Enteric fever refers to a clinical syndrome caused by Salmonella typhi (typhoid fever) or, less commonly, Salmonella paratyphi (paratyphoid fever). Disease may be acquired by either direct fecal-oral spread or through fecal contamination of food or water. Typhoid fever is common in many developing nations, and travel to Mexico, India, the Philippines, Pakistan, El Salvador, and Haiti accounts for the majority of cases.
Following an incubation period of 5 to 21 days, patients usually present with sustained fever, anorexia, malaise, and vague abdominal discomfort. Although diarrhea may occur early, it often resolves before fever develops, and constipation is the usual complaint on presentation. A pulse-temperature dissociation may be noted on vital signs. Rose spots are found in 30% to 50% of patients but are subtle and must be searched for carefully. Hepatosplenomegaly may also be identified. Laboratory findings are nonspecific, with anemia, leukopenia, and elevated transaminases common.
There are few distinctive clinical features, and the diagnosis should be considered in all febrile travelers, even those without gastrointestinal symptoms. Since current typhoid vaccines have an efficacy of approximately 70%, enteric fever is still a possibility in those who have been immunized. Diagnosis is achieved by isolation of the organism in cultures of blood, stool, urine, bone marrow, and duodenal aspirates. Prior or concurrent antibiotic use reduces the ability to isolate the bacterium. Fluoroquinolone antibiotics are the treatment of choice.
*202/348/5*
ENTERIC FEVER AS ONE OF THE MAJOR TROPICAL CAUSES OF FEVEREnteric fever refers to a clinical syndrome caused by Salmonella typhi (typhoid fever) or, less commonly, Salmonella paratyphi (paratyphoid fever). Disease may be acquired by either direct fecal-oral spread or through fecal contamination of food or water. Typhoid fever is common in many developing nations, and travel to Mexico, India, the Philippines, Pakistan, El Salvador, and Haiti accounts for the majority of cases.Following an incubation period of 5 to 21 days, patients usually present with sustained fever, anorexia, malaise, and vague abdominal discomfort. Although diarrhea may occur early, it often resolves before fever develops, and constipation is the usual complaint on presentation. A pulse-temperature dissociation may be noted on vital signs. Rose spots are found in 30% to 50% of patients but are subtle and must be searched for carefully. Hepatosplenomegaly may also be identified. Laboratory findings are nonspecific, with anemia, leukopenia, and elevated transaminases common.There are few distinctive clinical features, and the diagnosis should be considered in all febrile travelers, even those without gastrointestinal symptoms. Since current typhoid vaccines have an efficacy of approximately 70%, enteric fever is still a possibility in those who have been immunized. Diagnosis is achieved by isolation of the organism in cultures of blood, stool, urine, bone marrow, and duodenal aspirates. Prior or concurrent antibiotic use reduces the ability to isolate the bacterium. Fluoroquinolone antibiotics are the treatment of choice.*202/348/5*
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