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Sinha, S., Sengupta, U., Ramu, G. & Ivanyi, J. (1985). Serological survey of leprosy and control subjects by a monoclonal antibody based immunoassay. International

Journal of Leprosy, 53, 33-38. Sinha, S., McEntegart, A., Girdhar, B. K., Bhatia, A. S. & Sengupta, U. (1989). Appraisal of two Mycobacterium leprae specific serological assays for monitoring chemotherapy in iepromatous (LLIBL) leprosy patients. Zntemational Journal of Leprosy, 57, 24-32. WHO (1982). Chemotherapy of Leprosy for Control Programmes. Geneva: World Health Organization, Technical Report Series, no. 675. WHO (1988). Leprosy. Geneva: World Health Organization, Technical Report Series, no. 768.

Received 20 September 1990; acceptedfor publication 25 October 1990

TRANSACTIONS OF THE ROYAL. SOCIETY OF TROPICAL.MEDICINE AND HVCENE (1991) 85, 302

1 Short Report 1 Outbreak of typhoid fever due to multiresistant Salmonella typhi in northern India-a preliminary report Archana Ayyagari and Nibedita Pal Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India

Typhoid fever causedby Salmonella typhi continues to be a common endemic illness in developing countries. Outbreaks of infection due to S. typhi resistant to chloramphenicoi, ampicillin, or co-trimoxazole have been reported (PANIKAR & VIMLA, 1972; WARD et al., 1982). Recovery of S. typhi resistant to all 3 antibiotics, though quite rare, has been reported recently (SCHWALBE et al., 1990; GUPTA et al., 1990). We here report an outbreak of typhoid fever due to multiresistant S. typhi in a north Indian hospital during April-July 1990. Thirty-four patients (19 adults, 15 children) of 62 positive by blood culture were infected with multiresistant S. typhi (resistant to chloramphenicoll0 pg/disc, co-trimoxazole 26 @ disc and amoxycillin 10 pg/disc; the minimum inhibitory concentrations of all 3 antibiotics were >1024 @ml. All the strains were sensitive to ciprofloxacin and cefotaxime. The overall complication rate was 79.4% (Table), compared to 13%aspreviously reported (PATHANIA & SACHAR, 1965). The cases

Table. Incidence of complications in 34 cases of typhoid fever due to multiresistant Salmonella typhi

No. of cases Complications Gastrointestinal bleeding/perforation 15 (44.1%) 7 (20.6%) Encephalopathy Infective endarteritis Pneumonia i (2.9%j Haematuria 1 (2.9%) DeXh 27 (79.4%) Total came from various parts of northern India and had a range of socio-economic backgrounds. References

Gupta, p. .L., Bhujwala, R. 4. . & Shriniwas (1990). $%$nreststant Salmonella typht III In&a. Lame& 336, Panika;, C. K. & Vimala, K. N. (1972). Transferable chloramphenicol resistance in Salmonelk ryphi. Nature, 239, lO%llO. Pathania, N. S. & Sachar, R. S. (1965). Typhoid and paraqphoid fevers in Punjab, India. A study of 30 cases. ~~m~2~Journul

of Tropical Medicine and Hygene, 14,

SchGalbe, R. S., Hoge, C. W., Morris, J. G., Hanlon, P. N., Crawford, R. A. & Gilligan, P. H. (1990). In vivo selection for transmissible drug resistance in Salmonella typhi during antimicrobial therapy. Antimicrobial Agents and Chemotherapy, 34, 161-163.

Ward, J. R., Rowe, R. & Threlfall, E. J. (1982). Incidence of trimethoprim resistance in salmonellae isolated in Britain: a twelve year study. Lancet, ii, 705-706. Received 16 October 1990; accepted for publication 7 November 1990

Outbreak of typhoid fever due to multiresistant Salmonella typhi in northern India--a preliminary report.

302 Theuvenet, W. J. & Adiga, R. B. (1990a). Heterogeneity of serological responses in paucibacillary leprosy. Differential responsesto protein and ca...
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