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How multidrug resistance in typhoid fever affects treatment options.
[typhoid]
Salmonella
enterica
serotype
Typhi
(
S
.
Typhi
)
is
an
enteric
pathogen
that
causes
typhoid
fever
.
The
infection
can
be
severe
,
with
significant
morbidity
and
mortality
,
requiring
antimicrobial
therapy
.
Cases
of
S
.
Typhi
infection
in
the
United
States
and
other
developed
countries
are
often
associated
with
travel
to
endemic
regions
.
The
empirical
use
of
first
-line
drugs
for
therapy
,
including
ampicillin
,
chloramphenicol
,
and
trimethoprim
/
sulfamethoxazole
,
has
resulted
in
transmissible
multidrug
resistance
.
With
the
global
increase
in
multidrug-resistant
S
.
Typhi
,
use
of
ciprofloxacin
,
with
excellent
oral
absorption
,
few
side
effects
,
and
cost-effectiveness
,
has
become
popular
for
treatment
.
However
,
decreased
ciprofloxacin
susceptibility
due
to
point
mutations
in
the
S
.
Typhi
genes
gyrA
and
/
or
parC
has
caused
treatment
failures
,
necessitating
alternative
therapeutic
options
.
S
.
Typhi
is
typically
genetically
homogenous
,
with
phylogenetic
and
epidemiological
studies
showing
that
identical
clones
and
diverse
S
.
Typhi
types
often
coexist
in
the
same
geographic
region
.
Studies
investigating
point
mutations
have
demonstrated
that
selective
pressure
from
empirical
use
of
first
-line
drugs
and
fluoroquinolones
has
led
to
the
global
emergence
of
haplotype
H-
58
.
Antibiotic
resistance
is
subject
to
high
selective
pressure
in
S
.
Typhi
and
thus
demands
careful
use
of
antimicrobials
.
Diseases
Validation
Diseases presenting
"travel to endemic regions"
symptom
typhoid
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