SIR—Salmonella continues to be highly endemic in Mumbai, India [1]. We have noticed a worrisome trend in the past 5 years: there has been a steady increase in the absolute numbers of Salmonella enteritidis serotype Paratyphi A isolates recovered from blood cultures (with use of the BACTEC 9050 automated culture system; Becton Dickinson) at our institute, a tertiary care center in central Mumbai. The increase in the rate of isolation of this organism has been remarkable: from only 1 S. Paratyphi A isolate in 1992 to 27 isolates in the first 7 months of this year (table 1). The majority of patients (18 of the 24 patients available for follow-up) who had paratyphoid had received typhoid immunization in the form of the orally administered typhoid vaccine or the injectable capsular Vi polysaccharide vaccines. Immunization protects against Salmonella enterica serotype Typhi but not against S. Paratyphi A. This is not withstanding the fact that infection with S. Typhi is still rampant in the city and shows no signs of abating. To compound matters, the percentage of nalidixic acid—resistant S. Typhi increased from 82% of isolates in 2000 to 88% in 2002, and the MIC of ciprofloxacin (as determined by Etest; AB Biodisk) also increased, from 0.125–1 μg/mL in 2000 to 0.19–1.5 μg/mL in 2002 [2].
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Rodrigues et al. (2003) studied this question.
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