View
217
Download
4
Category
Tags:
Preview:
Citation preview
Chattanooga-Hamilton County Epidemiology Department
Gram-negative bacilli Humans only reservoir Contaminated food/water or person
to person Incubation 7-14 days (range 3-60) Fever, abd. pain, malaise
◦ (diarrhea, rash, hepato/splenomegaly)
Potentially fatal
Image courtesy of the Centers for Disease Control and Prevention
Worldwide incidence highest in:
◦ South & East Asia
◦ Africa
◦ Central & South America
22 million cases with 200,000 deaths per
year
~ 1% of adults may become chronic carriers
Source: PHLIS Surveillance Data, 2006
15 cases – MSR 5, CHR 5, NDR 2, MCR 1,
SER 1, SUL 1
Median age 23, female 8, male 7
10 cases associated with foreign travel
14 cases hospitalized, 0 deaths
3 cases April 28 – June 3
Children ages 2-6
Fever, abdominal pain, h/a, diarrhea (2)
No recent travel history
Worked with 6 household contacts, 20
school contacts
4-19 2 y/o child with fever, abdominal pain,
diarrhea
4-20 appendectomy
4-23 stool specimen collected
4-28 salmonella + stool
5-5 serotype S. typhi +
No obvious exposures identified
5-12 2 y/o child with fever, abdominal pain,
vomiting, diarrhea
5-16 blood culture + S. typhi
5-16 to 5-19 hospitalized and treated
No obvious exposures
No connection to case A??
5-17 6 y/o child with fever, chills, headache
sibling of case A
5-29 stool + salmonella
6-3 serotype S. typhi
Initial interviews did not reveal a connection
5-26 home visits with interpreter to Case A &
Case B
Mothers of the cases are sisters
No illness except in sibling
3 adults in each household, deny recent travel
All agreed to submit clinical specimens
Case C attended kindergarten while ill
18 of 20 school contacts were interviewed
for illness
All received a certified letter by mail
1 child evaluated for febrile illness
Media avoidance on a Friday afternoon was unsuccessful!
PFGE pattern of the cases revealed a rare serotype not seen since 2007
6 adult contacts tested negative for salmonella in stool and negative IgM in blood
2 adult males tested + for antibody to S. typhi Vi antigen
Carriers were treated to eradicate S. typhi No contacts in high risk occupations
Consider chronic carrier in cases with no travel hx or association with others who have traveled
Epi links are hard to find initially Utilizing interpreter with similar culture may
yield better results Although no recent travel was identified,
most foreign born are not vaccinated prior to travel
Providers do not normally include typhoid in differential diagnosis if no travel identified
Recommended