21st-century typhoid fever—progression of knowledge but regression of control?

In The Lancet Infectious Diseases, Farah Naz Qamar and colleagues detail the epidemiological investigation into an outbreak of typhoid fever in Hyderabad, Pakistan. The outbreak strain of Salmonella enterica serovar Typhi was resistant to two of the most commonly used antimicrobial classes used in treatment and control of the disease: third-generation cephalosporins and fluoroquinolones. S Typhi has evolved to become highly adapted to its human host, becoming the perfect infectious model, through asymptomatic carriage of the pathogen and rapid dissemination during large outbreaks. With the advent of antimicrobial therapy, S Typhi has become extensively drug resistant.

This is not simply another story of antimicrobial failure—this is a siren call to action.