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Enteric fever in a British soldier from Sierra Leone
  1. Lucy G Osborne1,2,
  2. M Brown3 and
  3. M S Bailey1,4
  1. 1Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK
  2. 2Army Medical Directorate, Camberley, UK
  3. 3Hospital for Tropical Diseases, University College London Hospital Trust, London, UK
  4. 4Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Lt Col M S Bailey, Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5ST, UK; markbailey{at}nhs.net

Abstract

Enteric fever (typhoid and paratyphoid) remains a threat to British troops overseas and causes significant morbidity and mortality. We report the case of a soldier who developed typhoid despite appropriate vaccination and field hygiene measures, which began 23 days after returning from a deployment in Sierra Leone. The incubation period was longer than average, symptoms started 2 days after stopping doxycycline for malaria chemoprophylaxis and initial blood cultures were negative. The Salmonella enterica serovar Typhi eventually isolated was resistant to amoxicillin, co-amoxiclav, co-trimoxazole and nalidixic acid and had reduced susceptibility to ciprofloxacin. He was successfully treated with ceftriaxone followed by azithromycin, but 1 month later he remained fatigued and unable to work. The clinical and laboratory features of enteric fever are non-specific and the diagnosis should be considered in troops returning from an endemic area with a febrile illness. Multiple blood cultures and referral to a specialist unit may be required.

  • Diagnostic microbiology < INFECTIOUS DISEASES
  • Enteric fever
  • Typhoid fever
  • Military Personnel
  • Sierra Leone
  • Received May 13, 2015.
  • Revision received June 30, 2015.
  • Accepted July 2, 2015.

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