Rare Salmonella paratyphi Sepsis Following Travel to an Endemic Area

Abstract

Salmonella paratyphi (SP) and Salmonella typhi (ST) are closely related encapsulated facultative gram-negative aerobes that cause enteric fever and sepsis more frequently in developing countries than in the United States. Recent travel to Asia may predispose to infection by these organisms. Typhoid vaccination prevents ST infection but is not protective against SP. A 24-year-old woman presented with high-grade fever, generalized body aches, and mild arthralgia of several weeks' duration. She had traveled to Asia (Bangladesh) 3 months previously without any malaria prophylaxis and became symptomatic 3 days after returning to the United States. There was no history of rash and no meningeal, cardiovascular, respiratory, or gastrointestinal manifestations. She had received typhoid fever vaccination in the past. Laboratory findings showed normal white blood cell count with monocytosis (14.3%). Negative malaria screen and lack of influenza vaccination raised the suspicion of acute viral/rickettsial illness. Blood cultures grew a gram-negative aerobe identified by biochemical testing as SP, sensitive to ampicillin, cephalosporins, ciprofloxacin, and trimethoprim/sulfamethoxazole. The patient was treated with ciprofloxacin and ceftriaxone with prompt resolution of her symptoms. SP spreads through fecal oral route, especially in poor hygienic conditions. SP sepsis produced clinical and laboratory manifestations mimicking viral infection with no symptoms of enteric fever. This case study highlights the importance of suspecting bacterial sepsis in patients with recent history of travel to Asia even if symptoms are subtle and flu-like. It is indeed more important in patients with history of prophylaxis against malaria and viral infections before travel. This case study also shows that typhoid vaccination is not helpful in preventing SP infections. Good hygiene is the key to prevention. Identification of SP in blood with prompt effective therapy is important in preventing spread.