Abstract
Typhoid fever remains a problem in developing countries, including Pakistan. The emergence of multidrug-resistant and, since 2016, of extensively drug-resistant cases is a continuous challenge for health care workers. The COVID-19 pandemic is making management more difficult. In the present study, a total of 52 confirmed cases of typhoid have been studied during 2019. Detailed clinical features, complications and, lab findings were studied. Typhoid culture and sensitivity were recorded and patients were treated accordingly. Patients were asked about risk factors to aim at informing prevention. Out of the 52 having blood culture positive for Salmonella Typhi 47 (90.4%) and Salmonella Paratyphi 5 (9.6%), 4 (7.7%) were sensitive to first-line (Non-resistant), 11 (21.2%) MDR and 37 (71.2%) patient were XDR. One case was resistant to azithromycin. Nausea, vomiting or, abdominal pain was present in 12 (23%), abdominal distension present in 9 (17.3%), abdominal tenderness in 8 (15.4%), hepatomegaly in 10 (19.2%) and, splenomegaly in 22 (42.3%).There were ultrasound abnormalities in 58% of patients and GI complications in 19% of patients. No significant difference was found in clinical findings and complications between resistant and non-resistant cases. Only 23-27% of patients were aware of typhoid prevention and vaccination measures. The increasing prevalence of resistance and higher degree of complications seen in typhoid fever raises the concern further about prevention and effective infection management in the community as well as clinical settings. Moreover, judicial use of antibiotics is much needed in developing countries like Pakistan.
Highlights
Typhoid fever remains a problem in developing countries, including Pakistan
The goals of this study were to determine the prevalence of drug resistance in Salmonella Typhi, to identify demographic and clinical features and complications associated with typhoid fever and to identify clinical clues that might help in early diagnosis, and to look for the patterns of disease and complications in all resistant cases
We have found that 71.1% cases were XDR, 21.2% Multi Drug-resistant (MDR), and only 7.7% sensitive to the first line with one azithromycin resistant case being the only oral antibiotic available for XDR cases
Summary
Typhoid fever remains a problem in developing countries, including Pakistan. The emergence of multidrug-resistant and, since 2016, of extensively drug-resistant cases is a continuous challenge for health care workers. Conclusions: The increasing prevalence of resistance and higher degree of complications seen in typhoid fever raises the concern further about prevention and effective infection management in the community as well as clinical settings. Since 2016, an outbreak that started from Sindh, Pakistan of an extensively drug-resistant strain, has spread to other parts of the country like Punjab and so far, 5,200 extensively drug resistant cases have been reported [2]. This strain remains resistant to the standard first-line and second-line agents used for the treatment of enteric fever, including fluoroquinolones, and is only sensitive to macrolides and carbapenems [3,4]. Typhi cases resistant to amoxicillin, co-trimoxazole, chloramphenicol, ciprofloxacin, and ceftriaxone [8]
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