title: Changing characteristics of typhoid fever in Taiwan.
abstract: Typhoid fever, a systemic disease caused by Salmonella typhi, is classically characterized by fever and abdominal symptoms. Although now considered uncommon, it seems to have re-emerged in Taiwan in recent years. We conducted a retrospective study of the clinical characteristics and microbiologic findings in 24 confirmed cases of typhoid fever treated over a 7-year period at a medical center in northern Taiwan. There were 11 males and 13 females, including 15 adults (over 18 years in age) and 9 children. Their mean age was 24.7 years (range, 9 months to 58 years). Twelve patients had recently returned from abroad, mostly from Southeast Asia. The most common complaints were fever (24/24), diarrhea (18/24), abdominal pain (10/24), and cough (10/24). The average duration of fever before diagnosis was 14.1 days, with a maximum of 30 days. Relative bradycardia was noted in 6 patients. Leukopenia was noted in 2 patients. S. typhi was isolated from blood culture in 20 cases, from stool culture in 3 cases, and from bone marrow culture in 1 case. Widal test was only positive initially in 7/18 cases. Fever of unknown origin was the most common initial diagnosis. Typhoid or enteric fever was impressed initially in only 2 cases. Almost all isolates of S. typhi were susceptible to antibiotics currently used for typhoid fever, with only 1 isolate resistant to chloramphenicol. All patients survived after antibiotic treatment. Only 1 patient developed recurrence after a 10-day course of ceftriaxone. In conclusion, the diagnosis of typhoid fever is often challenging due to non-specific symptoms and lack of an immediate confirmatory test. It is important to include this disease in the differential diagnosis of febrile patients with abdominal symptoms.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan 100, ROC.
authors.forename: Chan-Ping
authors.initials: CP
authors.lastname: Su
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D001853:Bone Marrow / Q000382:microbiology; D002648:Child; D002702:Chloramphenicol Resistance; D003371:Cough / Q000209:etiology; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005334:Fever; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012485:Salmonella typhi / Q000187:drug effects; D013624:Taiwan; D014435:Typhoid Fever / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents