A Case of Typhoid Fever to Failed Ciprofloxacin, Infected in Korea

Kwang Sun Lee; Ha Yeon Lee; Eun Ju Jeon; Jin Won Chung

doi:10.3947/ic.2008.40.3.175

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Lee, Lee, Jeon, and Chung: A Case of Typhoid Fever to Failed Ciprofloxacin, Infected in Korea

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2008; 40(3): 175-178.

Published online: 20 June 2008

DOI: https://doi.org/10.3947/ic.2008.40.3.175

A Case of Typhoid Fever to Failed Ciprofloxacin, Infected in Korea

Kwang Sun Lee, M.D., Ha Yeon Lee, M.D., Eun Ju Jeon, M.D., Jin Won Chung, M.D.

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Correspondence: Jin Won Chung, M.D. Department of Internal Medicine, Chung-Ang University Yongsan Hospital 65-207 Hangangro3-ga, Yongsan-gu, Seoul 140-757, Korea. Tel: +82-2-748-9942, Fax: +82-2-790-2068, drjwchung@gmail.com

Received 2 January 2008 Accepted 18 March 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) and usually ciprofloxacin is first used for treatment. However, the incidence of fluoroquinolone resistance or reduced susceptibility in S. typhi has been increased in Asia over the past decade and there have been reports of failed treatment with ciprofloxacin. Recently, if typhoid fever does not improved with ciprofloxacin treatment, S. typhi with reduced susceptibility to ciprofloxacin should be considered. We experienced a case of nalidixic acid-resistant S. typhi infection that was refractory to treatment with ciprofloxacin in Korea. A 47-year-old woman presented with fever and headache for 14 days. Blood culture revealed the presence of S. typhi that was susceptible to ciprofloxacin. However, she remained feverish and new symptoms of abdominal pain and bloody diarrhea developed after 5 days treatment with ciprofloxacin and subsequent testing showed that isolate was resistant to nalidixic acid.

Keywords: Salmonella enterica serovar Typhi, Resistance, Ciprofloxacin, Nalidixic acid

Figures and Tables

Fig. 1

MIC pf malidoxic acid against S. typhi isolated from case patient was MIC 64 µg/mL by E-test.

Fig. 2

Edematous mucosal changes, multiple discreted ulceration with yellowish exudates and petechial hemorrhage are showed in colon mucosa.

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