Aussie Toddler Infected With First Case Of Extensively Drug-Resistant Typhoid
Doctors have reported the first case of extensively drug-resistant typhoid in Australia, warning the country is not immune to the "emerging threat".
A 20-month-old Australian-born girl is the first patient to develop the highly-resistant form of the superbug after returning from a three-month trip to Pakistan.
Dr Philip Britton and his colleagues from the Children's Hospital at Westmead and the University of Sydney published the findings in the Medical Journal of Australia letter on Monday.
Typhoid fever is caused by an infection with the bacteria Salmonella Typhi. In Australia, most typhoid infections are acquired by travellers consuming contaminated food or water overseas, particularly in endemic regions of South and South-East Asia.
Since 2016, an extensively drug-resistant (XDR) group of typhoid-related organisms, called a "clade", has emerged in Pakistan, showing resistance to first-line antibiotics.
Seven cases of XDR have been reported among travellers -- mostly children -- returning from Pakistan to England, Germany and the United States in the past two years.
According to Britton and his colleagues, the young girl presented to the Sydney hospital with features of typhoid fever (also known as enteric fever), 14 months after her return to Australia. She was a previously healthy child who had received routine vaccines, with no additional pre-travel vaccinations being recommended.
“Diarrhoea began in Pakistan six weeks before her return and continued despite the use of oral antibiotics prescribed locally in Pakistan," the authors wrote.
"Ten days of high fevers, irritability, vomiting and reduced oral intake prompted admission."
Doctors grew the bug from the young girl's bloodstream, finding it showed features typical of the XDR clade.
They treated the young girl with intravenous meropenem and oral azithromycin -- the last two remaining antibiotics -- which she responded to, and discharged her after eight days.
An 'Escalating Threat' Of Antimicrobial Resistance
The case was one of 12 travel-associated enteric fever cases managed at the Sydney hospital between January and March this year, with incidences growing between 2003 and 2015.
It adds to concerns around the global rise of antibiotic-resistant suberbugs, as infections that were once easy to treat with antibiotics are becoming less so.
The World Health Organisation defines AMR as the "ability of a micro-organisms (like bacteria, viruses and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it".
"As a result, standard treatments become ineffective, infections persist and may spread to others," it says.
Last month, researchers warned a "black hole in surveillance" has left Australians vulnerable to bugs including typhoid and gonorrhea.
Authors of an article, published in the Medical Journal of Australia, wrote a "large reservoir" of antimicrobial resistance was both "within Australia and at our doorstep".
Health experts have also warned rising temperatures will cause an increase in enteric and food-borne diseases, such as salmonella, as research hones in on the health-related impacts of climate change.
Britton and his colleagues said Australia is not only not immune to the "escalating" threat of AMR but the "emerging threat" of XDR typhoid, given our tendency to travel.
"Typhoid must be considered as a diagnosis for febrile returned travellers from endemic regions, including South and South‐East Asia," they wrote.
The researchers urged travellers visiting affected regions to get vaccinated, adding typhoid is a key illness of concern between January and March -- the "peak season" for travellers returning to Australia.
Typhoid vaccination is recommended from two years of age if travel is planned to these regions.
The researchers said GPs have an important role in providing travel-related vaccine advice, adding care for returning travellers "must not be underestimated".
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