First reported case of extensively drug‐resistant typhoid in Australia

Howard‐Jones, Annaleise; Kesson, Alison M; Outhred, Alexander C; Britton, Philip N

doi:10.5694/mja2.50316

Topics

To the Editor: The period from January to March marks the peak season for travellers returning to Australia, and typhoid is a key illness of concern. Since 2016, an extensively drug‐resistant (XDR) typhoid clade has emerged in Pakistan, showing resistance to all first‐line agents.1,2 Over the past 2 years, seven cases have been reported in returned travellers — mostly children — from Pakistan to England, Germany and the United States.1,3,4

1 Children's Hospital at Westmead, Sydney, NSW
2 University of Sydney, Sydney, NSW

Correspondence: philip.britton@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. Klemm EJ, Shakoor S, Page AJ, et al. Emergence of an extensively drug‐resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third‐generation cephalosporins. MBio 2018; 9: pii e00105‐18.
2. World Health Organization. Disease outbreaks in Eastern Mediterranean Region (EMR), January to December 2018. WHO EMRO Weekly Epidemiology Monitor 2018; 11: 1. http://applications.emro.who.int/docs/epi/2018/Epi_Monitor_2018_11_52.pdf?ua=1 (viewed July 2019).
3. Chatham‐Stephens K, Medalla F, Hughes M, et al. Emergence of extensively drug‐resistant Salmonella Typhi infections among travelers to or from Pakistan — United States, 2016–2018. MMWR Morb Mortal Wkly Rep 2019; 68: 11–13.
4. Kleine CE, Schlabe S, Hischebeth GTR, Molitor E, Pfeifer Y, Wasmuth JC, et al. Successful therapy of a multidrug‐resistant extended‐spectrum β‐lactamase‐producing and fluoroquinolone‐resistant Salmonella enterica Subspecies enterica serovar Typhi infection using combination therapy of meropenem and fosfomycin. Clin Infect Dis 2017; 65: 1754–1756.
5. Khatami A, Khan F, Macartney KK. Enteric fever in children in Western Sydney, Australia, 2003–2015. Pediatr Infect Dis J 2017; 36: 1124–1128.

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