Enteric fever in a UK regional infectious diseases unit: a 10 year retrospective review

Clark, T.W., Daneshvar, C., Pareek, M. and Stephenson, I. (2010) Enteric fever in a UK regional infectious diseases unit: a 10 year retrospective review. Journal of Infection, 60 (2), 91-98. (doi:10.1016/j.jinf.2009.11.009). (PMID:19962402)

Abstract

Enteric fever is an increasingly common diagnosis in returning travellers in the UK.

METHODS: We performed a retrospective descriptive study of culture-confirmed cases of enteric fever admitted to University Hospitals Leicester, UK between January 1999 and April 2009.

RESULTS: 100 cases of enteric fever were identified in adults (n = 76) and children (n = 24). The median age of adult subjects was 38 (range 18-71) and 55% were male. Of the 61 adult cases with notes available, 60 (98.3%) were of Asian ethnicity and 56 (92%) had a recent travel history, principally to the Indian Subcontinent. Symptoms included fever (100%), headache (62%), diarrhoea (59%) and abdominal pain (44%). Common examination findings included pyrexia and mild generalized abdominal tenderness. Mild hyponatraemia, transaminitis and a normal white cell count were commonly identified. Reduced ciprofloxacin sensitivity was common and increased over the study period. Median fever clearance time was 6 days, and treatment failure occurred in 20% of cases. Relapse occurred in 2 patients. Complications were unusual, and one patient died.

DISCUSSION: Patients with enteric fever presented with a non-specific febrile illness within one month after returning from travel, and most had an uncomplicated clinical course. Increasing ciprofloxacin insensitivity was the likely explanation for a high treatment failure rate and this agent can no longer recommended as empirical treatment.

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Contributors

Author: T.W. Clark

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