title: Enteric fever in a British soldier from Sierra Leone.
abstract: Enteric fever (typhoid and paratyphoid) remains a threat to British troops overseas and causes significant morbidity and mortality. We report the case of a soldier who developed typhoid despite appropriate vaccination and field hygiene measures, which began 23 days after returning from a deployment in Sierra Leone. The incubation period was longer than average, symptoms started 2 days after stopping doxycycline for malaria chemoprophylaxis and initial blood cultures were negative. The Salmonella enterica serovar Typhi eventually isolated was resistant to amoxicillin, co-amoxiclav, co-trimoxazole and nalidixic acid and had reduced susceptibility to ciprofloxacin. He was successfully treated with ceftriaxone followed by azithromycin, but 1 month later he remained fatigued and unable to work. The clinical and laboratory features of enteric fever are non-specific and the diagnosis should be considered in troops returning from an endemic area with a febrile illness. Multiple blood cultures and referral to a specialist unit may be required.
authors.affiliation: Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Army Medical Directorate, Camberley, UK.
authors.forename: Lucy G
authors.initials: LG
authors.lastname: Osborne
authors.affiliation: Hospital for Tropical Diseases, University College London Hospital Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Brown
authors.affiliation: Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
authors.forename: M S
authors.identifier: http://orcid.org/0000-0003-4840-5093
authors.initials: MS
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002432:Cecum / Q000000981:diagnostic imaging; D002443:Ceftriaxone / Q000627:therapeutic use; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging; D008889:Military Personnel; D012807:Sierra Leone; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014435:Typhoid Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D014436:Typhoid-Paratyphoid Vaccines / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D014436:Typhoid-Paratyphoid Vaccines; D002443:Ceftriaxone; D017963:Azithromycin
keywords: Diagnostic microbiology < INFECTIOUS DISEASES; Enteric fever; Military Personnel; Sierra Leone; Typhoid fever