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


CONCLUSIONS
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.
Clark
Tristan W
TW
Infectious diseases Unit, Level 6 Windsor building, Leicester Royal Infirmary, Leicester LE15WW, UK. tristan.w.clark@uhl-tr.nhs.uk
Daneshvar
Cyrus
C
Pareek
Manish
M
Perera
Nelun
N
Stephenson
Iain
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012485:Salmonella typhi / Q000302:isolation & purification*; D014195:Travel; D014435:Typhoid Fever / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin