title: Early small bowel perforation and cochleovestibular impairment as rare complications of typhoid fever.
abstract: Two Indian migrant workers suffering from fever and malaise were admitted to the hospital directly after arrival in the Netherlands. The first patient was 25-year-old man who had fever and rigors on admission. The patient was treated for presumptive typhoid fever with ciprofloxacin. Cefotaxime was added the following day because of the possibility of a nalidixic-acid resistant strain of S. typhi. The clinical course was complicated by a small bowel perforation on the third day of the disease. Blood cultures grew a nalidixic acid resistant strain of Salmonella enterica serovar typhi. The patient recovered completely. The second patient, a 22-year-old man, suffered from fever, malaise and hearing loss. A sensorineural hearing loss with vestibular dysfunction was diagnosed. Cultures of blood and bone marrow aspirate showed a nalidixic acid resistant strain of S. typhi. Treatment with ciprofloxacin and ceftazidime improved the hearing loss significantly. The clinical features of typhoid fever are heterogeneous and rare complications may occur. The emergence of multidrug and nalidixic acid resistance may complicate further the treatment of this serious systemic infection.
authors.affiliation: Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands.
authors.forename: Marlies E
authors.initials: ME
authors.lastname: van Wolfswinkel
authors.forename: Hakima
authors.initials: H
authors.lastname: Lahri
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Wismans
authors.forename: Pieter L C
authors.initials: PL
authors.lastname: Petit
authors.forename: Perry J J
authors.initials: PJ
authors.lastname: van Genderen
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015834:Cochlear Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D007416:Intestinal Perforation / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009268:Nalidixic Acid / Q000494:pharmacology; D009426:Netherlands; D012485:Salmonella typhi / Q000187:drug effects; D014195:Travel; D014435:Typhoid Fever / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D015837:Vestibular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid