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PubMed1993

Typhoid fever in rural Haiti.

A review was made of the clinical characteristics and evolution of all patients over 14 years old with typhoid fever who were treated at the Albert Schweitzer Hospital in Haiti from January 1989 through July 1991. Two hundred and seventeen patients were studied. Their most common symptoms were fever (100%), diarrhea (64.1%), and abdominal pain (51.2%). Splenomegaly and hepatomegaly were rarely noted. Sixty-eight patients (31.3%) were lost to follow-up, 129 (59.4%) were cured, and 20 (9.2%) died. There was a tendency for patients who were ill longer before seeking medical assistance to experience higher mortality. The data also indicate that patients with central nervous system involvement had a less favorable prognosis than other patients. Overall, the high incidence of hospital-reported cases (74 cases per 100,000 inhabitants) shown by these and other data makes it clear that typhoid fever is a highly prevalent infection in rural Haiti. At present, it appears that the only hope for effectively controlling the disease is by educating the population at risk, not only to prevent the disease but also to seek early medical assistance after becoming infected. Typhoid fever patients with a long history of illness before consultation may have a less favorable prognosis than other patients and should be kept under close observation. In addition, any suspected typhoid fever patient with signs of central nervous system involvement should be treated promptly with high-dose steroids, besides receiving an adequate antibiotic regimen.

Adolescent↗
PubMed1993

[Typhoid fever in the district of Outer Nordhordland. Ways of transmission, incidence and mortality 1854-1883].

Typhoid fever was endemic and unmatched in causing the heaviest workload for the local doctors. Around 1870 the incidence suddenly dropped by 2/3. Before that it had been highest in April and subsequent months. After 1870 typhoid fever became most prevalent in the winter, as in other places. The reason for this shift in incidence was probably the cessation of the spring herring fisheries, from which many fishermen used to return with typhoid. The case fatality rate was approximately 5%, only half of that found elsewhere, and what is regarded as a normal case fatality rate for untreated typhoid fever. This was probably due to the endemic state of the disease. Sick infants probably died undiagnosed while older children may have developed milder forms of the disease. Most deaths were found among adolescents and young adults.

Adolescent↗
PubMed1996

Acute viral hepatitis A: a cause of jaundice in typhoid fever.

A typhoid patient presenting with fever and jaundice is reported. Investigations revealed that the patient had both typhoid fever and acute viral hepatitis A. Jaundice is a rare clinical presentation in typhoid fever, therefore hepatitis A should be considered in typhoid fever and jaundice because both enterically transmitted disease may simultaneously occur.

Acute Disease↗
PubMed1998

Epidemic typhoid fever--Dushanbe, Tajikistan, 1997.

Typhoid fever, a severe systemic illness transmitted through food or water, is caused by the bacterium Salmonella serotype Typhi. This report describes a major epidemic of typhoid fever in Dushanbe, Tajikistan, that resulted from contamination of the municipal water system. In Tajikistan, the Sanitary Epidemiologic Service (SES) maintains records for reportable diseases. Dushanbe (1997 population: 600,000) residents receive health care through assigned polyclinics; surveillance for reportable diseases is based on polyclinic records. A case of typhoid fever is defined as physician diagnosis or isolation of S. Typhi from stool, blood, or urine cultures. In February 1997, a sudden increase in the number of typhoid fever cases was identified by SES in Dushanbe, with approximately 2000 cases registered during a 2-week period. In March, the Ministry of Health of Tajikistan requested assistance from CDC. In collaboration with local authorities and nongovernmental partners, CDC reviewed epidemiologic and laboratory surveillance; conducted a case-control study to identify risk factors for infection; and evaluated municipal drinking water quality, water wastage, and health-education campaigns.

Adolescent↗
PubMed1998

Typhoid fevers: treatment with lomefloxacin.

Typhoid group of fevers pose a major threat and are a cause of high morbidity and mortality in the tropical countries. Over the last decade there has been a steady increase in the development of multiresistant strains of Salmonellae all over the world. Multiresistance ranges between 5% to 86%. In a recent study in Pakistan multidrug resistance in Salmonellae has increased to over 39%. Hence alternative therapy is needed. Fluroquinolones are an effective alternative requiring a shorter course of treatment than conventional antimicrobial agents. Lomefloxacin because of its longer half life and convenient BD dose was used in a multicentre study to treat cases of typhoid group of fevers including cases due to multiresistant isolates. In order to overcome the challenge presented by the multiresistant salmoneallae, a dual purpose multicentre study was conducted in two stages. The first stage included a vitro study and the second in vivo study. Two hundred local salmonellae isolates were collected and their sensitivity and minimum inhibitory concentrations were determined by standard methods. Two hundred and fourteen patients clinically suspected of suffering from typhoid groups of fevers were given Lomefloxacin 200 mg. BD for 14 days. Forty percent of Salmonellae isolates were found to be multiresistant while only 2% were found to be resistant to Fluroqunilones. The mean MIC 90 was found to be 0.06 mg/L Lomefloxacin was found to be effective in over 97% cases for treating typhoid group fevers including the ones due to multiresistant isolates. The side effects were found to be minimal and transient.

Adolescent↗
PubMed1954

Measles encephalitis; a successful method of treatment with typhoid vaccine.

During a 12-year period 50 patients with measles encephalitis were treated with typhoid vaccine-45 of them not until they were in a vegetative state. There were no deaths in the treated cases. All except one were clinically normal after treatment was ended. Late in the series it became apparent that after the clinical normal is attained and the electroencephalogram becomes normal, treatment should still be continued until the cortex has been "challenged" repeatedly and the electroencephalogram shown to remain normal. The "shock" element in the treatment with typhoid vaccine was prevented by anticipating and circumventing the unfavorable reactions to the vaccine. It may take 20 to 50 treatments or more with typhoid vaccine to return a patient to normality. Each individual is different and responds in a different period of time.

Encephalitis↗
PubMed1964

INTERNATIONAL REFERENCE PREPARATIONS OF TYPHOID VACCINE. A REPORT ON INTERNATIONAL COLLABORATIVE LABORATORY STUDIES.

Before their establishment as International Reference Preparations of Typhoid Vaccine, an acetone-inactivated vaccine (vaccine K) and a heat-phenol-inactivated vaccine (vaccine L) were tested on man in large-scale controlled field trials and simultaneously subjected to extensive collaborative laboratory studies on their relative potencies. Some 20 laboratories in 12 countries took part in these collaborative studies. This paper describes in detail the results of the investigation of 14 different assay procedures.One of the main objects of these studies was to determine whether one or more of the laboratory methods showed a correlation with the protective effectiveness of the vaccines against typhoid fever in man. It is clear from the results reported that none of the potency tests in animals reliably reflected the evidence obtained in human beings in the controlled field trials. Some of the assays, however, seem to offer promise of ability to distinguish between the potencies of typhoid vaccines in a manner reflecting their efficacy in man. Further research is needed before the value of these procedures can be definitely assessed.

Animals↗
PubMed1965

THE PRESENT STATUS OF FIELD AND LABORATORY STUDIES OF TYPHOID AND PARATYPHOID VACCINES WITH SPECIAL REFERENCE TO STUDIES SPONSORED BY WORLD HEALTH ORGANIZATION.

The authors present a summary of the information yielded by a number of collaborative field and laboratory studies of typhoid vaccines conducted under the auspices of the World Health Organization, comparing, in particular, the results of various controlled field trials carried out in British Guiana, Poland, the USSR and Yugoslavia, and attempting to evaluate the effectiveness of the vaccines in man.Acetone-inactivated typhoid vaccine, which has been established as an international reference preparation, has been proved in field trials to be of a high degree of effectiveness and to confer protection of long duration.Comparison of the results of the field trials with those of laboratory studies indicate that further research is needed in order to develop a test or tests the results of which can be fully correlated with the effectiveness of typhoid vaccines as demonstrated in man.Reference is also made to field studies of paratyphoid vaccines.

Adolescent↗
PubMed1996

Non-typhoidal Salmonella bacteraemia: clinical features and risk factors.

A case control study was conducted to determine the risk factors of non-typhoidal Salmonella bacteraemia. Eighty adult patients with non-typhoidal Salmonella bacteraemia admitted to Siriraj Hospital from January to December 1993 served as the cases. The controls comprised 3 groups: group 1, 80 adult in-patients with Escherichia coli bacteraemia; group 2, 80 adult in-patients who did not have bacteraemia and had been admitted to the hospital during the same period as the cases; group 3, 80 in-patients who did not have Salmonella bacteraemia and matched the cases in terms of gender, age, hospital services and admission date. AIDS and corticosteroid use were the major risk factors for acquiring non-typhoidal Salmonella bacteraemia with an odds ratio of 7.27 to 12.31 (95% confidence interval of 3.39 to 29.40). Almost all patients with non-typhoidal Salmonella bacteraemia presented with a fever for a median duration of 7 days. AIDS patients usually had concomitant opportunistic infections. Salmonella group D was the most common serogroup. Most patients were treated with co-trimoxazole, quinolones, ceftriaxone and ampicillin. Localized suppurative complications were observed in 14% of the patients; the overall mortality rate was 36.3%, 12% of whom died prior to receiving appropriate antibiotics for Salmonella.

AIDS-Related Opportunistic Infections↗
PubMed2000

Non-typhoidal Salmonella bacteraemia without gastroenteritis: a marker of underlying immunosuppression. Review Of cases at St. Thomas' Hospital 1970-1999.

OBJECTIVES: To classify non-typhoidal salmonella bacteraemia according to clinical presentation, and to study how this correlates with the presence of underlying immunosuppression. METHODS: We analysed data collected prospectively for all 82 cases of non-typhoidal salmonella bacteraemia presenting to St. Thomas' Hospital between 1970 and 1999. RESULTS: Patients presented with one of three syndromes: diarrhoea, an extra-intestinal focus of infection, or isolated fever with no focus. Only 18% of those with diarrhoea had underlying immunosuppression, compared with 80% of those with extra-intestinal focal infections (P= 0.001) and 80% of those with no focus (P= 0.0001). There was no significant association between salmonella serotype and underlying immunosuppression. Salmonella enteritidis isolates, especially phage type 4, increased significantly during the last decade (P= 0.001). The presentation of non-typhoidal salmonella bacteraemia in the absence of diarrhoea prompted the diagnosis of HIV in two patients. CONCLUSION: Underlying immunosuppression should be excluded in patients presenting with non-typhoidal salmonella bacteraemia in the absence of gastroenteritis. This may lead to an earlier diagnosis of HIV.

Adult↗
PubMed1997

Immune Response to Hepatitis A Vaccine Combined or Given Simultaneously with Typhoid Fever Vaccine.

Background: Because both hepatitis A and typhoid vaccination are frequently indicated in the same traveler, a prospective, randomized controlled study was performed to evaluate the feasibility of simultaneous administration of hepatitis A and typhoid fever vaccines in adult volunteers. Methods: Two groups of 25 subjects received either separate injections of hepatitis A (Havrixtrade mark, SmithKline Beecham Biologicals) and typhoid fever (Typhim Vitrade mark, Pasteur-Mérieux) vaccines in opposite arms, or a syringe-mixed combination of both vaccines as a single injection. A booster dose of Havrix was given at 6 months. Results: The immune response to hepatitis A tended to be higher in the mixed-injection group, but this difference was significant (p=.048) only following the booster dose. Adverse reactions were generally mild with no differences between the two groups. Conclusion: A combined formulated vaccine against both typhoid fever and hepatitis A is feasible and offers more convenience without added adverse reactions to travelers who have appropriate indications for both vaccines.

Journal Article↗
PubMed1987

[Potential manifestation of fowl typhoid in chicks fed Salmonella gallinarum-contaminated feed].

The possibility was checked to infect young birds with fowl typhoid through feeding them with S. gallinarum--contaminated forage. The three test groups of birds were kept on the floor of one and same premise, and a fourth group was kept separately in isolation. The feed offered to the first and second test group was contaminated at the rate of 5.10(8) and 1.2.10(8) microbial cells, respectively. With the first group, where feed contamination was at the rate of 6.10(6) S. gallinarum cells per bird, mortality rate ran as high as 61 per cent, 53 per cent of the total number of birds dying of typhoid septicaemia. With the second group, where feed contamination was 1.2.10(6) S. gallinarum cells per bird the total rate of mortality was 34 per cent, 32 per cent of the birds dying of typhoid septicaemia. With the third group, exposed to air-borne infection and offered Salmonella-free feed only, 8 per cent of the birds died of typhoid. It was found that the manifestation and the intensity of the epizootic process were in direct dependence on the microbial number, and that air played a part in transmitting S. gallinarum to young birds raised on the floor.

Air Microbiology↗
PubMed2005

Vaccines against typhoid fever.

Because of high infectivity and significant disease burden, typhoid fever constitutes a major global health problem. Implementation of adequate food handling practices and establishment of safe water supplies are the cornerstone for the development of an effective prevention program. However, vaccination against typhoid fever remains an essential tool for the effective management of this disease. Currently, there are two well tolerated and effective licensed vaccines. One is based on defined subunit virulence (Vi) polysaccharide antigen and can be administered either intramuscularly or subcutaneously and the other is based on the use of live attenuated bacteria for oral administration. The advantages and disadvantages of the various approaches taken in the development of a vaccine against typhoid fever are discussed, along with the potential for future vaccine candidates.

Antigens, Bacterial↗
PubMedDate not supplied

Typhoid and paratyphoid fever.

Typhoid fever is estimated to have caused 21.6 million illnesses and 216,500 deaths globally in 2000, affecting all ages. There is also one case of paratyphoid fever for every four of typhoid. The global emergence of multidrug-resistant strains and of strains with reduced susceptibility to fluoroquinolones is of great concern. We discuss the occurrence of poor clinical response to fluoroquinolones despite disc sensitivity. Developments are being made in our understanding of the molecular pathogenesis, and genomic and proteomic studies reveal the possibility of new targets for diagnosis and treatment. Further, we review guidelines for use of diagnostic tests and for selection of antimicrobials in varying clinical situations. The importance of safe water, sanitation, and immunisation in the presence of increasing antibiotic resistance is paramount. Routine immunisation of school-age children with Vi or Ty21a vaccine is recommended for countries endemic for typhoid. Vi vaccine should be used for 2-5 year-old children in highly endemic settings.

Developing Countries↗
PubMed1987

Protective activity of Vi capsular polysaccharide vaccine against typhoid fever.

The protective efficacy against typhoid fever of a single intramuscular injection of 25 micrograms of the Vi capsular polysaccharide (CPS) was assessed in a randomised double-blind controlled trial. Vaccination of 11,384 children was followed by 21 months' surveillance. 47 blood-culture-proven cases of typhoid occurred in children who received meningococcal A + C CPS vaccine and 19 cases in those vaccinated with Vi CPS. Protective efficacy was 60% calculated from the day of vaccination and 64% from 6 weeks after vaccination. Surveillance also included 11,691 unvaccinated children; 173 cases occurred in this group. Protective efficacy in relation to the unvaccinated group was 77.4% and 81.0% after 21 months, calculated immediately and 6 weeks after vaccination, respectively. Vaccination was associated with minimum local side-effects, and an increase in anti-Vi antibodies occurred, as measured by radioimmunoassay and enzyme-linked immunosorbent assay. Antibody levels remained significantly raised at 6 and 12 months post vaccination. Vi CPS is thus a safe and effective means of typhoid vaccination.

Adolescent↗
PubMed1977

Antibodies and the Aberdeen typhoid outbreak of 1964. I. The Widal reaction.

The outbreak of typhoid fever in Aberdeen during 1964 (Walker, 1965) presented an opportunity to study the antibody titres of typhoid fever patients and of TAB immunized individuals to obtain further knowledge concerning the behaviour of these titres with the passage of time.This paper gives an abbreviated version of part of a research programme which followed the Aberdeen typhoid outbreak of 1964.The antibody titres of patients were followed up for a period of 2 years after discharge from hospital and the findings have been compared with those in TAB immunized healthy individuals. The following points emerged:(1) The value of the Widal test as an aid to diagnosis was limited;(2) the flagellar antibody titre in patients' sera provided a more reliable aid towards diagnosis than did the somatic antibody titre;(3) the response of immunized and non-immunized patients to the somatic antigens was poor and often delayed well into the period following discharge from hospital;(4) titres of 1/40 and over for Vi agglutinins were present in immunized and non-immunized patients for at least 12 months after discharge without their being S. typhi excretors;(5) Vi agglutinin titres as high as 1/40 were present in TAB immunized healthy individuals and also in members of the general public;(6) the presence of S. typhi septicaemia need not result in a high antibody titre;(7) patients who relapse, may do so without enhancement of previous antibody titres and may relapse even in the presence of earlier appreciable titres.

Agglutinins↗
PubMed1961

Studies on infection and immunity in experimental typhoid fever. III. Effect of prophylactic immunization.

A study was made of the efficacy of various antityphoid immunizing agents in immunizing chimpanzees against typhoid fever produced by feeding viable S. typhosa. It was found that both acetone-killed and heat-killed, phenol-preserved typhoid vaccines were effective in protecting against infection induced with either homologous or heterologous strains of typhoid bacilli. Purified O antigen induced no discernible protection, but some immunity was afforded by the administration of purified Vi antigen.

Animals↗
PubMed2004

Immune responses to an oral typhoid vaccine strain that is modified to constitutively express Vi capsular polysaccharide.

Protection against typhoid fever might be best achieved by a vaccine that stimulates IgG antibody to Vi capsular polysaccharide (Vi) in serum, IgG antibody to O antigen in serum, and cell-mediated immune responses. Live typhoid vaccines have not elicited anti-Vi antibody, presumably because Vi expression is highly regulated. CVD 909 is an oral attenuated typhoid vaccine candidate that is engineered to constitutively express Vi. In the present study, CVD 909, at doses of 10(6-9) cfu, was orally administered to 32 healthy adults, and immune responses were measured. Although many of the volunteers generated antibody-secreting cell responses to Vi, only 2 of the 32 volunteers generated anti-Vi IgG antibody in serum.

Administration, Oral↗