AS05.b. Tropical/parasite infections & travel medicine

EP130 - TRAVEL ASSOCIATED EXTENSIVELY DRUG RESISTANT TYPHOID FEVER: A CASE SERIES TO INFORM MANAGEMENT IN NON-ENDEMIC REGIONS (ID 760)

Session Name
0772 - E-Poster Viewing (ID 124)
Presenter
Authors

Abstract

Backgrounds:

Travelers to Pakistan are at risk of extensively drug resistant (XDR) typhoid fever, which must be treated with a carbapenem or a macrolide. The objectives of this paper are to present a multicontinental case series of XDR typhoid fever acquired in Pakistan, and link laboratory findings with clinical data to assist front-line clinicians with their antimicrobial decision-making.

Methods

Cases were extracted from the GeoSentinel database, the microbiologic laboratory records of 2 large hospitals in Toronto, Canada, and by invitation to TropNet member sites. All isolates included in this study were confirmed XDR S. enterica serovar Typhi (S. Typhi), with resistance to ampicillin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. Data extracted included demographics and travel details, symptoms, timeline of illness and medical management, antimicrobial susceptibilities, and, where available, whole genome sequencing (WGS) reports.

Results:

Seventeen cases were identified in Canada (10), USA (2), Spain (2), Italy (1), Australia (1), and Norway (1). Patients under the age of 18 years represented 71% (12/17) of the cases, and all patients were VFR (visiting friends or relatives) travelers. Predominant symptoms were fever, abdominal pain, vomiting and diarrhea. Antimicrobial therapy was started on the day of medical presentation in 75% (12/16) of patients, and transition to a carbapenem or macrolide occurred a median of 2 days after blood culture was drawn. Antimicrobial susceptibilities were consistent with the XDR S. Typhi phenotype, and WGS on 3 isolates confirmed their belonging to the XDR variant of the H58 clade.

Conclusions/Learning Points:

Cases of typhoid fever imported from Pakistan may be resistant to first-line antimicrobials. An awareness of epidemiologic risk factors and clinical manifestations may improve early targetting of appropriate antimicrobial treatment (carbepenem for those with severe disease; macrolide for those with milder disease).

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