Dave Jayshree, Millar Michael, Maxeiner Horst, Freedman Joanne, Meade Rachel, Rosmarin Caryn, Jordan Matthew, Andrews Nick, Holliman Richard, Sefton Armine
Public Health Laboratory London, Public Health England, London, United Kingdom.
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
PLoS One. 2015 Mar 19;10(3):e0120926. doi: 10.1371/journal.pone.0120926. eCollection 2015.
The clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007-2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment.
A retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected.
Clinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0-57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1-20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown.
Further interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required.
描述2007年至2012年期间东伦敦两家医院肠热病患者的临床表现和流行病学情况，旨在确定预防机会并降低治疗成本。
对2007年至2012年期间因肠热病入院且微生物学确诊的患者病历进行回顾性分析。收集了临床表现、旅行史、人口统计学数据、实验室参数、治疗情况、患者结局和疫苗接种状况等详细信息。
98/129例（76%）患者有临床病历，其中包括69例伤寒沙门菌（伤寒杆菌）和29例副伤寒沙门菌。34例（35%）患者从急诊科出院时未被诊断为肠热病，血培养呈阳性后再次入院。98例患者中有71例（72%）是曾出国旅行的英国居民，23例（23%）是外国访客/新进入英国的人，4例（4%）未曾出国旅行。48/98例（49%）病例的初始鉴别诊断中未考虑肠热病。住院中位时间为7天（范围0 - 57天）。两家医院治疗肠热病的床位总费用为454,000英镑（平均每年75,666英镑）。临床症状缓解的中位时间为5天（范围1 - 20天）。98例患者中有7例（7%）因复发或持续感染再次入院。71例患者中有6例（8%）接种过伤寒疫苗，34例（48%）患者未接种疫苗，31例（44%）患者的疫苗接种状况未知。
需要针对旅行者的教育和疫苗接种以及南亚旅行者的急诊科临床医生对该病的识别采取进一步干预措施。
