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Volume 13, Number 12—December 2007

Letter

Multidrug-Resistant Typhoid Fever Outbreak in Travelers Returning from Bangladesh

Yasuyuki Kato*1Comments to Author , Makiko Fukayama†2, Takuya Adachi‡3, Akifumi Imamura§, Takafumi Tsunoda¶, Naohide Takayama§, Masayoshi Negishi§4, Kenji Ohnishi*, and Hiroko Sagara‡
Author affiliations: *Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; †Tokyo Metropolitan Toshima Hospital, Tokyo, Japan; ‡Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; §Tokyo Metropolitan Komagome Hospital, Tokyo, Japan; ¶Tokyo Metropolitan Ebara Hospital, Tokyo, Japan; 1Current affiliation: International Medical Center of Japan, Tokyo, Japan; 2Current affiliation: Tokorozawa Loyal Hospital, Saitama, Japan; 3Current affiliation: Japan International Cooperation Agency, Tokyo, Japan; 4Current affiliation: Negishi Medical Clinic, Tokyo, Japan

Main Article

Table

Characteristics of 8 case-patients with typhoid fever, Bangladesh, 2004*

Case-
patient† Age, y/ sex Date of onset Vi-phage type Ciprofloxacin MIC, μg/mL Cefotaxime MIC, μg/mL Treatment‡ FCT, d
1C 28/F Apr 19 E9 0.38 0.094 Ciprofloxacin 500 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 11 d
2C 17/F Apr 20 E9 0.38 0.094 Levofloxacin 200 mg 2× a day for 14 d 6
3C 17/F Apr 21 E9 0.38 0.094 Ciprofloxacin 500 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 11 d 3
4P 19/F Apr 21 NA NA NA Levofloxacin 200 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 13 d 12
5C 12/M Apr 22 E9 0.38 0.094 Azithromycin 1 g for 1 d, 500 mg a day for 
2 d; norfloxacin 250 mg 3× a day for 11 d 7
6C 16/F Apr 23 E9 0.38 0.094 Levofloxacin 500 mg a day for 14 d 5
7C 19/M Apr 23 E9 0.38 0.064 Ciprofloxacin 500 mg 2× a day for 5 d, ceftriaxone 2 g every 12 h for 16 d 6
8P 15/M Apr 28 NA NA NA Levofloxacin 200 mg 2× a day for 18 d 7

*MICs were determined by E-test (AB Biodisk, Solna, Sweden). MICs of chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid were >256 μg/mL, >256 μg/mL, >32 μg/mL, and >256 μg/mL, respectively. FCT, fever clearance time (time from the start of treatment until the body temperature reached 37.5°C and remained at 37.5°C for 48 h); NA:, not available.
†C, confirmed case, i.e., a patient with fever (>38°C) for >3 d and a laboratory-confirmed positive blood culture for Salmonella enterica serotype Typhi; P, probable case, i.e., a patient with fever (>38°C) for >3 d without isolation of S. Typhi.
‡Daily dosages are shown. All fluoroquinolones were given orally. Tosufloxacin is a fluoroquinolone with properties similar to those of levofloxacin.
§Fever relapsed 15 d after completion of treatment. Retreatment with tosufloxacin, 600 mg/d for 14 d, was successful.

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1Current affiliation: International Medical Center of Japan, Tokyo, Japan

2Current affiliation: Tokorozawa Royal Hospital, Saitama, Japan

3Current affiliation: Japan International Cooperation Agency, Tokyo, Japan

4Current affiliation: Negishi Medical Clinic, Tokyo, Japan

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