Caumes E, Ehya N, Nguyen J, Bricaire F
Service des Maladies Infectieuses et Tropicales, Hopital Pitie-Salpetriere, Paris, France.
J Travel Med. 2001 Nov-Dec;8(6):293-7. doi: 10.2310/7060.2001.22378.
Enteric fever remains a major cause of fever in travelers. We evaluated new trends in enteric fever.
We reviewed the epidemiological, clinical, biological, bacteriological data, and outcome of all cases of typhoid and paratyphoid fever seen in our department over the last decade. The inclusion criteria were the presence of signs compatible with enteric fever and isolation of Salmonella typhi or Salmonella paratyphi A, B, or C from blood or stool cultures or any other site.
Among the 41 patients, 38 (93%) had travel-associated enteric fever. The main geographic source of contamination was the Indian subcontinent. One patient had been vaccinated with parenteral Vi vaccine 1 year previously. Fever and headaches were the only signs which were present in more than 80% of patients. The Widal test at inclusion was positive in 27%, and a second serological test was found to be positive in 50% of evaluated cases. Blood cultures and stool cultures were positive in 34 cases and 10 cases, respectively. Salmonellae spp were isolated in both hemocultures and stool cultures in 4 cases and in urine in 1 case. Two strains of S. typhi were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. One strain of S. typhi and one of S. paratyphi B were nalidixic acid resistant. All evaluable patients were cured with the exception of 2 patients (1 failure, 1 relapse). We observed 3 toxic reactions. No patients died.
The diagnosis and outcome of enteric fever are hampered by the lack of specificity of clinical and biological signs, the increasing rates of antimicrobial resistance, and the occurrence of toxic reactions during treatment.
伤寒热仍是旅行者发热的主要原因。我们评估了伤寒热的新趋势。
我们回顾了过去十年在我们科室所见的所有伤寒和副伤寒热病例的流行病学、临床、生物学、细菌学数据及结果。纳入标准为存在与伤寒热相符的体征，且从血液或粪便培养物或任何其他部位分离出伤寒沙门菌或甲型、乙型或丙型副伤寒沙门菌。
41例患者中，38例（93%）有与旅行相关的伤寒热。主要的污染地理来源是印度次大陆。1例患者1年前接种了肠外Vi疫苗。发热和头痛是超过80%的患者出现的仅有的体征。纳入时维达试验阳性率为27%，在50%的评估病例中发现第二次血清学试验呈阳性。血培养和粪便培养分别有34例和10例呈阳性。4例患者的血液培养物和粪便培养物中均分离出沙门菌属，1例患者尿液中分离出沙门菌属。2株伤寒沙门菌对氨苄西林、氯霉素和甲氧苄啶-磺胺甲恶唑耐药。1株伤寒沙门菌和1株乙型副伤寒沙门菌对萘啶酸耐药。除2例患者（1例治疗失败，1例复发）外，所有可评估患者均治愈。我们观察到3例毒性反应。无患者死亡。
临床和生物学体征缺乏特异性、抗菌药物耐药率上升以及治疗期间出现毒性反应，均妨碍了伤寒热的诊断和治疗结果。
