Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France.
Assistance Publique des Hôpitaux de Paris, Laboratoire de microbiologie, Hôpital Robert-Debré, Paris, France.
J Travel Med. 2018 Jan 1;25(1). doi: 10.1093/jtm/tay059.
Enteric fever in France is primarily travel-associated. Characteristics of paediatric cases are scarce and information from field studies in endemic countries might not be generalizable to non-endemic countries.
In this retrospective study, we reviewed all cases of typhoid and paratyphoid fever treated in a French paediatric tertiary care centre from 1993 to 2015.
Fifty cases of enteric fever due to Salmonella enterica serovar Typhi (n = 44) and Paratyphi (n = 6) were identified. Sixty-one percent of the children had travelled to Africa and 34% to the Indian subcontinent. Among travel-associated cases, 85% were visiting friends and relatives (VFR). Ninety-six percent had high fever associated with gastrointestinal symptoms. Anaemia (66%), elevated C-reactive protein (80%), transaminitis (87%) and mild hyponatremia (50%) were the main biological findings. Blood cultures were positive in 90% of cases. Twelve strains (24%) were resistant at least to one antibiotic, and all of them had been isolated since 2003, increasing the resistance rate during this last period to 43% (12/28). Ceftriaxone was administered to 71 patients for a median duration of 6 days (interquartile range (IQR): 4-8). The median time to apyrexia after the onset of treatment was 4 days (IQR: 2-5 days). Complications occurred in nine children with five (10%) presenting neurologic disorders. All 50 patients recovered.
In France, paediatric enteric fever is mainly a travel-associated disease and occurs in patients returning from a prolonged stay in an endemic area. Children VFR are at high risk and should be a priority target group for pre-travel preventive measures. The increase in antibiotic resistance reflects the situation in endemic countries and is a major concern.
法国的肠热病主要与旅行相关。儿科病例的特征很少，来自流行地区的实地研究信息可能不适用于非流行地区。
在这项回顾性研究中，我们回顾了 1993 年至 2015 年期间在法国一家儿科三级保健中心治疗的所有伤寒和副伤寒病例。
确定了 50 例由沙门氏菌血清型 Typhi（n=44）和 Paratyphi（n=6）引起的肠热病。61%的儿童曾前往非洲，34%的儿童前往印度次大陆。在与旅行相关的病例中，85%的儿童是探亲访友（VFR）。96%的儿童有高热伴胃肠道症状。贫血（66%）、C 反应蛋白升高（80%）、肝功能异常（87%）和轻度低钠血症（50%）是主要的生物学发现。90%的病例血培养阳性。12 株（24%）至少对一种抗生素耐药，所有这些菌株均自 2003 年以来分离得到，在此期间耐药率增加至 43%（12/28）。71 例患者使用头孢曲松治疗，中位数疗程为 6 天（四分位距（IQR）：4-8 天）。治疗开始后退热的中位数时间为 4 天（IQR：2-5 天）。9 例儿童出现并发症，其中 5 例（10%）有神经系统疾病。所有 50 例患者均康复。
在法国，儿科肠热病主要是一种与旅行相关的疾病，发生在从流行地区长期逗留返回的患者中。探亲访友的儿童风险很高，应成为旅行前预防措施的优先目标群体。抗生素耐药性的增加反映了流行地区的情况，是一个主要关注点。
