Extensively Drug-Resistant or XDR typhoid fever is primarily caused by Salmonella enterica serovar Typhi. It has turned out as a crucial public health concern, particularly in Pakistan. This strain is specified by its resistance to all of the first-line antibiotics used to treat typhoid, including third-generation Cephalosporins and Fluoroquinolones.
In this blog, I’ll provide a complete guide on the Drug resistant XDR strain of Typhoid and showcase its symptoms, treatment and recent situation in Pakistan. So catch up till the end!
Table of Contents
Drug Resistant Typhoid in Pakistan
The rise of extensively drug-resistant typhoid (XDR) fever in Pakistan isn’t just a public health concern; it’s a story of resistance, fear, and the urgent need for collective action. Since its first detection in 2016, XDR typhoid has spread deadly, affecting thousands and leaving families with the harsh realities of antibiotic resistance.
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A Growing Crisis
As of recent reports, over 15,000 cases of extremely drug resistant typhoid have been documented across Pakistan, with many more cases likely to be unreported due to inadequate healthcare infrastructure. The outbreak began in the Hyderabad district of Sindh province and has since spread to various regions, including Karachi, where nearly 69% of cases have been identified.
This rapid spread is a sharp reminder of how quickly infectious diseases can evolve and adapt, leaving people vulnerable and exposed.
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Understanding XDR Salmonella Typhi
What is XDR Typhoid?
XDR typhoid fever, also known as extensively drug-resistant typhoid, is a severe form of typhoid caused by the bacterium Salmonella Typhi. Unlike common strains, it’s resistant to multiple antibiotics, making treatment options extremely limited.
This situation can arise feelings of fear and helplessness in communities affected by outbreaks, as families worry about the health of their loved ones. This drug resistant typhoid is characterized by its ability to resist treatment with the most commonly prescribed antibiotics, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.
Now you can well imagine that a once-treatable disease has evolved into an untreatable condition. Patients often experience prolonged illness, leading to anxiety and mental depression about recovery.
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Comparison Between MDR and XDR Typhoid
While both XDR and multidrug-resistant (MDR) typhoid causes significant health challenges, they differ in their resistance profiles.
MDR typhoid is resistant to at least two of the first-line antibiotics but may still be treated by others. While XDR-typhoid is resistant to all antibiotics except one or two remaining options, like azithromycin or meropenem.
This distinction can be crucial for healthcare providers and families both. Understanding such kind of typhoid represents a more advanced stage of antibiotic resistance can increase the need of urgency and immediate action in prevention and treatment protocols.
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Causes of XDR Typhoid
Bacterium Salmonella Typhi and Its Resistance Mechanisms
The rise of this extremely drug resistant fever is largely due to Salmonella Typhi, a resistant bacterium capable of rapidly adapting to its environment. This adaptability often leads to genetic mutations leading to antibiotics resistance,
The bacterium lives in environments with poor sanitation and hygiene practices, which are prevalent in many regions of Pakistan. This connection between S.typhi and its surroundings highlights the importance of quick treatment practices.
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Factors Contributing to the Rise of XDR Strains in Pakistan
Several factors contribute to the alarming rise of XDR strains in Pakistan. One major issue is the extensive misuse and overuse of antibiotics, often driven by self-medication or incomplete courses of treatment.
This practice not only allows resistant strains to grow but also implant a sense of hopelessness among healthcare professionals who are working to provide effective care.
Additionally, insufficient sanitation facilities and limited access to clean drinking water worsen the situation. For many families living in affected areas, this reality converts into daily anxiety about their own and children’s health.
Furthermore, urbanization and population density have increased physical contact among individuals, further spreading the resistant strains.
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Symptoms and Diagnosis:
Understanding the symptoms of extensively drug-resistant (XDR) typhoid is crucial for early detection and treatment.
XDR Typhoid Symptoms
The antibiotic resistant typhoid fever shows a range of symptoms that can grow quickly, making it important to recognize them early. The most common symptoms include:
High Fever: One of the signature mark is the mounting fever that can rise to alarming levels, sometimes reaching over 103°F (39.4°C).
Stomach Pain: Abdominal discomfort is another prevalent symptom. Patients often feel it as a low ache or sharp pain that can fluctuate in intensity. This pain can be distressing, especially for parents watching their children suffer.
Diarrhea: Many typhoid fever experience severe diarrhea, which can lead to dehydration.
Headache and Weakness: Along with these symptoms, headaches and general weakness is also prominent. The combination creates a sense of tiredness that disturbs daily life.
Diagnosis of XDR Typhoid Fever
Laboratory Tests: Blood cultures are commonly used to identify the presence of Salmonella Typhi. In cases of ampicillin and chloramphenicol resistant typhoid, specialized tests may be conducted to determine antibiotic resistance patterns.
Travel History Considerations: Healthcare providers often ask about recent travel history, particularly to areas where the typhoid is prevalent.
Physical Examination: Doctors will check for vital signs such as abdominal weakness or rash. This process may feel invasive, but it’s a necessary step toward understanding what’s happening inside the body.
Rapid Diagnostic Tests: In some cases, rapid diagnostic tests may be employed to provide quicker results.
XDR Typhoid Treatment
In the fight against the XDR strains of typhoid, Azithromycin and Meropenem came out as the primary treatment options. Azithromycin is an oral antibiotic providing a more accessible solution, particularly in small settings.
It’s also affordable—averaging around $5.87 per day—makes it a first choice for many families who are already concerned by healthcare costs.
While the later, Meropenem is often prescribed for severe cases due to its intravenous administration and higher cost, which can reach up to $88.46 per day.
Treatment Duration and Considerations
Let’s talk about the typical XDR typhoid treatment duration, it generally ranges from 5 to 14 days depending on the severity of the infection and the patient’s response to medication. Factors like age, overall health may affect this timeframe, also any complications that may arise during treatment.
For example, children may stay longer at hospital if they show severe symptoms like high fever or gastrointestinal discomfort.
Drug of Choice for Typhoid
When it comes to selecting the most effective antibiotics for treating both MDR (multidrug-resistant) and extremely drug-resistant typhoid, azithromycin remains the most effective one due to its action against resistant strains. However, as resistance to azithromycin begins to arise, healthcare professionals are increasingly turning to meropenem as an effective alternative.
Preventive Measures:
To control the rapid spread of the resistant Typhoid, prevention strategies have become more crucial than ever.
Vaccination Against Typhoid
In 2019, Pakistan became the first country to introduce the WHO’s recommended typhoid conjugate vaccine (TCV) into its routine immunization program. This vaccine is critically important for children under 15. Parents feel great relief when their children receive vaccine; it marks a bold step towards safeguarding their health.
One promising way is the introduction of the typhoid conjugate vaccine (TCV) which has shown a remarkable efficacy rate of 97% against XDR strains during outbreaks in Hyderabad.
The Typhoid vaccination campaign in Punjab has successfully reached 100% of the targeted population, providing long-lasting typhoid protection.
The TCV can be administered to children as young as 6 months. Healthcare workers and local authorities are committed to ensure that every child is vaccinated to control this public health crisis.
What to Eat During Typhoid
Recovering from typhoid fever can be quite challenging, filled with uncertainty and discomfort. A well-planned diet plays a crucial role in this recovery process, not only providing nourishment but also emotional comfort.
Dietary Recommendations for Patients Recovering from Typhoid Fever
- Porridge and Soft Rice
- Bananas
- Boiled Potatoes
- Chicken Soup
- Coconut Water
Research & Future Directions
Recent studies have shown the alarming rise of extensively drug-resistant typhoid in Pakistan, highlighting both treatment responses and the challenges faced in managing this public health crisis.
A significant genomic analysis revealed multiple circulating variants of XDR Salmonella enterica serovar Typhi, particularly in Sindh Province, where the outbreak first emerged in 2016.
This study in which they sequenced 58 XDR isolates collected from 2018 to 2020, found that almost one-third had inserted resistance genes into their chromosomes, enabling them to acquire further resistance and virulence traits.
The occurrence of XDR typhoid has increased, with cases reported rising from 7-15 per 100,000 population in some specific regions. The current treatment of typhoid fever in Pakistan has shifted to azithromycin; however, emerging resistance to this antibiotic poses a significant concern.
Recent data indicates that the majority of XDR cases are now resistant to azithromycin as well, leaving healthcare providers with limited options and leading to increased reliance on more expensive intravenous antibiotics like carbapenems. The situation gets worsen in case of inadequate sanitation and contaminated water sources, which promotes the spread of infection.
Research Paper on XDR Typhoid in Pakistan
Here’s the link to a research study conducted by the Department of Paediatrics and Child Health, Aga Khan University Pakistan about the treatment response of this Extensively Drug-Resistant Typhoid.
Does the Typhoid Vaccine Work for XDR?
The typhoid vaccine can be protective in certain forms of XDR strains of typhoid but its protection is not always absolute.
How to Overcome XDR typhoid?
The best way to counter typhoid fever due to XDR is washing hands, and use of clean water while vaccination in areas badly hit by the disease.
Difference Between MDR and XDR Typhoid
Multidrug-Resistant Typhoid is resistant to at least two of the main classes of antibiotics used to treat typhoid fever while Extensively Drug-Resistant Typhoid is resistant to all different antibiotic groups used in human medicine apart from some highly restrictive ones.
What to Eat in Typhoid
You should stick with low-acid foods such as rice, boiled potatoes, and soft fruits along with plenty of water & fluids uptake.
How to Treat Extensively Drug Resistant Typhoid?
To treat extensively drug-resistant (XDR) typhoid, the recommendations include azithromycin and carbapenems depending on the severity of the infection.
Final Thought
In short, understanding XDR typhoid is crucial for both effective treatment and prevention. This multidrug-resistant Superbug presents significant health risks, but with proper awareness and on-time medical procedures, we can tackle its spread.
Moreover, international collaborations are putting their efforts to monitor and reduce the spread of XDR S. Typhi globally. The Global Typhoid Genomics Consortium aims to track genetic variations and transmission patterns across the countries with strong travel links to Pakistan.
Remember, staying informed is your greatest defense against any infectious diseases. If you found this information helpful, do share it with your friends and family.
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