Typhoid the current trend in treatment and

Typhoid fever is caused by a highly specific human adapted pathogen, Salmonella enterica serotype25 typhi. This organism is an important cause of febrile illness and death in population living in crowded and26 poorly sanitized environment. The risk of the disease is increasing in populations that are exposed to27 unsafe water and food and also pose a risk to travelers visiting to endemic country 1.UNDER PEER REVIEW2Salmonella typhi is a particular Salmonella serovar that causes typhoid fever, 28 a major public29 health problem in developing countries 2. Typhoid fever is a systemic disease, without therapy, the30 illness may last for three to four weeks and death rate ranges between 12% and 30%. Although the global31 burden of typhoid fever has reduced, emergence of multidrug resistant S. typhi (MDRST) is still a threat to32 public health. S. typhi is a motile, facultative anaerobe that is susceptible to various antibiotics. Currently,33 107 strains of this organism have been isolated; many containing varying metabolic characteristics, levels34 of virulence, and multi-drug resistance genes that complicate treatment in areas that resistance are35 prevalent 3. Diagnostic identification can be attained by growth on MacConkey and Eosine Methylene36 Blue agars, and the bacteria is strictly non-lactose fermenting. It also produces no gas when grown in37 Triple Sugar Iron agar, which is used to differentiate it from other Enterobacteriaceae 4.38 Despite the emergence of newer antibacterial drugs, enteric fever has continued to be a major39 health problem 5. S. typhi gained resistance to antibiotics like ampicillin, ceftriaxone, and co-trimoxazole,40 besides developing resistance to efficacious drugs like ciprofloxacin. The emergence of multidrug41 resistance to the commonly used antibiotics has further complicated the treatment and management of42 enteric fever and this is recognized as one of the greatest challenges in the management of this disease43 6. The importance of vaccination and other preventive measures for typhoid fever is heightened by44 increasing resistance of Salmonella serotype typhi to antimicrobial agents, including fluoroquinolones, in45 many parts of the world 5. The paper aimed to review the current trend in treatment and vaccine46 development.