A disease known for causing brain swelling is re-emerging, with new variants showing resistance to antibiotics. In India, drug-resistant forms of typhoid have been identified in 32 samples collected from various hospitals.

Typhoid fever is contracted through the consumption of water or food that has been contaminated with Salmonella Typhi. This bacterium is found in areas of Asia, Africa, and Central and South America. In the UK, the majority of typhoid cases are linked to recent travel to countries like India, Pakistan, and Bangladesh.

The UK Health Security Agency reported 702 cases of imported typhoid and paratyphoid fever in 2024, marking an increase of 8% from the previous year. This figure is the highest ever recorded in the UK.

Symptoms of typhoid fever generally appear within three weeks of exposure, though they can occasionally take up to six weeks to manifest. These symptoms include fever, headaches, coughing, chills, body aches, fatigue, constipation, and loss of appetite.

The emergence of a new drug-resistant gene, blaNDM-5, which can be transferred between different bacteria types, has raised alarms about the potential for other diseases to develop similar resistance.

Recent outbreaks of extensively drug-resistant (XDR) typhoid have been reported in South Asia. Since 2016, Pakistan has documented over 15,000 cases of XDR typhoid, with additional resistant strains observed in Bangladesh, India, and Nepal.

Dr Malick Gibani, clinical lecturer in infectious diseases at Imperial College London, told The Telegraph: “We all hear that antimicrobial resistance is a problem, but typhoid really exemplifies it – how resistance seems to emerge relentlessly, moving from one class of antibiotics to the next.

“It’s not yet untreatable, but the treatments we do have are much more limited and significantly more challenging to deliver. Although the number of cases described is still relatively small, this feels very much like a canary-in-the-coal-mine signal.

“This was always going to happen and probably reflects the relentless evolution of AMR in typhoid. While these infections are not yet “untreatable”, they are clearly becoming much harder to manage.”

The NHS recommends contacting 111 if you have recently travelled to an area with typhoid fever and feel unwell, even if you have been vaccinated. Call 999 or go to A&E if you have sudden stomach pain that worsens, your poo is black or dark red, you vomit blood, or have vomit that looks like ground coffee.