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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
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated