Mar 21, 2018
2:21 PM
Pakistan Races to Combat First Drug-Resistant Typhoid
Rumors about poisoned vaccines are making this bacterial infection hard to control
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A family bathes and in a canal filled with sewage in Hyderabad. Researchers believe unclean water sources are a root cause of typhoid
By Meher Ahmad FROM Scientific American
When Qaurat al-Ain brought her fever-stricken daughter Mariam to a doctor in this city 90 miles east of Karachi, she assumed the one-year-old had a chest cold. The doctor prescribed antibiotics and sent her on her way, but the fever persisted. Another doctor tried antimalarial drugs, also to no avail. That’s when al-Ain got really worried – the fever had already lasted two weeks.

She sought a third opinion, and finally doctors at a specialized maternal and child care hospital in Hyderabad said her child likely had typhoid. That made sense: Pakistan is one of the few places where the bacterial infection remains endemic. Just over half a million people a year contract it here, often by consuming feces-contaminated food or water. Its hallmark symptom is a persistently high fever, and when left untreated it can cause intestinal perforation and fatal sepsis. “I remember having typhoid as a kid,” al-Ain says. “I just remember being out of school for a week, and other kids in my class having it, too.” But Mariam’s illness did not seem typical. “She would shake with fever chills for hours,” al-Ain recalls. “Seeing my baby like that was terrifying. It didn’t help that the doctors seemed so anxious, too.”

Mariam’s doctors, it turned out, had reason to be concerned: A blood test revealed the typhoid strain Mariam carried was resistant to five classes of antibiotics typically used to treat the infection. Although resistance to three classes of typhoid medication – formally known as “multidrug-resistant” typhoid – had become common in Pakistan in recent decades, this extreme level of resistance was much worse. Mariam’s infection was designated “extensively drug resistant,” or XDR – meaning it would only respond to one powerful, broad-spectrum class of antibiotics: azithromycin, which is considered the last line of defense against typhoid.


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