XDR TYPHOID: THE PROBLEM AND ITS SOLUTION

Authors

  • Ejaz Ahmed Khan Shifa International Hospital, Islamabad

Abstract

Pakistan has unfortunately witnessed an epidemic of extensively drug resistant (XDR) typhoid arising from Hyderabad since November 2016 and accounting for almost 50% cases now. Reports of XDR typhoid cases are occurring in other parts of Pakistan as well. The issue is mainly fewer antibiotic options for treatment with expected poor outcome. Diagnostics and therapeutic options must include more informative, acceptable and "gold standard" test of blood culture with emphasis on development of more rapid, reliable and cheap tests.Treatment options have dwindled to only two!: Oral azithromycin and for suspected severe or complicated XDR typhoid fever patients carbapenems. On a national level awareness of the problem and immediate preventive and control measures should be instituted at all levels and every sector to control typhoid. Measures aimed at health education of the healthcare professional and public about water hygiene, sanitary disposal and food safety, vaccination is of paramount importance.

Author Biography

Ejaz Ahmed Khan, Shifa International Hospital, Islamabad

Department of Pediatrics and Infectious Diseases

References

WHO. Typhoid: Key facts. [Internet]. WHO. [cited 2018 Mar 19]. Available from: https://www.who.int/mediacentre/factsheets/typhoid/en/

Antillón M, Warren JL, Crawford FW, Weinberger DM, Kürüm E, Pak GD, et al. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis 2017;11(2):e0005376.

Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health 2014;2(10):e570–80.

Radhakrishnan A, Als D, Mintz ED, Crump JA, Stanaway J, Breiman RF, et al. Introductory Article on Global Burden and Epidemiology of Typhoid Fever. Am J Trop Med Hyg 2018;99(3 Suppl):4–9.

Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AKM. A three-year review of antimicrobial resistance of Salmonella enterica serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries 2014;8(8):981–6.

Qamar FN, Yousafzai MT, Sultana S, Baig A, Shakoor S, Hirani F, et al. A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. J Infect Dis 2018;218(suppl 4):S201–5.

Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK, et al. Emergence of an extensively drug resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. MBio 2018;9(1):e00105–18.

Wong VK, Baker S, Pickard DJ, Parkhill J, Page AJ, Feasey NA, et al. Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events. Nat Genet 2015;47(6):632–9.

Qamar FN, Yousafzai MT, Khalid M, Kazi AM, Lohana H, Karim S, et al. Outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype Typhi and its risk factors among the general population in Hyderabad, Pakistan: a matched case-control study. Lancet Infect Dis 2018;18(12):1368–76.

WHO. Typhoid fever - Islamic Republic of Pakistan. [Internet]. [cited 2018 Mar 19]. Available from: https://www.who.int/csr/don/27-december-2018-typhoid-pakistan/en/

Ministry of National Health Services, Regulation & Coordination Government of Pakistan. National Institute of Health, Islamabad, Pakistan. Field Epidemiology & Disease Surveillance Division (FE&DSD). [Internet]. [cited 2018 Mar 19]. Available from: https://www.nih.org.pk/wp-content/uploads/2018/10/43rd-Issue-SAAL-October-2018.pdf

Chatham-Stephens K, Medalla F, Hughes M, Appiah GD, Aubert RD, Caidi H, et al. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan - United States, 2016-2018. MMWR Morb Mortal Wkly Rep 2019;68(1):11–3.

Parry CM, Basnyat B, Crump JA. The management of antimicrobial-resistant enteric fever. Expert Rev Anti Infect Ther 2013;11(12):1259–61.

Thompson CN, Karkey A, Dongol S, Arjyal A, Wolbers M, Darton T, et al. Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal. Clin Infect Dis 2017;64(11):1522–31.

Pieters Z, Saad N, Antillón M, Pitzer VE, Bilcke J. Case Fatality Rate of Enteric Fever in Endemic Countries: A Systematic Review and Meta-analysis. Clin Infect Dis 2018;67(4):628–38.

Andualem G, Abebe T, Kebede N, Gebre-Selassie S, Mihret A, Alemayehu H. A comparative study of Widal test with blood culture in the diagnosis of typhoid fever in febrile patients. BMC Res Notes 2014;7:653.

Ajibola O, Mshelia MB, Gulumbe BH, Eze AA. Typhoid Fever Diagnosis in Endemic Countries: A Clog in the Wheel of Progress? Medicina (Kaunas) 2018;54(2):E23.

Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Ralph R. Typhoid fever: issues in laboratory detection, treatment options and concerns in management in developing countries. Future Sci OA 2018;4(6):FSO312.

Khan EA. “Situation Analysis Report on Antimicrobial Resistance in Pakistan - Findings and Recommendations for Antibiotic Use and Resistance”. [Internet]. The Global Antibiotic Resistance Partnership (GARP), Pakistan. [cited 2018 Mar 19]. Available from: https://www.cddep.org/publications/garp-pakistan-situation-analysis/

Ryan ET, Jason A. Treatment and prevention of enteric (typhoid and paratyphoid) fever. [Internet]. In Uptodate® [cited 2019 Mar 19]. Available from: https://www.uptodate.com/contents/treatment-and-prevention-of-enteric-typhoid-and-paratyphoid-fever

Bennett SD, Lowther SA, Chingoli F, Chilima B, Kabuluzi S, Ayers TL, et al. Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi. PLoS One 2018;13(2):e0193348.

Carey ME, Diaz ZI, Zaidi AKM, Steele AD. A Global Agenda for Typhoid Control-A Perspective from the Bill & Melinda Gates Foundation. Clin Infect Dis 2019;68(Suppl 1):S42–5.

Field Epidemiology & Disease surveillance division. National Institute of Health, Islamabad, Pakistan. Advisory for prevention and treatment of Typhoid. Ministry of National Health Services, Regulations & Coordination. [Internet]. [cited 2019 Mar 19]. Available from: https://www.nih.org.pk/wp-content/uploads/2018/08/Advisory-for-prevention-and-treatmentof-Typhoid-Fever-10-August-2018.pdf

WHO. Typhoid vaccine prequalified. [Internet]. WHO. [cited 2019 Mar 19]. Available from: http://www.who.int/medicines/news/2018/WHOprequalifies-breakthrough-typhoid-vaccine/en/

Published

2019-04-01