An Outbreak of Antibiotic-Resistant Salmonella enteritidis in Liberia, West Africa

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Abstract
Between October 1980 and August 1982, 100 patients in the pediatric population at Curran Lutheran Hospital, Zorzor, Liberia were identified as having multiple drug-resistant Salmonella enteritidis serotype enteritidis. The illness usually presented as an enteric fever but also as meningitis, gastroenteritis, empyema, subcutaneous abscesses, chronic otitis media, or a combination of these conditions. Predisposing factors were young age and debilitation from malnutrition or measles. The mortality of infected patients was 27.8%. The organism was originally misidentified as a Citrobacter species because of a delayed reaction on lysine decarboxylase medium. Incubation of the medium for five days resulted in a positive reaction that identified the organism as a Salmonella species. The isolates were resistant to multiple antibiotics. Genes mediating resistance were located on a 120-megadalton conjugative plasmid. A cryptic nonconjugative 40-megadalton plasmid was also present in several isolates.

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