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PubMed1991

Fulminant hepatic failure with typhoid fever in childhood.

Although hepatic dysfunction has been described among adults with typhoid, there are few reports of significant hepatic functional impairment in children with typhoid. Of 355 children with culture proven typhoid seen at the Aga Khan University Hospital, hepatomegaly was noted in 118 (33%) and isolated right hypochondrial tenderness in 30 (8.5%). The liver function tests were normal in 78% and 47% of these children respectively and significant hepatic dysfunction was seen only in 26 (7.3%). However, children with typhoid and significant hepatic dysfunction had higher mortality (P less than 0.001) and two patients presented with a picture of fulminant hepatic failure with fatal outcome.

Chi-Square Distribution↗
PubMedDate not supplied

[The surgical complications of typhoid fever: a report of 10 cases].

This is a retrospective review of 10 consecutive patients with intra-abdominal complications of typhoid fever requiring surgical treatment, during a four-year period at the Instituto Nacional de la Nutrición Salvador Zubirán. There were 7 males and 3 females with an average age of 33.9 years. In 80 per cent of the cases Salmonella typhi was obtained in blood and bone narrow cultures. Five cases developed terminal ileum perforations, 4 massive bleeding related to ulcerated typhoid ileitis and one patient was operated on with the preoperative diagnosis of acute abdomen during the course of severe, toxic, typhoid fever. At laparotomy, no abnormalities were found. Five patients were treated with right hemicolectomy, 3 with local resections and primary closure, and another one, with segmental terminal ileum resection and end to end anastomosis. One patient died of mixed shock and multiple organ failure. This event was secondary to partial dehiscence of the ileo-transverse anastomosis and massive bleeding. Four patients had complications; a) pneumonia, b) urinary tract infection, c) splenic abscess that required splenectomy and: d) intestinal obstruction. All patients were treated with chloramphenicol. We found a high morbidity and mortality rate of the typhoid fever complications. The surgical resection and specific antibiotic therapy are the most effective treatment, however, complications can appear during its treatment.

Adolescent↗
PubMed1988

[Diagnostic importance of various methods of determining infectious O-antigenemia in patients with typhoid and paratyphoid fevers A and B].

Altogether 181 patients with typhoid and paratyphoid fever (54 with typhoid fever, 50 with paratyphoid fever type A, and 77 with paratyphoid fever type B) were investigated. Of them 108 (59.7%) patients were examined during the 1st week of disease. Serum specific O-antigens of typhoid and paratyphoid fever agents were determined by enzyme immunoassay (EIA), radioimmunoassay (RIA), and O-aggregate hemagglutination reaction (O-AHA), serum specific O-antibodies were determined by RDHA, EIA, RIA or O-AHA used during the 1st week of disease were twice as effective as RDHA. Combined use of EIA and O-AHA for the detection of serum specific O-antigens made it possible to diagnose typhoid fever in 90.91%, paratyphoid fever type A in 96.15%, and paratyphoid fever type B in 95.55% of cases.

Antigens, Bacterial↗
PubMed1989

Detection of typhoid fever by Widal and indirect fluorescent antibody (IFA) tests. A comparative study.

Widal test is a conventional method for the detection of typhoid fever. However, it takes 18-24 hours to complete the test. In the present study indirect fluorescent antibody test has been compared with the Widal test using single serum specimens and was found to be rapid, sensitive and specific. Serum specimens from 41 culture proven cases of typhoid fever, 14 clinically suspected cases and 22 normal individuals were collected. Whereas Widal test detected 63.41% positive cases, IFA test detected 87.80% from among culturally proven typhoid cases. Among the clinically suspected cases of typhoid fever, IFA test detected 85.71% (28.57 + 57.14%) while Widal test detected only 57.13% (35.71 + 21.42%) positive cases out of above 14 cases.

Agglutination Tests↗
PubMed1987

Inactivated Saccharomyces cerevisiae as virulence-enhancing agent in the toxicity test of Salmonella typhi and the immunity assay of typhoid vaccine in mice.

Mucin has been used as virulence-enhancing (VE) agent in estimation of the toxicity of bacteria to mice and the potency of bacterial vaccines such as typhoid vaccine. Discontinuance of the acceptable brand of mucin made it necessary to search for an effective alternative. Five percent inactivated Saccharomyces cerevisiae (IY) showed a significant higher VE effect on S. typhi in mice (132 colony forming units/LD50) with lower viscosity when compared to 5% mucin (740 colony forming units/LD50), and either one could promote bacterial lethal toxicity in mice more than 10(4) times. The strong correlation (r2 = 0.9765) between the immune dose and the ratio of mouse death was found by using 5% IY as VE agent in the active mouse protection test for typhoid vaccine. The relative potencies of a typhoid vaccine to the reference vaccine obtained by using 5% mucin or 5% IY as VE agent were not significant difference. Therefore, IY was a suitable substitute for mucin as a VE agent in the toxicity test of bacteria and in the immunity assay of typhoid vaccines.

Animals↗
PubMed1979

Salmonella typhi--induced stimulation of blood lymphocytes from persons with previous typhoid fever.

In 21 persons with previous typhoid fever and in 15 controls thymidine incorporation of blood lymphocytes stimulated in vitro by killed Salmonella typhi was studied. The optimal culture conditions were established to be a cell density of 10(5) cells per vial, stimulated with 10(8) S. typhi and incubated for 5 days. The lymphocytes response to S. typhi was significantly higher in the typhoid group than in the controls. The lymphocyte responsiveness was not correlated to the time elapsed since the attack, and was not found different in patients who had had typhoid relapse. No difference was found in lymphocyte response to the mitogens PHA, PWM and Con-A between the typhoid group and the controls.

Adolescent↗
PubMed1967

International reference preparations of typhoid vaccine. Potency assay by the active mouse protection test with three different routes of immunization.

International collaborative laboratory studies on the International Reference Preparations of Typhoid Vaccine have so far failed to provide data on which international units for these vaccines can be based. Further assays carried out using the active mouse protection test, with immunization by the subcutaneous, intraperitoneal or intravenous route, confirmed the findings by some workers that the International Reference Preparation of Typhoid Vaccine (Acetone-Inactivated) (vaccine K) was more effective than the International Reference Preparation of Typhoid Vaccine (Heat-Phenol-Inactivated) (vaccine L), and indicated that intraperitoneal immunization was the most promising method. Vaccine K, together with the material extracted by the acetone in the preparation of the vaccine, had a significantly lower effectiveness (at the 5% probability level) only when intraperitoneal immunization was used. The reasons for the differences found between the various vaccines and routes of immunization are discussed at length.It is suggested that challenge with a strain of Salmonella moscow instead of the strain of Salm. typhi used until now gives a true infection and forms the basis of a reliable method for the potency assay of typhoid vaccines.

Animals↗
PubMed1977

Studies of the effects of estradiol, progesterone, cortisol, thrombophlebitis, and typhoid vaccine on synthesis and catabolism of antithrombin III in the dog.

Effects of estradiol, progesterone, cortisol, thrombophlebitis and typhoid vaccine on the synthesis and catabolism of antithrombin III (AT) in dogs were studied, using I-125-labeled AT (I-125-AT) as a tracer. Five dogs were used for each study. A single intramuscular injection of 20 mg estradiol caused a 20% decrease of plasma AT concentration in 6 days without appreciable changes in the plasma half-lives of I-125-AT but with a significant decrease in the fractional catabolic rate of I-125-AT(j3u). A single intramuscular injection of 250 mg progesterone did not produce any appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. On the other hand, intravenous and intramuscular injections of a total of 750 mg cortisol caused a 17% increase of plasma AT concentration in a day after the injections without alterations of the plasma half-lives of I-125-AT or j3u. Next, thrombophlebitis was produced in dogs by a single intravenous injection of 1 ml 90% phenol into a leg vein occluded for 1 min by a gauze tourniquet and the effects of thrombophlebitis were studied. The results indicated that it did not cause appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. However, studies of the effects of a single intravenous injection of 3 ml typhoid vaccine showed a 25% decrease of plasma AT concentration in a day after the injection with a moderate acceleration of the decline rate of plasma I-125-AT and a 14% increase in j3u values. Further studies in heparinized dogs showed similar effects with typhoid vaccine. These results indicate that estradiol causes a decreased rate of AT synthesis, that progesterone has no appreciable effects on AT metabolism, that cortisol increases the rate of AT synthesis, that localized thrombophlebitis has no appreciable effects on AT metabolism and that typhoid vaccine causes an increased j3u by unknown mechanisms which is not an accelerated coagulation process.

Animals↗
PubMed1980

[Calculation of trends in typhoid morbidity in different regions of the country].

The relationship linearity criterion and its derivatives were used in processing the mass of official statistical data on typhoid morbidity throughout the whole territory of the USSR and in the union republics during the period 1950-1976. In the majority of the union republics (the RSFSR, the Ukrainian, Byelorussian, Georgian, Armenian, Moldavian, Lithuanian, Latvian and Estonian SSR) the time course of typhoid morbidity was found to have a linear character and could be adequately described by the exponential function. The calculation of the average rate of annual decrease in typhoid morbidity in the above-mentioned union republics and the extrapolation of the tendencies of morbidity decrease for the last 20 years indicated that the morbidity level in the USSR would decrease by 6.14%, varying from 3.09% to 9.89% in individual union republics. The authors believe that similar rates of decrease in typhoid morbidity in different regions of the country can be attributed to reduced circulation of the causative agent of this infection and to the constant radical improvement of the sanitary and hygienic conditions of the Soviet people.

Epidemiologic Methods↗
PubMed1982

A study of humoral and cell-mediated immune response following typhoid vaccination in human volunteers.

The specific antibody response to O, H and Vi antigens, levels of IgG, IgM, IgA, and C3 presence of soluble immune complexes, in vitro tests of cellular immunity and subsets of lymphocytes in the peripheral blood were investigated in human volunteers after a single dose of 0.1 ml intradermal typhoid vaccination. The results indicated that typhoid vaccination induced antibody formation, slightly increased IgA levels and led to a decrease in C3 which was probably due to immune complex formation. There was also a relative increase in circulating Fc-IgG receptor-bearing lymphocytes and T-gamma cells after vaccination. In those subjects who showed specific cellular immunity before vaccination, a transient depression in lymphocyte transformation and a negative leucocyte migration inhibition test with typhoid baccilli occurred post-vaccination. These findings raised doubts over the advantages of giving typhoid vaccine during an epidemic.

Antibody Formation↗
PubMed1982

Studies of cellular and humoral immunity in typhoid fever and TAB vaccinated subjects.

An assessment of both humoral and cell-mediated immune responses to Salmonella typhi antigens in patients with acute typhoid infection, TAB inoculated subjects and in healthy controls is reported. Cell-mediated immunity as assessed by the leucocyte migration inhibition test (LMI), and developed in all cases with typhoid fever. Positive LMI was evident in the first week of the illness and was maintained during the evolution of disease and in some patients was still present after a year. It also developed at the end of 3 weeks in five out of nine TAB vaccinated subjects. Weakly positive LMI was noticed in only two of twenty asian and caucasian controls. Antibodies, determined by the standard Widal test, were significantly raised in both patients with typhoid fever and TAB inoculated subjects. The antibodies and cellular reactivity developed almost simultaneously but there was no correlation between the agglutination titres and LMI positivity, implying that they are independent of each other. Typhoid patients also showed significantly raised serum IgM and IgA levels and increased concentrations of secretory IgA in their saliva.

Adult↗
PubMed1981

Hemostasis in typhoid fever.

Abnormalities of hemostasis in vivo and in vitro were defined in a prospective study of patients with typhoid fever. In a group of 56 patients with a proven diagnosis of typhoid fever, hemostatic abnormalities were frequently found. In patients with normal clotting tests the fibrinogen level was found to be higher than in normal controls. This finding established a new normal level for patients with typhoid fever. Using this redefined normal level it was found that low fibrinogen was associated with other hemostatic abnormalities. Low fibrinogen levels in patients with typhoid fever are possibly the result of disseminated intravascular coagulation. This process affected 20% of our patients and was often of mild to moderate intensity. Clinically significant bleeding occurred in 18 patients and, in contrast to the results of previously published studies, was found to correlate with clotting abnormalities.

Adolescent↗
PubMed1995

A new typhoid vaccine composed of the Vi capsular polysaccharide.

Typhoid is still prevalent in many parts of the world. We reviewed all published and unpublished studies of a newly licensed vaccine composed of the Vi capsular polysaccharide of Salmonella typhi, the causative agent of the disease, which had been licensed previously outside the United States. These included observational studies and double-blind randomized studies done in the United States, Europe, and the developing world in which children and adults unexposed to typhoid or those living in endemic areas were enrolled. A single dose of 25 micrograms of the purified polysaccharide was given by intramuscular injection. The vaccine was well tolerated, inducing only minor reactions in fewer than 10% of subjects. An antibody response occurred in about 90% of subjects and lasted about 3 years. Seroconversion was shown in children as young as 2 years. Protective efficacy was evaluated in two studies conducted in areas in which typhoid is endemic; the efficacy was 55% and 75%, respectively, in adults and in children older than 5 years. The Vi vaccine compares favorably with other typhoid vaccines in regard to safety, patient compliance, immunogenicity, and efficacy. Vi polysaccharide is a well-standardized antigen that is effective in a single parenteral dose, is safer than whole-cell vaccine, and may be used in children 2 years of age or older.

Adult↗
PubMed1994

Typhoid fever associated with severe hepatitis.

While typhoid is quite common in our environment, presentation in association with severe hepatitis and hepatic encephalopathy is uncommon. The case of a 14 year old male with typhoid who presented with jaundice and severe hepatitis with encephalopathy is presented. The first symptoms occurred one week before presentation. The clinical features and laboratory investigations confirmed typhoid fever. The associated severe hepatitis could have been related to a direct liver involvement by Salmonella typhi, drug toxicity or hepatitis B infection from previous indiscriminate parenteral drugs. The specific cause of the hepatitis could not be confirmed. The patient is presented to illustrate a rare association and possible complication of typhoid fever, inappropriate self and other medication in the place of proper hospital presentation and assessment and the diagnostic difficulties confronting many centres in the developing environment.

Adolescent↗
PubMed1994

A case of recurrent typhoid fever in the United States: importance of the grandmother connection and the use of large restriction fragment pattern analysis of genomic DNA for strain comparison.

An 8-year old girl was infected for a second time with Salmonella typhi by contact with her grandmother, a known typhoid carrier. The S. typhi from both patient and grandmother had closely related genomic pulsed field gel electrophoresis patterns that differed from epidemiologically unrelated strains. The girl responded well to a 14-day course of oral trimethoprimsulfamethoxazole. The grandmother was treated successfully with a 28-day regimen of oral ciprofloxacin. Typhoid fever remains an endemic disease in the United States, largely because of recognized chronic stool carriers. Most of these carriers had typhoid in the preantibiotic era and remain potential sources of disease when they provide meals for others, not uncommonly grandchildren. The importance of this "grandmother" connection to endemic typhoid fever is reviewed, as is the potential use of pulsed field gel electrophoresis pattern analysis for comparison of strains of S. typhi.

Aged↗
PubMed1994

Typhoid fever in New York City, 1980 through 1990.

BACKGROUND: Although typhoid fever incidence decreased in the 1960s and 1970s in New York City and elsewhere, it did not disappear. In this article, trends associated with various modes of transmission of Salmonella typhi in New York City patients are described. METHODS: Typhoid fever surveillance reports from 1980 to 1990 were reviewed for clinical, demographic, and epidemiologic characteristics. Cases of typhoid fever were classified as travel related or domestically acquired. RESULTS: In all, 479 typhoid cases were identified, of which 67% were travel related. The age groups most frequently affected were children and adolescents. Cases more than doubled in the decade, and the ratio of travel-related cases to domestically acquired cases increased steadily from 63% to 80%. Travelers to Southeast Asia were at three times higher risk than those visiting South America and eight times higher than those visiting the Caribbean. The case-fatality proportion was 1.5%. CONCLUSION: The trends of S typhi infection in New York City followed the trends observed in the United States since 1978, which demonstrates the importance of international travel. Although food and water precautions may be effective for short-term travelers, selective use of oral antityphoid vaccines for New York City travelers to high-risk endemic countries should be encouraged.

Adolescent↗
PubMed1993

[Typhoid fever].

The epidemiology, clinical presentation, diagnosis and treatment of typhoid fever has been studied retrospectively in 50 hospitalized patients. Typhoid fever is increasing in Norway, owing to more travel, especially by immigrants visiting their home countries. Among 50 patients admitted to hospital for typhoid, we found no fatal complications. Fever was a main symptom, and 13 of the 50 patients had additional concomitant infections. The standard treatment was chloramphenicol for 14 days. In 1990 and 1991, however, most cases were caused by multi-resistant strains of Salmonella typhi. The adults were therefore treated with ciprofloxacin and the children with third generation cephalosporins. All the multiresistant infections had been contracted in Pakistan or India. There were no secondary cases among the more than 214 family contacts in the 47 families involved. The increase in resistant strains of typhoid fever may affect future treatment and control strategies.

Adolescent↗
PubMed1993

[Outbreak of typhoid fever in a family].

We describe a small epidemic of typhoid fever in a family who came originally from Pakistan. In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period. The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever. Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse. The source of her first infection is unknown. The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case. Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome. There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.

Adult↗