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Typhoid fever‐causing bacteria are getting better at evading antibiotics

Bacteria causing typhoid fever are becoming increasingly resistant to some of the most important antibiotics for human health, according to a study published in The Lancet Microbe. The largest genome analysis of Salmonella enterica serovar Typhi (S. Typhi) also reveals that resistant strains — almost all originating in South Asia — have spread to other countries at least 197 times since 1990. Typhoid fever causes 11 million infections and more than 100000 deaths per year. While it is most prevalent in South Asia — which accounts for 70% of the global disease burden — it also has significant impacts in sub‐Saharan Africa, South East Asia and Oceania, highlighting the need for a global response. The authors of the new study performed whole genome sequencing on 3489 S. Typhi solates obtained from blood samples collected between 2014 and 2019 from people in Bangladesh, India, Nepal, and Pakistan with confirmed cases of typhoid fever. A collection of 4169 S. Typhi samples isolated from more than 70 countries between 1905 and 2018 was also sequenced and included in the analysis. Resistance‐conferring genes in the 7658 sequenced genomes were identified using genetic databases. Strains were classified as multidrug‐resistant if they contained genes giving resistance to classical frontline antibiotics ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole. The authors also traced the presence of genes conferring resistance to macrolides and quinolones. While these resistant strains most often occurred within South Asia and from South Asia to South East Asia, and East and Southern Africa, they have also been reported in the UK, US and Canada.

https://www.thelancet.com/journals/lanmic/article/PIIS2666‐5247(22)00093‐3/fulltext

Inability to stand on one leg later in life linked to near doubling of death risk

The inability to stand on one leg for 10 seconds in mid to later life is linked to a near doubling in the risk of death from any cause within the next 10years, finds research published in the British Journal of Sports Medicine. This simple and safe balance test could be included in routine health checks for older adults, say the researchers. The researchers drew on participants in the CLINIMEX Exercise cohort study. This was set up in 1994 to assess associations between various measures of physical fitness, exercise‐related variables, and conventional cardiovascular risk factors, with ill health and death. The current analysis included 1702 participants aged 51–75years (average of 61years) at their first check‐up, between February 2009 and December 2020. Around two‐thirds (68%) were men. Weight and several measures of skinfold thickness plus waist size were taken. Details of medical history were also provided. Only those with stable gait were included. As part of the check‐up, participants were asked to stand on one leg for 10 seconds without any additional support. To improve standardisation of the test, participants were asked to place the front of the free foot on the back of the opposite lower leg, while keeping their arms by their sides and their gaze fixed straight ahead. Up to three attempts on either foot were permitted. In all, around 1 in 5 (20.5%, 348) participants failed to pass the test. The inability to do so rose in tandem with age, more or less doubling at subsequent 5‐year intervals from the age of 51–55years onwards. The proportions of those unable to stand on one leg for 10 seconds were: nearly 5% among 51–55‐year‐olds; 8% among 56–60‐year‐olds; just under 18% among 61–65‐year‐olds; and just under 37% among 66–70‐year‐olds. More than half (around 54%) of those aged 71–75years were unable to complete the test. In other words, people in this age group were more than 11 times as likely to fail the test as those just 20years younger. During an average monitoring period of 7years, 123 (7%) people died: cancer (32%); cardiovascular disease (30%); respiratory disease (9%); and COVID‐19 complications (7%). The proportion of deaths among those who failed the test was significantly higher (17.5% v 4.5%), reflecting an absolute difference of just under 13%. In general, those who failed the test had poorer health: a higher proportion were obese, and/or had heart disease, high blood pressure, and unhealthy blood fat profiles. Type 2 diabetes was three times as common in this group: 38% v around 13%. This was an observational study, and as such, could not establish cause.

https://bjsm.bmj.com/content/early/2022/05/15/bjsports‐2021‐105360