Toddler becomes the first case of extensively drug-resistant typhoid in Australia

The first case of extensively drug-resistant (XDR) typhoid in Australia has been reported by the authors of a letter published today in the Medical Journal of Australia, highlighting the need for people contemplating travel to South and South East Asia to be vaccinated.

Since 2016, an XDR group of related typhoid organisms (known as a clade) has emerged in Pakistan and has been reported as resistant to all first-line antibiotic agents. Seven cases have been reported in travellers returning to England, Germany and the United States from Pakistan.

Dr. Philip Britton, a senior lecturer in Child and Adolescent Health at the University of Sydney and the Children's Hospital at Westmead, and colleagues reported on a 20-month-old Australian-born girl who presented to the hospital with features of enteric fever 14 days after returning from a 3-month trip to Pakistan.

"Diarrhoea began in Pakistan 6 weeks before her return and continued despite the use of oral antibiotics prescribed locally in Pakistan. Ten days of high fevers, irritability, vomiting and reduced oral intake prompted admission," Britton and colleagues wrote.

"Blood and stool cultures grew extended spectrum β-lactamase-producing Salmonella enterica serovar Typhi. The isolate showed microbiological features typical for the XDR clade, with resistance to chloramphenicol, ampicillin, trimethoprim–sulfamethoxazole, fluoroquinolones and third-generation cephalosporins.

"The child responded to intravenous meropenem and oral azithromycin and was discharged after an uncomplicated 8-day admission to complete a further week of azithromycin."

The authors warned that Australia was not immune to the "emerging threat" of XDR typhoid.

"Typhoid must be considered as a diagnosis for febrile returned travellers from endemic regions, including South and South-East Asia," they concluded.

"Typhoid vaccination is recommended from 2 years of age if travel is planned to these regions. The important role of GPs in providing travel-related vaccine advice and care to returning travellers must not be underestimated."