Laurie C. offers this entry, in the hope that other PHNs will share some of their stories as well. After all, we need to justify that we are about more than doing Blood Pressures or giving Flu Shots… Please send your comments!
Disease Investigation – Protecting the public’s health!!
(Part of a Typical Day in the Life of a Public Health Nurse)
Laurie Courtney, BSN, RN
Salmonellosis refers to disease caused by any serotype of bacteria in the Salmonella genus, other than Salmonella Typhi. It is a common GI illness in the US with 40,000 reported cases, and many more unreported cases, a year.
Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year (1).
This case unfolds as follows –
The local hospital’s IC nurse calls me to report a blood culture positive for Salmonella Paratyphi A. She has little information at the moment. The case is a 32 year old male who is inpatient. We discuss the difference between S. Typhi and non-S. Typhi, look up S. Paratyphi, and determine that it is not S. Typhi therefore this will be a case of Salmonellosis, not typhoid fever. The IC nurse tells me she will fax the lab report and MD note.
Once I receive the fax I enter the case in MAVEN. I also find out that the case traveled to India with family, became ill with diarrhea x 24 hours the last day of his trip, and has had a febrile illness (max 103.4 PO) since returning home a week ago. He was admitted to the hospital, worked up, and has been receiving IV antibiotics. He is not employed as a food handler. No other members of his family are ill. There is no info regarding his wife’s employment.
I attempt to reach the case, but am unable to.
At this point I have a case of salmonellosis; however the case’s symptoms more closely resemble typhoid fever.
In my follow up two days later I find that the case was discharged from the hospital, is receiving daily IV antibiotics in the ED, and is being treated for typhoid fever.
I call the ID physician treating the case to clarify whether this is a Salmonellosis case or a typhoid fever case. I receive a message back that it is a “typhoid fever illness”.
I call the epidemiology department at MA DPH and ask for an epi to call me back. I want to determine if this case should be labeled salmonellosis or typhoid fever. In consultation with the epi it is confirmed that since this is a case of positive S. Paratyphi it is Salmonellosis. Only S. Typhi is typhoid fever.
I then do a brief search on the CDC website and find that S. Paratyphi A can cause a syndrome similar to typhoid fever, and that it causes 1-15% of enteric fever cases in India (2). CDC has been conducting surveillance of typhoid fever cases since 1975 and in 2008 expanded its surveillance to include paratyphoid fever (3).
I am finally able to reach the case by telephone. He confirms the information I have already obtained. His wife does not work outside the home. No other family members are or have been ill. He has never had an illness like this before and has never been vaccinated against typhoid fever (there is no vaccine for paratyphoid fever). He also reports that the IV antibiotics have been discontinued and he will now be on PO antibiotics for an as yet undetermined amount of time. He will also be followed by the ID physician. His symptoms have almost fully resolved – he still has a low grade (99.2 PO) fever at night. I provide him with some basic information about salmonella infection and give him my contact information should he want to contact me for any reason.
I complete the case report form in MAVEN and close the case, having learned something new, as I do most days in my role as a public health nurse.
1. Centers for Disease Control and Prevention (CDC). 2011. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/
2. Chandel DS, Chaudhry R, Dhawan B, Pandey A, Dey AB. Drug-Resistant
Serotype Paratyphi A in India. Emerging Infectious Diseases. 2000, Aug. Available from http://wwwnc.cdc.gov/eid/article/6/4/00-0420.htm DOI: 10.3201/eid0604.000420
3. Centers for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance System Overview. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2011. Available from http://www.cdc.gov/ncezid/dfwed/PDFs/typhi_surveillance_overview_508c.pdf