Name: CDC Warns of Drug-Resistant Typhoid Fever Outbreak
Brand: medscape.com
SKU: medscape-com-14
Availability: OnlineOnly

critic

CDC Warns of Drug-Resistant Typhoid Fever Outbreak

preview

MedscapeUnivadisEnglish EditionMedscapeUnivadisXPlease confirm that you would like to log out of Medscape.If you log out, you will be required to enter your username and password the next time you visit.&gt;A new drug-resistant strain of Salmonella Typhi has infected at least 71 people in the United States, according to the Centers for Disease Control and Prevention.The new strain, extensively drug-resistant (XDR) Typhi, caused a large outbreak in Pakistan's Sindh province starting in 2016, and has spread throughout that country. Now it may be taking root in the United States.XDR Typhi strains are resistant to antibiotics generally recommended to treat typhoid fever, including ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole. Carbapenem and azithromycin remain effective treatments against the strain."This marks the first time cases of ceftriaxone-resistant Typhi infections have been identified in the United States that don't appear to have been acquired during international travel," Louise Francois Watkins, MD, MPH, medical officer in the CDC's Enteric Diseases Epidemiology Branch, told Medscape Medical News in an email.of XDR Typhi infection in the United States as of January 14 of this year, with specimens obtained from February 9, 2018, through November 16, 2020.Among the 67 patients with known travel history, 58 (87%) had traveled to Pakistan in the 30 days before illness began. But another nine patients had not left the United States during that time."Because typhoid fever (the infection caused by the Salmonella Typhi bacterium) can cause severe illness and death if not treated, the emergence of antibiotic-resistant typhoid fever has become an increasing concern over the past decade," said Watkins.Although other types of Salmonella are among the principal&nbsp;causes of foodborne illness in the United States, these are generally self-limiting and less severe than Typhi. Typhi is more common in South Asian countries where it is most often spread through contaminated drinking water, said Siddhartha Thakur, DVM, PhD, a professor of molecular epidemiology at North Carolina State University in Raleigh."Typically, you don't expect Typhi cases in the US because we have safe drinking water," he told Medscape Medical News. "This strain is concerning. I have seen in the past how new strains of pathogens come to the US from people who travel or food that's imported, and slowly they establish themselves."The nine US patients infected with XDR Typhi without recent travel lived in six states: New York, California, Illinois, Maryland, New Jersey, and Texas. The CDC has not established any link among the patients or a common source of infection.One way the US patients might have been infected is by coming into contact with someone who had traveled to Pakistan, Thakur said. People can spread the bacteria even without experiencing symptoms. The US patients might also have consumed an imported food or beverage, or even touched an object contaminated by someone with an infection, he said.The CDC is advising anyone traveling to South Asia to get vaccinated against typhoid fever and to carefully observe .Clinicians should consider typhoid fever as a diagnosis in patients with fever, headache, constipation or diarrhea, malaise, and chills, Watkins said.Severe or complicated typhoid fever can include "bacteremia with sepsis or shock, gastrointestinal complications (eg, intestinal perforation, peritonitis, intestinal hemorrhage, hepatitis), and neurologic complications (eg, encephalopathy)," according to the CDC alert.It advised obtaining a 30-day international travel history from all patients with suspected or confirmed typhoid fever."If clinicians do not suspect typhoid fever and do not order appropriate tests, the diagnosis can be missed," said Watkins.If they do suspect typhoid fever, clinicians should order blood cultures — and more than one culture may be necessary, she added. "Bone marrow cultures have the highest sensitivity and may be considered for some patients, such as those who have already started or completed a course of antimicrobial treatment," Watkins said.&nbsp;She recommended testing Typhi isolates for antimicrobial susceptibility and adjusting treatment accordingly.While awaiting the results of these tests, clinicians should vary their empiric treatment plans depending on patients' travel history in the 30 days prior to symptoms, the CDC advised:Once XDR typhus infection is confirmed, the CDC recommends treating patients with severe or complicated illness with a carbapenem, adding azithromycin if that doesn't work. Patients with uncomplicated illness may be treated with an oral azithromycin alone, the advisory says.Typhoid fever should be reported following local health department requirements. Follow-up testing may be advised to ensure microbiological cure before people return to high-risk occupations, such as food handling, daycare, or healthcare.Watkins and Thakur have disclosed no relevant financial relationships.CDC Health Advisory. February 12, 2021.Laird Harrison writes about science, health, and culture. His work has appeared in national magazines, in newspapers, on public radio and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto.&nbsp;Visit him at&nbsp;www. or follow him on&nbsp;For more news, follow Medscape on , , , and&nbsp;Medscape Medical News&nbsp;©&nbsp;2021&nbsp;Send news tips to .Cite this: CDC Warns of Drug-Resistant Typhoid Fever Outbreak&nbsp;-&nbsp;Medscape&nbsp;-&nbsp;Feb&nbsp;17,&nbsp;2021.Commenting is limited to medical professionals. To comment please .Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our for further information. We reserve the right to remove posts at our sole discretion.Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our for further information. We reserve the right to remove posts at our sole discretion.According to PHYSICIANSMy AlertsYou have already selected for My AlertsClick the topic below to receive emails when new articles are available.You've successfully added to your alerts. You will receive email when new content is published.processing....What to Read Next on MedscapeBusiness of MedicineMedscape ConsultRecommended ReadingRelated Conditions &amp; ProceduresSlideshowExpert CommentaryRecommendationsb:curatedcuratedHasData : trueEmail ThisFeedbackSendSend FeedbackPleasedo not use this form to submit personal or patient medical information or to report adverse drug events. You are encouraged to report adverse drug event information to the FDA.Your Name is required.Subject is required.Please enter a Recipient Address and/or check the Send me a copy checkbox.Your email has been sent.is an Invalid Email Address.Find Us OnAboutMembershipNetworkEditionsAll material on this website is protected by copyright, Copyright © 1994-2022 by WebMD LLC. This website also contains material copyrighted by 3rd parties.Close

MedscapeUnivadisEnglish EditionMedscapeUnivadisXPlease confirm that you would like to log out of Medscape.If you log out, you will be required to enter your username and password the next time you visit.&gt;A new drug-resistant strain of Salmonella Typhi has infected at least 71 people in the United States, according to the Centers for Disease Control and Prevention.The new strain, extensively drug-resistant (XDR) Typhi, caused a large outbreak in Pakistan's Sindh province starting in 2016, and has spread throughout that country. Now it may be taking root in the United States.XDR Typhi...

CDC Warns of Drug-Resistant Typhoid Fever Outbreak

No article scores yet.

CRITIC REVIEWS

PUBLIC REVIEWS