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Enteric fever in a UK regional infectious diseases unit: a 10 year retrospective review
Tristan W Clark1, Cyrus Daneshvar, Manish Pareek
1Infectious diseases Unit, Level 6 Windsor building, Leicester Royal Infirmary, Leicester LE15WW, UK. tristan.w.clark@uhl-tr.nhs.uk
Insights
Enteric fever, a common diagnosis in UK travellers, presents as a non-specific febrile illness. Increasing ciprofloxacin resistance explains high treatment failure rates, making it unsuitable for empirical treatment.
Area of Science:
- Infectious Diseases
- Travel Medicine
- Microbiology
Background:
- Enteric fever is a growing concern among UK travellers.
- The study focuses on culture-confirmed cases in a UK hospital setting.
Purpose of the Study:
- To analyze trends and characteristics of enteric fever cases.
- To evaluate treatment outcomes and antibiotic sensitivity.
Main Methods:
- Retrospective descriptive study of 100 enteric fever cases (1999-2009).
- Data collected on patient demographics, travel history, symptoms, and clinical findings.
Main Results:
- Most cases (98.3%) in adults were of Asian ethnicity with recent travel to the Indian Subcontinent.
- Common symptoms included fever, headache, and diarrhoea; complications were rare.
- Reduced ciprofloxacin sensitivity increased over time, correlating with a 20% treatment failure rate.
Conclusions:
- Enteric fever presents as a non-specific febrile illness post-travel.
- Rising ciprofloxacin resistance necessitates alternative empirical treatment strategies.
- The study highlights the need for updated treatment guidelines for enteric fever in travellers.
Introduction:
Enteric fever is an increasingly common diagnosis in returning travellers in the UK.
Methods:
We performed a retrospective descriptive study of culture-confirmed cases of enteric fever admitted to University Hospitals Leicester, UK between January 1999 and April 2009.
Results:
100 cases of enteric fever were identified in adults (n = 76) and children (n = 24). The median age of adult subjects was 38 (range 18-71) and 55% were male. Of the 61 adult cases with notes available, 60 (98.3%) were of Asian ethnicity and 56 (92%) had a recent travel history, principally to the Indian Subcontinent. Symptoms included fever (100%), headache (62%), diarrhoea (59%) and abdominal pain (44%). Common examination findings included pyrexia and mild generalized abdominal tenderness. Mild hyponatraemia, transaminitis and a normal white cell count were commonly identified. Reduced ciprofloxacin sensitivity was common and increased over the study period. Median fever clearance time was 6 days, and treatment failure occurred in 20% of cases. Relapse occurred in 2 patients. Complications were unusual, and one patient died.
Discussion:
Patients with enteric fever presented with a non-specific febrile illness within one month after returning from travel, and most had an uncomplicated clinical course. Increasing ciprofloxacin insensitivity was the likely explanation for a high treatment failure rate and this agent can no longer recommended as empirical treatment.
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