title: Characteristics of typhoid fever in children and adolescents in a major metropolitan area in the United States.
abstract: To examine the epidemiology of typhoid fever in children in an area that was not endemic, we analyzed 55 cases of typhoid fever in children and adolescents who were < or = 18 years and whose cases were reported to the Chicago and suburban Cook County Health Departments over 7 years. Cases had positive blood and/or stool cultures for Salmonella typhi. The ethnic distribution of the patients was as follows: 25% Asian, 22% Hispanic, 15% African American, 9% Caucasian, 18% other, and 11% unknown. Of the 55 cases, 35% were aged 0-5 years, 25% were aged 6-10 years, 31% were aged 11-15 years, and 9% were aged 16-18 years. Twelve patients did not have a history of travel. All patients recovered; none became carriers. Symptoms in 41 patients whose charts were available for review included fever (100%), diarrhea (77%), vomiting (50%), and dehydration (30%). Bacteremia was documented in 27 (66%) of 41 cases. In 17 of 41 cases, the household contacts were food handlers or health care workers. Eight (31%) of 26 isolates were resistant to both ampicillin and trimethoprim-sulfamethoxazole. The findings in our study were as follows: typhoid fever occurred frequently in children aged 0-5 years (in contrast with reports from areas of endemicity), approximately 20% of patients did not have a history of travel, and multidrug-resistant strains were prevalent.
authors.affiliation: Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois 60153, USA.
authors.forename: S
authors.initials: S
authors.lastname: Misra
authors.forename: P S
authors.initials: PS
authors.lastname: Diaz
authors.forename: A H
authors.initials: AH
authors.lastname: Rowley
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002641:Chicago / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012485:Salmonella typhi / Q000302:isolation & purification*; D017678:Sex Distribution; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D014481:United States / Q000453:epidemiology