Current major event
Drug resistant Salmonella infections in Pakistan: update
Pakistan is experiencing a continuous surge of extensively drug resistant (XDR) Salmonella enterica serovarTyphi (S. Typhi) cases since November 2016. Till the reporting week 34, 2019 a total of 10,365 cases were reported from different districts of province Sindh with no associated deaths.
Editorial note
Even though this was the first major upsurge of XDR Typhoid fever cases in Pakistan but it is not the first time the country has experienced an outbreak of drug resistant Salmonellosis. Previous documented outbreaks of drug resistant Salmonellosis occurred in 1989, and then 1994-95 in the country.
Typhoid fever is endemic in Pakistan but not reported regularly as it's not one of the priority diseases, for this reason the true burden of disease is unknown. Contributing factors to high prevalence of the disease in the country include poor water and sanitation infrastructure.
Since November 2016, the emergence of extensively drug resistant (XDR) strain of Salmonella enterica serovarTyphi (S. Typhi) ,that acquired a plasmid resistant to multiple antibiotics including first-line antibiotics (i.e. chloramphenicol, ampicillin, and trime-thoprim-sulfamethoxazole), fluoroquin-olones and third-generation cephalosporins. The pathogen remained sensitive to azithro-mycin and carbapenims only.
During the last week of November 2016, the first few cases were laboratory confirmed from the Hyderabad district of Sindh province of Pakistan. In addition to these reported cases, there were cases diagnosed in US as XDR typhoid fever cases with the travel history from Pakistan. After these reports, typhoid fever laboratory confirmation through culture and drug sensitivity was reinforced in different hospitals of Hyderabad and Karachi districts. Till the reporting date, a total of 83 cases were confirmed in US and 27 out of these total were reported as XDR typhoid fever cases with the travel history from Pakistan. Few other countries also reported XDR typhoid fever cases with the travel history to Pakistan.
