Moffitt AM report PEARLS 6/12: Enteric fever; Fever in a returning traveler

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

Fever in returning traveler

Evernote link: http://www.evernote.com/l/APgMYt4WbEhODpiHzxYXsQWt7ZGaPdUn6sA/

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