# Imported Typhoid Fever in Romania Between 2010 and 2024

## TL;DR

Typhoid fever cases in Romania from 2010 to 2024 were mostly imported, with drug-resistant strains observed but all responding to ceftriaxone.

## Contribution

This study documents imported typhoid fever cases in Romania and highlights the emergence of drug-resistant strains and treatment outcomes.

## Key findings

- Most patients were from Sub-Saharan Africa and the Indian subcontinent.
- Drug-resistant strains were common, but all were sensitive to ceftriaxone.
- An eosinopenia was the most frequent laboratory finding.

## Abstract

Background/Objectives: Although a “forgotten” disease in developed countries, typhoid fever remains a significant global health problem, especially in regions with inadequate sanitation and overcrowding. Despite medical advances, this systemic bacterial infection, caused by Salmonella Typhi, continues to affect millions worldwide. Accurate diagnosis and timely treatment are crucial to prevent severe complications and mortality. Even though antibiotic therapy is effective, the emergence of drug-resistant strains is a growing challenge. Methods: We present a series of cases encountered in a tertiary infectious disease hospital in Romania over 15 years. Results: The hospitalised patients were mainly from Sub-Saharan Africa and the Indian subcontinent; the median time between the onset of the first symptoms and hospital admission was 15 days. The symptoms encountered along with fever were headache, chills, cough, diarrhoea and tachycardia, an unusual feature in the clinical picture of this disease. Aneosinophilia (the absence of peripheral eosinophilic granulocytes) was the most frequently encountered laboratory finding, followed by increased serum transaminases and inflammatory syndrome. Conclusions: S. Typhi was generally identified from blood culture, demonstrating, except in one case, resistance to ciprofloxacin and, in several cases, multi-drug resistance (MDR). In this series of cases, all strains were sensitive to ceftriaxone.