First reported case of extensively drug‐resistant typhoid in Australia

Annaleise Howard‐Jones, Alison M Kesson, Alexander C Outhred and Philip N Britton
Med J Aust 2019; 211 (6): . || doi: 10.5694/mja2.50316
Published online: 16 September 2019

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

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. (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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