Cases of typhoid fever imported into England, Scotland and Wales (2000-2003).

Although typhoid fever is no longer endemic in most of the developed world, it remains a major infectious disease in less developed regions and imported cases continue to occur in returning travellers, immigrants or migrant workers. We analysed all 692 isolates of Salmonella enterica subspecies enterica serovar Typhi from cases in England, Scotland and Wales that were sent to the Laboratory of Enteric Pathogens at the Health Protection Agency, Centre for Infections, London, UK between 2000 and 2003. The country of acquisition was known for 416 isolates (60%), and the majority of these (70%) came from India or Pakistan. Overall, 24 countries were listed, mainly in Asia and Africa. A total of 48 phage types were detected, 41% of which were Vi-phage type E1. Antimicrobial susceptibility testing revealed that 22% of isolates were multidrug resistant (MDR) (defined as resistance to chloramphenicol, ampicillin and co-trimoxazole) and 39% were quinolone resistant. A significant number of isolates (n=49) were sensitive to nalidixic acid by disk test but exhibited low-level ciprofloxacin resistance, suggesting a novel mechanism of resistance and reinforcing the need for minimum inhibitory concentration determination. Overall, 13% of isolates were both MDR and likely to show a poor response to a fluoroquinolone. A third-generation cephalosporin (e.g. ceftriaxone) should be considered as empirical therapy in regions of the Indian subcontinent where resistance is now at high levels as well as in patients returning from these areas. This study helps to describe the epidemiology of antimicrobial drug resistance in typhoid fever.

AFLP analysis of Salmonella enterica serovar Typhimurium isolates of phage types DT 9 and DT 135: diversity within phage types and its epidemiological significance.

Amplified fragment length polymorphism (AFLP) was applied to 35 and 34 isolates, respectively, of Salmonella enterica serovar Typhimurium phage types DT 9 and DT 135, using eight primer pair combinations. Eight and 17 AFLP types were observed in DT 9 and DT 135, respectively. DT 9 is rare in the UK and common in Australia, but one AFLP form dominated with 28 isolates, comprising 22 of 25 UK isolates, four of five Australian isolates, one Jamaican and one Spanish isolate. Of the others, two UK isolates are closely related to the major form, two from elsewhere are in the major cluster and three isolates from different countries are in a separate cluster. For DT 135, two closely related AFLP types of seven and 11 isolates form the major cluster, which also includes 11 isolates, mostly in single-isolate AFLP types, while five isolates from different countries form a well-separated minor cluster. For both DTs all isolates are grouped together if only the phage type specific bands identified earlier are used, confirming their value for molecular-based 'phage typing'. Polymorphic markers identified in this study could also be used for subtyping within both phage types. The value of AFLP is in locating DNA fragments useful for typing, but implementation of a replacement typing scheme would probably involve multiplex PCR or microarray technologies.

Role of electronic data exchange in an international outbreak caused by Salmonella enterica serotype Typhimurium DT204b.

From July through September 2000, patients in five European countries were infected with a multidrug-resistant strain of Salmonella Typhimurium DT204b. Epidemiologic investigations were facilitated by the transmission of electronic images (Tagged Image Files) of pulsed-field gel electrophoresis profiles. This investigation highlights the importance of standardized protocols for molecular typing in international outbreaks of foodborne disease.

Multiply resistant (MR) Salmonella enterica serotype Typhimurium DT 12 and DT 120: a case of MR DT 104 in disguise?

Multiresistant Salmonella enterica serotype Typhimurium definitive phage type (DT) 12 and DT 120 are more closely related to DT 104 than to non-multiresistant strains of their respective phage types. Multiresistant DT 12 and DT 120 appear to have arisen due to changes in phage susceptibility of DT 104 rather than horizontal transfer of resistance genes.

Resistance to ciprofloxacin in non-typhoidal salmonellas from humans in England and Wales-the current situation.

OBJECTIVE: To report on the prevalence of isolates with ciprofloxacin resistance in non-typhoidal salmonellas from humans in England and Wales in 1997. METHODS: All non-typhoidal salmonellas referred to the Laboratory of Enteric Pathogens in 1997 were screened for resistance to ciprofloxacin at 0.125 and 1.0 mg/L and nalidixic acid at 16 mg/L, and results were compared to those for 1994. Full minimal inhibitory concentrations (MICs) of these antimicrobials were also determined for a selection of isolates resistant to ciprofloxacin at 0.125 mg/L but sensitive at 1.0 mg/L, and for all isolates resistant at 1.0 mg/L. RESULTS: Since 1994 there have been increases in the occurrence of resistance to ciprofloxacin (MICs: 0.25-1.0 mg/L) in Salmonella enterica serotypes Enteritidis, Typhimurium, Virchow and Hadar. Of particular importance have been increases in the occurrence of resistance in multiresistant S. Typhimurium DT 104, and also in S. virchow, a serotype with a propensity for causing extraintestinal infections in humans. High-level resistance (MIC >/=2.0 mg/L) was uncommon and was identified in only a few strains, all from patients with a history of recent foreign travel. CONCLUSIONS: There is a strong temporal association between increases in the occurrence of ciprofloxacin resistance in Salmonella serotypes Typhimurium, Virchow and Hadar from humans in England and Wales and with the licensing for use in food animals in the UK of the related fluoroquinolone antibiotic enrofloxacin; in contrast, for S. enteritidis ciprofloxacin resistance was most common in a phage type associated with foreign travel. It is hoped that recent recommendations for the use of fluoroquinolone antimicrobials in food animals in the UK will result in a reduction in the occurrence of resistance to ciprofloxacin in zoonotic salmonellas causing infections in humans.