East London Experience with Enteric Fever 2007-2012

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.

Enteric fever among children: 50 cases in a French tertiary care centre

“…This distribution is different from what is reported in other studies from non-endemic countries where most infections were acquired in the Indian subcontinent and South-East Asia. 13,19,20 It is however consistent with French national surveillance data fro -2015 which show that travel-associated enteric fever cases among persons aged under 18 are predominantly acquired in Africa (61%) followed by Asia (36%). 9 Forty-four percent of immigrants in France come from Africa, 31% from Europe and 25% from the rest of the world.…”

“…As described in previous studies among children and adults in endemic and non-endemic countries, clinical features of enteric fever are non-specific and mimic other febrile illnesses like malaria, dengue fever or influenza, especially in younger children. 4,19,20,30,31 Fever (48-96%), asthenia (42-84%) and intestinal symptoms (e.g., diarrhoea (37-74%), vomiting (24-48%) and abdominal pain (25-50%)), were the most common findings in our case series.…”

Typhoid fever in travellers: estimating the risk of acquisition by country

“…Overall, our findings concur with previous studies of travellers from low-incidence countries in identifying south Asia as a prominent region for acquisition of typhoid. 14–17 , 40 Importantly, however, our analysis provides a contemporaneous assessment of the Asia-Pacific region including Oceanic countries that to date have had little data evaluation. The limited ability to assess subcategories of risk, including reason for travel, highlights that such information ideally should be routinely captured in case notification data to help identify and focus preventive strategies on those with greatest need.…”

British Infection Association guidelines for the diagnosis and management of enteric fever in England

“…15 The extent of this threat has been more evident since the widespread adoption of new thresholds for defining resistance around 2012, prompted by reports of increasing treatment failure. 16 In which countries are travellers at risk of acquiring multidrug-resistant plus FQ-resistant infection?…”