The Gathering Storm: Is Untreatable Typhoid Fever on the Way?

Myron M Levine,Raphael Simon

doi:10.1128/mbio.00482-18

Abstract

ABSTRACTKlemm et al. (mBio 9:e00105-18, 2018, https://doi.org/10.1128/mBio.00105-18) present comprehensive antibiotic sensitivity patterns and genomic sequence data on Salmonella enterica serovar Typhi blood culture isolates from typhoid fever cases during an epidemic in Pakistan. Microbiologic and genomic data pinpoint the identities and locations of the antimicrobial resistance genes and the outbreak strain’s lineage. They propose that Salmonella enterica serovar Typhi be added to the list of bacterial pathogens of public health importance that have become extensively drug resistant (XDR). This paper portends possible dire scenarios for typhoid fever control if XDR strains disseminate globally. Since the outbreak strain is of the H58 haplotype, known for its ability to spread worldwide and displace endemic S. Typhi, this concern is well-founded. The report of Klemm et al. forewarns the global community to address control of typhoid fever more aggressively through prevention, should therapeutic options disappear. This Commentary frames the Klemm et al. findings within a historic perspective.

Highlights

Most clinicians and clinical microbiologists today do not appreciate the lethality that typhoid fever exhibited in the preantibiotic era, when this acute generalized infection of the gut-associated lymphoid tissue, reticuloendothelial system, and gallbladder caused by Salmonella enterica serovar Typhi manifested a case fatality rate of ~15%
By preventing mortality, this oral antibiotic became the main tool for typhoid fever control in developing countries
Typhi containing stable incompatibility group H1 (IncH1) plasmids that encoded chloramphenicol resistance caused an extensive epidemic in Mexico [5] and were isolated in Vietnam [6]

Summary

Introduction

Most clinicians and clinical microbiologists today do not appreciate the lethality that typhoid fever exhibited in the preantibiotic era, when this acute generalized infection of the gut-associated lymphoid tissue, reticuloendothelial system, and gallbladder caused by Salmonella enterica serovar Typhi manifested a case fatality rate of ~15%. By preventing mortality, this oral antibiotic became the main tool for typhoid fever control in developing countries. Typhi behaved differently than nontyphoidal Salmonella and Shigella, pathogens that readily acquired R factor plasmids that encode resistance to chloramphenicol and other antibiotics.

Results

Conclusion