Typhoid The emergence of multi drug resistance to

Typhoid fever is an infectious disease of global distribution 7. It is a systemic infection caused by51 Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality 8.52 It is a prolonged febrile illness and continues to be a health problem in developing countries where there53 is poor sanitation, poor standard of personal hygiene and prevalence of contaminated food. It is endemic54 in many parts of the developing world, and as global travel increases, illness can and do occur around the55 world in span of a day 9. In urban areas where sewage disposal is lacking or inadequate, water suppliesUNDER PEER REVIEW3get contaminated and thus cause the outbreaks of typhoid. The contamination of food 56 by carrier is the57 second most frequent route of infection 10. A number of reports on typhoid were made in different part58 of the world 11. A number of reports regarding the epidemiology of this disease have been made 12.59 2.1 Salmonella typhi60 Salmonellae are aerobic, non-spore-forming, flagellated bacilli. Salmonella typhi, the etiologic agent for61 typhoid fever, is a member of the salmonella genus which belongs to the Enterobacteriaceae family of62 Gram negative bacteria. Members of this genus have a variety of pathogenic effect 13. Salmonella typhi63 cells are rod shaped 2-3 ?m long and 0.4-0.6 ?m diameter. Salmonella strains have evolved to infect a64 wide variety of reptiles, birds and mammals resulting in many different syndromes ranging from65 colonization and chronic carriage to acute fatal diseases. Differences in lipopolysaccharide (LPS)66 generate the antigenic variations, which also affect the virulence of the strain 14.67 S. Typhi is generally transmitted via food or water contaminated with feces or urine from a case68 or carrier. Direct person-to-person spread can also occur. Shellfish harvested from sewage-contaminated69 water are potential vehicles, as are fruits and vegetables grown in soil fertilized with human waste in70 developing countries. Sexual transmission from an asymptomatic carrier has been documented.71 Laboratory-acquired infections also have been reported, including in lab workers who do not directly72 handle Salmonella specimens 13. The emergence of multi drug resistance to S. typhi (MDRST) has73 been of major concern in recent years. MDRST is defined as strains of S. typhi resistant to all three first74 line antibiotics for typhoid fever. The number of reported multi resistant typhoid fever increased rapidly75 throughout the world from 1989 onwards with most of the cases from the Africa, Middle East and Asia76 especially in the Indian subcontinent, Pakistan and China. Resistance to these agents is associated with77 the plasmid present in the bacteria 15.78 2.2 Clinical Symptoms7980 Typhoid fever is a systemic bacterial disease. Initial symptoms typically include sustained fever,81 abdominal pain, anorexia, lethargy, malaise, dull continuous headache, and a nonproductive cough.82 Constipation is reported more frequently than diarrhea in adults. Nausea and vomiting may also occur.83 Diarrhea

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