. Serum O agglutinins, while eventually present in 54% of the patients tested, did not help in establishing an early diagnosis. No deaths occurred, though two patients sustained relapses. Sporadic enteric fever is unlikely to be suspected unless associated with recent foreign travel, but is easily diagnosed by usual culture methods.
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Acute Diarrheal Disease in Children under Five Years of Age in the Eastern Province of Saudi Arabia
Article
  • May 1990
A follow-up study was conducted in 859 children younger than 5 years who were treated for acute diarrhea at the Diarrhoea Control Center, Dammam, during 1408H (1987-1988). The purpose of the study was to investigate the potential enteropathogens responsible for causing diarrhea among these children. An enteropathogen was isolated from stool samples in 52.6% of the children. Multiple infections were seen in 0.8% of the children. The most common enteropathogens isolated, in descending frequency, were rotavirus, Salmonella, Shigella, and Campylobacter jejuni, followed by enteropathogenic Escherichia coli and nonagglutinating vibrios. Rotavirus infection was accompanied by respiratory infection and fever among 30% of the children. The most common parasite isolated was Giardia lamblia.
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Typhoid fever in Singapore: A review of 370 cases
Article
  • Nov 1991
  • J Trop Med Hyg
The medical records of 370 patients treated for typhoid fever between 1986 and 1988 at the Communicable Disease Centre, Singapore, were reviewed. The disease was generally mild. There was no mortality. Fever was found in 98.4% of patients on admission and diarrhoea in 21%. Cough was predominantly a symptom of children and occurred in 7.1% of patients aged below 15 years. Other symptoms were uncommon. Hepatomegaly was found in 71% and splenomegaly in 47%. Leucopenia was not a helpful diagnostic marker. Chloramphenicol was the drug of choice. The relapse rate was 5.4% and the convalescent and temporary carrier rates 11.6%. The risk of developing the carrier state was significantly higher among patients who were afebrile on admission compared with those who were febrile (P less than 0.001); it was also higher in patients treated with ampicillin as compared to those treated with chloramphenicol (P less than 0.001, chi 2 = 22.7, odds ratio = 5.25, 95% confidence limits: 2.46 and 11.29). The role of ampicillin as a first line treatment for acute typhoid fever may need further re-evaluation.
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Clinical presentation of enteric fever: Its changing pattern in Kuwait
Article
  • Nov 1991
  • J Trop Med Hyg
The clinical experience with enteric fever (1985-89) at a general hospital in Kuwait is presented. There were 90 cases of typhoid and 10 cases of paratyphoid fever, with a mortality rate of 2%. Typhoid complications of bowel perforation, haemorrhage or septic shock were present in 5% and abortion in 2%. Neurological or psychiatric manifestations were a feature in 15%. Most infections were imported (78%). Despite rapid economic development, enteric fever may still be acquired locally but less frequently with time. This contributed to initial diagnostic uncertainty in 18% of cases, and especially in children. Another changing pattern emerged with the recent finding of five drug-resistant Salmonella typhi isolates, two in 1988 and three in 1989. Efforts are clearly needed to diagnose enteric fever more rapidly and to utilize new antibiotics for drug-resistant cases.
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Treatment of typhoid fever with ofloxacin
Article
  • Jun 1989
Ofloxacin, 300 mg 12-hourly, was given orally to 64 patients with typhoid fever, all with positive blood cultures. Almost 80% of the isolates were resistant to chloramphenicol, ampicillin and co-trimoxazole, but sensitive to ofloxacin and norfloxacin. Fever subsided within five days in most patients (mean 3.2 +/- 1.1), rates of clinical effectiveness and bacteriological cure both being 100%. Thirty patients were followed for 1-3 months after the completion of therapy with no occurrence of relapse.
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Chloramphenicol-resistant Salmonella typhi in Durban, South Africa
Article
  • Feb 1987
A retrospective survey was undertaken to determine the incidence of chloramphenicol-resistant Salmonella typhi in Durban, South Africa. Of the 3313 strains tested over a 7 year period 20 (0.6%) showed intermediate resistance to chloramphenicol and 19 (0.6%) were fully resistant. Resistance to chloramphenicol was found to fluctuate over the period studied (0-2%). Resistance to ampicillin/amoxycillin was encountered less frequently (0-0.9%). For the present we would still recommend chloramphenicol or amoxycillin for the initial treatment of typhoid fever in this region.
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Successful Treatment of Typhoid Fever in Children with Parenteral Ceftriaxone
Article
  • Feb 1987
Eight children, seriously ill with bacteriologically proven Salmonella typhi septicemia, were successfully treated with a single daily intramuscular injection of 2 g ceftriaxone given for 5-7 days. All children improved clinically within 48 h of starting therapy and all except 1 became afebrile within 5 days. None relapsed during the 4-week follow-up study.
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Current clinical patterns of typhoid fever: A prospective study
Article
  • Jan 1986
  • J Trop Med Hyg
This paper reports on a prospective study comprising 125 consecutive adult cases of typhoid fever diagnosed on the basis of positive cultures for typhoid organisms. Salmonella typhi infection was found to be more frequent (89.6%) than S. paratyphi A & B (10.4%). Onset of the disease was usually insidious and the classical step-ladder pattern of fever was uncommon (12%). Rose spots were observed in 9.6% cases. Gut perforation was more common, while typhoid toxaemia and peripheral circulatory failure were less frequent than in most of the series reported from India. Both these variations are ascribed to the widespread use of corticosteroids in our patients. Gut perforation alone accounted for three-quarters of the deaths.
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Plasmid-Mediated Resistance to Multiple Antibiotics in Salmonella typhi
Article
  • Mar 1986
Two hundred forty-one strains of Salmonella typhi isolated in Lima, Peru, from October 1981 through February 1983were tested for susceptibility to antimicrobial agents. Seventytwo strains (29.9%) were resistant to chloramphenicol and other antibiotics, including ampicillin, sulfonamides, and trimethoprim. The minimal inhibitory concentrations of 17 antimicrobial agents were determined for all of these chloramphenicol-resistant strains. Sch 25393, new β-lactams, new quinolones, and the formulation clavulanic acid-amoxicillin were effective against all the strains. Four different resistance patterns distributed among eight phage types were observed. The 72 resistant S. typhi could transfer the resistance marker into Escherichia coli ell and all the plasmids belonged to the incompatibility group H1.
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