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Typhoid fever. An epidemic with remarkably few clinical signs and symptoms
Abstract:
A major common-source, foodborne epidemic of typhoid fever occurred in San Antonio, Tex, in the fall of 1981, involving 80 verified cases. We summarize the clinical course of our 34 patients who had a nonspecific symptom complex that included at the initial examination fever (32 patients, 93%), headache (19 patients, 57%), diarrhea (11 patients, 33%), and anorexia (ten patients, 30%). The most common initial diagnoses were urinary tract and upper respiratory tract infections. The subsequent isolation of Salmonella typhi from blood cultures was usually unexpected. Physical findings were different from two previous series originating in the United States. Hepatomegaly was noted in only 7% (two patients), splenomegaly was noted in 13% (four patients), and rose spots were noted in 5% (two patients) of the patients. Liver function test results, however, were abnormal in 32 (95%) of the 34 patients (mean SGOT, 155 IU/mL). Typhoid fever, as seen in this outbreak, was notable for its nonspecific and mild manifestation and uniformly favorable outcome.
Insights
A 1981 foodborne typhoid fever outbreak in San Antonio showed mild, nonspecific symptoms like fever and headache. This common-source epidemic of Salmonella typhi infections had a favorable outcome in most patients.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- A significant foodborne outbreak of typhoid fever occurred in San Antonio, Texas, in the fall of 1981.
- The epidemic involved 80 confirmed cases, highlighting a public health concern.
Purpose of the Study:
- To summarize the clinical presentation and outcomes of patients during this specific typhoid fever outbreak.
- To compare the clinical findings with previous typhoid fever cases in the United States.
Main Methods:
- Retrospective analysis of clinical data from 34 confirmed typhoid fever patients.
- Review of initial symptoms, physical examination findings, and laboratory results, including liver function tests.
Main Results:
- Patients presented with nonspecific symptoms: fever (93%), headache (57%), diarrhea (33%), and anorexia (30%).
- Initial diagnoses were often misleading, commonly suggesting urinary or respiratory tract infections.
- Classic physical findings like hepatomegaly (7%), splenomegaly (13%), and rose spots (5%) were infrequent.
- Abnormal liver function tests (elevated SGOT) were observed in 95% of patients.
Conclusions:
- Typhoid fever in this outbreak presented with mild and nonspecific manifestations.
- The clinical picture differed from previous US-based series, emphasizing varied disease presentation.
- The outbreak demonstrated a uniformly favorable outcome for affected individuals.