SHM Converge Scientific Abstract ePoster Gallery-The One With the Resistant Foreign Bug

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This case describes a 41-year-old woman who developed fever, abdominal bloating, vomiting, and diarrhea shortly after returning from Bangladesh. Initial workup showed mild anemia and hyponatremia, while tests for other travel-related infections were negative. CT imaging demonstrated right-sided colitis with bowel wall edema and mild mesenteric lymph node enlargement. She was initially treated with ciprofloxacin and metronidazole for presumed infectious colitis.

Blood cultures later grew <em>Salmonella typhi</em>, confirming typhoid fever. However, despite completing the initial antibiotics, her symptoms persisted and she developed transaminitis. Additional testing for hepatitis B, hepatitis C, HIV, repeat blood cultures, and abdominal ultrasound were unrevealing. The clinicians suspected treatment failure due to ciprofloxacin resistance in the isolate, especially given newer CLSI susceptibility interpretation guidelines showing resistance at lower MIC levels than previously recognized.

She was then treated with azithromycin, after which her symptoms resolved and liver enzymes improved. The case highlights several important points: typhoid fever should be considered in patients with gastrointestinal symptoms after travel to endemic regions; <em>S. typhi</em> is increasingly resistant to common antibiotics; and accurate interpretation of susceptibility testing is essential for selecting effective therapy.

The discussion emphasizes that delayed or ineffective treatment can increase the risk of complications and chronic carriage. It also notes that while azithromycin is currently a treatment option, azithromycin-resistant strains are emerging as well. Overall, the case underscores the need for a low threshold to suspect <em>Salmonella</em> infection in travelers and to use updated laboratory standards to guide antibiotic choice.

Asset Subtitle

Tijana Samardzic

Meta Tag

Author List Gais Tarat, Sabiha Tamima, Suleyman Felek, Tijana Samardzic

Category Clinical Vignettes

Concept Salmonella typhi infection

Concept Antibiotic susceptibility

Concept Multidrug Resistance

Concept Minimum inhibitory concentration

Concept Contaminated Food

Distinguished Non-Finalist

Presenter Organization Yale-Waterbury Internal Medicine Program

Presenting Author Tijana Samardzic

Track Adult

Keywords

typhoid fever

Salmonella typhi

travel-related infection

Bangladesh

ciprofloxacin resistance

azithromycin treatment

infectious colitis

transaminitis

blood cultures

antibiotic susceptibility testing

Salmonella typhi infection

Antibiotic susceptibility

Multidrug Resistance

Minimum inhibitory concentration

Contaminated Food