Prevention in VFR travelers to South Asia is critical and efforts should be targeted at better education and pre-travel immunization. Typhoid fever is endemic in
many areas of the world and also a leading cause of fever in the returning traveler.[1] Approximately 21 million people are affected with typhoid each year, which results in 200,000 to 600,000 deaths annually.[2-4] The highest prevalence is among infants, children, and adolescents in South Asia, where poor sanitation and food handling practices continue to make typhoid a persistent public health issue.[1-6] There is growing concern over the emergence of multidrug-resistant strains of Salmonella Typhi in many parts of Asia and Africa.[7] Since the rapid spread
of Roxadustat concentration multidrug-resistant (as defined by resistance to chloramphenicol, amoxicillin, and co-trimoxazole) S Typhi in the 1990s[7] and early 2000s,[8] quinolones have been the mainstay of treatment in adults.[9-11] However, during the last 2 decades, nalidixic acid-resistant strains (NARST) are being isolated with increasing frequency. Despite in vitro sensitivity to ciprofloxacin [minimum inhibitory concentration (MIC) < 1, though usually >0.1], the disease caused by these strains can have a prolonged and sometimes unfavorable course when treated with quinolones.[12] In the United States, approximately 400 cases of typhoid are reported each year, 70% to 90% of which are associated CP-868596 supplier with recent travel.[7, 13-15] Immigrants and travelers visiting friends and relatives (VFR travelers) are at a higher risk of acquiring typhoid.[8, 9, 16-19] Another 10% to 30% are domestic cases.[14] The vast majority of imported cases come from seven countries: India, Bangladesh, Pakistan, Mexico, the Philippines, El Salvador, and Haiti.[3, 8, 9] The overall risk of acquiring typhoid from travel to the Indian subcontinent is at least 10 to 20[20] and up to 100 times[21]
higher than from other geographic areas. History Glycogen branching enzyme of travel to the above regions,[15-17] in conjunction with clinical and laboratory features unique to typhoid, may be helpful in the initial diagnosis, prior to blood culture results being available.[22] Clinically, typhoid is typically characterized by a syndrome of prolonged high fever, relative bradycardia, splenomegaly, and abdominal symptoms.[1-3] Laboratory abnormalities often consist of pancytopenia with zero or near-zero eosinophils[10, 23-25] and mild transaminitis.[1-3, 9, 10, 15] This study is a retrospective analysis of the epidemiologic, clinical, and basic hematologic features of patients diagnosed with typhoid, as well as an analysis of the sensitivity profiles of S Typhi isolates collected over a 5-year period at Jacobi Medical Center, a municipal tertiary center that serves a large immigrant population. We queried all positive S Typhi isolates over a 5-year period, from January 2006 to December 2010.