The enteric fever serovar Salmonella Typhi exhibits impaired growth at pH 4.5 compared to S. Typhimurium. These results suggest S.Typhi has lost the ability to withstand acid stress due to differences...

AbstractAzithromycin is a frontline oral treatment for uncomplicated enteric fever in South Asia; however, emerging resistance in Salmonella enterica serovars Typhi and Paratyphi challenges its long-term efficacy. We conducted a PRISMA-compliant systematic review and meta-analysis, searching 6 databases to estimate the prevalence of azithromycin resistance in low-income and developing countries in South Asia. Accepted resistance classifications were based on interpretive criteria used by individual study authors, acknowledging that the Clinical and Laboratory Standards Institute breakpoints for S. Typhi were introduced in 2015 and that no official breakpoints exist for S. Paratyphi. From 1863 screened records, 74 studies comprising 30 085 isolates were analyzed using random-effects models. The pooled azithromycin resistance was 5% (95% CI: 4%–5%) for S. Typhi and 5% (95% CI: 0%–9%) for S. Paratyphi. When both serotypes were combined, the overall prevalence was 9% (95% CI: 3%–14%). Subgroup analysis revealed significant geographical heterogeneity: Pakistan and India reported the highest prevalence (8% and 7%, respectively), while Nepal and Bangladesh remained at 1%. Meta-regression did not detect a statistically significant temporal trend from 2005 to 2024. Although overall resistance remains relatively low, high prevalence in specific regions necessitates rigorous antimicrobial stewardship and enhanced surveillance to preserve azithromycin's clinical utility against enteric fever in South Asia.

Una cocinera portadora sana de la bacteria ‘Salmonella typhi’ fue responsable de varios brotes de enfermedad a lo largo de su vida.

This meta-analysis of 74 South Asian studies involving 30,085 clinical isolates reveals a stable 5% pooled azithromycin resistance for both Salmonella Typh

Salmonella Typhi (STy) causes typhoid fever by preferentially invading the ileum, yet the molecular basis of this tropism has remained unknown. Yoon et al. show STy senses microbiota-released mucin sugars via the surface protein OmpW to trigger invasion, and leverage this mechanism to establish an oral mouse model of typhoid.

This meta-analysis of 74 South Asian studies involving 30,085 clinical isolates reveals a stable 5% pooled azithromycin resistance for both Salmonella Typh

Author summary Enteric fever caused by the bacteria Salmonella enterica serovars Typhi and Paratyphi, remains common in many low- and middle-income countries, including Cambodia. Its true burden is of...

AbstractAzithromycin is a frontline oral treatment for uncomplicated enteric fever in South Asia; however, emerging resistance in Salmonella enterica serovars Typhi and Paratyphi challenges its long-term efficacy. We conducted a PRISMA-compliant systematic review and meta-analysis, searching six databases to estimate the prevalence of azithromycin resistance in low-income and developing countries in South Asia. Accepted resistance classifications were based on interpretive criteria used by individual study authors, acknowledging that CLSI breakpoints for S. Typhi were introduced in 2015 and that no official breakpoints exist for S. Paratyphi. From 1,863 screened records, 74 studies comprising 30,085 isolates were analyzed using random-effects models. The pooled azithromycin resistance was 5% (95% CI: 4-5%) for S. Typhi and 5% (95% CI: 0-9%) for S. Paratyphi. When both serotypes were combined, the overall prevalence was 9% (95% CI: 3-14%). Subgroup analysis revealed significant geographical heterogeneity: Pakistan and India reported the highest prevalence (8% and 7%, respectively), while Nepal and Bangladesh remained at 1%. Meta-regression did not detect a statistically significant temporal trend from 2005 to 2024. Although overall resistance remains relatively low, high prevalence in specific regions necessitates rigorous antimicrobial stewardship and enhanced surveillance to preserve azithromycin’s clinical utility against enteric fever in South Asia.

and objectivesAzithromycin is a critical oral treatment for typhoid fever caused by Salmonella enterica serovar Typhi (Salmonella Typhi), since XDR has rendered other first-line treatment options ineffective. Azithromycin resistance conferred by amino acid changes in AcrB, an AcrAB-TolC efflux pump component, represents an emerging public health concern. Leveraging phenotypic and genotypic data from U.S. Salmonella Typhi surveillance systems, this study describes the prevalence, phenotype and genomic epidemiology of Salmonella Typhi with AcrB mutations in U.S. patients since the first detection in 2015.MethodsAST and WGS data of >3000 Salmonella Typhi isolates were used to identify all cases with an AcrB mutation in the United States (2015–2025). We calculated annual prevalence and MIC ranges. Phylogenetic analysis was used to contextualize U.S. cases of Salmonella Typhi with an AcrB mutation within all globally reported cases.ResultsWhile the prevalence of AcrB mutations in the United States is low (1.5%), it has risen significantly in recent years, from 0.2% in 2016–2022 to 2.2% in 2023–2025. This increase is predominantly driven by clonal expansion of existing strains circulating in South Asia. AcrB mutations do not reliably confer resistance to azithromycin (MIC ≥ 32 mg/L), complicating clinical interpretation.ConclusionsThe prevalence of AcrB mutations in Salmonella Typhi is increasing in the United States, and likely globally, given that U.S. data function as an informal proxy for regions without routine surveillance infrastructure. Clinical outcomes data are needed to inform Salmonella Typhi treatment guidelines and potentially amend clinical breakpoints for azithromycin.

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Fleaborne typhus (FBT) is reemerging as a significant cause of febrile illness in southern California, USA. We performed enhanced testing on low-titer Rickettsia typhi antibody–positive specimens from patients with FBT-compatible illness reported in Los Angeles County, California, during 2022–2024. We tested 114 specimens by repeat serology and 113 by real-time PCR; 81 (71%) were PCR-positive, and 95 (83%) had higher antibody titers by repeat serology. Most PCR-positive specimens were collected 8–10 days after illness onset, but some were collected up to 15 days after illness onset. All PCR-positive specimens were R. typhi–specific. After additional testing, 113 (99%) suspected cases were reclassified as probable or confirmed FBT cases. Our findings indicate that many low-titer seropositive results represent true infections and that use of minimum serology thresholds for public health investigation underestimates surveillance case counts. Expanding commercial molecular testing capacity will improve clinical FBT diagnosis and enhance surveillance accuracy.

Flea-borne typhus (FBT), due to Rickettsia typhi and R. felis, is an infection typically causing fever, headache, rash, hepatitis, and thrombocytopenia. About one quarter of patients suffer pulmonary,...

Typhoid fever is an infection caused by Salmonella Typhi, a bacterium that can spread when food or water becomes contaminated with human faeces. This makes everyday food handling an important part of preventing the disease. The post 7 simple ways to prevent typhoid fever in your home appeared first on Tribune Online.

We have established a THP-1 macrophage model to characterise the intracellular pharmacodynamics of azithromycin. Our findings indicate that azithromycin is likely ineffective for treating infections c...

Read the full paper: Determining intracellular and extracellular activities of azithromycin against azithromycin-resistant Salmonella Typhi and their association with clinical treatment responses