Extensively drug-resistant typhoid fever in Pakistan

Rasheed, Muhammad Kamran; Hasan, Syed Shahzad; Babar, Zaheer‐Ud‐Din; Ahmed, Syed Imran

doi:10.1016/s1473-3099(19)30051-9

Cited by 54 publications

(47 citation statements)

References 2 publications

(3 reference statements)

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“…More recent reports suggest that around 21 million contract typhoid annually, leading to 161,000 cases ending in fatality. Inhabitants of the Pakistani provinces of Punjab and Sindh have been declared to be most at risk of developing typhoid, out of all of the 16 Asian countries where typhoid is prevalent [10].…”

Section: Global Epidemiology Of Typhoid Fevermentioning

confidence: 99%

“…Gavi, the vaccine alliance, has committed $85 million towards the production of conjugate vaccines in poverty-stricken countries [11]. An estimated 250,000 children in Hyderabad have received the WHO prequalified Vi-polysaccharide typhoid vaccine since 2017 [10].…”

Section: Immunization Since the Processes Of Rapid Urbanizationmentioning

confidence: 99%

“…Thus, practical recommendations to contain the local outbreak continues to be the taking up of adequate sanitation measures by local government and wide spread immunization by the typbar TVC vaccine. For the former of these recommendations, according to news reports, the provincial government has set aside 399 million Pakistani rupees for the restoration of water distribution networks and 414 million Pakistani rupees for the revival of the sewage system in Hyderabad [10].…”

Section: Future Outlookmentioning

confidence: 99%

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Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management

Akram

Khan

et al. 2020

BioMed Research International

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Typhoid fever is the result of a human host-restricted Salmonella enteric serotype typhi infection that causes enteric fever. Around 21 million people contract typhoid annually, with Pakistan’s inhabitants at most risk amongst Asian countries where typhoid remains prevalent. Decades of indiscriminate antibiotic usage has driven the evolution of multidrug-resistant strains and more recently, extensively drug-resistant (XDR) strains of Salmonella enteric serotype typhi. Current reports of extensively drug-resistant typhoid fever outbreak in Pakistan are not only a major concern for Pakistan but also for health authorities worldwide: intercontinental transmission, spread, and replacement of native strains in neighboring countries and a major impediment to Pakistani health care management. The WHO records that there are 5274 cases of extensively drug-resistant (XDR) typhoid fever out of a total of 8188 total cases of typhoid fever reported in Pakistan. The last remaining feasible oral antibiotic that XDR typhoid remains susceptible to is azithromycin; this is a cause of major concern. Additionally, several cases of XDR typhoid fever have also been reported in patients travelling from Pakistan to the USA, UK, and Canada. This review article attempts to raise the issue of XDR typhoid with respect to its epidemiology, prevention, management, and future outlook and stresses a better understanding of antimicrobial stewardship and general surveillance of the disease. Although progress is being made to combat XDR typhoid locally, efficient, unified efforts on a national and international scale are required to contain the XDR outbreak before it is no longer manageable and leads us back to the preantibiotic era.

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Section: Global Epidemiology Of Typhoid Fevermentioning

confidence: 99%

Section: Immunization Since the Processes Of Rapid Urbanizationmentioning

confidence: 99%

Section: Future Outlookmentioning

confidence: 99%

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Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management

Akram

Khan

et al. 2020

BioMed Research International

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“…Universal coverage with pneumococcal vaccination could potentially avoid more than 11 million days of antibiotic use per year in children under 5 [51,52]. A newer typhoid conjugate vaccine has a potential for high impact on prevention and control of antimicrobial resistant typhoid fever and was recently strategically used to control an extensively drug resistant typhoid outbreak in Pakistan [53]. But vaccines against viruses, e.g., influenza, can also exert a major impact here, due to the inappropriate prescription of antibiotics.…”

Section: Promoting Integration Of Immunization In the Health Sectormentioning

confidence: 99%

New immunization strategies: adapting to global challenges

Mantel

Cherian²

2019

Bundesgesundheitsbl

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“…This composite transposon has also been found integrated into the chromosome in some H58 S. Typhi lineages (Klemm et al 2018). Many drug resistant determinants are abundant in Salmonella emterica plasmids isolated from different animal sources as well as water and thus AMR is a problem increasing salmoniasis in animal and typhoid in human (Rasheed et al 2019). Typhoid fever, the causative agent of Salmonella enterica serovar Typhi is spreading in the Asian countries due to acquisition of MDR plasmids from multidrug resistant Escherichia coli and Klebsiella pneumonia (Mandal et al 2012).…”

mentioning

confidence: 99%

High Prevalence of Metal Resistant Genes in <em>Salmonella enterica</em> MDR Plasmids Correlates Severe Toxicities of Water with higher Typhoid AMR

Ak¹,

Roy²

2020

Preprint

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AMR and drug void have caused huge panic today with few thousand death per year. MDR Typhoid was a serious old disease and caused serious health hazard in humen and animals demanding an update on molecular biology of the status on transferable genetic elements. R-plasmids combined in F’-plasmid and the new MDR conjugative plasmids were shown abundant in Sanmonella ranging 70-440kb with similarities. BlaTEM, blaCTX-M, blaOXA, blaNDM mdr genes were abundant in >50 plasmids analyzed and metal resistant gene clusters are predominant in most large plasmids. Among the acetyltransferase all catA1, aacA1 and aac-1b-cr genes were located. Abundant streptomycin phosphotransferases (StrAB) and rarely colistin resistant Mcr-5/9 phosphoethanolamine–lipid A transferase were detected. Altered isomeric dihydropterote synthases (Sul1/2/3) were present giving sulfamethoxazole resistance and dhfr gene frequently associated giving trimethoprim resistance. Metal resistant gene clusters like SilABC (CusABC), PcoAB, RcnA, terABC, and merABCXT etc were found in many Salmonella enterica plasmids. Toxin genes like HipA and virulence genes like spvABD were located in few plasmids increasing virulence and pathogenesis. Drug efflux genes tetA or tetB and OqxB, floR, CmlA were frequent where as QepA and EamA genes were rarely seen. Thus, Salmonella metal resistant genes combined with antibiotic resistant genes has tried to overcome the both toxic antibiotics and metalions causing Typhoid AMR. Such acquisition spreads salmoniasis in the live stocks (pig, cow, chicken) where toxic soil and water dominate increasing chance of MDR typhoid in human.

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Extensively drug-resistant typhoid fever in Pakistan

Cited by 54 publications

References 2 publications

Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management

Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management

New immunization strategies: adapting to global challenges

High Prevalence of Metal Resistant Genes in <em>Salmonella enterica</em> MDR Plasmids Correlates Severe Toxicities of Water with higher Typhoid AMR

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