The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices
Waison Wong,
Hatem Al Rawahi,
Samir Patel,
Yvonne Yau,
Alireza Eshaghi,
Sandra Zittermann,
Leah Tattum,
Shaun K. Morris
Affiliations
Waison Wong
Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
Hatem Al Rawahi
Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
Samir Patel
Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King’s College Circle, Toronto, ON, M5S 1A1, Canada
Yvonne Yau
Division of Microbiology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
Alireza Eshaghi
Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada
Sandra Zittermann
Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada
Leah Tattum
Department of General Pediatrics, The Scarborough Health Network, Scarborough, 3050 Lawrence Avenue East, ON, M1P 2V5, Canada
Shaun K. Morris
Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Centre of Global Child Health, Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada; Corresponding author at: Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
We report on a three year-old male who contracted enteric fever during a visit to the Sindh province of Pakistan in the summer of 2018. He was diagnosed after returning to Canada and blood cultures isolated Salmonella enterica serovar Typhi which harbored extensive drug-resistance (XDR) to all first-line antibiotics including ceftriaxone. Empiric ceftriaxone was switched to meropenem and he was successfully treated with a two-week course. An outbreak of XDR typhoid is currently emerging from Pakistan and several outbreak-related cases have been identified in the U.K and U.S. Whole genome sequencing confirmed that our child was infected with the XDR outbreak-strain. Current empiric antimicrobial choices will result in treatment failure if an XDR strain is encountered, therefore clinicians must adapt their empiric approach for those returning from high risk regions. This is the first XDR typhoid case in Canada and the first pediatric case to be diagnosed and treated outside of Pakistan. Clinicians must be vigilant of future cases. Keywords: Salmonella Typhi, Typhoid, Pediatric, Extensive drug resistance, Antimicrobial resistance, Canada
