Salmonella Typhi in Pakistan has acquired a DNA plasmid encoding further antibiotic resistance genes from another bacteria. Credit: Dave Goulding, Wellcome Sanger Institute.

Scientists at the Wellcome Sanger Institute, UK, have discovered the genetic cause associated with a strain of typhoid that has become resistant to five classes of antibiotics.

The researchers found that the strain, which caused the current typhoid outbreak in Pakistan, has acquired an extra DNA piece to become resistant to various antibiotics.

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Typhoid fever is caused by the Salmonella enterica serovar Typhi bacterium, which is highly contagious. The ongoing outbreak of drug-resistant typhoid in Pakistan began in November 2016.

Pakistani health experts found that this typhoid strain was resistant to even ceftriaxone antibiotic that is reserved for the treatment of multidrug-resistant infections.

After analysing the samples provided by collaborators from Aga Khan University in Pakistan, Wellcome Sanger Institute found that the strain called H58 is responsible for the breakout. The researchers said that the strain might have picked up the additional strand of bacterial DNA from E. coli.

“Sporadic cases of typhoid with these levels of antimicrobial resistance have been seen before, but this is the first time we’ve seen an ongoing outbreak, which is concerning.”

Wellcome Sanger Institute scientist Gordon Dougan said: “We have used genetic sequencing to uncover how this particular strain of typhoid became resistant to several key antibiotics.

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“Sporadic cases of typhoid with these levels of antimicrobial resistance have been seen before, but this is the first time we’ve seen an ongoing outbreak, which is concerning.”

Based on the findings from their study, the scientists believe that the options for treating this bacterial disease are running out.

Wellcome Sanger Institute Vaccines head Dr Charlie Weller said: “It’s time we focus on prevention, in addition to treatment.

“Vaccines offer another way to tackle drug-resistant infections and we have a unique opportunity to address typhoid with a new Typhoid Conjugate Vaccine that has been recently pre-qualified by the World Health Organisation.”