van Wolfswinkel Marlies E, Lahri Hakima, Wismans Pieter J, Petit Pieter L C, van Genderen Perry J J
Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands.
Travel Med Infect Dis. 2009 Sep;7(5):265-8. doi: 10.1016/j.tmaid.2009.06.003. Epub 2009 Jul 12.
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.
两名患有发热和不适症状的印度移民工人抵达荷兰后直接被送往医院。第一名患者是一名25岁男性，入院时发热且伴有寒战。该患者因疑似伤寒热接受环丙沙星治疗。由于可能存在耐萘啶酸的伤寒杆菌菌株，第二天加用了头孢噻肟。病程在疾病第三天因小肠穿孔而复杂化。血培养培养出一株耐萘啶酸的伤寒沙门氏菌血清型菌株。患者完全康复。第二名患者是一名22岁男性，患有发热、不适和听力丧失。诊断为伴有前庭功能障碍的感音神经性听力丧失。血液和骨髓穿刺培养显示为耐萘啶酸的伤寒杆菌菌株。环丙沙星和头孢他啶治疗使听力丧失明显改善。伤寒热的临床特征多种多样，可能会出现罕见并发症。多重耐药和萘啶酸耐药的出现可能会使这种严重的全身感染的治疗进一步复杂化。
