| Summary: | In the past 5 years, The Lancet Global Health has reported seminal Articles about typhoid, typhus, tuberculosis, and antimicrobial resistance. This Comment will address these common problems in a different perspective over a longer time frame in south Asia. Typhoid and typhus fevers are the first two chapters in William Osler’s The Principles and Practice of Medicine, published in 1892.1 It is disheartening that well over a century later, south Asia continues to have a large burden of these diseases, despite antibiotics. Additionally, antimicrobial resistance—including antibiotic-resistant typhoid fever—is on the increase. For example, extensive drug-resistant typhoid fever in Pakistan’s Sindh province has been documented since November, 2016.2 The H58 strain of Salmonella enterica serotype Typhi, which is ubiquitous in south Asia, became extensively drug resistant by acquiring a so-called highly promiscuous DNA molecule (ie, a plasmid) from another common bacterium such as Escherichia coli. It will be no surprise if the extensively drug-resistant typhoid organism (which currently responds to only azithromycin and not ceftriaxone among the commonly used, effective typhoid drugs) spreads to other parts of Pakistan, or indeed the rest of the subcontinent, making treatment of this common disease daunting.
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