The lack of sanitation in the city has led to the rapid spread of XDR typhoid in Karachi. Open garbage dumps around the city and contaminated water have increased the risk of this type of typhoid, which is resistant to most antibiotics and hence difficult and expensive to curtail.It is a serious water-borne infection caused by the bacterium Salmonella Typhi that spreads through contaminated food and water. Reports of cases of XDR typhoid first emerged in Hyderabad from where they spread to the rest of the province. According to the National Institute of Child Health (NICH) Paediatric Dr Umar Sultan, the disease has made its way from different cities of Sindh to Karachi.High-grade fever, weakness, stomach pain, nausea, vomiting, headache, cough and loss of appetite are some of the symptoms.Dr Sultan said that a large number of the patients suffering from XDR typhoid were children who had contracted the disease by using contaminated water supply at schools.He said that the main causes of this disease include contaminated water and atmospheric pollutants, inappropriate sewerage disposal and contaminated food items. He added that garbage dumps in Karachi were conducive for the bacteria to grow as they provide optimal conditions for these organisms to thrive.Stressting the severity of the situation, he said that this strain of typhoid was resistant to most antibiotics, which made it difficult to save lives. He suggested that one take precautionary measures like drink boiled water, avoid eating outside, wash hands before eating and after using the washroom and to wash vegetables, fruits and dishes with warm water before using them to stay safe. He advised citizens to approach authorised doctors immediately if any symptoms appear.Physician Dr Muneer Sadiq said that XDR typhoid could be cured by Meropenem and Imipenem, however, she added they were expensive medicines for ordinary citizens. She said that the cost of daily diet was around Rs1,500 to Rs2,000 which, if not taken on a regular basis, could lead to hazardous conditions.According to Pakistan Medical Association (PMA), around 8,000 cases have been reported of this deadly typhoid since 2016, with Karachi ranking first followed by Hyderabad and Sanghar. Medical and Health Services Senior Director Dr Beerbal Ginani said that around 69% of cases of XDR typhoid have been reported in Karachi, 27% in Hyderabad and 4% in other districts of Sindh.According to citizens, the Sindh health department has left the people at the mercy of this deadly virus. The doctors in the hospitals do not have the cure, they said. The citizens have also demanded that the government take measures to ensure cleanliness in the city.The hospitals under Karachi Metropolitan Corporation (KMC) have been issued the alert for taking precautionary measures on an emergency basis.