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SAPUVETNET
MULTI-RESISTANTSalmonella enterica
ThyphimuriumOUTBREAK

• PUBLIC HEALTH AND PRUDENT USE OF ANTIBIOTICS

Additional material Manual on DISEASE OUTBREAK
INVESTIGATION Manual on PRUDENT USE OF
ANTIBIOTICS
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SAPUVETNET
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
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SAPUVETNET
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 symptoms The same microorganism was
isolated Salmonella enterica Typhimurium
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SAPUVETNET
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, its a 12 yrs old child from the
nearby city, with the same symptoms and
microbiological results. The connection between
these people was investigated
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SAPUVETNET
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 diseases outbreak
detected? If you think it was involved in the
problem, how would you go on with the
investigation trying to solve it?
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SAPUVETNET
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
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SAPUVETNET
DIAGNOSTIC INVESTIGATION
Samples were taken from the shops animals, from
the farms animals and from the second childs
hamster. A microbiological analysis was
done Shops animals were negative 20 of the
farms animals were positive Salmonella enterica
Typhimurium was detected The secound childs
hamster was also positive to S. enterica
Thyphimurium
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SAPUVETNET
SOME MORE INTERESTING FACTS - I
Last 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
citys 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
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SAPUVETNET
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...
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SAPUVETNET
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_at_unizar.es)