Abstract
Introduction: Typhoid fever is caused by Salmonella enterica serovar Typhi while Paratyphoid fever is caused by serovar Paratyphi A, B (S.Schottmülleri) or C ( S.Hirschfeldii ). The incidence of these diseases collectively termed enteric fever has reduced dramatically in developed countries but remains endemic in developing countries. Over 25 million cases are still being reported yearly with a higher fatality rate observed among children and the elderly. Although S.Paratyphi B has become dominant recently, S.Paratyphi C infection is rarely reported. This report illustrated the only case of paratyphoid fever in which S.Paratyphi C was isolated by laboratory surveillance in the past decade in Malaysia.
Case Presentation: This is a case of 1 ½-year-old Malay girl residing in Kuala Krai, Kelantan presented with acute febrile illness, cough and seizure. Gram stain of blood sample on admission revealed Gram-negative bacilli later confirmed as Salmonella species . She was treated for Salmonella bacteremia with pneumonia and febrile fit. She responded well to Cefotaxime. The blood sample was further sent to the National Public Health Laboratory (NPHL) for serotyping as part of the National Laboratory Surveillance Program. A month after, the Kelantan State Health Department received the confirmation of S.Paratyphi C isolates from the sample. A local epidemiological investigation resumed immediately. All household contacts were asymptomatic while their stool cultures were negative for Salmonella. The child had no history of contact with animals and rarely played in the surrounding of the house. We identified the likely source of contamination to be the main water supply used for drinking and daily activities originating from a Gravity Feed System (GFS). The child 's residence didn't have the access to a safe water supply. The GFS was poorly maintained and exposed to animals. Several plantations housing immigrants with no proper sewage system were also located nearby. The environmental sampling was positive for Salmonella Orientalis. Discussion & Conclusion: S.Paratyphi C has not been isolated by the NPHL in over ten years. The control measures for typhoid should be equally effective against paratyphoid. However, the finding that this case contracted enteric fever caused by S.Paratyphi C in this country raises the concern about the source of the strain and the manner of transmission in the community. Humans and some animals are the reservoirs and chronic carriers may continue to shed the organism in faeces, but it may survive in the environment for an extended period. However, the transmission is considered to be mostly indirect and predominantly vehicle-borne through contaminated water and food mediated by inadequate hygiene and sanitation. How the source is contaminated may vary, suggesting the importance of local epidemiologic investigation for control and preventive measures. Safe water, sanitation and hygiene (WASH) interventions remain critical in preventing the spread of enteric fever and other diarrheal diseases. The role of migrants in spreading diseases and altering the disease prevalence in a given geographical area must be addressed. Continuous monitoring of infectious disease patterns via laboratory surveillance is important to detect the changes in the epidemiology of enteric fever in this country.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-7.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-7,
title = {A Rare Salmonella Enterica Serovar Paratyphi C Infection in a Febrile Child in Kelantan, Malaysia - A Case Report},
author = {Hazlienor Mohd Hatta and Nik Mohd Hafiz Mohd Fuzi and Hasneezah Hassan and Mimi Rodzaimah Abd Karim and Nor Zahrin Hasran},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-7.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/APCPH2022-P-7-Poster-Submission-a556295040e5cf140826db4886fcb1a5.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: Typhoid fever is caused by Salmonella enterica serovar Typhi while Paratyphoid fever is caused by serovar Paratyphi A, B (S.Schottm\"{u}lleri) or C ( S.Hirschfeldii ). The incidence of these diseases collectively termed enteric fever has reduced dramatically in developed countries but remains endemic in developing countries. Over 25 million cases are still being reported yearly with a higher fatality rate observed among children and the elderly. Although S.Paratyphi B has become dominant recently, S.Paratyphi C infection is rarely reported. This report illustrated the only case of paratyphoid fever in which S.Paratyphi C was isolated by laboratory surveillance in the past decade in Malaysia.
Case Presentation: This is a case of 1 ½-year-old Malay girl residing in Kuala Krai, Kelantan presented with acute febrile illness, cough and seizure. Gram stain of blood sample on admission revealed Gram-negative bacilli later confirmed as Salmonella species . She was treated for Salmonella bacteremia with pneumonia and febrile fit. She responded well to Cefotaxime. The blood sample was further sent to the National Public Health Laboratory (NPHL) for serotyping as part of the National Laboratory Surveillance Program. A month after, the Kelantan State Health Department received the confirmation of S.Paratyphi C isolates from the sample. A local epidemiological investigation resumed immediately. All household contacts were asymptomatic while their stool cultures were negative for Salmonella. The child had no history of contact with animals and rarely played in the surrounding of the house. We identified the likely source of contamination to be the main water supply used for drinking and daily activities originating from a Gravity Feed System (GFS). The child 's residence didn't have the access to a safe water supply. The GFS was poorly maintained and exposed to animals. Several plantations housing immigrants with no proper sewage system were also located nearby. The environmental sampling was positive for Salmonella Orientalis. Discussion \& Conclusion: S.Paratyphi C has not been isolated by the NPHL in over ten years. The control measures for typhoid should be equally effective against paratyphoid. However, the finding that this case contracted enteric fever caused by S.Paratyphi C in this country raises the concern about the source of the strain and the manner of transmission in the community. Humans and some animals are the reservoirs and chronic carriers may continue to shed the organism in faeces, but it may survive in the environment for an extended period. However, the transmission is considered to be mostly indirect and predominantly vehicle-borne through contaminated water and food mediated by inadequate hygiene and sanitation. How the source is contaminated may vary, suggesting the importance of local epidemiologic investigation for control and preventive measures. Safe water, sanitation and hygiene (WASH) interventions remain critical in preventing the spread of enteric fever and other diarrheal diseases. The role of migrants in spreading diseases and altering the disease prevalence in a given geographical area must be addressed. Continuous monitoring of infectious disease patterns via laboratory surveillance is important to detect the changes in the epidemiology of enteric fever in this country.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Communicable Disease Control Unit, Kelantan State Health Department, Ministry of Health Malaysia; Kuala Krai District Health Office, Kelantan State Health Department, Ministry of Health Malaysia; National Public Health Laboratory, Ministry of Health Malaysia},
keywords = {Enteric fever, Paratyphi C, Paratyphoid},
pubstate = {published},
tppubtype = {proceedings}
}