Emergency department presentations of typhoid fever

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pai n, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), an d Mexico (7/21) and El Salvador (3/21) represented the most common countrie s of origin, Recent tra, el to an endemic area was noted in 14 patients. Th e most common complaints were fever (15/21), headache (10/21), abdominal pa in (9/21), and diarrhea (6/21), Average duration of symptoms before present ation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 pati ents. Blood culture was the most sensitive confirmatory test while the Wida l test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses , It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential d iagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries, (C) 2000 Elsevier Science Inc.