JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v2i4.2176 jpsim.v2i4.2176 Case Report Infection and Reinfection with Salmonella Typhi- A Case from Hyderabad Outbreak due to Hesitancy of Vaccination Fatima Tazeen taz.fatima88@gmail.com * Haq Imran Shaheen Ghazala Department of Pathology, Aga khan University Hospitals, Karachi *Correspondence: Tazeen Fatima (taz.fatima88@gmail.com) 14 12 2021 2021 2 4 334 335 11 08 2021 16 11 2021 Copyright © 2021 The Author(s) 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We report a case of Salmonella typhi reinfection from Hyderabad, the current outbreak area in Pakistan. A 3-year-old boy resident of Hyderabad, Sindh presented with enteric fever with XDR Salmonella typhi resistant to ceftriaxone and treated with azithromycin for total 2 weeks. After 18 days of defervescence, patient again developed fever and a repeat blood culture grew MDR Salmonella typhi sensitive to ceftriaxone. This case emphasizes the importance of availability and provision of clean water, awareness regarding intake of boiled water and hygienic food, and stress on educating and creating public awareness regarding vaccination against Salmonella typhi to avoid infection and reinfection.

 Keywords Salmonella typhi extensively drug-resistant multi drug resistant vaccination References World Health Organization. Typhoid vaccines: WHO position paper, March 2018–Recommendations. Vaccine. 2019;37(2):214-6. Federal Disease Surveillance and Response Unit Field Epidemiology & Disease Surveillance Division National Institute of Health (NIH) Islamabad. Weekly Field Epidemiology Report. 2021;3(2):3-9.