First Reported Case of Ceftriaxone-Resistant Typhoid Fever in the Middle-East

Abstract

Introduction: Typhoid fever is a potential febrile illness caused by Salmonella enterica serovar Typhi. It is mainly transmitted through contaminated food and water, and spreads from infected persons and chronic carriers. Humans are the only reservoir host. There were many multi-drug resistant S. Typhi cases reported in many parts of South Asia and Africa. However, since 2016there were reported case series of extended drug resistant S. Typhi from Pakistan (resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones and third generation cephalosporines). Genomic sequencing analysis of this organism was of haplotype H58 transmitted by a plasmid. Case Presentation: This is the first reported case of ceftriaxone-resistant typhoid fever in the Middle-East, who travelled from Pakistan to Qatar in September 2019. He recovered completely with injection meropenem and oral azithromycin. Conclusion: A detailed travel history and early diagnosis and treatment with appropriate drugs are inevitable in the management of such cases. Safe drinking water, improved sanitation and effective public health infrastructure will play a key role in the control of the disease.