Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes
Abstract Background India is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors. Blood culture surveillance was conducted at St. John’s Medical College Hospital, Bangalore, between July...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41182-020-00247-2 |
| _version_ | 1818656877013106688 |
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| author | Carl D. Britto Sitarah Mathias Ashish Bosco Zoe A. Dyson Gordon Dougan Savitha Raveendran V. L. Abin Sanju Jose Savitha Nagaraj Kathryn E. Holt Andrew J. Pollard |
| author_facet | Carl D. Britto Sitarah Mathias Ashish Bosco Zoe A. Dyson Gordon Dougan Savitha Raveendran V. L. Abin Sanju Jose Savitha Nagaraj Kathryn E. Holt Andrew J. Pollard |
| author_sort | Carl D. Britto |
| collection | DOAJ |
| description | Abstract Background India is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors. Blood culture surveillance was conducted at St. John’s Medical College Hospital, Bangalore, between July 2016 and June 2017. Clinical, laboratory and demographic data were collected from each case, and bacterial isolates were subjected to whole genome sequencing. Comparative analysis between adults and paediatric patients was carried out to ascertain differences between adult and paediatric disease. Results Among the 113 cases of blood culture-confirmed enteric fever, young adults (16–30 years) and children < 15 years accounted for 47% and 37% of cases, respectively. Anaemia on presentation was seen in 46% of cases, and 19% had an abnormal leucocyte count on presentation. The majority received treatment as inpatients (70%), and among these, adults had a significantly longer duration of admission when compared with children (p = 0.002). There were atypical presentations including arthritis, acute haemolysis and a case of repeated typhoid infection with two separate S. Typhi genotypes. There was no association between infecting genotype/serovar and treatment status (outpatient vs inpatient), month of isolation, duration of admission, patient age (adult or child), antimicrobial susceptibility, Widal positivity or haematologic parameters. Conclusions Amidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors. Robust clinical surveillance as well monitoring of pathogen population structure is required to inform treatment and preventive strategies. |
| first_indexed | 2024-12-17T03:32:33Z |
| format | Article |
| id | doaj.art-e6ac352481d847ef934026ce21bd5c92 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-12-17T03:32:33Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-e6ac352481d847ef934026ce21bd5c922022-12-21T22:05:13ZengBMCTropical Medicine and Health1349-41472020-07-014811710.1186/s41182-020-00247-2Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypesCarl D. Britto0Sitarah Mathias1Ashish Bosco2Zoe A. Dyson3Gordon Dougan4Savitha Raveendran5V. L. Abin6Sanju Jose7Savitha Nagaraj8Kathryn E. Holt9Andrew J. Pollard10Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research CentreSt. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research InstituteSt. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research InstituteDepartment of Infectious Diseases, Central Clinical School, Monash UniversityDepartment of Medicine, University of CambridgeDepartment of Infectious Diseases, Central Clinical School, Monash UniversityDepartment of Infectious Diseases, Central Clinical School, Monash UniversityDepartment of Infectious Diseases, Central Clinical School, Monash UniversityDepartment of Infectious Diseases, Central Clinical School, Monash UniversityDepartment of Infectious Diseases, Central Clinical School, Monash UniversityOxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research CentreAbstract Background India is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors. Blood culture surveillance was conducted at St. John’s Medical College Hospital, Bangalore, between July 2016 and June 2017. Clinical, laboratory and demographic data were collected from each case, and bacterial isolates were subjected to whole genome sequencing. Comparative analysis between adults and paediatric patients was carried out to ascertain differences between adult and paediatric disease. Results Among the 113 cases of blood culture-confirmed enteric fever, young adults (16–30 years) and children < 15 years accounted for 47% and 37% of cases, respectively. Anaemia on presentation was seen in 46% of cases, and 19% had an abnormal leucocyte count on presentation. The majority received treatment as inpatients (70%), and among these, adults had a significantly longer duration of admission when compared with children (p = 0.002). There were atypical presentations including arthritis, acute haemolysis and a case of repeated typhoid infection with two separate S. Typhi genotypes. There was no association between infecting genotype/serovar and treatment status (outpatient vs inpatient), month of isolation, duration of admission, patient age (adult or child), antimicrobial susceptibility, Widal positivity or haematologic parameters. Conclusions Amidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors. Robust clinical surveillance as well monitoring of pathogen population structure is required to inform treatment and preventive strategies.http://link.springer.com/article/10.1186/s41182-020-00247-2Enteric feverTyphiParatyphiClinical featuresH58India |
| spellingShingle | Carl D. Britto Sitarah Mathias Ashish Bosco Zoe A. Dyson Gordon Dougan Savitha Raveendran V. L. Abin Sanju Jose Savitha Nagaraj Kathryn E. Holt Andrew J. Pollard Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes Tropical Medicine and Health Enteric fever Typhi Paratyphi Clinical features H58 India |
| title | Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| title_full | Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| title_fullStr | Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| title_full_unstemmed | Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| title_short | Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| title_sort | pathogen genomic surveillance of typhoidal salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes |
| topic | Enteric fever Typhi Paratyphi Clinical features H58 India |
| url | http://link.springer.com/article/10.1186/s41182-020-00247-2 |
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