[Abdominal typhus and paratyphoid fever in 2 academic hospitals: 1984-1990]

A diagnosis of blood culture-positive typhoid (TF; n = 39) or paratyphoid (PTF; n = 17) fever was made in 56 patients admitted to two Dutch university hospitals in the period 1984-1990. The group of TF patients constituted 9% of the reported national total during those years. A retrospective analysis of available clinical, laboratory and epidemiological data was carried out. Without exception, infections were contracted during travel abroad, especially to India and Indonesia. The clinical features and the response to antimicrobial treatment of TF and PTF proved essentially the same. Fever, headache and anorexia were important symptoms; rose spots and splenomegaly were found in 18/38 and 10/39 with S. typhi respectively. Most patients had a normal white blood cell count; less than half of the patients had thrombocytopenia. A positive Widal-test was found in 15/24 patients with S. typhi. 18/39 patients with S. typhi had been vaccinated; 10 did not know. Amoxycillin was the preferred antimicrobial agent in 69% of cases. Median defervescence time was 5 days in TF and 4 days in PTF. Relapse occurred in 3 TF cases. The recurrence rate after amoxycillin treatment was 7.6%. Profuse intestinal bleeding (1x), septic shock (1x) and cholangitis plus ARDS (1x) were major complications, seen in TF patients only. All patients recovered fully. None of the isolated strains of S. typhi or S. paratyphi proved multiresistant. Surveillance data from the Dutch National Institute of Public Health and Environmental Protection suggest that multidrug-resistance of S. typhi is increasing, especially in strains imported from countries such as India and Pakistan.(ABSTRACT TRUNCATED AT 250 WORDS)