Typhoid Fever in an inner city hospital: a 5-year retrospective review
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Published on: October 25, 2024
Dimitrios Farmakiotis1, Julie Varughese, Paul Sue
1Department of Internal Medicine, Infectious Diseases, Jacobi Medical Center, Bronx, NY, USA. dfarmakiotis@mdanderson.org
Background:
Typhoid is a leading cause of fever in returning travelers. The prevalence is highest in migrants visiting friends and relatives (VFR travelers) in the Indian subcontinent, where reports of resistance have been of concern. This study is a retrospective analysis of patients with typhoid, seen over a 5-year period, in a tertiary center that serves a large immigrant population.
Methods:
Patients with blood cultures positive for Salmonella Typhi were identified between 2006 and 2010. Charts were reviewed for demographic data, travel history, symptoms and signs, basic laboratory results, susceptibility profiles, treatment, and clinical course. Resistance to nalidixic acid was used as a marker of decreased susceptibility to quinolones.
Results:
Seventeen patients were identified with S Typhi. The median age was 12 years (range: 2-47 y) and 94% (16 of 17) were hospitalized with a median stay of 7 days; two were admitted to the intensive care unit. Fourteen patients (82%) had a history of recent travel. Twelve were VFR travelers in Bangladesh and Pakistan and two had recently immigrated. In our study, typhoid patients had low eosinophil counts and elevated transaminases. Seventy-six percent (12 of 17) of all isolates were resistant to nalidixic acid, 23.5% (4 of 17) were resistant to ampicillin and co-trimoxazole, and one was resistant to ciprofloxacin. All isolates were susceptible to third-generation cephalosporins.
Conclusions:
Younger VFR travelers appear to be at greater risk of acquiring infection and developing complications. Absolute eosinopenia and increased liver function test values could be useful early diagnostic clues in a returning traveler with fever, once malaria has been excluded. There was a high rate of decreased susceptibility to fluoroquinolones, confirming that the use of third-generation cephalosporins or macrolides in patients from the Indian subcontinent is most appropriate. Prevention in VFR travelers to South Asia is critical and efforts should be targeted at better education and pre-travel immunization.
Insights
Typhoid fever is a significant concern for travelers, especially migrants visiting family in South Asia. High rates of antibiotic resistance necessitate using third-generation cephalosporins or macrolides for treatment.
Area of Science:
- Infectious Diseases
- Travel Medicine
- Microbiology
Background:
- Typhoid fever is a prevalent cause of fever in travelers, particularly impacting migrants visiting friends and relatives (VFR travelers) in the Indian subcontinent.
- Concerns exist regarding increasing antimicrobial resistance in Salmonella Typhi strains from this region.
Purpose of the Study:
- To analyze the clinical characteristics and antimicrobial susceptibility of Salmonella Typhi infections in a tertiary care center serving a large immigrant population.
- To identify risk factors and diagnostic clues for typhoid fever in returning travelers.
Main Methods:
- Retrospective analysis of patients with blood culture-confirmed Salmonella Typhi between 2006 and 2010.
- Review of patient demographics, travel history, clinical presentation, laboratory results, antimicrobial susceptibility, and treatment outcomes.
- Nalidixic acid resistance was used as a surrogate marker for reduced fluoroquinolone susceptibility.
Main Results:
- Seventeen patients with Salmonella Typhi were identified; 82% had recent travel history, predominantly VFR travelers to Bangladesh and Pakistan.
- Seventy-six percent of isolates showed nalidixic acid resistance, indicating decreased fluoroquinolone susceptibility.
- All isolates remained susceptible to third-generation cephalosporins.
Conclusions:
- Younger VFR travelers are at higher risk for typhoid infection and complications.
- Absolute eosinopenia and elevated liver function tests may aid early diagnosis in febrile travelers.
- High rates of fluoroquinolone resistance underscore the importance of third-generation cephalosporins or macrolides for empirical treatment in this population.
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