Enteric Fever (both typhoid and paratyphoid)
- Transmitted by contaminated food and water
- Presentation: variable, but generally fever, chills, abdominal pain +/- rash (classically, “rose spots”). Do NOT have to have diarrhea.
- Chronic carriage: occurs in 1-6%, less common these days with modern antibiotics per HH
- Diagnosis: culture
- Complications to consider: splenic rupture, bowel perforation, chronic carriage
- Treatment: increasing fluoroquinolone resistance in S and SE Asia. Must check test with nalidixic acid. Otherwise CTX and azithromycin are acceptable alternatives depending on clinical situation
- Vaccinations: not very good
- Efficacy at year 1 (35% oral; 69% IM) and efficacy at year 2 (58% oral; 59% IM)
- Typhoid vaccinates against S. typhi but does NOT vaccinate against S. paratyphi
Fever in a returning traveler
- Think about geography and incubation period to narrow the ddx. Here is a super helpful table of incubation periods and geography from the CDC Yellow Book chapter on fever in returned travelers
- Full chapter at: http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-5-post-travel-evaluation/fever-in-returned-travelers
- See attached for a slightly older NEJM article from 2002 for a full discussion of fever in a returning traveler.
- GeoSentinel: global surveillance network run by the International Society of Travel Medicine