Clinical and bacteriological profiles of patients with typhoid fever treated during 1975-1998 in the Tokyo Metropolitan Komagome Hospital

Patients with typhoid fever presenting to the Tokyo Metropolitan Komagome H ospital during the period 1975-1998 were retrospectively investigated. All cases were diagnosed by a positive culture for Salmonella typhi in either o f their clinical specimens. Of the total number of 130 patients, 57% contra cted the disease abroad; this population increased in later Sears as the to tal numbers of cases decreased. The period from disease onset to diagnosis averaged 14 days with 20% of the cases requiring over three weeks to establ ish a diagnosis. As for symptomatology relative bradycardia was seen in les s than half of the cases, and rose spots or splenomegaly in less than one t hird. A positive blood culture was the most frequent test establishing the diagnosis followed by a positive stool culture. Intestinal bleeding was rec ognized in as many as 35 cases (27%) and even intestinal perforation occurr ed in two cases (1.5%). Chloramphenicol was most commonly employed during t he early study period, however, during the late period it was replaced by f luoro quinolones. The clinical cure rate was 98% with regimens that include fluoroquinolones/quinolone; however it was 87% with the other antimicrobia l regimens. Bacteriological relapse occurred in 25% of the non-fluoroquinol one group while only in 2.0% in the fluoroquinolone/quinolone group. Four s trains of Salmonella typhi that were multi-resistant to chloramphenicol, am picillin and cotrimoxazole were isolated in travelers from Asia. Early diag nosis by appropriate bacteriological examination regardless of classical sy mptomatology should be stressed and the use of fluoroquinolones is warrante d in the treatment of typhoid fever.