Mahwish LATİF, Mehreen GİLANİ, Javaid USMAN, Tehmina MUNİR, Maria MUSHTAQ, Nazish BABAR

Lactose Fermenting Salmonella Paratyphi A: A case report

Salmonella genusunda 2500’den fazla antijenik tipleri bulunmaktadır. Salmonella Typhi ve Salmonella Paratyphi A, B ve C tifo etkenidirler. Karakteristik olarak bu dört tür de laktozu fermente etmezler. Burada, 12 günlük ateş hikâyesi olan 27 yaşında bir erkek hastanın kanından izole edilen ve laktozu fermente eden bir S. Paratyphi A olgusu sunuldu. Laktozu fermente eden koloniler Crystal Mac Conkey agar besiyerinde 35°C’de 24 saatlik inkübasyon sonunda izole edildi. Bakteri, koloni morfolojisi, Gram boyama, Oksidaz testi, şeker testleri (indol, üre, sitrat, üç-şeker-demir) ve API 20E ile adlandırıldı. İzole edilen bakteri Salmonella polivalan A-S ve antiserum O2 antiserumları ile pozitif aglütinasyon reaksiyonu vermesi ile teyit edildi.Laktozu fermente eden S. Paratyphi A suşunun tanınması, atlanması veya yanlış tanı konması açısından önemlidir. S. Paratyphi A, tifo etkeni olarak S. Typhi’nin yerini almaktadır ve yüksek ilaç direncine sahiptir. Bu nedenle yanlış tanıdan kaçınmak için, S. Paratyphi A’nın nadiren 24 saatlik Crystal MacConkey agar üzerindeki inkübasyonunda laktozu fermente eden koloniler şeklinde üreyebileceği unutulmamalıdır

Anahtar Kelimeler:

Antibiyotik direnci, Laktoz fermantasyonu, Salmonella, Salmonella Paratyphi A

Lactose Fermenting Salmonella Paratyphi A: A case report

Mahwish Latif, Mehreen Gilani, Javaid Usman, Tehmina Munir, Maria Mushtaq, Nazish Babar There are more than 2500 antigenic types of the genus Salmonella. Typhoid fever is caused by Salmonella typhi, Salmonella paratyphi A, B and C. Characteristically all four of these is non-fermenters of lactose. We report a case of lactose fermenting Salmonella paratyphi A isolated from the blood sample of a 27 years old male with 12 days history of fever. Lactose fermenting colonies were isolated on Crystal Mac Conkey agar plate after 24 hours incubation at 35°C. It was identified using colony morphology, Gram staining, Oxidase test, sugar sets (Indole, Urea, Citrate, Triple sugar iron tests) and API 20E. It was confirmed as Salmonella paratyphi A after positive agglutination reaction with Salmonella antisera polyvalent A-S and antiserum O2. The emergence of lactose fermenting strain of Salmonella paratyphi A is important because it is likely to be missed or misdiagnosed. As Salmonella paratyphi A is taking over Salmonella typhi as cause of typhoid and is exhibiting high levels of drug resistance too. So in order to avoid incorrect identification it should be kept in mind that S. paratyphi A can very rarely yield lactose fermenting colonies on Crystal MacConkey agar after 24 hours incubation.

Keywords:

Antibiotic resistance, Lactose fermentation, Salmonella, Salmonella Paratyphi A,

PDF

___

Reeves MW, Evins GM, Heiba AA, et al. Clonal nature of Salmo- nella Typhi and its genetic relatedness to other Salmonellae as shown by multilocus enzyme electrophoresis and proposal of Salmonella bongori comb. nov. J Clin Microbiol 1989;27,313- 320.
D.C.Old. Salmonella. In Mackie & McCartney Practical Medical Microbiology Fourteenth edition p: 385-404. Edited by Collee JG, Marmion BP, Fraser AG, Smiths A. 2011, Elsevier, a divi- sion of Reed Elsevier India Private Limited.
Yang H, Tongrui L, Margie LD, et al. A rapid screen of broth en- richments for Salmonella enterica serovars enteritidis, Hadar, Heidelberg, and Typhimurium by Using an allelotyping multi- plex PCR that targets O- and H-antigen alleles. J Food Protect 2009;72:2198-2201.
Kohbata S, Takahashi M, Yabuuchi E. Lactose-fermenting, multiple drug-resistant Salmonella Typhi strains isolated from a patient with postoperative typhoid fever. J Clin Microbiol 1983;18:920-925.
Ewing WH. Isolation and Identification of Salmonella and Shi- gella. 1972. U. S. Dept. of Health, Education and Welfare, Public Health Service, Center for Disease Control, Bureau of Laboratories, Enterobacteriology Branch, Enterobacteriaceae. Pages 49.
Doolittle RF, Feng DF, Tsang S, et al. Determining divergence times of the major kingdoms of living organisms with a protein clock. Science 1996;271:470-477.
Eswarappa SM, Karnam G, Nagarajan AG, et al. lac repressor is an anti-virulence factor of Salmonella enterica: Its role in the evolution of virulence in Salmonella. PLoS ONE 2009; 4(6): e5789. doi:10.1371/journal.pone.0005789.
Cheesbrough M. Microbiological Tests in District Laboratory Practice in Tropical Countries, Second Edition, 2005, Part 2. P:7.18.15.
Murray PR, Baron EJ, Pfaller MA, et al. “Antigenic formulae of the Salmonella serovars, 9th edition” Manual of Clinical Micro- biology. 1995. Washington, DC:ASM Press + Grimont, Patrick. WHO Collaborating Centre for Reference and Research on Salmonella. Retrieved 2 July 2013
Blackburn BO, Ellis EM. Lactose-Fermenting Salmonella from Dried Milk and Milk-Drying Plants Applied Microbiol 1973;26:672-674.
McDonough PL, Shin SJ, Lein DH. Diagnostic and Public Health Dilemma of Lactose-Fermenting Salmonella enterica Serotype Typhimurium in Cattle in the Northeastern United States. J Clin Microbiol 2000;38:1221-1226.
Gonzalez AB. Lactose-Fermenting Salmonella. J Bacteriol 1966;91:1661-1662.
Falcao DP, Trabulsi LR, Hickman FW, Farmer JJ. Unusual Enterobacteriaceae: lactose-positive Salmonella typhimuri- um which is endemic in Sao Paulo, Brazil. J Clin Microbiol 1975;2:349-353.
Falkow S, Baron LS. Episomic Element in a Strain of Salmo- nella Typhosa. J Bacteriol 1962;84:581-589.
Cohen SL, Wylie BA, Sooka A, Koornhof HJ. Bacteremia caused by a lactose-fermenting, multiply resistant Salmonella Typhi strain in a patient recovering from typhoid fever. J Clin Microbiol 1987;25:1516-1518.
Kunz LJ, Ewing WH. Laboratory Infection with a Lactose-Fer- menting Strain of Salmonella Typhi. J Bacteriol 1965;89:1629.
Lapage SP, Efstratiou A, Hill LR. The ortho-nitrophenol (ONPG) test and acid from lactose in Gram-negative genera. J Clin Path 1973;26:821-825.