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PubMed2005

Study of clinical profile and antibiotic response in typhoid fever.

The objective of the present study is to evaluate the clinical profile and pattern of various drugs used in the treatment of typhoid fever. A retrospective analysis of adult patients suffering from typhoid fever was done at Kasturba Medical College hospital, Attavar during the year 1999-2001. Diagnosis of patients was based on clinical features, widal test and blood culture. The sensitivity pattern of isolates from blood culture was recorded. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antibiotic administered, response to therapy and the complications were recorded. Total number of 44 cases of typhoid fever were studied. Out of these 21(47.7%) were males and 23(52.3%) were females. Average age of presentation was 23.9 years. Average duration of hospital stay was 10.8 days. Fever was present in all patients. Resistance of S. typhi to amoxicillin, chloramphenicol, ampicillin and co-trimoxazole were significantly high. Ciprofloxacin also showed resistance in 18.1% of cases. Sensitivity to cephalosporin was 100% in our study. Ciprofloxacin was the most commonly used antibiotic in our study (23 patients). Chloramphenicol alone was used in 2 patients and in 3 patients it was given after 6 days of ciprofloxacin treatment. Third generation cephalosporins (ceftriaxone) alone were used in 16 patients. Indiscriminate use of drugs in typhoid fever should be discouraged. Appropriate antibiotic as indicated by sensitivity tests should be employed to prevent the development of resistant strains of S. typhi.

Adult↗
PubMed2002

Simple dipstick assay for the detection of Salmonella typhi-specific IgM antibodies and the evolution of the immune response in patients with typhoid fever.

Application of a dipstick assay for the detection of Salmonella typhi-specific IgM antibodies on samples collected from S. typhi or S. paratyphi culture-positive patients at the day of admission to the hospital revealed the presence of specific IgM antibodies in 43.5%, 92.9%, and 100% for samples collected 4-6 days, 6-9 days, and > 9 days after the onset of fever, respectively. The mean sensitivity for samples collected an average of 6.6 days after the onset of fever was 65.3%. Culture was positive in 65.9% of the cases with a final clinical diagnosis of typhoid fever. Testing of paired serum samples from culture negative patients with a final clinical diagnosis of typhoid fever resulted in staining of the dipstick in 4.3% of the samples collected at the day of admission to the hospital and in 76.6% of the samples collected one week later, thereby provided strong supporting evidence of typhoid fever by demonstrating seroconversion in a large proportion of the patients. The dipstick assay may thus also be useful for the serodiagnosis of culture-negative patients with clinical signs and symptoms consistent with typhoid fever. The advantages of the dipstick assay are that the result can be obtained on the same day allowing a prompt treatment, that only a small volume of serum is needed, and that no special laboratory equipment is needed to perform the assay. The stability of the reagents of the dipstick and the simplicity of the assay allows its use in places that lack laboratory facilities.

Adolescent↗
PubMed1993

Typhoid in 1993.

Typhoid remains a disease of major importance world-wide although improvements in public health have made it an exotic disease in developed countries like Australia. Effective antibiotic therapy with the advent of chloramphenicol, which was first used to treat typhoid in the 1940s, has also dramatically altered the natural course of the disease and reduced its mortality rate from around 25% to as low as 1%. The main areas of recent change include the emergence of resistance to previously effective antibiotics, more aggressive intervention in the management of severe typhoid and some of its complications such as perforation, and the development of an oral typhoid vaccine that may replace the equally effective but more unpleasant parenteral vaccination that has been widely used since World War.

Australia↗
PubMed2005

Prognostic factors in typhoid perforation.

OBJECTIVE: To discuss the effect of duration of illness before perforation and time interval between perforation and surgery on the prognosis of typhoid perforation. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Nishtar Hospital, Multan from September 2002 to September 2004. PATIENTS AND METHODS: Seventy-two patients of typhoid perforation were included in this study. The patients were divided into three groups A, B and C according to duration of illness before perforation. In these groups, typhoid perforation occurred during 1st, 2nd and 3rd week respectively. Further patients were divided into group D, E and F according to time interval between perforation and surgery. In these groups surgery was carried out within 24 hours, 24-48 hours and after 48 hours respectively. RESULTS: Fifty-six patients were males and 16 were females. In groups A, B and C, mortality rate was 6.6%, 13.3% and 25%, while morbidity rate was 33.3%, 55.5% and 75% respectively. There were 12, 42 and 18 patients in Group D, E and F with mortality rate of 8.33%, 11.9% and 22.2% respectively. Group D had 41.6% morbidity rate while group E and F had 71.42% and 77.7% respectively. CONCLUSION: In this study, early perforation during the typhoid fever and short perforation-operation interval were good prognostic signs. So best results can be achieved by early patient's presentation and early operation.

Adolescent↗
PubMed1999

Of mice, calves, and men. Comparison of the mouse typhoid model with other Salmonella infections.

Numerous Salmonella typhimurium virulence factors have been identified and characterized using experimental infection of mice. While the murine typhoid model has been used successfully for Salmonella typhi vaccine development and to infer virulence mechanisms important during typhoid fever, information derived from infection of mice has been of limited value in elucidating the mechanisms by which S. typhimurium causes enteritis in humans. Progress in our understanding of virulence mechanisms contributing to diarrheal disease comes from recent studies of bovine enteritis, a S. typhimurium infection, which manifests as acute gastroenteritis. This review compares virulence genes and mechanisms required during murine typhoid, typhoid fever, and bovine enteritis. Comparison of illnesses caused in different animal hosts identifies virulence mechanisms involved in species specific disease manifestations. The determination of the relative importance of virulence factors for disease manifestations in different host species provides an important link between the in vitro characterization of genes and their role during host pathogen interaction.

Animals↗
PubMedDate not supplied

Typhoid fever in a 7 month old infant.

The clinical profile of typhoid fever in an infant is variable and non-specific. A rare case of typhoid fever in a 7 month old infant is reported. The child presented with only a day's history of fever and loose motions which resulted in severe dehydration, acute tubular necrosis and death. The diagnosis of typhoid fever was made only on post-mortem study. The problem in diagnosing typhoid fever in a young infant is highlighted with a brief literature review on the subject.

Fatal Outcome↗
PubMed1975

Typhoid cardiac involvement.

Three cases of typhoid cardiac complications are reported. Salmonella typhi was the aetiological agent in all three; The discovery of 3 patients over a period of 18 months merits special interest, especially since typhoid fever is endemic in the area concerned. The significance of the complication reported here is further enhanced by absence of similar specific cases in the English literature dealing with cardiac salmonellosis. One of the cases described in this article, the only fatality of the series, developed a rhythm disturbance identical with that of a patient whose myocardial abscess was due to Salmonella typhimurium. The rarity of typhoid cardiac complications may be deceptive; The septicaemic disturbance may mask it and one must note that cardiac salmonellosis is reported from developed countries, where typhoid fever is a rarity.

Adult↗
PubMed1975

Acute renal failure and typhoid fever.

Over a two-year period, out of 40 adult Ghanaians admitted to the renal unit of Korle Bu Hospital with acute renal failure, 6 (15%) had typhoid fever. During this period approximately 500 cases of typhoid were admitted to this Hospital. Prominent features in these cases were a blackwater fever syndrome and leucocytosis. These features in a patient with typhoid should suggest the possibility of complicating acute renal failure. Three patients showed a deficiency of glucose-6-phosphate dehydrogenase (G-6-P.D.) in their red blood cells. It is suggested that typhoid is likely to be an important cause of acute renal failure in areas where it is endemic and G-6-P.D. deficiency common.

Acute Kidney Injury↗
PubMed1975

Lymphoreticular tissue lesions in mice after immunization with typhoid fever vaccine and immunosuppression with azathioprine.

C57BL and Balb/c mice were immunized, were immunized and then administered immunosuppressives, were immunized with concurrent immunosuppression, and were immunized after prior administration of immunosuppressive agents. Typhoid fever vaccine used clinically was used for immunization. Immunosuppression was accomplished with azathioprine (Imuran). Control groups received azathioprine or no treatment. The experiment lasted 5 months. In mice immunized with typhoid fever vaccine and subsequent azathioprine administration, malignant lymphomas of a lymphoblastic type appeared in 20% of C57BL mice and in 70% of Balb/c mice. In mice receiving antigenic vaccine together with azathioprine, malignant lymphomas appeared in only 5 to 10% of cases. However, mice that first received azatioprine and were later immunized, died after the second administration of typhoid fever vaccine and showed pictures that brought to mind blastic transformation of lymphocytes in vitro. This proliferation was primarily found in subcortical areas of lymph nodes. Analysis of presented results indicates that chronic immunization of animals with typhoid fever vaccine may serve as experimental model of malignant lymphoma morphologically similar to that appearing in human pathology.

Animals↗
PubMed2002

Antibody response in typhoid fever in endemic Indonesia and the relevance of serology and culture to diagnosis.

Culture and serology were performed on blood and serum samples collected at or shortly after admission from 473 patients presented with suspected clinical typhoid. Clinical symptoms at first presentation including confusion, hepatomegaly, splenomegaly, abdominal pain, anemia, and gastrointestinal bleeding were non-specific as they were observed even more often in non-typhoid patients. Culture confirmed the diagnosis in 65.3% of the patients with typhoid fever as the final diagnosis. The sensitivity (58%) and specificity (98.1%) of a rapid dipstick assay for the detection of S. typhi-specific immunoglobulin M were somewhat lower than those of culture but higher than those of the Widal test. The dipstick assay thus may well be used in the serodiagnosis of typhoid in situation where culture facilities are not available. Combination of test results of dipstick and culture improved sensitivity to 82.5%. In laboratories that perform blood culture the dipstick assay may be used as a rapid screening tests to facilitate a rapid diagnosis. Sensitivity of the dipstick assay strongly increased with duration of illness and was higher for culture positive than for culture negative patients. Duration of illness, and different pathogen and host factors including dose of infection, pathogenicity and antigenicity, and prior antibiotic use are likely to influence the immune response, therefore the result of the dipstick assay. Duration of illness and presence of S. typhi in the blood are major factors that determine severity of disease.

Abdominal Pain↗
PubMed1992

Diagnostic accuracy of IgM antibody detection in typhoid by a modification in Widal test.

Specific IgM antibodies were detected indirectly in sera of patients of typhoid by observing fourfold or more fall in the agglutinin titres after treatment of the serum with 2-mercaptoethanol (2-ME) for removal of IgM antibodies. Significant fall in titres was observed in 94 per cent patients of bacteriologically confirmed typhoid and 67 per cent patients in whom a diagnosis of typhoid was based only on a significant Widal test result. Patients of non-typhoid febrile illnesses showed either no fall or an insignificant fall in their titres. The detection of specific IgM antibodies by this simple modification of Widal test thus seems to enhance the sensitivity and specificity of the test.

Agglutination Tests↗
PubMed2004

Typhoid ileal perforation: surgical experience of 64 cases.

OBJECTIVE: Intestinal complications of typhoid fever are quite common in developing countries. In order to contribute to the improvement of the prognosis of typhoid ileal perforation, the authors report their own surgical experience PATIENTS AND METHODS: between May 95 and July 98, 64 patients, (31 men and 33 women), with an average age of 34 years (ranging from 5 to 63 years) underwent surgery for typhoid ileal perforation. The surgical techniques used were excision-suture (n = 31) and resection-ileostomy (n = 33). All the patients were operated under similar pre-, per- and postoperative care facilities. RESULTS: Postoperative complications were observed in 59 patients (88.1%). The mean hospital stay was 30 days (ranging from 8 to 52 days). The overall postoperative mortality was 34% (22/64), mainly due to digestive fistula in 11 cases (8 cases of anastomotic leak after excision-suture, 3 cases of bowel fistula after conservative resection-ileostomy) and to chronic peristomal ulceration in 9 cases, which led to progressive malnutrition, cachexy and death. CONCLUSION: The mortality and morbidity after surgical treatment of typhoid ileal perforation remains very high in developing countries. However some recommendations could improve the outcome: aggressive resuscitation by intravenous hydratation of 4 to 6 hours, associated with adequate antibiotherapy, the resection of the last 60 centimetres of the ileum, in cases of serious abdominal suppuration, and a large abdominal washout.

Adolescent↗
PubMedDate not supplied

Presentation of typhoid fever patients in Hazara Division and response to different treatment regimens.

BACKGROUND: Response to treatment can vary in patients with typhoid fever. This study was carried out on a group of typhoid patients who were treated in Medical B ward of Ayub Teaching Hospital. Resistance to antibiotic is commonly acquired by Salmonella typhi and is widely reported. Objective of study was to identify such resistance in patients coming from parts of Hazara Division. METHODS: All patients who presented with typhoid fever and admitted to Medical B Unit from 1st July to 30th September 2002 were included in study. Out of 76 patients 46 (60%) were male. Epidemiological date, presenting symptoms, finding on physical examination, laboratory investigation and radiological examination were recorded. Then one of six commonly used treatment regimens were started. Response to treatment was studied. RESULTS: Common presenting symptoms and signs were recorded. Headache and fever were seen in 100% of patients. Cough and hypotension were among presenting features in 65% of patients. Leucocyte count of Less than 4 x 10(3)/dl was seen in 11% of samples. Liver functions and Renal function were found altered in 30% of patients. Study of response pattern to different regimens suggested relatively poor response to flouroquinolones. Fever of those patients who were treated with chloamphenicol and cefexime, settled early as compared to patients on other regimens. CONCLUSIONS: In addition to well known presenting features of typhoid like headache, fever, cough, hypotension and leucopenia abnormalities of renal and liver functions were commonly seen. Response to quinolone was poor suggesting emergence of resistance of salmonella typhi in this area.

Adolescent↗
PubMed2005

[Typhoid fever with atypical manifestation in a 5-year-old boy].

Nowadays in Poland, Salmonella typhi (S. typhi) infections are diagnosed rare. Despite the low incidence of typhoid fever, this disorder should be still in our mind. The clinical profiles of typhoid fever are various and atypical manifestation often makes the serious diagnostic problem, in childhood especially. We report herewith a case of typhoid fever in 5 years old boy, manifested as a respiratory tract infection. We present also some basic information on this rare but still serious disorder and on Gram-negative bacilli identified as S. typhi causing the typhoid fever.

Anti-Bacterial Agents↗
PubMed2006

Typhoid perforation still a common problem: situation in Pakistan in comparison to other countries of low human development.

The objective of this study was to analyze the present situation of typhoid perforation and the factors behind the still common occurrence of the disease in our country. The study was conducted with the collection and retrospective analysis of the data of typhoid perforation treated in surgical unit III of Nishtar Hospital, Multan from January 1998 to September 2000. All the patients were received and operated upon in emergency ward of the hospital, after initial resuscitation as necessary investigation. Primary closure of perforation or primary exteriozation as loop ileostomy were the surgical options adopted. Among 31 patients, 25 were male and 7 female, with a male to female ratio of 3.57:1. Majority of patients were 15-30 years of age. Twenty six (81.25%) were from remote rural areas while only 6 (18.75%) were city dwellers. One patient expired before operation and 30 underwent exploratory laparotomy. Overall expiry rate was 12.5%. Wound infection and burst abdomen were the major post operative complications responsible for prolonged hospital stay. The factors leading to occurrence of typhoid perforation were identified as, lack of civic facilities like clean drinking water and sewage disposal, poverty, poor yield of primary health care system causing a delay in diagnosis and atypical presentation of typhoid and perforation due to the emergence of multi drug resistant strains of salmonella typhae. The results of the study were similar to those of Indian studies but better than African studies. The situation warrants attention of health care providers and policy makers.

Adolescent↗
PubMed2006

Prospective evaluation of a rapid diagnostic test Typhidot for typhoid fever.

BACKGROUND & OBJECTIVE: Typhoid fever still continues to be a major public health problem around the world. A simple, reliable and affordable rapid diagnostic test has been a long felt need of the clinicians. We therefore prospectively evaluated the sensitivity and specificity of Typhidot test. METHODS: The study was carried out between January 2002 and December 2003, on a total of 563 samples from patients clinically suspected to have typhoid fever; blood culture as well as serum for Typhidot test were received. RESULTS: Of the 563 samples, Typhidot test and blood culture were positive in 36 patients, both the tests were negative for 503 patients. Typhidot test was positive for 9 patients with S. Paratyphi A infection. The sensitivity and specificity of the test using blood culture as gold standard were 92.3 and 98.8 per cent respectively for the typhoid fever. INTERPRETATION & CONCLUSION: Typhidot test is rapid, easy to perform and reliable test for diagnosing typhoid fever, useful for small less equipped laboratories as well as for those with better facilities.

Antibodies, Bacterial↗
PubMed1991

[Hygiene habits at the family level and typhoid].

We studied the relation of habits related to the fecal-oral cycle and incidence of typhoid fever in children attending the school system for 1 to 2 years and in their families. The goal was to identify a predictor to detect families at risk for typhoid fever. A sample of 80 school-mother dyads, 40 of high and 40 of low socio-economic status was studied. 20 children in each group had had typhoid fever. Logistic regression analysis allowed to identify dirty edges of the toilet bowl and nail eating habits as highly specific (97%) and sensitive (82%) index of risk. The predictor held both in high and low socio-economic groups and could be used to identify families at risk of developing typhoid fever.

Adult↗
PubMed1991

[Evaluation of an immunoenzyme technique (ELISA) to diagnose typhoid fever].

The efficiency of an ELISA method, designed to detect polyvalent IgG and IgM antibodies to Salmonella typhi polysaccharide was evaluated in patients admitted or convalescing from typhoid fever and in control subjects. Polyvalent antibodies to S typhi were demonstrated in 28/30 (93%) typhoid patients, 0/11 bacteremic patients (E coli or S paratyphi A) and 0/15 asymptomatic individuals. Widal test showed significant anti-0 agglutinin values (> = 1: 160) in only 12/30 (40%), 1/11 (9%) and 0/15 subjects from each group respectively. Typhoid patients tested on admission or at discharge showed similar high reactivity rates to ELISA. On the contrary, the Widal test detected only 2/15 (13%) patients on admission (p < 0.02) and 10/15 (67%) at discharge. These results and additional immunoblotting tests suggest that ELISA developed to detect polyvalent anti-LPS antibodies could represent a highly specific diagnostic tool to confirm typhoid fever in endemic areas.

Adult↗