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Description
A 35-year-old previously healthy Japanese woman presented to our hospital, with a 1-month history of chills and fever. She denied recent travel. Prior to the admission, she had visited multiple physicians but diagnosis was not made and her symptoms persisted. On admission, her temperature was 37.3°C, blood pressure 140/78 mm Hg and pulse 115/min. Abdominal examination showed splenomegaly. There was no rash. In laboratory tests, peripheral leucocyte count was 6560 μL and there was mild elevation of hepatobiliary enzymes. Abdominal CT scan (figure 1) showed the thickened wall of the ileocaecum. Blood cultures grew Gram-negative bacilli.
CT scan showing the thickened ileocaecal wall (white arrows) of the patient.
Further history taking revealed that the patient worked as a hospital microbiologist and, 1 month prior to the symptom onset, she had handled stool specimens isolated 5 years earlier from a patient with typhoid fever (a returned traveller from southeast Asia). Typhoid fever was suspected and intravenous ceftriaxone administered. The blood and stool cultures grew Salmonella enterica serotype Typhi. After the patient was successfully treated, she was discharged uneventfully and continued to work as usual in her hospital laboratory.
South Asia and Africa have high incidence of typhoid fever with a drug—such as fluoroquinolone—resistance issue.1 However, a case of nosocomially-acquired typhoid fever is extremely rare and there have been only 13 reports to date (based on a MEDLINE PubMed search; personal communication). Regarding a hospital-acquired case of a microbiologist, there was a reported patient of typhoid fever who developed the infection with a microbiology laboratory strain isolated 41 years earlier.2
Learning points
Occupational history is occasionally important for making a diagnosis.
Typhoid fever is characterised by severe systemic infectious illness with fever and abdominal symptoms caused by Salmonella enterica serotype Typhi.
Hospital microbiologists have a higher risk of developing tropical infections since they may have occupational exposures to specimens from patients with those infections.
Acknowledgments
The authors would like to thank the reviewer for their excellent comments.
Footnotes
Contributors ST, TA and KY were responsible for care of the patient. ST and YT wrote the manuscript. All the authors contributed to revision of the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.