Challenges in the Management of Multiple Splenic Abscesses caused by Extensively Drug-resistant (XDR) Salmonella Typhi

Abstract

Extensively drug-resistant (XDR) typhoid emerged in Hyderabad, Pakistan in 2016. It spread regionally and globally due to fast travelling. An immuno-competent young male referred by general practitioner, was diagnosed and managed as XDR salmonella typhi with multiple splenic abscesses. We faced challenges in its management, like little suspicion of potentially lethal disease; non-availability of evidence-based medicine and further delay in diagnosis as he was already on antibiotics therapy. Patient was diagnosed by radiology and blood cultures. In our case, option of conservative treatment with sensitive antibiotics (azithromycin and meropenem) was successful, though with increased hospital stay. There is no data on treatment duration and choice between two sensitive antibiotics or both in combination. In the present situation, sensitisation of clinicians to salmonella drug resistance, rational use of antibiotics and prompt public health awareness is the need of the day, especially in endemic areas.

Extensively Drug-Resistant Salmonella typhi Infection: From Pill to Scalpel

“…Gastrointestinal and hepatobiliary involvement in XDR S. typhi infection has been reported. Abscesses in various viscera like the spleen and infarcts in the spleen and kidneys caused by XDR S. typhi have been reported [ 10 - 11 ]. Similarly, hepatic involvement manifested by more than a three-fold elevation of alanine aminotransferase in 14% of cases of XDR S. typhi has been reported [ 10 ].…”

“…Acute hepatitis, visceral abscesses in organs like the spleen and splenic and renal infarcts have been reported in association with XDR S. typhi [ 10 - 11 ]. During the course of our literature search, this is the first case report of acute appendicitis caused by XDR S. typhi.…”

Knowledge, Attitude, and Practices (KAPS) of the Inhabitants of Punjab, Pakistan toward XDR Typhoid Outbreak During COVID-19

“…Infection is transmitted through the fecal-oral route by contaminated water or food; humans are the only identified reservoir [4]. S. typhi can only be treated successfully with antibiotics [5].…”

Extensively drug-resistant Salmonella typhi Infection in Adults; Experience from A Tertiary Care Hospital

“…Acute hepatitis, acute appendicitis, and abscesses and infarcts in spleen and kidneys due to XDR S. typhi have been reported. 6,7 Extensively drug-resistant S. typhi is sensitive only to two classes of drugs, i.e., carbapenems and azithromycin. The outbreak is becoming a global threat with the isolation of an XDR S. typhi strain resistant to azithromycin in Bangladesh.…”