Objectives:

Typhoid fever is endemic in many developing countries. Number of the cases is estimated between 12 and 33 million/year in the world. In the Czech republic these diseases occur very rarely. Since the World War II, the occurrence has decreased. While in 1951 the incidence rate was more than 14/100 000 inhabitants, in 2002 was only 0.01/100 000. The incidence rate of paratyphoid fever B decreased from 0.75/100 000 in 1951 to 0/100 000 in 2002. Almost all cases are imported. Between the years 1993 and 2003 50 cases of enteric fever were reported in the Czech republic. In our department we admitted 20 patients with imported typhoid or paratyphoid fever during this time. Seventeen patients had typhoid fever and three paratyphoid fever A. Seventeen patients were from the Czech republic, three were foreigners. Men prevailed women (16:4). Majority of cases were from the age group between 20 and 30 years. Eighty-five per cent of all patients were infected in Asia, the rest in Africa and Europe. The highest risk of infection was in India, where 13 patients travelled.

Methods:

All patients were physically examined and diagnosis was verified by haemoculture, stool culture and Widal's test. In all patients blood count, liver function test and other biochemical examination were examined.

Results

Clinical picture was usually mild or moderate, only one patient had severe course with confusion. Fever occurred in 100%, hepatosplenomegaly in 75%, diarrhoea in 70% and headache in 68.4% of all patients. The other signs (hypotension, abdominal pain, bradycardia) were less frequent. Roseola was found only in 10% of all patients. 94.5% of patients had hepatopathy, 40% leucopenia. Complications occurred very rarely, relapse was seen only once. Four patients had dual infection. Diagnosis was usually made by haemoculture (90% positive), stool culture was positive only in 35%. Fifty per cent of all strains were resistant to antibiotics. Multiresistant strain occurred only once from India. Patients were treated by fluoroquinolones in 75%, sometimes by antibiotic combination. Corticosteroids were used only once.

Conclusions:

Typhoid and paratyphoid fever are very rare in the Czech republic, usually are imported. In our department were treated 41% of all cases occurring in the Czech republic between the years 1993 and 2003. The highest risk of infection was in Asia (India) followed by Africa and Europe. Fifty per cent of all strains were resistant to antibiotics. Fluoroquinolones were the drug of choice and treatment was successful.