MULTI-RESISTANTSalmonella enterica

ThyphimuriumOUTBREAK

• PUBLIC HEALTH AND

PRUDENT USE OF

ANTIBIOTICS

Additional material:

Manual on DISEASE OUTBREAK INVESTIGATION

Manual on PRUDENT USE OF ANTIBIOTICS

CASE BEGINNING; DISEASE IN HUMANS

European city It started on 12th June of 2004

A four year old child was admitted to hospital. He had high temperature

(40ºC), fluid diarrhoea and abdominal distress

A microbiological test was done and Salmonella enterica Typhimurium was

detected

This germ was multi-resistant to antibiotics

OUTBREAK CASE IN HUMANS

A second child, who was 5 years old, went to the hospital 2 days later. He also had

high temperature (39ºC), fluid diarrhoea, abdominal distress and

vomiting

Salmonella enterica Typhimurium was detected again

On the next day, a 40 yrs old person was admitted to hospital with the same

symptomsThe same microorganism was isolated:

Salmonella enterica Typhimurium

CASE INVESTIGATION - I

In your view, how would you study this case taking into account that

the course of the outbreak is generating a growing concern and

the outbreak seems to become very serious?

Another case appeared, it’s a 12 yrs old child from the nearby city, with

the same symptoms and microbiological results.

The connection between these people was investigated

CASE INVESTIGATION - II

There is no direct or occasional connection between these people

The food they had eaten seems not to have anything to do with the case

A hamster was given to one of the children fifteen days before, and four days later

the animal died

Do you think this fact has got something to do with the disease’s

outbreak detected? If you think it was involved in the problem, how would you go on with the investigation trying to solve it?

CASE INVESTIGATION - III

The sick adult worked in a pet shop

The two first children had hamsters which were bought in that shop

These hamsters had arrived to the shop seventeen days before from a farm of a

nearby city

-         At the time of the arrival, both hamster were put on sale and were kept in a plastic cage whithout any contact with other animals.

The third child (who lived in a different town) visited the farm one week ago

DIAGNOSTIC INVESTIGATION

Samples were taken from the shop’s animals, from the farm’s animals and from the second child’s hamster. A microbiological analysis was done:

Shop’s animals were negative

20% of the farm’s animals were positive:Salmonella enterica Typhimurium was

detected

The secound child’s hamster was also positive to S. enterica Thyphimurium

SOME MORE INTERESTING FACTS - ILast days there had been some animals with

diarrhoea in the farm. Three of them died

Thirty days ago a ferret had been brought over

The ferret was located in a cage of the farm for four days, later, a group of hamsters was put there

Some of them were sold to a nearby city’s shop and the rest was relocated in the farm

With the available information, could you explain the outbreak? Define the transmission chain and explain the

subsequent mistakes done

SOME MORE INTERESTING FACTS - II

The investigation done in the farm showed that:

Antibiotics had been constantly used in the last years to prevent digestive

diseases

They used half a therapeutic treatment dose

A mix of spectinomycin, tetracyclin and nitrofurazone was used

This treatment has been used during the last four years...

Which involvements would this MULTI-RESISTANT bacteria have in Public

Health?

In case you choose to carry on a disease control program, would you include an

antibiotic treatment for a specific group of animals?

In this case, which rules to select the drug and to use it would you consider

essential?Case developed by the SAPUVETNET II member – University of Zaragoza,

Fac_Med_Vet. (contact: Carmelo Ortega/Olga Gimeno epidemio@unizar.es)