Prolonged Fever in a Multidrug-Resistant Typhoid Fever Patient Despite Appropriate Antimicrobial Therapy: A Case Report

TL;DR

A boy with multidrug-resistant typhoid fever had a prolonged fever but improved after switching to a combination antibiotic treatment.

Contribution

This case report highlights the challenges of treating multidrug-resistant typhoid and the effectiveness of meropenem and azithromycin.

Findings

The patient's fever and bacteremia resolved after switching to meropenem and azithromycin.

Blood cultures became sterile by day 12, indicating successful treatment.

The case emphasizes the global spread of drug-resistant typhoid linked to international travel.

Abstract

Typhoid fever, caused by Salmonella enterica serovar Typhi (S. Typhi), remains a significant global health concern. The emergence of multidrug-resistant (MDR) S. Typhi strains, including extended-spectrum beta-lactamase (ESBL) producers, has further complicated treatment by limiting the effectiveness of first-line and some second-line antibiotics. We present a case of a 10-year-old boy who developed a prolonged febrile illness after traveling to a typhoid-endemic region. Initial treatment with ceftriaxone proved ineffective due to the presence of ESBL-producing S. Typhi, necessitating a change to meropenem combined with azithromycin. Despite persistent fever, the patient showed clinical improvement by day five and became afebrile by day 11, and there was improvement of inflammatory markers and resolution of bacteremia, as confirmed by sterile blood cultures on day 12. This case underscores the challenges in managing MDR typhoid fever and highlights the critical need to maintain appropriate antibiotic regimens, even in the context of prolonged febrile responses. Furthermore, it draws attention to the global spread of MDR and extensively drug-resistant (XDR) S. Typhi, often facilitated by international travel, emphasizing the need for vigilant resistance monitoring and empiric treatment adjustments. Effective antibiotic stewardship, adherence to evidence-based guidelines, and heightened clinical awareness are essential to address the complex public health and clinical challenges posed by MDR and XDR S. Typhi.

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