Imported Enteric Fever: Case Series from the Hospital for Tropical Diseases, London, United Kingdom

Trupti A. Patel Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

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Margaret Armstrong Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

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Stephen D. Morris-Jones Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

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Stephen G. Wright Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

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Tom Doherty Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

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Our current knowledge of the clinical characteristics of enteric fever is drawn mainly from population-based studies in disease-endemic countries, and there are limited data published on cases in returning travelers. We report the clinical characteristics of enteric fever in 92 travelers returning to London, United Kingdom. Salmonella typhi and S. paratyphi resulted in an almost indistinguishable clinical picture. Rose spots and relative bradycardia were found only in a few patients. A total of 91% of the patients had a normal leukocyte count, which was associated with a markedly increased level of alanine aminotransferase in 82%. A total of 57% of the S. typhi isolates had decreased susceptibility to ciprofloxacin and resistance to nalidixic acid; these isolates were from southern Asia. Thirty percent were multidrug resistant; all were from southern Asia and Nigeria. None of the paratyphoid isolates were multidrug resistant but rates of decreased susceptibility to fluoroquinolones were higher than in S. typhi (74%).

Author Notes

*Address correspondence to Trupti A. Patel, Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London WC1E 6JB, United Kingdom. E-mail: trupti@doctors.org.uk

Authors' addresses: Trupti A. Patel, Margaret Armstrong, Stephen G. Wright, and Tom Doherty, Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom. Stephen D. Morris-Jones, Department of Clinical Microbiology, The Windeyer Institute of Medical Sciences, London, United Kingdom.

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