CoChat
Sign Up
Cited by 167Salmonella and Campylobacter epidemiologyAntibiotic Resistance in BacteriaBacterial Infections and Vaccines

Rapid Emergence of Multidrug Resistant, H58-Lineage Salmonella Typhi in Blantyre, Malawi

Open access
Feasey, Nicholas A., Gaskell, Katherine, Wong, Vanessa, Msefula, Chisomo, Selemani, George, Kumwenda, Save, Allain, Theresa J., Mallewa, Jane +9 more·2015·PLOS Neglected Tropical Diseases
DOI 10.1371/journal.pntd.0003748PMC PMC4409211
Open this paper in CoChat — free accountOpen PDF

Abstract

INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH). METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context. RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi. CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1371/journal.pntd.0003748

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In the past two decades, multidrug-resistant Salmonella Typhi has emerged and spread throughout the sub-Saharan Africa region.

    “in the past two decades, multidrug-resistant (defined as resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol) S. Typhi has emerged and spread throughout the region.”

    From Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? (2022) · cites this paper as [67]

    The Discussion reports that multidrug-resistant S. Typhi increased in Blantyre beginning in 2011 and notes recent typhoid outbreaks in Eastern and Southern Africa. It does not establish that multidrug-resistant S. Typhi spread throughout sub-Saharan Africa over the past two decades; the Introduction says antimicrobial-resistance surveillance data for the region are sparse. Our copy provides no page numbers for these passages. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 32

  1. [1]Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012; 2(1): 010401 Epub 2012/12/01. 10.7189/jogh.02.010401 23198130 PMC3484760 · DOI
  2. [2]Peters RP, Zijlstra EE, Schijffelen MJ, Walsh AL, Joaki G, Kumwenda JJ, et al A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management. Trop Med Int Health. 2004; 9(8): 928– 34. Epub 2004/08/12. doi: 10.1111/j.1365-3156.2004.01288.xTMI1288 [pii].. 15304000 · DOI
  3. [3]Mweu E, English M. Typhoid fever in children in Africa. Trop Med Int Health. 2008; 13(4): 532– 40. Epub 2008/03/04. doi: TMI2031 [pii] 10.1111/j.1365-3156.2008.02031.x. 10.1111/j.1365-3156.2008.02031.x 18312473 PMC2660514 · DOI
  4. [4]Reddy EA, Shaw AV, Crump JA. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010; 10(6): 417– 32. Epub 2010/06/01. S1473-3099(10)70072-4 [pii]10.1016/S1473-3099(10)70072-4. 10.1016/S1473-3099(10)70072-4 20510282 PMC3168734 · DOI
  5. [5]Gordon MA, Graham SM, Walsh AL, Wilson L, Phiri A, Molyneux E, et al Epidemics of invasive Salmonella enterica serovar enteritidis and S. enterica Serovar typhimurium infection associated with multidrug resistance among adults and children in Malawi. Clin Infect Dis. 2008; 46(7): 963– 9. Epub 2008/05/01. 10.1086/529146. 18444810 · DOI
  6. [6]Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002; 347(22): 1770– 82. Epub 2002/11/29. doi: 10.1056/NEJMra020201347/22/1770 [pii].. 12456854 · DOI
  7. [7]Parkhill J, Dougan G, James KD, Thomson NR, Pickard D, Wain J, et al Complete genome sequence of a multiple drug resistant Salmonella enterica serovar Typhi CT18. Nature. 2001; 413(6858): 848– 52. Epub 2001/10/26. doi: 10.1038/3510160735101607 [pii].. 11677608 · DOI
  8. [8]Wain J, Hoa NT, Chinh NT, Vinh H, Everett MJ, Diep TS, et al Quinolone-resistant Salmonella typhi in Viet Nam: molecular basis of resistance and clinical response to treatment. Clin Infect Dis. 1997; 25(6): 1404– 10. Epub 1998/02/07.. 9431387
  9. [9]Gordon MA, Walsh AL, Chaponda M, Soko D, Mbvwinji M, Molyneux ME, et al Bacteraemia and mortality among adult medical admissions in Malawi—predominance of non-typhi salmonellae and Streptococcus pneumoniae. J Infect. 2001; 42(1): 44– 9. Epub 2001/03/13. doi: 10.1053/jinf.2000.0779S0163-4453(00)90779-5 [pii].. 11243753 · DOI
  10. [10]Barrow G FR. Cowan and Steele’s manual for the identification of medical bacteria. Cambridge, UK: Cambridge University Press; 1993.
  11. [11]Kauffmann F. Kauffmann-White scheme. J Hyg. 1934; 34: 333– 50. 20475239
  12. [12]Mtunthama N, Gordon SB, Kusimbwe T, Zijlstra EE, Molyneux ME, French N. Blood culture collection technique and pneumococcal surveillance in Malawi during the four year period 2003–2006: an observational study. BMC Infect Dis. 2008; 8: 137 Epub 2008/10/16. 10.1186/1471-2334-8-137 18854024 PMC2576305 · DOI
  13. [14]Roumagnac P, Weill FX, Dolecek C, Baker S, Brisse S, Chinh NT, et al Evolutionary history of Salmonella typhi. Science. 2006; 314(5803): 1301– 4. Epub 2006/11/25. doi: 314/5803/1301 [pii]0.1126/science.1134933. 17124322 PMC2652035
  14. [15]Holt KE, Parkhill J, Mazzoni CJ, Roumagnac P, Weill FX, Goodhead I, et al High-throughput sequencing provides insights into genome variation and evolution in Salmonella Typhi. Nat Genet. 2008; 40(8): 987– 93. Epub 2008/07/29. ng.195 [pii]10.1038/ng.195. 10.1038/ng.195 18660809 PMC2652037 · DOI
  15. [16]Harris SR, Cartwright EJ, Torok ME, Holden MT, Brown NM, Ogilvy-Stuart AL, et al Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study. Lancet Infect Dis. 2013; 13(2): 130– 6. Epub 2012/11/20. 10.1016/S1473-3099(12)70268-2 23158674 PMC3556525 · DOI
  16. [17]Croucher NJ, Harris SR, Fraser C, Quail MA, Burton J, van der Linden M, et al Rapid pneumococcal evolution in response to clinical interventions. Science. 2011; 331(6016): 430– 4. Epub 2011/01/29. 331/6016/430 [pii]10.1126/science.1198545. 10.1126/science.1198545 21273480 PMC3648787 · DOI
  17. [18]Stamatakis A. RAxML-VI-HPC: maximum likelihood-based phylogenetic analyses with thousands of taxa and mixed models. Bioinformatics. 2006; 22(21): 2688– 90. Epub 2006/08/25. 10.1093/bioinformatics/btl446. 16928733 · DOI · Paper page
  18. [19]Sejvar J, Lutterloh E, Naiene J, Likaka A, Manda R, Nygren B, et al Neurologic manifestations associated with an outbreak of typhoid fever, Malawi—Mozambique, 2009: an epidemiologic investigation. PLoS One. 2012; 7(12): e46099 Epub 2012/12/12. 10.1371/journal.pone.0046099 23226492 PMC3513310 · DOI
  19. [20]Feasey NA, Houston A, Mukaka M, Komrower D, Mwalukomo T, Tenthani L, et al A reduction in adult blood stream infection and case fatality at a large African hospital following antiretroviral therapy roll-out. PLoS One. 2014; 9(3): e92226 Epub 2014/03/20. 10.1371/journal.pone.0092226 24643091 PMC3958486 · DOI
  20. [21]Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS, et al Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. Clin Infect Dis. 2012; 54(8): 1100– 6. Epub 2012/02/24. 10.1093/cid/cis012.22357702 22357702 · DOI
  21. [22]Hendriksen RS, Leekitcharoenphon P, Lukjancenko O, Lukwesa-Musyani C, Tambatamba B, Mwaba J, et al Genomic signature of multidrug-resistant Salmonella enterica serovar typhi isolates related to a massive outbreak in Zambia between 2010 and 2012. J Clin Microbiol. 2015; 53(1): 262– 72. Epub 2014/11/14. 10.1128/JCM.02026-14 25392358 PMC4290967 · DOI · Paper page
  22. [23]Imanishi M, Kweza PF, Slayton RB, Urayai T, Ziro O, Mushayi W, et al Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe. Am J Trop Med Hyg. 2014; 90(5): 945– 54. Epub 2014/03/26. 10.4269/ajtmh.13-0497 24664784 PMC4015591 · DOI
  23. [24]Neil KP, Sodha SV, Lukwago L, S OT, Mikoleit M, Simington SD, et al A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008–2009. Clin Infect Dis. 2012; 54(8): 1091– 9. Epub 2012/02/24. 10.1093/cid/cis025. 22357703 · DOI
  24. [25]Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon MA. Invasive non-typhoidal salmonella disease: an emerging and neglected tropical disease in Africa. Lancet. 2012; 379(9835): 2489– 99. Epub 2012/05/17. 10.1016/S0140-6736(11)61752-2 22587967 PMC3402672 · DOI
  25. [26]Biggs HM, Lester R, Nadjm B, Mtove G, Todd JE, Kinabo GD, et al Invasive Salmonella infections in areas of high and low malaria transmission intensity in Tanzania. Clin Infect Dis. 2014; 58(5): 638– 47. Epub 2013/12/18. 10.1093/cid/cit798 24336909 PMC3922215 · DOI
  26. [27]Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, et al Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis. 2011; 52(3): 341– 8. Epub 2011/01/11. ciq103 [pii]10.1093/cid/ciq103. 10.1093/cid/ciq103 21217181 PMC3106248 · DOI
  27. [28]Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health. 2001; 6(6): 484– 90. Epub 2001/06/26.. 11422963
  28. [29]Tarr PE, Kuppens L, Jones TC, Ivanoff B, Aparin PG, Heymann DL. Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan. Am J Trop Med Hyg. 1999; 61(1): 163– 70. Epub 1999/08/04.. 10432074
  29. [30]Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, et al Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health. 2014; 2(11): e645– 53. Epub 2014/12/03. 10.1016/S2214-109X(14)70307-9. 25442689 · DOI · Paper page
  30. [31]Kumwenda S TM, Kalulu K., Kamabala C. Determination of Physical and Chemical pollutants in Mudi River in Malawi Journal of Basic and Applied Scientific Research. 2012; 2(7): 6833– 9.
  31. [32]Kumwenda CM S., Kadewa W., Ngwira B. and Morse T.. Is manure from ecological sanitation latrines safe for use as fertilizer in agricultural fields? A review of evidence from literature. 2014 37th WEDC International Conference; Hanoi, Vietnam.
  32. [35]Parry CM, Thuy CT, Dongol S, Karkey A, Vinh H, Chinh NT, et al Suitable disk antimicrobial susceptibility breakpoints defining Salmonella enterica serovar Typhi isolates with reduced susceptibility to fluoroquinolones. Antimicrob Agents Chemother. 2010; 54(12): 5201– 8. Epub 2010/09/15. 10.1128/AAC.00963-10 20837759 PMC2981260 · DOI

Cited by

Sorted by citations

Authors
Feasey, N. A., Gaskell, K., Wong, V., Msefula, C., Selemani, G., Kumwenda, S., Allain, T. J., Mallewa, J., Kennedy, N., Bennett, A., Nyirongo, J. O., Nyondo, P. A., Zulu, M. D., Parkhill, J., Dougan, G., Gordon, M. A., & Heyderman, R. S.
Affiliations
  • University of Malawi (MW)
  • Wellcome Sanger Institute (GB)
  • Malawi University of Business and Applied Sciences (MW)
  • University of Liverpool (GB)
Corresponding author
Feasey, Nicholas A.
ORCID
Venue
PLOS Neglected Tropical Diseases
Publisher
Public Library of Science (PLoS)
Published
2015-04-24
Volume
9
Issue
4
Pages
e0003748
ISSN
  • 1935-2727 (ISSN-L)
  • 1935-2735
DOI
10.1371/journal.pntd.0003748
PMC
PMC4409211
OpenAlex
W2046418337
Cited by
167
References
0
Citations by year
2026: 4 · 2025: 6 · 2024: 21 · 2023: 21 · 2022: 13 · 2021: 19 · 2020: 28 · 2019: 15 · 2018: 15 · 2017: 7 · 2016: 12 · 2015: 6
FWCI
17.80
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS neglected tropical diseases (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (publishedVersion, cc-by)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Greater South Information System
Funders
  • Wellcome Trust (101113, 101113/Z/13/Z084, 100890, WT092152MA, 101113/Z/13/Z, 098051)
  • National Institute for Health and Care Research (ACF-2014-20-001)
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
Salmonella typhi, typhoid fever, multidrug resistance, bloodstream infection, phylogenetic analysis, molecular epidemiology, case fatality, HIV coinfection, Blantyre, Malawi, Eastern and Southern Africa
MeSH terms
Adolescent, Adult, Base Sequence, Child, Female, Humans, Malawi, Male, Molecular Sequence Data, Phylogeny, Retrospective Studies, Salmonella typhi, Typhoid Fever, Incidence, Prevalence, Sequence Analysis, DNA, Drug Resistance, Multiple, Bacterial

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review