title: Emergency department presentations of typhoid fever.
abstract: Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.
authors.affiliation: Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles, California 90033, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hoffner
authors.forename: E
authors.initials: E
authors.lastname: Slaven
authors.forename: J
authors.initials: J
authors.lastname: Perez
authors.forename: R N
authors.initials: RN
authors.lastname: Magana
authors.forename: S O
authors.initials: SO
authors.lastname: Henderson
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000372:Agglutination Tests; D001919:Bradycardia / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology*; D004638:Emergency Treatment / Q000379:methods*; D004641:Emigration and Immigration; D005076:Exanthema / Q000382:microbiology*; D005260:Female; D005334:Fever / Q000382:microbiology*; D006261:Headache / Q000382:microbiology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000208:ethnology; D007970:Leukopenia / Q000382:microbiology*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014435:Typhoid Fever / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology