First case of drug-resistant typhoid reported in Australia

17 September 2019
Vaccinations increasingly important as drug- resistance increases
A letter in the MJA this week reports Australia's first case of extensively drug resistant typhoid, highlighting the importance of vaccination as drug-resistant infections become more common.

The first case of extensively drug-resistant typhoid in Australia has been reported, highlighting the need for people planning to travel to South and South-East Asia to be vaccinated.

Dr Philip Britton, from the University of Sydney and the Children’s Hospital at Westmead, and colleagues revealed the findings in a letter published in the Medical Journal of Australia (MJA) yesterday.

What happened?

In February this year a 20-month-old Australian-born girl was taken to hospital with a high fever and vomiting. It was 14 days after she had returned from a three-month trip to Pakistan.

The researchers report the illness had begun in Pakistan and continued despite the use of oral antibiotics prescribed there.

Since 2016, an extremely drug-resistant group of related typhoid organisms (known as a clade) has emerged in Pakistan and has been reported as resistant to first-line antibiotic agents. Seven cases have been reported in travellers from Pakistan returning to England, Germany and the United States.

Infectious diseases expert Dr Britton explained about the new Australian finding: "It was only when we grew the bug from her blood stream that we became aware it was a highly resistant form, and a bug that's associated with an outbreak of this extensively drug-resistant typhoid in Pakistan and western India."

The child was treated successfully with third-line antibiotics , which are used for multidrug-resistant organisms, and was discharged from the hospital eight days after admission.

"… we became aware it was a highly resistant form, associated with an outbreak of this extensively drug-resistant typhoid.
Dr Philip Britton

What is typhoid?

Typhoid is an infection caused by the bacteria Salmonella Typhi subspecies enterica serovar Typhi. It is spread through contact with faeces, usually through ingesting contaminated food and water. It occurs predominantly in association with poor sanitation and lack of clean drinking water.

Symptoms include a prolonged fever which can last three or four weeks if left untreated, headache, diarrhoea or constipation, abdominal pain and vomiting. Untreated the infection can cause serious complications or even death.

Remember to vaccinate before travelling

The authors warned that Australia was not immune to the “emerging threat” of extensively drug resistant typhoid.

“Typhoid must be considered as a diagnosis for febrile returned travellers from endemic regions, including South and South-East Asia,” they concluded in the MJA paper.

“Typhoid vaccination is recommended from two years of age if travel is planned to these regions.”

Learn more about our research at the University of Sydney Children's Hospital Westmead Clinical School.

Ivy Shih

Assistant Media and Public Relations Adviser (Health)

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