Mermin J H, Townes J M, Gerber M, Dolan N, Mintz E D, Tauxe R V
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Arch Intern Med. 1998 Mar 23;158(6):633-8. doi: 10.1001/archinte.158.6.633.
Typhoid fever is a potentially fatal illness common in the less industrialized world. In the United States, the majority of cases occur in travelers to other countries.
We reviewed surveillance forms submitted to the Centers for Disease Control and Prevention, Atlanta, Ga, for patients with culture-confirmed typhoid fever between 1985 and 1994.
The Centers for Disease Control and Prevention received report forms for 2445 cases of typhoid fever. Median age of patients was 24 years (range, 0-89 years). Ten (0.4%) died. Seventy-two percent reported international travel within the 30 days before onset of illness. Six countries accounted for 80% of cases: Mexico (28%), India (25%), the Philippines (10%), Pakistan (8%), El Salvador (5%), and Haiti (4%). The percentage of cases associated with visiting Mexico decreased from 46% in 1985 to 23% in 1994, while the percentage of cases associated with visiting the Indian subcontinent increased from 25% in 1985 to 37% in 1994. The incidence of typhoid fever in US citizens traveling to the Indian subcontinent was at least 18 times higher than for any other geographic region. Complete data on antimicrobial susceptibility to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were reported for 330 (13%) Salmonella Typhi isolates. Isolates from 1990 to 1994 were more likely than isolates from 1985 to 1989 to be resistant to any of these antimicrobial agents (30% vs 12%; P<.001) and to be resistant to all 3 agents (12% vs 0.6%; P<.001).
American travelers to less industrialized countries, especially those traveling to the Indian subcontinent, continue to be at risk for typhoid fever. Antimicrobial resistance has increased, and a quinolone or third-generation cephalosporin may be the best choice for empirical treatment of typhoid fever.
伤寒热是一种在工业化程度较低的国家常见的潜在致命疾病。在美国，大多数病例发生在前往其他国家的旅行者中。
我们回顾了1985年至1994年间提交给佐治亚州亚特兰大疾病控制与预防中心的针对血培养确诊伤寒热患者的监测表格。
疾病控制与预防中心收到了2445例伤寒热病例的报告表格。患者的中位年龄为24岁（范围为0至89岁）。10例（0.4%）死亡。72%的患者报告在发病前30天内有国际旅行史。六个国家占病例的80%：墨西哥（28%）、印度（25%）、菲律宾（10%）、巴基斯坦（8%）、萨尔瓦多（5%）和海地（4%）。与前往墨西哥相关的病例百分比从1985年的46%降至1994年的23%，而与前往印度次大陆相关的病例百分比从1985年的25%增至1994年的37%。前往印度次大陆的美国公民中伤寒热的发病率比其他任何地理区域至少高18倍。报告了330株（13%）伤寒沙门菌分离株对氨苄西林、氯霉素和甲氧苄啶 - 磺胺甲恶唑的抗菌药敏完整数据。1990年至1994年的分离株比1985年至1989年的分离株更有可能对这些抗菌药物中的任何一种耐药（30%对12%；P<0.001），并且对所有三种药物耐药（12%对0.6%；P<0.001）。
前往工业化程度较低国家的美国旅行者，尤其是前往印度次大陆的旅行者，仍然有患伤寒热的风险。抗菌药物耐药性有所增加，喹诺酮类或第三代头孢菌素可能是伤寒热经验性治疗的最佳选择。
