Extensively drug-resistant Salmonella Typhi infections among U.S. residents without international travel

The majority of people in the United States who contract typhoid fever acquire it during travel abroad, but some acquire it domestically. As of January 14, 2021, CDC received 71 reports of extensively drug-resistant (XDR) Salmonella enterica serotype Typhi infections in the United States, from specimens obtained from February 9, 2018, through November 16, 2020. Among 67 patients with known travel history, 58 (87%) traveled to Pakistan in the 30 days before illness began. Nine (13%) patients from six states—New York, California, Illinois, Maryland, New Jersey, and Texas—reported that they had not traveled to Pakistan or any other country. An unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq has been reported in the United States and the United Kingdom. CDC notes that clinicians should consider that typhoid fever symptoms and clinical presentation may resemble those of other febrile infectious diseases, with severe cases causing bacteremia and neurologic complications such as encephalopathy. Clinicians should obtain a 30-day international travel history from all patients with suspected or confirmed typhoid fever, order blood cultures, order antimicrobial susceptibility testing for Typhi isolates, and adjust treatment accordingly. Patients with XDR Typhi infection may be treated with a carbapenem, azithromycin, or both.