Title: Repeated Outbreaks of Paratyphoid Fever– An Ongoing Threat in North Kerala

Authors: Pushpa Kizhakkekarammel, Ajithkumar V T, Rekha Rachel Philip, Geetha Raveendran

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.65

Abstract

Two major episodes of Salmonella Paratyphi A outbreaks had occurred in different localities of a same Muncipality panchayath following wedding feasts- the first episode in April 2016 and the second one in January 2017. Patients presented with fever and abdominal discomfort, 10-14 days after the suspected exposure.

Objective: To identify the magnitude and source of two different food borne outbreaks of Salmonella Pparatyphi A.

Methods: A team from the local tertiary care centre which included personnel from Departments of Microbiology, Community Medicine and Paediatrics had visited the places, conducted medical camps and field visits.  Blood samples were collected from symptomatic patients for culture and serological tests. Stool samples were subjected to culture. Drinking water sources and food samples were collected for microbiological analysis.

Results: Blood cultures yielded Salmonella Paratyphi A in 5 out of 34 patients during the first episode and 7 out of 59 patients in the second episode. The isolates were sensitive to Ampicillin, Ceftriaxone, Ciprofloxacin and Chloramphenicol. Significant levels of Salmonella Paratyphi A antibody were demonstrated in 53% (18/34) and 27% (18/59) of patients during first and second episodes respectively. Stool cultures and environment samples were negative for Salmonella species.

Conclusion: All identified patients were treated with Ceftriaxone or Ciprofloxacin for 2 weeks and no relapse was noted. Intensive health awareness programs were conducted all over the panchayath, along with chlorination of drinking water sources and health education. Salmonella Paratyphi A infection, which was once thought to be rare compared to Salmonella Typhi enteric fever, is being reported more frequently associated with outbreaks.

Keywords: Paratyphoid fever, Widal test.

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Corresponding Author

Pushpa Kizhakkekarammel

Departments of Microbiology,

Government Medical College Manjeri