title: Salmonella enterica serotype Typhi infections in a Canadian pediatric hospital: a retrospective case series.
abstract: BACKGROUND
  In developed countries, typhoid fever generally occurs in travellers or recent immigrants from endemic areas. Our aim was to describe the epidemiology of Salmonella enterica serotype Typhi infections among children presenting to a pediatric teaching hospital in Montréal, Quebec.
  
  
  METHODS
  We included all patients less than 18 years of age who presented to the Montreal Children's Hospital between 1991 and 2011 with a laboratory-confirmed diagnosis of typhoid fever (Salmonella enterica ser. Typhi isolated from blood or stool) in a retrospective case series.
  
  
  RESULTS
  During the study period, we identified 39 cases of typhoid fever (mean age of patient 7.5 yr). Four (10.3%) of these cases occurred in newly arrived immigrants shortly after their arrival in Canada (median 15.5 d). Most cases (76.9%) occurred in children who had visited friends and relatives in their home country. None of the travellers had received a vaccination against typhoid fever before their departure. All cases presented with high fever (mean temperature 40.4°C) that lasted for a mean of 15.8 days. Common accompanying symptoms included anorexia, abdominal pain, vomiting and diarrhea. All 39 isolates of S. enterica ser. Typhi were susceptible to third-generation cephalosporins, and 7 were resistant to ciprofloxacin. Ampicillin resistance occurred in 10 (25.6%) of the isolates. No deaths occurred among the study participants.
  
  
  CONCLUSIONS
  Most cases of typhoid fever occurred in children who had travelled to endemic areas to visit friends and relatives. Thus, there is a role for increased awareness on the part of family physicians and pediatricians caring for these children to discuss travel-related infections during regularly scheduled appointments, because parents might not consult travel clinics or discuss their travel plans before travelling back to their home country.
authors: Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que. ; Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que.
authors: Jeannette L
authors: JL
authors: Comeau
authors: Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que.
authors: Thai Hoa
authors: TH
authors: Tran
authors: Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que.
authors: Dorothy L
authors: DL
authors: Moore
authors: Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que.
authors: Chi-Minh
authors: CM
authors: Phi
authors: Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Que. ; Department of Microbiology, Montreal Children's Hospital, McGill University, Montréal, Que.
authors: Caroline
authors: C
authors: Quach