key: cord-0808817-45eix35m
authors: Ayoubzadeh, Sasha I; Isabel, Sandra; Coomes, Eric A; Morris, Shaun K
title: Enteric fever and COVID-19 co-infection in a teenager returning from Pakistan
date: 2021-02-08
journal: J Travel Med
DOI: 10.1093/jtm/taab019
sha: ff992d219651095a38796b04c04574bd00ee48b3
doc_id: 808817
cord_uid: 45eix35m

As SARS-CoV-2 has become widespread around the globe, co-infection with other endemic infectious diseases will occur. Here we present the first reported case of enteric fever and COVID-19 co-infection, in a teenager returning from travel to Pakistan and describe his clinical course.

PCR. Chest X-ray was unremarkable. Blood cultures were drawn, IV fluids were administered, and he was discharged home without antibiotics with blood cultures pending. The next day, on day 6 of illness, he was seen in the hospital's pediatric follow-up clinic and remained stable.

Repeat blood cultures and malaria screen were collected, and he was again discharged home. At 12 hours of incubation, the second blood culture set became positive with Gram-negative bacilli seen on microscopy. The patient was notified via telephone on day 7 of illness and instructed to present to the local children's hospital. Shortly afterwards his SARS-CoV-2 nasopharyngeal swab was reported as positive.

The patient presented to The Hospital for Sick Children (HSC), a large tertiary pediatric hospital in Toronto, on day 7 of illness as directed by the community physician. In addition to his previously identified gastrointestinal symptoms, he also reported a two-day history of sore throat and intermittent cough, beginning 13 days after returning to Canada. Review of systems revealed pre-syncopal episodes, frontal headaches, dizziness and myalgias associated with fevers. He denied any anosmia, loss of taste, abdominal pain, chest pain, or rashes.

On presentation to HSC, he was febrile at 39.4 °C and tachycardic to 108 bpm. Blood pressure was 124/56 mmHg, respiratory rate was 18, and oxygen saturation was 99% on room air. He

appeared in no acute distress and physical exam was effectively unremarkable other than tachycardia and cool extremities. Laboratory investigations are listed in Table 1 therapy was narrowed to IV ampicillin guided by susceptibility results and the patient defervesced on day seven of therapy. Given that enteric fever infection can rarely cause endocarditis and myocarditis and COVID-19 has been associated with myocarditis and coronary artery dilatation, an echocardiogram was performed; this showed no significant abnormality.

Given the normal ECG and echo and normal troponin I on eight samples, we monitored but did not diagnose a myocarditis in this case.

The rheumatology service was consulted due to elevated inflammatory markers (Table 1) On assessment in ID clinic two weeks after discharge, he had remained afebrile and had resolution of respiratory, gastrointestinal and constitutional symptoms with improving laboratory values (Table 1) . He was counselled regarding MIS-C, to monitor for fevers, seek medical attention if febrile or appears unwell, and to inform health care workers of recent COVID-19

infection. 

U N C O R R E C T E D M A N U S C R I P T U N C O R R E C T E D M A N U S C R I P T

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Enteric fever in a multicultural Canadian tertiary care pediatric setting: A 28-year review

COVID-19 and Salmonella Typhi co-epidemics in Pakistan: A real problem

The first Canadian pediatric case of extensively drugresistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices

Incubation period of COVID-19: a rapid systematic review and metaanalysis of observational research