Abstract
PurposeThe clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007–2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment.MethodsA retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected.ResultsClinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0–57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1–20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown.ConclusionsFurther interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required.
Highlights
Enteric fever, often described in the literature as typhoid fever, is characterised by a non-specific illness with low grade fever, malaise, dry cough, and abdominal pain
Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases
Recognition and public health interventions for enteric fever are important for high risk cases such as those working within the food industry or attending nursery to prevent onward transmission
Summary
Often described in the literature as typhoid fever, is characterised by a non-specific illness with low grade fever, malaise, dry cough, and abdominal pain. The infection is caused by Salmonella enterica serovar Typhi Recognition and public health interventions for enteric fever are important for high risk cases such as those working within the food industry or attending nursery to prevent onward transmission. A recent population based surveillance study indicated a high incidence of enteric fever in India and Pakistan, intermediate incidence in Indonesia, and low incidence in China and Vietnam [5]. Cases of typhoid fever in Copenhagen region: a retrospective study of presentation and relapse.
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