Health and Me

Ishita Roy

Superbug Alert: Drug-Resistant Typhoid Fever Returns as a Growing Global Threat

<span>Typhoid fever</span>, to many sound like it now belongs to history books, but a new strain that can resist strongest of antibiotics have emerged in South Asia. This has raised the concerns over the potential spread of drug-resistant infections. 

A gene, which is capable of breaking down carbapenems, which is a powerful antibiotics was seen as a drug of last resort, is discovered among 32 samples collected from hospitals, across western and southern India. This gene is known as blaNDM-5, which can move between different types of bacteria, raising fears that resistance could in fact grow quickly. 

Recent outbreaks of extensively drug-resistant (XDR) typhoid across South Asia have raised serious concerns, as these strains no longer respond to most commonly used antibiotics. Since 2016, Pakistan alone has reported over 15,000 XDR typhoid cases, while resistance to azithromycin has been detected in Bangladesh, India, Nepal and other neighboring regions.

Speaking to the Telegraph, Dr Malick Gibani, Clinical Lecturer in Infectious Diseases at Imperial College London, said, “We all hear that antimicrobial resistance is a problem, but typhoid really exemplifies it – how resistance seems to emerge relentlessly, moving from one class of antibiotics to the next."

“It’s not yet untreatable, but the treatments we do have are much more limited and significantly more challenging to deliver.”

Typhoid is caused by the bacteria Salmonella Typhi. It usually spreads through contaminated food or water and can lead to high fever, stomach pain and serious complications if not treated on time.

Antibiotics are the first line of treatment. These range from commonly used medicines such as amoxicillin and co-trimoxazole to stronger, hospital-only drugs for resistant infections, including carbapenems. Without timely treatment, typhoid can turn life-threatening and, in some cases, prove fatal. What has alarmed researchers is the emergence of typhoid strains that can resist even carbapenems. 

“Although the number of cases described is still relatively small, this feels very much like a warning sign,” said Dr Gibani. “This was always expected and reflects the steady evolution of antimicrobial resistance in typhoid. These infections are not untreatable yet, but they are becoming increasingly difficult to manage.”

Experts point out that typhoid is often difficult to diagnose. This uncertainty can lead to the widespread and sometimes unnecessary use of antibiotics, which further fuels resistance. There are also concerns that extensively drug-resistant typhoid may be more widespread than current data suggests, especially in low-income countries where surveillance and reporting are limited.

“The risk is highest in places with poor water quality, uncontrolled antibiotic use and weak healthcare systems,” said Prof Calman A. MacLennan from the University of Oxford. He noted that while current typhoid mortality is under one percent, the disease was far deadlier before antibiotics were available. “In the pre-antibiotic era, death rates were as high as 10 to 20 percent, and during some wars, more people died of typhoid than from combat.”

<h2>Best Line Of Defense Against Typhoid</h2>

Vaccination, experts say, could be key to preventing a resurgence. The Typhoid Conjugate Vaccine, or TCV, has shown strong effectiveness by triggering the body’s immune response rather than targeting the bacteria directly with antibiotics. “That makes it much harder for the pathogen to escape,” Prof MacLennan explained.

The vaccine has already been introduced into national immunization programmes in 11 countries. However, reaching the poorest regions, where typhoid is most common, remains a challenge. Rolling out a new vaccine requires significant planning and resources, even with international support.

Dr Gibani warned that although South Asia has been hit hardest so far, drug-resistant typhoid can spread globally through travel. Imported cases have already been reported in Europe, North America and Australia. Experts stress that surveillance, vaccination and better sanitation are critical to stopping these dangerous strains from taking hold elsewhere.

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Typhoid fever, to many sound like it now belongs to history books, but a new strain that can resist strongest of antibiotics have emerged in South Asia. This has raised the concerns over the potential spread of drug-resistant infections. A gene, which is capable of breaking down carbapenems, which is a powerful antibiotics was seen as a drug of last resort, is discovered among 32 samples collected from hospitals, across western and southern India. This gene is known as blaNDM-5, which can move between different types of bacteria, raising fears that resistance could in fact grow quickly. Recent outbreaks of extensively drug-resistant (XDR) typhoid across South Asia have raised serious concerns, as these strains no longer respond to most commonly used antibiotics. Since 2016, Pakistan alone has reported over 15,000 XDR typhoid cases, while resistance to azithromycin has been detected in Bangladesh, India, Nepal and other neighboring regions.Speaking to the Telegraph, Dr Malick Gibani, Clinical Lecturer in Infectious Diseases at Imperial College London, said, “We all hear that antimicrobial resistance is a problem, but typhoid really exemplifies it – how resistance seems to emerge relentlessly, moving from one class of antibiotics to the next."“It’s not yet untreatable, but the treatments we do have are much more limited and significantly more challenging to deliver.”What Is Typhoid?Typhoid is caused by the bacteria Salmonella Typhi. It usually spreads through contaminated food or water and can lead to high fever, stomach pain and serious complications if not treated on time.Antibiotics are the first line of treatment. These range from commonly used medicines such as amoxicillin and co-trimoxazole to stronger, hospital-only drugs for resistant infections, including carbapenems. Without timely treatment, typhoid can turn life-threatening and, in some cases, prove fatal. What has alarmed researchers is the emergence of typhoid strains that can resist even carbapenems. “Although the number of cases described is still relatively small, this feels very much like a warning sign,” said Dr Gibani. “This was always expected and reflects the steady evolution of antimicrobial resistance in typhoid. These infections are not untreatable yet, but they are becoming increasingly difficult to manage.”Experts point out that typhoid is often difficult to diagnose. This uncertainty can lead to the widespread and sometimes unnecessary use of antibiotics, which further fuels resistance. There are also concerns that extensively drug-resistant typhoid may be more widespread than current data suggests, especially in low-income countries where surveillance and reporting are limited.“The risk is highest in places with poor water quality, uncontrolled antibiotic use and weak healthcare systems,” said Prof Calman A. MacLennan from the University of Oxford. He noted that while current typhoid mortality is under one percent, the disease was far deadlier before antibiotics were available. “In the pre-antibiotic era, death rates were as high as 10 to 20 percent, and during some wars, more people died of typhoid than from combat.”Best Line Of Defense Against TyphoidVaccination, experts say, could be key to preventing a resurgence. The Typhoid Conjugate Vaccine, or TCV, has shown strong effectiveness by triggering the body’s immune response rather than targeting the bacteria directly with antibiotics. “That makes it much harder for the pathogen to escape,” Prof MacLennan explained.The vaccine has already been introduced into national immunization programmes in 11 countries. However, reaching the poorest regions, where typhoid is most common, remains a challenge. Rolling out a new vaccine requires significant planning and resources, even with international support.Dr Gibani warned that although South Asia has been hit hardest so far, drug-resistant typhoid can spread globally through travel. Imported cases have already been reported in Europe, North America and Australia. Experts stress that surveillance, vaccination and better sanitation are critical to stopping these dangerous strains from taking hold elsewhere.