Treatment of Chronic Carriers of Salmonella typhi and Salmonella paratyphi B with Trimethoprim-Sulfamethoxazole

Pichler, H; Knothe, H; Spitzy, K. H.; Vielkind, G.

doi:10.1093/infdis/128.supplement_3.s743

Cited by 20 publications

(5 citation statements)

References 3 publications

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“…The choice of antimicrobial depends on the susceptibility of the strain. Ampicillin or amoxicillin, sometimes combined with probenecid, trimethoprim-sulfamethoxazole, and fluoroquinolones have been used with some success (583)(584)(585)(586)(587)(588)(589)(590)(591). Cholecystectomy can be considered if antimicrobials fail, but the surgery can carry risks, and there should be additional indications for operation.…”

Section: Treatment Of Chronic Carriagementioning

confidence: 99%

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

et al. 2015

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SUMMARY Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica , initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.

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Section: Treatment Of Chronic Carriagementioning

confidence: 99%

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

et al. 2015

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“…S. paratyphi B can cause chronic infections by persisting in the gallbladder for many years [37], [38]. The ability of the related S. typhi to form biofilms on cholesterol-coated gallstones is believed to facilitate colonization of the gallbladder [39]–[41].…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, bacteria harboring the pmrA ( E211 ) allele exhibited enhanced biofilm formation on cholesterol-coated surfaces (Figure 7), which constitutes an in vitro model that mimics bacterial attachment to the surfaces of human gallstones [45]. This property may promote S. paratyphi B's survival in the gallbladder lumen, where it establishes chronic infection [37], [38], [40], [46]. Such fitness benefits might contribute to the maintenance of the pmrA ( E211 ) allele in S. paratyphi B natural populations (Figure S1A).…”

Section: Discussionmentioning

confidence: 99%

An Allele of an Ancestral Transcription Factor Dependent on a Horizontally Acquired Gene Product

2012

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Changes in gene regulatory circuits often give rise to phenotypic differences among closely related organisms. In bacteria, these changes can result from alterations in the ancestral genome and/or be brought about by genes acquired by horizontal transfer. Here, we identify an allele of the ancestral transcription factor PmrA that requires the horizontally acquired pmrD gene product to promote gene expression. We determined that a single amino acid difference between the PmrA proteins from the human adapted Salmonella enterica serovar Paratyphi B and the broad host range S. enterica serovar Typhimurium rendered transcription of PmrA-activated genes dependent on the PmrD protein in the former but not the latter serovar. Bacteria harboring the serovar Typhimurium allele exhibited polymyxin B resistance under PmrA- or under PmrA- and PmrD-inducing conditions. By contrast, isogenic strains with the serovar Paratyphi B allele displayed PmrA-regulated polymyxin B resistance only when experiencing activating conditions for both PmrA and PmrD. We establish that the two PmrA orthologs display quantitative differences in several biochemical properties. Strains harboring the serovar Paratyphi B allele showed enhanced biofilm formation, a property that might promote serovar Paratyphi B's chronic infection of the gallbladder. Our findings illustrate how subtle differences in ancestral genes can impact the ability of horizontally acquired genes to confer new properties.

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“…Later, the administration of sulfonamides, alone or in combination with cholecystectomy, and antibiotics (also with or without cholecystecto my) was recommended, chiefly penicillin and its derivatives as well as chloramphenicol, tetracycline, streptomycin, neomycin, and kanamycin [2-6, 10, 11, 14, 21-33, 35, 36, 38, 47, 49, 50, 52-56]. Combinations were sporadically applied, more recently mainly trimethoprimsulfamethoxazole preparations, such as Bactrim and Eusaprim (in table I-III and further in this presentation referred to as TSP) [7,12,14,39,40,55].…”

Section: Medicaments Previous Methods and Resultsmentioning

confidence: 99%

Treatment of Chronic Salmonella Carriers

Freerksen¹,

Rosenfeld²,

Freerksen³

et al. 1977

Chemotherapy

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The present stage of our studies suggests that, provided a highly effective combined therapy is, and can be, carried out correctly, all excreters can be cured of their chronic carrier state by chemotherapy within 8–12 weeks. Although we cannot recommend a universal therapeutic regimen for all patients, a highly effective ‘basic therapy’ (RMP+TSP) is available for the majority of the cases, needing occasional modification, depending on the specific requirements of the individual patient as shown by the result of the serum activity determination. This method saves the patient from toxic inconveniences caused by inadequate treatment, it shortens the treatment time and makes cholecystectomy superfluous – unless it is considered necessary out of a different indication in which case it should certainly be done. We cannot share the often expressed view that Salmonella enteritidis excreters cannot be cured, a view which is found even in the most recent manuals. The same applies to the view that therapy is not necessary because it would delay cure. It is indispensable to establish a close cooperation between the public health authorities and the private physician, and we therefore wish to sincerely thank all colleagues and Public Health Officers for their collaboration.

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Treatment of Chronic Carriers of Salmonella typhi and Salmonella paratyphi B with Trimethoprim-Sulfamethoxazole

Cited by 20 publications

References 3 publications

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

An Allele of an Ancestral Transcription Factor Dependent on a Horizontally Acquired Gene Product

Treatment of Chronic Salmonella Carriers

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