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Article in Japanese

A relapse case of typhoid fever diagnosable by blood culture in the absence of the three main principal symptoms

Haruka AIHARA1), Yoshiaki OKUMA1), Kei YAMAMOTO2), Minsoo LEE-YOSHIMOTO1), Yuri YOSHIMOTO1,3), Masao KANESHIGE1), Mizue TANAKA1), Hideko URYU1), Junko YAMANAKA1,3), Ayumi MIZUKAMI1), Keiji GOISHI1), Noriko SATO1), Hiroyuki SHICHINO1)

Typhoid fever is a common disease in East Asia, but there are few reports of pediatric cases in Japan. The relapse rate of typhoid fever is relatively high at 5-10% at 3-4 weeks after treatment. This study presented the case of a 7-year-old girl who developed fever and loose stools 2 days after returning from a trip to Pakistan. She was treated successfully with ceftriaxone, but relapsed 24 days after the end of treatment. The symptoms of typhoid fever in children are atypical and even more so in cases of relapse. Therefore, diagnosis is difficult, and starting appropriate treatment is delayed in some cases. The three main symptoms of relative bradycardia, rose spots, and splenomegaly were not observed at the time of the first episode or relapse. Only blood cultures were positive at the initial diagnosis; both blood and fecal cultures were positive at relapse. Therefore, only blood culture was the basis for the diagnosis.

1) The Department of Pediatrics, National Center for Global Health and Medicine
2) The Department of Infectious Disease, National Center for Global Health and Medicine
3) Juntendo University Graduate School of Medicine

Key words typhoid fever, three main symptoms, blood culture, relapse
Received May 9, 2019
Accepted December 21, 2019

32 (1):33─38,2020