Virginie Pommelet1, Patricia Mariani2,3, Romain Basmaci1,4, Mathieu Tourdjman5, Laurence Morin6, Jean Gaschignard1, Agathe de Lauzanne1, Chloé Lemaitre1, Stéphane Bonacorsi2,3, Albert Faye1,4. 1. Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France. 2. Assistance Publique des Hôpitaux de Paris, Laboratoire de microbiologie, Hôpital Robert-Debré, Paris, France. 3. IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité Paris, France. 4. Université Paris Diderot, Sorbonne Paris Cité, UMRS 1123 ECEVE, Paris, France. 5. Département des maladies infectieuses, unité des infections alimentaires, zoonotiques et vectorielles, Santé publique France, the French Public Health Agency, France. 6. Assistance publique - Hôpitaux de Paris, Service d'Accueil des Urgences, Hôpital Robert-Debré, Paris, France.
Abstract
Background: Enteric fever in France is primarily travel-associated. Characteristics of paediatric cases are scarce and information from field studies in endemic countries might not be generalizable to non-endemic countries. Methods: In this retrospective study, we reviewed all cases of typhoid and paratyphoid fever treated in a French paediatric tertiary care centre from 1993 to 2015. Results: Fifty cases of enteric fever due to Salmonella enterica serovar Typhi (n = 44) and Paratyphi (n = 6) were identified. Sixty-one percent of the children had travelled to Africa and 34% to the Indian subcontinent. Among travel-associated cases, 85% were visiting friends and relatives (VFR). Ninety-six percent had high fever associated with gastrointestinal symptoms. Anaemia (66%), elevated C-reactive protein (80%), transaminitis (87%) and mild hyponatremia (50%) were the main biological findings. Blood cultures were positive in 90% of cases. Twelve strains (24%) were resistant at least to one antibiotic, and all of them had been isolated since 2003, increasing the resistance rate during this last period to 43% (12/28). Ceftriaxone was administered to 71 patients for a median duration of 6 days (interquartile range (IQR): 4-8). The median time to apyrexia after the onset of treatment was 4 days (IQR: 2-5 days). Complications occurred in nine children with five (10%) presenting neurologic disorders. All 50 patients recovered. Conclusion: In France, paediatric enteric fever is mainly a travel-associated disease and occurs in patients returning from a prolonged stay in an endemic area. Children VFR are at high risk and should be a priority target group for pre-travel preventive measures. The increase in antibiotic resistance reflects the situation in endemic countries and is a major concern.
Background: Enteric fever in France is primarily travel-associated. Characteristics of paediatric cases are scarce and information from field studies in endemic countries might not be generalizable to non-endemic countries. Methods: In this retrospective study, we reviewed all cases of typhoid and paratyphoid fever treated in a French paediatric tertiary care centre from 1993 to 2015. Results: Fifty cases of enteric fever due to Salmonella enterica serovar Typhi (n = 44) and Paratyphi (n = 6) were identified. Sixty-one percent of the children had travelled to Africa and 34% to the Indian subcontinent. Among travel-associated cases, 85% were visiting friends and relatives (VFR). Ninety-six percent had high fever associated with gastrointestinal symptoms. Anaemia (66%), elevated C-reactive protein (80%), transaminitis (87%) and mild hyponatremia (50%) were the main biological findings. Blood cultures were positive in 90% of cases. Twelve strains (24%) were resistant at least to one antibiotic, and all of them had been isolated since 2003, increasing the resistance rate during this last period to 43% (12/28). Ceftriaxone was administered to 71 patients for a median duration of 6 days (interquartile range (IQR): 4-8). The median time to apyrexia after the onset of treatment was 4 days (IQR: 2-5 days). Complications occurred in nine children with five (10%) presenting neurologic disorders. All 50 patients recovered. Conclusion: In France, paediatric enteric fever is mainly a travel-associated disease and occurs in patients returning from a prolonged stay in an endemic area. Children VFR are at high risk and should be a priority target group for pre-travel preventive measures. The increase in antibiotic resistance reflects the situation in endemic countries and is a major concern.
Authors: Stefan H F Hagmann; Kristina M Angelo; Ralph Huits; Katherine Plewes; Gilles Eperon; Martin P Grobusch; Anne McCarthy; Michael Libman; Eric Caumes; Daniel T Leung; Hilmir Asgeirsson; Mogens Jensenius; Eli Schwartz; Adrian Sánchez-Montalvá; Paul Kelly; Prativa Pandey; Karin Leder; Daniel L Bourque; Yukihiro Yoshimura; Frank P Mockenhaupt; Perry J J van Genderen; Silvia Odolini; Patricia Schlagenhauf; Bradley A Connor; Davidson H Hamer Journal: Antimicrob Agents Chemother Date: 2020-10-20 Impact factor: 5.191
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