Abstract
BackgroundHyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.ObjectiveTo address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.MethodsWe reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.ResultsA total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).ConclusionsAs this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.
Highlights
MethodsTyphoid fever is caused by Salmonella enterica serovar Typhi and is characterized by prolonged fever, headache, nausea, loss of appetite, constipation, or diarrhea [1]
Since the extensively drug resistant (XDR) Typhi outbreak began in Hyderabad in late 2016 [7], typhoid fever cases in Pakistan increased, in Hyderabad and other parts of Sindh province; this is attributed to the circulating extensively drug resistant https (XDR) Typhi strain [8]
Despite the large number of cases, little information on mortality and morbidity attributable to XDR Typhi infections has been available. To address this knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Typhi infections in Hyderabad, Pakistan
Summary
MethodsTyphoid fever is caused by Salmonella enterica serovar Typhi (hereinafter referred to as “Typhi”) and is characterized by prolonged fever, headache, nausea, loss of appetite, constipation, or diarrhea [1]. Treatment of enteric fever has been complicated by the development and rapid global spread of typhoidal organisms resistant to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Since the extensively drug resistant (XDR) Typhi outbreak began in Hyderabad in late 2016 [7], typhoid fever cases in Pakistan increased, in Hyderabad and other parts of Sindh province; this is attributed to the circulating XDR Typhi strain [8]. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, greatly limiting treatment options. Objective: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P
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