Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation

Iqra Bashir; Sohaib Raza Danish; Ghulam Khadija Bashir

doi:doi:10.11648/j.scif.20250101.20

Review Article |

| Peer-Reviewed

Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation

Iqra Bashir^*, Sohaib Raza Danish, Ghulam Khadija Bashir

Published in Science Futures (Volume 1, Issue 1)

Received: 20 August 2025 Accepted: 7 October 2025 Published: 11 December 2025

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Due to the advent of XDR Salmonella Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of Salmonella enterica, serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) S. Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR Salmonella Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR Salmonella Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR Salmonella Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.

Published in	Science Futures (Volume 1, Issue 1)
DOI	10.11648/j.scif.20250101.20
Page(s)	84-94
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

XDR, MDR, AMP, CHL, CRO

1. Introduction

Salmonella enterica serovar Typhi is a Gram-negative bacterial gut pathogen that is limited to humans and causes severe bloodstream infections leading even to sepsis, which are all referred to as enteric fever

[1]

. Enteric fever is particularly common in low and middle income countries (LMICs), and is spread by tainted food or water

[1, 2]

. In South Asia, Southeast Asia, and sub-Saharan Africa, it is a leading cause of feverish illnesses. According to global data, there were 135 000 associated deaths and 14.3 million cases of enteric fever worldwide

[3]

In spite of the continuous efforts to control, S. Typhi, the causative agent of typhoid fever, remains a hazard to public health. Since multidrug resistance (MDR) of Salmonella Typhi to the three first-line therapies ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol and XDR Salmonella Typhi (first line drugs, fluoroquinolones and third generation cephalosporins) has emerged, the continuous battle against Salmonella Typhi has grown more complicated

[4]

. With reports of resistance to ampicillin, trimethoprim sulfamethoxazole, chloramphenicol, fluoroquinolones and third generation cephalosporins, the advent of XDR Salmonella Typhi has more worrisome and left only few alternatives for treatment. In recent years, there has been a noticeable increase in XDR Salmonella Typhi outbreaks worldwide, particularly in places like Pakistan, where these strains have led to protracted infections and unsuccessful treatments

[5-7]

. The first XDR S. Typhi resistant strain was observed in Pakistan in November, 2016 in Hyderabad, Karachi

[8]

. Nearly 21 million individuals worldwide are afflicted by this disease each year, with South Asians making up the bulk. The World Health Organization (WHO) estimates that between 11 and 21 million cases of typhoid fever and 200,000 fatalities have been reported worldwide

[9]

. Typhoid is endemic in 16 Asian countries, with residents of the Punjab and Sindh provinces most at risk of getting it

[10, 11]

. A study published in 2018 estimated that, out of all the South East Asian nations, Pakistanis had the highest risk of S. Typhi infection. Nearly 493 instances were reported for every 100,000 people

[12]

. Sindh, a province in Pakistan's Southeast, reported the first widespread outbreak in 2016

[13]

. The prevalence of XDR typhoid has risen from 7/100,000 to 15/100,000 in certain areas of Pakistan where certain circumstances are present

[11, 14]

. According to Pakistani health authorities, there were around 22,354 cases of typhoid fever reported between 2016 and 2020, with 15,717 of those cases being extensive drug-resistant typhoid fever from various Sindh locations

[9]

. There have been 2,883 cases reported in Pakistan since September 2020, and all of them were isolates with high levels of resistance. By 2019, almost 10,365 cases of XDR S. Typhi were reported, according to a WHO estimate

[15, 16]

. The XDR strain of typhoid fever is extremely resistant to the antibiotic, a condition known as extensive drug resistance. The illness rate, as determined by these estimates, is approximately 15.5/1,000

[91]

A comprehensive analysis of prevalence of XDR S. Typhi infections in different continents of the world is given in Figure 1.

Download: Download full-size image

Figure 1. A Comprehensive view of prevalence of XDR S. Typhi in different Continents of the world

[8]

Salmonella infections are a direct risk, especially on farms, as the disease can spread from the excrement of infected animals or humans to healthy ones

[17]

. Salmonella Typhi infections has been connected to the contamination of a number of food sources, including fruits, vegetables, poultry, fresh produce, and ready-to-eat items, according to investigations into these outbreaks

[18, 19]

. Furthermore, consuming tainted food items might result in indirect infections, increasing the likelihood of Salmonella transmission

[20]

. A synopsis of Salmonella infections in humans and animals is presented in Figure 2.

Download: Download full-size image

Figure 2. A synopsis of Salmonella infections in humans and animals

[21]

Symptoms include vomiting, fever, cramping in the abdomen, and diarrhea; severe instances can result in complications or even death, particularly in susceptible populations. Safe handling of animals and their surroundings, good hygiene, and careful cooking are all essential preventive steps for reducing the risk of Salmonella transmission

[18, 19]

Salmonella pathogenicity is linked to a number of virulence factors. Included in the Salmonella pathogenicity islands (SPI) are virulence features such as flagella, capsules, plasmids, adhesion systems such as adhesins, invasins, fimbriae, hemagglutinins, exotoxins, endotoxins, biofilm development, and type 3 secretion systems (T3SS)

[22, 23]

. Through horizontal gene transfer, the bacteria also picks up virulence genes found on the SPI

[24-26]

. Together with other virulence determinants, these genes (invA, spvC, sopE, and sseL) generate proteins that help bacteria elude the host's immune system, colonize and persist in host tissues, and induce tissue damage and inflammation

[27-29]

Because Salmonella Typhi is so adaptable, it can acquire resistance genes and is frequently linked to foodborne illnesses, which contributes to its widespread existence. It has been proposed that MDR Salmonella develop resistant plasmids, changing into XDR Salmonella and gaining resistance to all prescribed antibiotics. The H58 clade of Salmonella Typhi, a common serotype in South and Southeast Asia as well as areas of Africa and Oceania, has been linked in reports to several local typhoid epidemics and is also the cause of the XDR Salmonella outbreak

[13, 30-32]

. It contains the IncY plasmid, which confers ceftriaxone and fluoroquinolone resistance via the bla_CTX-M-15 gene

[33]

. It was discovered that the H58 S. Typhi clonal population carried a plasmid that may have been obtained from E. coli and carried a gene for both qnr fluoroquinolone resistance and extended-spectrum β-lactamase (ESBL). But it is susceptible to carbapenems and macrolides

[13, 34]

According to multiple research, XDR Salmonella has been isolated from animals, their feces, and the caregivers. A study conducted by Abd El-Aziz, Tartor

[20]

, 82.8% of poultry farms had XDR Salmonella (24/29), of which 41.38% were caused by XDR Salmonella Typhimurium, which was found in 33.3% of fowl and 66.67% of poultry workers.

According to another study by Joaquim, Herrera

[35]

, the greatest XDR index is found in S. Typhimurium and swine Salmonella.

Due to the spread of XDR Salmonella in both humans and animals, the introduction of this strain emphasizes the urgent need to stop more resistance and the creation of Salmonella infections that are challenging to treat with current medications. There is a lot of information on Salmonella's resistance to different antibiotics, but not much on XDR Salmonella.

It is essential to comprehend the different aspects of S. Typhi transmission, from direct exposure on farms to indirect dispersion across the food supply chain, in order to put effective control measures in place and protect public health.

2. Global Distribution of XDR Salmonella in Human Population

As per World Health Organization (WHO) reports, Salmonella is one of the main causes of diarrheal illness

[36]

. Every year, more than 2 billion people are impacted

[37]

. Around 22 million cases of typhoidal Salmonella resulted in 210,000 deaths and 5.4 million cases of paratyphoid fever worldwide

[38-40]

Additionally, recent estimates indicated that each year, roughly 6 million cases and 54,000 fatalities are attributed to paratyphoid, whereas approximately 11-21 million cases and 128,000-161,000 deaths are attributed to typhoid fever worldwide

[41, 42]

. Typhoid fever is claimed to affect 17.8 million people annually in low and middle income nations. MDR and XDR S. Typhi are the are prevalent in these regions due to lack of antibiotic stewardship programmes. The first outbreak of XDR typhoid fever was held in Pakistan in 2016 in Hyderabad, Sindh. According to reports, the strain known as S. Typhi 4.3.1 (H58) clade possesses a bla_CTX-M-15 ESBL gene that confers resistance to ceftriaxone and is resistant to trimethoprim-sulfamethoxazole, ampicillin, fluoroquinolones, and third-generation cephalosporins

[13, 34]

. But they were susceptible to meropenem, imipenem, and azithromycin roughly 27% and 69% of XDR S. Typhi were found in Hyderabad and Karachi, respectively

[43]

. Between January 2017 and June 2021, 14,360 cases of XDR-Typhoid Fever (XDR-TF) were reported in Karachi, 5,741 confirmed cases were reported in Sindh province between November 2016 and June 2021, and 69.5% of cases were recorded in Hyderabad, according to weekly field epidemiological reports published by the NIH Isl since 2016

[44]

. As advised by the WHO, Pakistan was the first nation to incorporate a typhoid conjugated vaccine into its regular immunization schedule in 2019

[33]

. The CDC received reports of XDR S. Typhi cases in the US in 2018 that were connected to travel to Pakistan

[45]

Additionally, Canada documented its first case involving a 3-year-old and travel to Pakistan in 2018

[46]

. The first XDR S. Typhi case was reported in 2019 by Australia, Spain, and Denmark; all of the cases included travel to Pakistan

[47-49]

. An unvaccinated 4 year old child with XDR-TF was reported to have had the disease in the United Arab Emirates in 2019. The girl was vaccinated and showed full recovery after receiving intravenous meropenem and oral azithromycin

[50]

. 71 cases of XDR S. Typhi infections in the US were reported to the CDC in 2021. Of the 67 patients, 87% had visited Pakistan, according to the records published by CDC

[51]

3. Impact of XDR S. Typhi on Public Health

Other than causing increased morbidity and mortalities due to low efficacy and availability of limited treatment options, it has long lasting consequences on human health especially those with weekend immune system

[52]

. It may disseminate to blood stream, bones, joints, brain and sometime to other other organs when become invasive and can cause potentially life threatening infections

[53, 54]

. One such consequences is the colonization of the organism which causes the shedding into the stool, hence causing risk to the community and the individual itself

[7]

People who have XDR S. Typhi infections are more likely to develop sepsis or other secondary infections such urinary tract infections. These side effects can be serious and necessitate further medical care, increasing the initial Salmonella infection's health impact

[55]

. The introduction of XDR S. Typhi has led to a substantial socioeconomic burden, especially for those from low-income families who are more likely to contract typhoid fever, and the cost of treatment has increased

[56]

. Travelers from endemic to non-endemic areas are subject to restrictions in order to stop the outbreak. According to the CDC, families are more likely to get infected with XDR S. Typhi species when traveling to Pakistan. Additionally, a level 2 notice for the outbreak is issued by the CDC, requiring heightened precautions

[33]

. According to reports, this pathogen has an impact on diagnosis, treatment, and cost. There have been reports of both a concerning rate of azithromycin resistance and clinical treatment failures. Using whole genome sequencing to determine the genetic basis of the resistance has become difficult as a result. Consequently, this has caused a delay in the creation of new antibiotics for medical use

[16, 57]

. Zakir, Khan

[58]

reported notable resistance among S. Typhi isolates. He reported half of the blood culture positive isolates in one of the tertiary care hospital in Lahore.

Fatima, Saleem

[59]

stated that veterinary medicine encounters multiple challenges as a result of the rising incidence of XDR Salmonella in animals, such as higher rates of morbidity and mortality in impacted livestock populations, more difficult infection diagnosis and treatment because antimicrobials are less effective, and a higher risk of zoonotic transmission. In addition to having an impact on the health of individual animals, XDR Salmonella can also pose financial difficulties for agricultural practices by lowering overall animal productivity, decreasing the market value of animal products, and causing financial losses due to higher treatment and prevention costs

[60]

. It may also contribute to environmental contamination and the ensuing risks to human health.

Furthermore, the transmission of XDR S. Typhi from Pakistan to nearby nations via air travel emphasizes how urgently international cooperation is needed to stop the spread of this infection. In response to the growing threat, public health organizations around the world have started surveillance and mitigation measures, such as issuing traveler advisories stressing the value of vaccination prior to departure in order to guard against this extremely resistant strain. Additionally, a study of air travel trends has been used to determine which nations are most likely to see outbreaks of XDR S. Typhi. This is accomplished by looking at air travel ties to Pakistan, evaluating these nations' capacity to maintain local pathogen transmission, and determining how well public health officials can target preventive efforts

[6]

Despite the urgent need, a crucial gap still exists since there is a lack of comprehensive data, which makes it difficult to comprehend the dynamics of XDR S. Typhi outbreaks and to develop practical, real time remedies. This chapter offers a current analysis of the ongoing outbreaks of XDR S. Typhi and trends to combat XDR resistance.

4. Challenges

Significant obstacles exist in the diagnosis, treatment, and prevention of XDR S. Typhi infections, which pose a serious risk to global human health. Numerous factors can confound the diagnosis of infections. Conventional culture based Salmonella testing techniques can be laborious, postpone starting treatment, and sometimes make the infection worse

[61]

. Furthermore, certain testing facilities and knowledge are needed to identify the antibiotic resistance profile of XDR S. Typhi strains, and these resources could only be easily accessible in certain healthcare environments

[62]

. Additionally, it can be difficult to differentiate XDR S. Typhi from other pathogens exhibiting comparable symptoms because of their overlapping clinical presentations, which could result in incorrect diagnosis and therapy

[61]

. The symptoms of EF and salmonellosis, for example, are similar to those of several other conditions

[63]

. When antimalarial medication fails to alleviate the illness or when malaria cannot be verified, enteric fever and salmonellosis are considered.

It typically leads to typhoid fever and malaria co-infection. The limited treatment options for XDR Salmonella infections have made treating them a therapeutic challenge for medical professionals worldwide, making the therapeutic approach more difficult and requiring the use of antibiotics as a last resort, which may have negative side effects and be less effective

[64]

. Since azithromycin is the only oral medication available among the three regularly used treatments for XDR typhoid fever, it is the last choice for treating XDR S. Typhi patients in an outpatient setting. Nevertheless, new research indicates that the XDR typhoid is becoming increasingly resistant to azithromycin, which further reduces the range of available treatments

[65]

Furthermore, even with relatively few treatment choices, the majority of sick patients in endemic areas self-medicate with over the counter medications, making the management of XDR typhoid difficult. Antibiotic resistance cases are more prevalent in these locations because of a lack of affordable, high-quality healthcare facilities and medical personnel, as well as a lack of affordable services

[65, 66]

Another factor contributing to the spread of XDR typhoid fever is the lack of funding in endemic nations like Pakistan to construct basic healthcare facilities for their populace, the majority of whom live in overcrowded areas and below the poverty line

[67]

Finally, because XDR S. Typhi is a novel disease, there are few existing treatments and no information on how well XDR Typhoid treatments work. Health officials worldwide should be aware that the XDR H58 strain of S. Typhi, which is found in Sindh, has the ability to invade, disseminate, and possibly displace native strains in other areas. Given the likelihood of the disease spreading quickly on a worldwide scale, WHO has designated the pathogen as a target for the development of novel drugs

[33, 68]

5. Prevention and Control

Salmonella infection must be prevented and controlled using a variety of methods, such as vaccination, better hygiene, the use of bacteriophages, preserving the safety of human consumables, addressing environmental deficiencies, identifying and treating chronic carriers of the infection, making sure that food safety measures are adequate, protecting drinking and treated water, removing antibiotics from food animals, and the One Health approach. The following provides a sufficient summary of each tactics:

5.1. Food Hygiene

In wealthy nations, preventing salmonellosis requires strict adherence to food hygiene from farm to plate. Implementing evidence-based prevention strategies requires an understanding of the causes and processes of Salmonella transmission in low- and middle-income nations

[69]

. Foodborne outbreaks are complicated, and there are many possible sources of contamination, making this task difficult

[6]

. Reducing the number of people without access to clean drinking water is a consistent goal of Millennium Development Goal 7

[70]

. The relevant government officials in developing nations should make sure that the infrastructure required to remove human waste from water supplies is put in place and that the general public is taught the need of practicing good hygiene

[33, 71]

5.2. Prebiotics, Probiotics, Synbiotics and Post-biotics

Synbiotics are a combination of probiotics and prebiotics. The combined benefits of probiotics and prebiotics prevent or lessen the symptoms of Salmonella via altering gut microbiota, reducing pathogen count, inducing immune system synergistic activities, and other mechanisms. Prebiotics are utilized by the host micro-organisms as food substrate. Prebiotics causes the formation of biofilm on the epithelium of the intestine thereby preventing the pathogen from causing adhesion (120). When administered in the recommended dosage, probiotics are advantageous microorganisms that improve the host's health. Lactobacillus, Bifidobacterium, Bacillus, Enterococcus, and Pediococcus species are among the probiotics

[72]

. Because they increase the host immune system, compete with infections for resources, and suppress them by secreting lactic acid, probiotics are good for your health

[73]

Another recently developed idea is "postbiotics." Non-viable bacteria, their cell fragments, and health-promoting metabolites are the ingredients of postbiotic treatments

[74]

. Postbiotic preparations can make use of a variety of bacterial metabolites, such as peptides, organic acids, short-chain fatty acids, exopolysaccharides, enzymes, and plasmalogens. Postbiotic-treated animals exhibited improved nutritional absorption and decreased Salmonella counts

[75]

5.3. Reduced Use of Antibiotics Food Animals

Antibiotic resistance in humans and animals is not the sole effect of the inappropriate use of antibiotics in food animals. Many slaughterhouses in LMIC nations lack a drug monitoring system, which enables farmers to kill food animals on medications without adhering to the manufacturer's recommended withdrawal period. Due to this action, people have been exposed to antibiotics while they are not ill, which has raised the prevalence of antibiotic resistance globally.

According to Dutil, Irwin

[76]

, there is a direct link between the rise in human cases in Canada and chicken samples tainted with Salmonella Heidelberg, which is resistant to ceftriaxone. To lessen the rise in XDR Salmonella cases, governments and providers of animal healthcare services should use fewer antibiotics on food animals. The use of antibiotics to treat human Salmonella infections ought to be prohibited in the practice of food animal medicine. This will help reduce the spread of resistant Salmonella to human populations.

5.4. Bacteriophages

These are the viruses which infect bacteria. Phages may be able to stop the emergence of resistant Salmonella because of their bacteriolytic activity, stability throughout a wider range of salt concentrations, pH, temperature, ability to self-limit, environmental friendliness, genetic amenability, etc.

[77]

. They attack multiple strains rather than a single one; phage mixtures with restricted host ranges are better at reducing germs in different foods. SalmoLyseR, PhageGuardS, SalmoFresh, SalmonFREER and other phages are examples of those used in the food business to combat Salmonella

[78]

The peptidoglycan layer inside and outside of pathogenic bacteria is hydrolyzed by virion-associated peptidoglycan hydrolases and endolysins derived from bacteriophages, which are produced following lytic cycles. Because of their great efficacy, quick action, specificity, and low likelihood of resistance development, they are a promising alternative therapy against multidrug-resistant bacteria in a variety of disciplines, including food safety and medicine

[79]

5.5. One Health Approach

This method is transdisciplinary, multisectoral, and collaborative. Optimal local, regional, national, and global health outcomes are attained by acknowledging the connections among humans, animals, plants, and their shared environment

[80]

. Fighting drug-resistant Salmonella requires a multipronged approach on several fronts. To lessen antibiotic dependency, especially in cattle production, alternative, non-antibiotic techniques must be employed. Further research on the existing alternative control measures as well as newer strategies are required. The One Health paradigm must be the foundation for interdisciplinary and global collaborative initiatives since Salmonella's growing antibiotic resistance impacts not only human health but also animal and environmental health

[81]

One approach to health is to increase funding for vaccines and non-antimicrobial-based interventions; use multiomics (metagenomics, transcriptomics, proteomics etc.) as a surveillance tool to determine the origin, pattern, and epidemiology of antimicrobial resistance genes; improve sanitation and infection prevention measures; and take part in antimicrobial stewardship programs to ensure that antibiotics are used responsibly in both humans and animals

[82]

5.6. Vaccination

Immunization is a crucial technique for preventing typhoid fever infections and is crucial for protecting both human and animal populations. Typhoid conjugate vaccines (TCVs) licensed by the WHO for humans include Typbar TCVTM, which uses tetanus toxoid as a carrier, and Vi CMR197, which uses CMR197, a non-toxic mutant of diphtheria toxin as a carrier

[83]

. These vaccines provide sufficient protection against typhoid fever and have decreased the prevalence of XDR Salmonella in both endemic and epidemic areas.

Because the TCVs enhance immunological qualities, are safe for kids, and offer a long-lasting period of protection, they are given to people of all ages. In national vaccination regimens, the vaccine has demonstrated negligible immune interference and is well tolerated, particularly in endemic nations

[84]

. Everyone traveling to areas of the world where typhoid is endemic should get vaccinated against the disease, according to the most recent CDC recommendations

[33, 83, 85]

. The CDC advises individuals visiting endemic regions to get either the Ty21a or ViPS vaccines

[86]

. Because vaccine efficacy varies, further precautions including better cleanliness and food safety procedures may be required

[87]

In addition, current research and development initiatives to create vaccines against typhoid fever infections

[88, 89]

have the potential to slow the spread of these diseases and lower the morbidity and fatality rates that go along with them. Simultaneously, the veterinary or animal health industry uses a variety of vaccines to prevent salmonellosis in animals, especially livestock and poultry

[90]

. These vaccines prevent human exposure to Salmonella through tainted food products, protecting animal health and promoting food safety.

In order to improve public health and lessen the prevalence of these infectious diseases worldwide, immunization against typhoid fever infections is essential.

6. Further Recommendations and Conclusions

Given the emergence of extensively drug-resistant (XDR) strains of Salmonella, vaccination is a crucial weapon in the fight against infections. Humans may be able to stop the spread of antibiotic resistance if targeted vaccines are developed against common XDR Salmonella serotypes like Typhimurium and Enteritidis, as well as multivalent alternatives.

The disease burden can be considerably reduced by giving vaccination programs priority to high-risk groups like healthcare workers and food handlers. Vaccines provide promising means of preventing antibiotic resistance and granting herd immunity, protecting unvaccinated members of a human and animal population as a sizable percentage of the population receives vaccinations. Antimicrobial drug abuse is decreased as a result of their ability to target particular infections and guarantee treatment specificity

[91-94]

The One Health approach provides a comprehensive framework for tackling the issues raised by XDR Salmonella because it acknowledges the interdependence of environmental, animal, and human health. It will be crucial to adopt this strategy in upcoming studies and legislative efforts in order to lessen the effects of these illnesses. To stop the spread of XDR Salmonella across the food chain, extensive immunization programs for pigs, poultry, and animals are therefore necessary. It is equally crucial to expand these initiatives to include wildlife and companion animals like dogs and cats that may act as reservoirs for human infection.

Additionally, introducing sustainable farming methods, such probiotics and organic farming, can lessen Salmonella contamination in food production systems. Powerful tools for efficient disease control and prevention are provided by technological developments, such as genetic surveillance and artificial intelligence for outbreak prediction.

International cooperation and support for strong policy frameworks that emphasize shared accountability for health protection are essential to our joint effort to ensure that human and animal populations have a healthier, more resilient future.

Furthermore, since it is a necessity for disease prevention, putting water, sanitation, and hygiene (WASH) into practice should have top priority. In addition, a more effective and reasonably priced healthcare system and education should be offered in endemic and epidemic regions to lessen the severity of Salmonella infections.

In conclusion, XDR Salmonella species represent a serious and constantly changing risk to the health of people and animals around the world. The significance of immunization programs, the One Health philosophy, environmentally friendly agricultural methods, and technology developments in the fight against these illnesses has been underlined in this revised overview. For a healthier, more resilient future, interdisciplinary research partnerships, public awareness initiatives, and strong policy frameworks are crucial. Our common duty to protect the health of both human and animal populations is highlighted by the need for a coordinated, international effort to address the problems posed by XDR Salmonella.

Abbreviations

XDR	Extensively Drug Resistant
WASH	Water, Sanitation, and Hygiene
CDC	Centre for Disease Control and Prevention
WHO	World Health Organization
MDR	Multi Drug Resistant
CRO	Ceftriaxone
T3SS	Type 3 Secretion System
SPI	Salmonella Pathogenecity Island
LMICs	Low and Middle Income Countries
ESBLs	Extended Spectrum Beta Lactamases
CHL	Chloramphenicol
AMP	Ampicillin
TCV	Typhoid Conjugate Vaccine

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Abatcha, M. G., Goni, M. D., Abbas, M. A., Jalo, I. M., & Mohammed, G. (2020). A review of Listeria and Salmonella: An update on description, characteristics, incidence, and antibiotic susceptibility. Adv. Anim. Vet. Sci, 8(11), 1232-1249.
[2]	Abd El-Aziz, N. K., Tartor, Y. H., Gharieb, R. M. A., Erfan, A. M., Khalifa, E., Said, M. A., Ammar, A. M., & Samir, M. (2021). Extensive drug-resistant Salmonella enterica isolated from poultry and humans: prevalence and molecular determinants behind the co-resistance to ciprofloxacin and tigecycline. Frontiers in Microbiology, 12, 738784.
[3]	Ahmad, S., Tsagkaris, C., Aborode, A. T., Haque, M. T. U., Khan, S. I., Khawaja, U. A., dos Santos Costa, A. C., Essar, M. Y., & Lucero-Prisno Iii, D. E. (2021). A skeleton in the closet: the implications of COVID-19 on XDR strain of typhoid in Pakistan. Public health in practice, 2, 100084.
[4]	Akram, J., Khan, A. S., Khan, H. A., Gilani, S. A., Akram, S. J., Ahmad, F. J., & Mehboob, R. (2020). Extensively drug‐resistant (XDR) typhoid: evolution, prevention, and its management. BioMed Research International, 2020(1), 6432580.
[5]	Andrews, J. R., Qamar, F. N., Charles, R. C., & Ryan, E. T. (2018). Extensively drug-resistant typhoid-are conjugate vaccines arriving just in time? New England Journal of Medicine, 379(16), 1493-1495.
[6]	Antillón, M., Warren, J. L., Crawford, F. W., Weinberger, D. M., Kürüm, E., Pak, G. D.,... Pitzer, V. E. (2017). The burden of typhoid fever in low-and middle-income countries: a meta-regression approach. PLoS neglected tropical diseases, 11(2), e0005376.
[7]	Appiah, G. D., M. J. Hughes and K. Chatham-Stephens, 2019. (2019). Chapter 4: Travel-related infectious diseases: Typhoid and paratyphoid fever: Centers for Disease Control and Prevention (CDC).
[8]	Batool, R., Qureshi, S., Yousafzai, M. T., Kazi, M., Ali, M., & Qamar, F. N. (2022). Risk factors associated with extensively drug-resistant typhoid in an outbreak setting of Lyari Town Karachi, Pakistan. The American journal of tropical medicine and hygiene, 106(5), 1379.
[9]	Bell, B. G., Schellevis, F., Stobberingh, E., Goossens, H., & Pringle, M. (2014). A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC infectious diseases, 14, 1-25.
[10]	Bisola Bello, A., Olamilekan Adesola, R., Idris, I., Yawson Scott, G., Alfa, S., & Akinfemi Ajibade, F. (2024). Combatting extensively drug-resistant Salmonella: a global perspective on outbreaks, impacts, and control strategies. Pathogens and Global Health, 1-15.
[11]	Browne, A. J., Chipeta, M. G., Fell, F. J., Haines-Woodhouse, G., Hamadani, B. H. K., Kumaran, E. A. P., Aguilar, G. R., McManigal, B., Andrews, J. R., Ashley, E. A., & Ashley, E. A. (2024). Estimating the subnational prevalence of antimicrobial resistant Salmonella enterica serovars Typhi and Paratyphi A infections in 75 endemic countries, 1990–2019: a modelling study. The Lancet Global Health, 12(3), e406-e418.
[12]	Buckle, G. C., Walker, C. L. F., & Black, R. E. (2012). Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. Journal of global health, 2(1).
[13]	Butt, M., Mohammed, R., Butt, E., Butt, S., & Xiang, J. (2020). Why have immunization efforts in Pakistan failed to achieve global standards of vaccination uptake and infectious disease control? Risk management and healthcare policy, 111-124.
[14]	Butt, M. H., Saleem, A., Javed, S. O., Ullah, I., Rehman, M. U., Islam, N., Tahir, M. A., Malik, T., Hafeez, S., & Misbah, S. (2022). Rising XDR-typhoid fever cases in Pakistan: are we heading back to the pre-antibiotic era? Frontiers in public health, 9, 794868.
[15]	CDC. (2021a). Extensively drug-resistant Salmonella typhi infections among US residents without international travel.
[16]	CDC. (2021b). Typhoid vaccine information statement. Retrieved from [cited 2021 Sep 9]. from https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html
[17]	CDC. (2021c). Typhoid fever and paratyphoid fever. Retrieved from https://www.cdc.gov/typhoid-fever/health-professional.html
[18]	CDC. (2023). Information for healthcare professionals and laboratories. Retrieved from https://www.cdc.gov/Salmonella/general/technical.html
[19]	CDC. (2024). Drug-Resistant Salmonella Serotype Typhi. n.d [cited 2024 Feb 23]. from http://www.cdc.gov/DrugResistance/Biggest-Threats.html
[20]	Chami, B., & Bao, S. (2012). Salmonella: Invasion, Evasion & Persistence. In Salmonella-Distribution, Adaptation, Control Measures and Molecular Technologies: IntechOpen.
[21]	Chatham-Stephens, K. (2019). Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan-United States, 2016–2018. MMWR. Morbidity and Mortality Weekly Report, 68.
[22]	Chernov, V. M., Chernova, O. A., Mouzykantov, A. A., Lopukhov, L. L., & Aminov, R. I. (2019). Omics of antimicrobials and antimicrobial resistance. Expert opinion on drug discovery, 14(5), 455-468.
[23]	Chong, A., Cooper, K. G., Kari, L., Nilsson, O. R., Hillman, C., Fleming, B. A., Wang, Q., Nair, V., & Steele-Mortimer, O. (2021). Cytosolic replication in epithelial cells fuels intestinal expansion and chronic fecal shedding of Salmonella Typhimurium. Cell Host & Microbe, 29(7), 1177-1185.
[24]	Costa, M. M., Penido, M., Dos Santos, M. S., Doro, D., de Freitas, E., Michalick, M. S. M., Grimaldi, G., Gazzinelli, R. T., & Fernandes, A. P. (2012). Improved canine and human visceral leishmaniasis immunodiagnosis using combinations of synthetic peptides in enzyme-linked immunosorbent assay. PLoS neglected tropical diseases, 6(5), e1622.
[25]	Crump, J. A., Sjölund-Karlsson, M., Gordon, M. A., & Parry, C. M. (2015). Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clinical microbiology reviews, 28(4), 901-937.
[26]	Dos Santos, A. M. P., Ferrari, R. G., & Conte-Junior, C. A. (2019). Virulence factors in Salmonella Typhimurium: the sagacity of a bacterium. Current microbiology, 76, 762-773.
[27]	Dutil, L., Irwin, R., Finley, R., Ng, L. K., Avery, B., Boerlin, P., Bourgault, A. M., Cole, L., Daignault, D., Desruisseau, A., & Desruisseau, A. (2010). Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging infectious diseases, 16(1), 48.
[28]	Ehuwa, O., Jaiswal, A. K., & Jaiswal, S. (2021a). Food Safety and Food Handling Practices.
[29]	Ehuwa, O., Jaiswal, A. K., & Jaiswal, S. (2021b). Salmonella, food safety and food handling practices. Foods, 10(5), 907.
[30]	Engsbro, A. L., Jespersen, H. S. R., Goldschmidt, M. I., Mollerup, S., Worning, P., Pedersen, M. S., Westh, H., & Schneider, U. V. (2019). Ceftriaxone-resistant Salmonella enterica serotype Typhi in a pregnant traveller returning from Karachi, Pakistan to Denmark, 2019. Eurosurveillance, 24(21), 1900289.
[31]	Fatima, A., Saleem, M., Nawaz, S., Khalid, L., Riaz, S., & Sajid, I. (2023). Prevalence and antibiotics resistance status of Salmonella in raw meat consumed in various areas of Lahore, Pakistan. Scientific Reports, 13(1), 22205.
[32]	Fatima, M., Kumar, S., Hussain, M., Memon, N. M., Vighio, A., Syed, M. A., Chaudhry, A., Hussain, Z., Baig, Z. I., Baig, M. A., & Baig, M. A. (2021). Morbidity and mortality associated with typhoid fever among hospitalized patients in Hyderabad district, Pakistan, 2017-2018: retrospective record review. JMIR Public Health and Surveillance, 7(5), e27268.
[33]	Feasey, N. A., Gaskell, K., Wong, V., Msefula, C., Selemani, G., Kumwenda, S., Allain, T. J., Mallewa, J., Kennedy, N., Bennett, A., & Bennett, A. (2015). Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi. PLoS neglected tropical diseases, 9(4), e0003748.
[34]	Ghurnee, O., Ghosh, A. K., Abony, M., Aurin, S. A., Fatema, A. N., Banik, A., & Ahmed, Z. (2021). Isolation of multi-drug resistant (MDR) and extensively drug resistant (XDR) Salmonella typhi from blood samples of patients attending tertiary medical centre in Dhaka city, Bangladesh. Advances in Microbiology, 11(9), 488-498.
[35]	Hanumunthadu, B., Kanji, N., Owino, N., Da Silva, C. F., Robinson, H., White, R., Ferruzzi, P., Nakakana, U., Canals, R., Pollard, A. J., & Pollard, A. J. (2023). Salmonella Vaccine Study in Oxford (SALVO) trial: protocol for an observer-participant blind randomised placebo-controlled trial of the iNTS-GMMA vaccine within a European cohort. BMJ open, 13(11), e072938.
[36]	Hendriksen, R. S., Leekitcharoenphon, P., Lukjancenko, O., Lukwesa-Musyani, C., Tambatamba, B., Mwaba, J., Kalonda, A., Nakazwe, R., Kwenda, G., Jensen, J. D., & Jensen, J. D. (2015). Genomic signature of multidrug-resistant Salmonella enterica serovar Typhi isolates related to a massive outbreak in Zambia between 2010 and 2012. Journal of clinical microbiology, 53(1), 262-272.
[37]	Hooda, Y., Sajib, M. S. I., Rahman, H., Luby, S. P., Bondy-Denomy, J., Santosham, M., Andrews, J. R., Saha, S. K., & Saha, S. (2019). Molecular mechanism of azithromycin resistance among typhoidal Salmonella strains in Bangladesh identified through passive pediatric surveillance. PLoS neglected tropical diseases, 13(11), e0007868.
[38]	Hooper, D. C., & Wolfson, J. S. (1991). Fluoroquinolone antimicrobial agents. New England Journal of Medicine, 324(6), 384-394.
[39]	Howard‐Jones, A., Kesson, A. M., Outhred, A. C., & Britton, P. N. (2019). First reported case of extensively drug‐resistant typhoid in Australia. The Medical Journal of Australia, 211(6), 286-286.
[40]	Hughes, M. J., Birhane, M. G., Dorough, L., Reynolds, J. L., Caidi, H., Tagg, K. A., Snyder, C. M., Yu, A. T., Altman, S. M., Boyle, M. M., & Boyle, M. M. (2021, 2021). Extensively drug-resistant typhoid fever in the United States.
[41]	Humam, A. M., Loh, T. C., Foo, H. L., Samsudin, A. A., Mustapha, N. M., Zulkifli, I., & Izuddin, W. I. (2019). Effects of feeding different postbiotics produced by Lactobacillus plantarum on growth performance, carcass yield, intestinal morphology, gut microbiota composition, immune status, and growth gene expression in broilers under heat stress. Animals, 9(9), 644.
[42]	Idris, I., & Adesola, R. O. (2022). Vaccine as a remedy for antimicrobial resistance; what are the Pros and Cons? World News of Natural Sciences, 42, 76-84.
[43]	Jabeen, K., Saleem, S., Jahan, S., Nizamudin, S., Arshad, F., Huma, Z.-e., Raza, S. M., Mehmood, M., Roman, M., & Haq, F. U. (2023). Molecular characterization of extensively drug resistant Salmonella enterica Serovar Typhi clinical isolates from Lahore, Pakistan. Infection and Drug Resistance, 2987-3001.
[44]	Jajere, S. M. (2019). A review of Salmonella enterica with particular focus on the pathogenicity and virulence factors, host specificity and antimicrobial resistance including multidrug resistance. Veterinary world, 12(4), 504.
[45]	Jangid, M. K. (2021). A rare case of an imported typhoid fever caused by extensively drug-resistant salmonella typhi in the UAE. Hamdan Medical Journal, 14(2), 95-97.
[46]	Joaquim, P., Herrera, M., Dupuis, A., & Chacana, P. (2021). Virulence genes and antimicrobial susceptibility in Salmonella enterica serotypes isolated from swine production in Argentina. Revista Argentina de Microbiología, 53(3), 233-239.
[47]	Khan, E. A. (2019). XDR Typhoid: The problem and its solution. Journal of Ayub Medical College Abbottabad, 31(2), 139-140.
[48]	Khan, M. A. S., & Rahman, S. R. (2022). Use of phages to treat antimicrobial-resistant Salmonella infections in poultry. Veterinary Sciences, 9(8), 438.
[49]	Kirk, M. D., Pires, S. M., Black, R. E., Caipo, M., Crump, J. A., Devleesschauwer, B., Döpfer, D., Fazil, A., Fischer-Walker, C. L., Hald, T., & Hald, T. (2015). World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: a data synthesis. PLoS medicine, 12(12), e1001921.
[50]	Klemm, E. J., Shakoor, S., Page, A. J., Qamar, F. N., Judge, K., Saeed, D. K.,... Baker, S. (2018). Emergence of an extensively drug-resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. MBio, 9(1), 10-1128.
[51]	Kombade, S., & Kaur, N. (2021). Pathogenicity island in Salmonella. In Salmonella spp.-A Global Challenge: IntechOpen.
[52]	Kong-Ngoen, T., Santajit, S., Tunyong, W., Pumirat, P., Sookrung, N., Chaicumpa, W., & Indrawattana, N. (2022). Antimicrobial resistance and virulence of non-typhoidal Salmonella from retail foods marketed in Bangkok, Thailand. Foods, 11(5), 661.
[53]	Kwoji, I. D., Aiyegoro, O. A., Okpeku, M., & Adeleke, M. A. (2021). Multi-strain probiotics: synergy among isolates enhances biological activities. Biology, 10(4), 322.
[54]	Latif, A., Shehzad, A., Niazi, S., Zahid, A., Ashraf, W., Iqbal, M. W., Rehman, A., Riaz, T., Aadil, R. M., Khan, I. M., & Khan, I. M. (2023). Probiotics: Mechanism of action, health benefits and their application in food industries. Frontiers in Microbiology, 14, 1216674.
[55]	Li, Q., Ren, J., Xian, H., Yin, C., Yuan, Y., Li, Y., Ji, R., Chu, C., Qiao, Z. & Jiao, X. (2020). rOmpF and OMVs as efficient subunit vaccines against Salmonella enterica serovar Enteritidis infections in poultry farms. Vaccine, 38(45), 7094-7099.
[56]	Li, X., Cao, H., Chen, J. H.-K., Ng, Y.-Z., Fung, K.-K., Cheng, V. C.-C., & Ho, P.-L. (2023). Genomic investigation of Salmonella Typhi in Hong Kong revealing the predominance of genotype 3.2. 2 and the first case of an extensively drug-resistant H58 genotype. Microorganisms, 11(3), 667.
[57]	Lin, D. M., Koskella, B., & Lin, H. C. (2017). Phage therapy: An alternative to antibiotics in the age of multi-drug resistance. World journal of gastrointestinal pharmacology and therapeutics, 8(3), 162.
[58]	Liu, P.-Y., Wang, K.-C., Hong, Y.-P., Chen, B.-H., Shi, Z.-Y., & Chiou, C.-S. (2021). The first imported case of extensively drug-resistant Salmonella enterica serotype Typhi infection in Taiwan and the antimicrobial therapy. Journal of Microbiology, Immunology and Infection, 54(4), 740-744.
[59]	Majowicz, S. E., Musto, J., Scallan, E., Angulo, F. J., Kirk, M., O'Brien, S. J., Jones, T. F., Fazil, A., Hoekstra, R. M., & International Collaboration on Enteric Disease “Burden of Illness”, S. (2010). The global burden of nontyphoidal Salmonella gastroenteritis. Clinical infectious diseases, 50(6), 882-889.
[60]	Marcus, S. L., Brumell, J. H., Pfeifer, C. G., & Finlay, B. B. (2000). Salmonella pathogenicity islands: big virulence in small packages. Microbes and infection, 2(2), 145-156.
[61]	McEwen, S. A., & Collignon, P. J. (2018). Antimicrobial resistance: a one health perspective. Antimicrobial resistance in bacteria from livestock and companion animals, 521-547.
[62]	Memon, H., Saeed, F., Iqbal, M., Saboohi, E., Hanif, S., & Mallick, A. H. H. (2022). Association of extensively drug resistant salmonella infection in children with typhoid fever. Pakistan Journal of Medical Sciences, 38(7), 1864.
[63]	Mkangara, M. (2023). Prevention and control of human Salmonella enterica infections: An implication in food safety. International Journal of Food Science, 2023(1), 8899596.
[64]	Mumtaz, M. N., Irfan, M., Siraj, S., Khan, A., Khan, H., Imran, M., Khan, I. A., & Khan, A. (2024). Whole-genome sequencing of extensively drug-resistant Salmonella enterica serovar Typhi clinical isolates from the Peshawar region of Pakistan. Journal of Infection and Public Health, 17(2), 271-282.
[65]	Naushad, S., Ogunremi, D., & Huang, H. (2023). Salmonella: A Brief Review. Salmonella-Perspectives for Low-Cost Prevention, Control and Treatment.
[66]	Neupane, D. P., Dulal, H. P., & Song, J. (2021). Enteric fever diagnosis: current challenges and future directions. Pathogens, 10(4), 410.
[67]	NIH. (2021). Weekly field epidemiology. Report. https://www.nih.org.pk/wpcontent/uploads/2021/06/25-FELTP-Pakistan-Weekly-Epidemiological-Report-June13-19-2021
[68]	Nizamuddin, S., Ching, C., Kamal, R., Zaman, M. H., & Sultan, F. (2021). Continued outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi across Pakistan and assessment of knowledge and practices among healthcare workers. The American journal of tropical medicine and hygiene, 104(4), 1265.
[69]	Parry, C. M., Hien, T. T., Dougan, G., White, N. J., & Fever, J. J. F. T. (2002). 347. https://doi.org/10.1056/NEJMra020201 1770-1782.
[70]	Popa, G. L., & Papa, M. I. (2021). Salmonella spp. infection-a continuous threat worldwide. Germs, 11(1), 88.
[71]	Rasheed, M., Hasan, S. S., & Ahmed, S. I. (2019). Extensively drug-resistant typhoid fever in Pakistan. The Lancet Infectious Diseases, 19(3), 242-243.
[72]	Riahi, M., Mohammadi, A. A., Moghadam, V. K., Robati, Z. S., & Bidkhori, M. (2018). Diarrhea deaths in children among countries with different levels of the human development index. Data in brief, 17, 954.
[73]	Roper, L. E. (2024). Use of Additional Doses of 2024–2025 COVID-19 Vaccine for Adults Aged≥ 65 Years and Persons Aged≥ 6 Months with Moderate or Severe Immunocompromise: Recommendations of the Advisory Committee on Immunization Practices-United States, 2024. MMWR. Morbidity and Mortality Weekly Report, 73.
[74]	Sabbagh, S. C., Forest, C. G., Lepage, C., Leclerc, J.-M., & Daigle, F. (2010). So similar, yet so different: uncovering distinctive features in the genomes of Salmonella enterica serovars Typhimurium and Typhi. FEMS microbiology letters, 305(1), 1-13.
[75]	Saeed, N., Usman, M., & Khan, E. A. (2019). An overview of extensively drug-resistant Salmonella Typhi from a tertiary care hospital in Pakistan. Cureus, 11(9).
[76]	Salminen, S., Collado, M. C., Endo, A., Hill, C., Lebeer, S., Quigley, E. M. M., Sanders, M. E., Shamir, R., Swann, J. R., Szajewska, H., & Vinderola, G. (2021). The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nature Reviews Gastroenterology & Hepatology, 18(9), 649-667.
[77]	Shaikh, O. A., Asghar, Z., Aftab, R. M., Amin, S., Shaikh, G., & Nashwan, A. J. (2023). Antimicrobial resistant strains of Salmonella typhi: The role of illicit antibiotics sales, misuse, and self-medication practices in Pakistan. Journal of Infection and Public Health, 16(10), 1591-1597.
[78]	Sirima, S. B., Ouedraogo, A., Barry, N., Siribie, M., Tiono, A. B., Nébié, I., Konaté, A. T., Berges, G. D., Diarra, A., Ouedraogo, M., & Ouedraogo, M. (2021). Safety and immunogenicity of co-administration of meningococcal type A and measles–rubella vaccines with typhoid conjugate vaccine in children aged 15–23 months in Burkina Faso. International Journal of Infectious Diseases, 102, 517-523.
[79]	Smith, C., Smith, E., Chiu, C., Hinton, J., Sepulveda, B. P., Gordon, M., Choy, R. K., Hill, P. W., Meiring, J. E., Darton, T. C., & Darton, T. C. (2023). The challenge non-typhoidal salmonella (CHANTS) consortium: development of a non-typhoidal salmonella controlled human infection model: report from a consultation group workshop, 05 July 2022, London, UK. Wellcome Open Research, 8.
[80]	Stanaway, J. D., Reiner, R. C., Blacker, B. F., Goldberg, E. M., Khalil, I. A., Troeger, C. E., Andrews, J. R., Bhutta, Z. A., Crump, J. A., Im, J., & Im, J. (2019). The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Infectious Diseases, 19(4), 369-381.
[81]	Teklemariam, A. D., Al-Hindi, R. R., Albiheyri, R. S., Alharbi, M. G., Alghamdi, M. A., Filimban, A. A. R.,... Almaneea, A. M. (2023). Human salmonellosis: a continuous global threat in the farm-to-fork food safety continuum. Foods, 12(9), 1756.
[82]	Tharwani, Z. H., Kumar, P., Salman, Y., Islam, Z., Ahmad, S., & Essar, M. Y. (2022). Typhoid in Pakistan: Challenges, efforts, and recommendations. Infection and Drug Resistance, 2523-2527.
[83]	Ul Huda, N., Sohail, M., Mirani, Z. A., & Khan, S. (2024). Source tracking of extensively drug resistant Salmonella Typhi in food and raw vegetables using molecular approaches. The Journal of Infection in Developing Countries, 18(02), 227-234.
[84]	Van Camp, R. O., & Shorman, M. (2025). Typhoid Vaccine. In StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.
[85]	Vanderslott, S., Kumar, S., Adu-Sarkodie, Y., Qadri, F., & Zellweger, R. M. (2023). Typhoid control in an era of antimicrobial resistance: challenges and opportunities.
[86]	Vt Nair, D., Venkitanarayanan, K., & Kollanoor Johny, A. (2018). Antibiotic-resistant Salmonella in the food supply and the potential role of antibiotic alternatives for control. Foods, 7(10), 167.
[87]	Walker, J., Chaguza, C., Grubaugh, N. D., Carey, M., Baker, S., Khan, K., Bogoch, I. I., & Pitzer, V. E. (2023). Assessing the global risk of typhoid outbreaks caused by extensively drug resistant Salmonella Typhi. Nature Communications, 14(1), 6502.
[88]	Wang, Y., Lu, D., Jin, Y., Wang, H., Lyu, B., Zhang, X., Huang, Y., Shu, G., Liu, B., Lin, C., & Lin, C. (2022). Extensively drug-resistant (XDR) Salmonella typhi outbreak by waterborne infection-Beijing Municipality, China, January–February 2022. China CDC Weekly, 4(12), 254.
[89]	War, J. M., Nisa, A. U., Wani, A. H., & Bhat, M. Y. (2022). Microbial food-borne diseases due to Climate Change. In Climate Change and Microbes (pp. 187-234): Apple Academic Press.
[90]	WHO. (2019a). Drug resistant Salmonella infections in Pakistan: update. Wkly Epidemiol Monit, 12(1).
[91]	WHO. (2019b). Typhoid vaccines: WHO position paper, March 2018–Recommendations. Vaccine, 37(2), 214-216.
[92]	Wong, W., Al Rawahi, H., Patel, S., Yau, Y., Eshaghi, A., Zittermann, S., Tattum, L., & Morris, S. K. (2019). The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. IDCases, 15, e00492.
[93]	Yesigat, T., Jemal, M., & Birhan, W. (2020). Prevalence and associated risk factors of Salmonella, Shigella, and intestinal parasites among food handlers in Motta town, North West Ethiopia. Canadian Journal of Infectious Diseases and Medical Microbiology, 2020(1), 6425946.
[94]	Zakir, M., Khan, M., Umar, M. I., Murtaza, G., Ashraf, M., & Shamim, S. (2021). Emerging trends of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella Typhi in a tertiary care Hospital of Lahore, Pakistan. Microorganisms, 9(12), 2484.

Cite This Article

Plain Text BibTeX RIS

APA Style

Bashir, I., Danish, S. R., Bashir, G. K. (2025). Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Science Futures, 1(1), 84-94. https://doi.org/10.11648/j.scif.20250101.20

Copy | Download

ACS Style

Bashir, I.; Danish, S. R.; Bashir, G. K. Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Sci. Futures 2025, 1(1), 84-94. doi: 10.11648/j.scif.20250101.20

Copy | Download

AMA Style

Bashir I, Danish SR, Bashir GK. Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Sci Futures. 2025;1(1):84-94. doi: 10.11648/j.scif.20250101.20

Copy | Download

@article{10.11648/j.scif.20250101.20,
  author = {Iqra Bashir and Sohaib Raza Danish and Ghulam Khadija Bashir},
  title = {Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation},
  journal = {Science Futures},
  volume = {1},
  number = {1},
  pages = {84-94},
  doi = {10.11648/j.scif.20250101.20},
  url = {https://doi.org/10.11648/j.scif.20250101.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.scif.20250101.20},
  abstract = {Due to the advent of XDR Salmonella Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of Salmonella enterica, serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) S. Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR Salmonella Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR Salmonella Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR Salmonella Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation
AU  - Iqra Bashir
AU  - Sohaib Raza Danish
AU  - Ghulam Khadija Bashir
Y1  - 2025/12/11
PY  - 2025
N1  - https://doi.org/10.11648/j.scif.20250101.20
DO  - 10.11648/j.scif.20250101.20
T2  - Science Futures
JF  - Science Futures
JO  - Science Futures
SP  - 84
EP  - 94
PB  - Science Publishing Group
SN  - 3070-6289
UR  - https://doi.org/10.11648/j.scif.20250101.20
AB  - Due to the advent of XDR Salmonella Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of Salmonella enterica, serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) S. Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR Salmonella Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR Salmonella Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR Salmonella Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.
VL  - 1
IS  - 1
ER  -

Copy | Download

Author Information

Iqra Bashir

Institute of Microbiology, Government College University, Faisalabad, Pakistan

Contact Email
Sohaib Raza Danish

Department of General Surgery, Jinnah Hospital, Lahore, Pakistan
Ghulam Khadija Bashir

Department of Zoology, University of Agriculture Faisalabad, Toba Tek Singh, Pakistan

Download PDF

Submit an Article

Plain Text BibTeX RIS

APA Style

Bashir, I., Danish, S. R., Bashir, G. K. (2025). Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Science Futures, 1(1), 84-94. https://doi.org/10.11648/j.scif.20250101.20

Copy | Download

ACS Style

Bashir, I.; Danish, S. R.; Bashir, G. K. Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Sci. Futures 2025, 1(1), 84-94. doi: 10.11648/j.scif.20250101.20

Copy | Download

AMA Style

Bashir I, Danish SR, Bashir GK. Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation. Sci Futures. 2025;1(1):84-94. doi: 10.11648/j.scif.20250101.20

Copy | Download

@article{10.11648/j.scif.20250101.20,
  author = {Iqra Bashir and Sohaib Raza Danish and Ghulam Khadija Bashir},
  title = {Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation},
  journal = {Science Futures},
  volume = {1},
  number = {1},
  pages = {84-94},
  doi = {10.11648/j.scif.20250101.20},
  url = {https://doi.org/10.11648/j.scif.20250101.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.scif.20250101.20},
  abstract = {Due to the advent of XDR Salmonella Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of Salmonella enterica, serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) S. Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR Salmonella Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR Salmonella Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR Salmonella Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation
AU  - Iqra Bashir
AU  - Sohaib Raza Danish
AU  - Ghulam Khadija Bashir
Y1  - 2025/12/11
PY  - 2025
N1  - https://doi.org/10.11648/j.scif.20250101.20
DO  - 10.11648/j.scif.20250101.20
T2  - Science Futures
JF  - Science Futures
JO  - Science Futures
SP  - 84
EP  - 94
PB  - Science Publishing Group
SN  - 3070-6289
UR  - https://doi.org/10.11648/j.scif.20250101.20
AB  - Due to the advent of XDR Salmonella Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of Salmonella enterica, serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) S. Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR Salmonella Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR Salmonella Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR Salmonella Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.
VL  - 1
IS  - 1
ER  -

Copy | Download