A frightening outbreak of Extensive drug resistant-Typhoid in Karachi, Pakistan: A threat to future generation

Muhammad Ishaq; Syeda Urooj Riaz; Muhammad Shariq; Khizra Ishaq; Shifa Ishaq; Syed Sanowar Naqvi

doi:10.5455/JMRR.20231002075013

Abstract
Aim
Laboratory of Jinnah Medical College Hospital identified an outbreak of Extensive drug-resistant (XDR)-Typhoid in Karachi, Pakistan. The frightening rise in the number of XDR typhoid cases observed here demands the need for urgent intervention and prevention for disease control. Recently a threat to future generations in terms of healthcare burden, antibiotic resistance, and public health is also digital diagnosis and self medication which also increases the resistance.
Methods
A descriptive, cross-sectional survey was conducted to measure the XDR-cases flare-up. Data was collected from Jinnah Medical College Hospital from 1st February-30th September 2019. Out of 175 blood cultures suspected for typhoid, only 65 XDR cases were included by non-probability consecutive sampling. Patients showing no growth on culture, growth of organisms other than Salmonella Typhi and Salmonella Typhi which was not XDR, were excluded. All data were analyzed using SPSS Software 25.0.
Results:
65 XDR cases had been reported in 8 months. 36 (55.4%) females and 24 (37%) young adults, aged between 20-29 years, were most affected. A few patients developed complications including intestinal perforation (n=1), acute hepatitis (n=7), and free peritoneal fluid (n=3). A number of cases reported were as low as 2 (3.1%) in February to as high as 11 (16.9%) in August.
Conclusions:
With declining antibiotic arsenal and evolution from Multidrug-resistant (MDR) to XDR typhoid, treating typhoid has become quite challenging. This adds insistence to the need for typhoid preventive measures including community awareness and education, and vaccination.

Key words: Typhoid, Salmonella infection, disease outbreak, drug resistance, Typhoid vaccine, drug resistance antibiotics.