{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T19:47:52Z","timestamp":1788983272938,"version":"build-2803163510"},"reference-count":11,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T00:00:00Z","timestamp":1582502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Typhoid fever is a potentially severe and occasionally life-threatening bacteraemic illness caused by Salmonella enterica serovar Typhi (S. Typhi). In Pakistan, an outbreak of extensively drug-resistant (XDR) S. Typhi cases began in November 2016. We report on a five-year-old boy who contracted enteric fever while travelling in Pakistan and was diagnosed after returning to Italy in September 2019. Blood culture isolated Salmonella enterica serovar Typhi that was XDR to all first-line antibiotics, including ceftriaxone and fluoroquinolones. Empiric therapy was switched to meropenem, and the patient recovered completely. Whole-genome sequencing showed that this isolate was of haplotype H58. The XDR S. Typhi clone encoded a chromosomally located resistance region and harbored a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum \u03b2-lactamase and the qnrS fluoroquinolone resistance gene. This is the first case of typhoid fever due to XDR S. Typhi detected in Italy and one of the first paediatric cases reported outside Pakistan, highlighting the need to be vigilant for future cases. While new vaccines against typhoid are in development, clinicians should consider adapting their empiric approach for patients returning from regions at risk of XDR S. Typhi outbreak with typhoid symptoms.<\/jats:p>","DOI":"10.3390\/pathogens9020151","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T04:21:26Z","timestamp":1582604486000},"page":"151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy"],"prefix":"10.3390","volume":"9","author":[{"given":"Michela","family":"Procaccianti","sequence":"first","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Motta","sequence":"additional","affiliation":[{"name":"Paediatric Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Giordani","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Riscassi","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Battista","family":"Guidi","sequence":"additional","affiliation":[{"name":"Paediatric Unit, AUSL of Modena, 41026 Pavullo nel Frignano (MO), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Ruffini","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Maffini","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-2837","authenticated-orcid":false,"given":"Susanna","family":"Esposito","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Icilio","family":"Dodi","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1056\/NEJMra020201","article-title":"Typhoid fever","volume":"347","author":"Parry","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.15585\/mmwr.mm6801a3","article-title":"Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan\u2013United States, 2016\u20132018","volume":"68","author":"Medalla","year":"2019","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Britto, C.D., Wong, V.K., Dougan, G., and Pollard, A.J. (2018). A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006779"},{"key":"ref_4","unstructured":"European Center for Disease Prevention (2020, January 16). Increase of XDR Typhoid fever in travellers returning from Pakistan. Available online: https:\/\/www.ecdc.europa.eu\/en\/news-events\/increase-xdr-typhoid-fever-travellers-returning-pakistan."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1093\/cid\/ciy877","article-title":"Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine","volume":"68","author":"Yousafzai","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Browne, A.J., Hamadani, B.H.K., Kumaran, E.A.P., Rao, P., Longbottom, J., Harriss, E., Moore, C.E., Dunachie, S., Basnyat, B., and Baker, S. (2020). Drug-resistant enteric fever worldwide, 1990 to 2018: A systematic review and meta-analysis. BMC Med., 18.","DOI":"10.1186\/s12916-019-1443-1"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ingle, D.J., Nair, S., Hartman, H., Ashton, P.M., Dyson, Z.A., Day, M., Chattaway, M.A., Holt, K.E., and Dallman, T.J. (2019). Informal genomic surveillance of regional distribution of Salmonella Typhi genotypes and antimicrobial resistance via returning travellers. PLoS Negl. Trop. Dis., 13.","DOI":"10.1101\/510461"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"pii:e00105","DOI":"10.1128\/mBio.00105-18","article-title":"Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins","volume":"9","author":"Klemm","year":"2018","journal-title":"mBio"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1007\/s10096-019-03658-0","article-title":"Typhoidal Salmonella strains in Pakistan: An impending threat of extensively drug-resistant Salmonella Typhi","volume":"38","author":"Hussain","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"020407","DOI":"10.7189\/jogh.05.020407","article-title":"Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever","volume":"5","author":"Azmatullah","year":"2015","journal-title":"J. Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hooda, Y., Sajib, M.S.I., Rahman, H., Luby, S.P., Bondy-Denomy, J., Santosham, M., Andrews, J.R., Saha, S.K., and Saha, S. (2019). Molecular mechanism of azithromycin resistance among typhoidal Salmonella strains in Bangladesh identified through passive pediatric surveillance. PLoS Negl. Trop. Dis., 13.","DOI":"10.1101\/594531"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/2\/151\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:01:18Z","timestamp":1760173278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/2\/151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,24]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["pathogens9020151"],"URL":"https:\/\/doi.org\/10.3390\/pathogens9020151","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,24]]}}}