CHARACTERISTICS OF TYPHOID-FEVER IN CHILDREN AND ADOLESCENTS IN A MAJOR METROPOLITAN-AREA IN THE UNITED-STATES

To examine the epidemiology of typhoid fever in children in an area th at was not endemic, we analyzed 55 cases of typhoid fever in children and adolescents who were less than or equal to 18 gears and whose case s were reported to the Chicago and suburban Cook County Health Departm ents over 7 years. Cases had positive blood and/or stool cultures for Salmonella typhi. The ethnic distribution of the patients was as follo ws: 25% Asian, 22% Hispanic, 15% African American? 9% Caucasian? 18% o ther, and 11% unknown. Of the 55 cases, 35% mere aged 0-5 years, 25% w ere aged 6-10 gears, 31% mere aged 11-15 years, and 9% were aged 16-18 years. Twelve patients did not have a history of travel. All patients recovered; none became carriers. Symptoms in 41 patients whose charts were available for review included fever (100%), diarrhea (77%), vomi ting (50%), and dehydration (30%). Bacteremia was documented in 27 (66 %) of 41 cases. In 17 of 41 cases, the household contacts were food ha ndlers or health care workers. Eight (31%) of 26 isolates were resista nt to both ampicillin and trimethoprim-sulfamethoxazole. The findings in our study were as follows: typhoid fever occurred frequently in chi ldren aged 0-5 years (in contrast with reports from areas of endemicit y), similar to 20% of patients did not hare a history of travel, and m ultidrug-resistant strains were prevalent.