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PubMed1976

[Live enteric typhoid vaccine consisting of a Vi-negative double-dependent mutant of S. typhi and a Vi-positive strain of Citrobacter].

The authors present experimental data on the study of the living enteral vaccine against the typhoid infection from the Vi-negative strain of salmonella with a double-dependence by streptomycin and purine, and from the Vi-positive strain -- citrobacter 5396/38. The method of immunoelectrophoretic analysis showed an indenticity of the O- and H-antigens of the doubledependent mutant with the O- and H-antigens of the typhoid strains of bacteria (Ty2-4446 and 5501). A sufficiently marked immunological reaction was revealed in the tests of antibody formation and in the study of the preventive activity of the sera of the immunized rabbits. The efficacy of the enteral immunization with the associated vaccine consisting of a doubledependent mutant of typhoid bacilli and the citrobacter strain in the doses tested (a 6-fold immunization) was demonstrated in experiments on albino mice. Association in one preparation of the cultures under study did not lead to any changes in the immunogenic properties of these strains. The cells of the mutant strain administered per os gave a positive culture (from the mouse organism) only in the course of the first 24 hours, in difference from the citrobacter strain which gave a positive culture in the course of 14 days.

Animals↗

PubMed1975

Controlled field trial on the effectiveness of one and two doses of acetone-inactivated and dried typhoid vaccine.

A controlled field trial was carried out with acetone-dried vaccine on about 35 000 people on the Tongan islands of tongatapu and 'Eua where typhoid fever is endemic. Volunteers were distributed at random into 3 groups, 1 of which received 1 dose of typhoid vaccine and a second 2 doses; the third, a control group, received tetanus toxoid. The population was vaccinated in 1966 and was studied until the end of 1973. Evaluation of the effectiveness of the vaccine was based on cases of typhoid fever that were confirmed by positive blood cultures. Morbidity rates in the 3 groups indicated that the acetone-dried vaccine used was effective and that a single dose of vaccine gave reasonable protection for a short period, but that 2 doses gave greater and longer protection. The results of this trial are compared with those of earlier field and laboratory studies.

Acetone↗

PubMed1996

Severe systemic reactions attributed to the acetone-inactivated parenteral typhoid vaccine.

Typhoid vaccine is recommended for people traveling to areas where they may be exposed to contaminated food and/or water. Two different parenteral forms of the vaccine have been utilized. We report five active duty patients with severe systemic reactions to the acetone-inactivated form of typhoid vaccine. The patients presented with very similar physical exam findings and laboratory abnormalities. Alternative typhoid vaccines that are less reactogenic are now available for use.

Adolescent↗

PubMed1995

Reassessment of frequency of occurrence of typhoid fever and cost efficacy analysis of antibiotic therapy.

Typhoid fever has assumed importance due to the increased incidence of drug resistance in India. The exact magnitude of the problem is not accurately known. The objective of this study was to collect retrospectively the data on the incidence and frequency of typhoid fever among hospital admissions at St. Johns Medical College Hospital (SJMCH), Bangalore during the year 1987 to 1992 and also to study the sensitivity pattern and the use of antibiotics. The study was also aimed at comparison of immunogenicity and tolerance of conventional vaccine to the newer polysaccharide vaccine. It was found that the incidence of typhoid fever showed change from epidemic to endemic situation with outbreaks of epidemics. Sensitivity pattern also showed change during the same period and antibiotic resistance was increasingly demonstrated from 1989. Cost per patient and total cost to the hospital due to increased admissions also showed progressive increase. The polysaccharide vaccine (recently made available in India) had very low adverse reaction profile with higher immunogenicity as compared to conventional vaccine. Its single dose effect with long lasting immunity indicates it probable usefulness in the eradication of disease.

Adolescent↗

PubMed1978

Typhoid fever. Studies of blood coagulation, bacteremia, and endotoxemia.

Patients with typhoid fever were studied to determine whether disseminated intravascular coagulation (DIC), circulating bacteria, and endotoxemia were responsible for the signs and symptoms of their illnesses. Coagulation tests in 28 patients detected thrombocytopenia in 17, hypofibrinogenemia in nine, and elevated titers of fibrinogen-related antigens in 20. Repeated testing during convalescence showed a return toward normal values. Intestinal bleeding, however, did not correlate with abnormalities of coagulation tests. Thus, DIC occurred commonly but appeared to be a subclinical event in these patients. In 25 patients with positive blood cultures for Salmonella typhi, quantitative cultures detected from less than 10 to 9 x 10(2) bacteria/ml. Limulus tests for endotoxin in plasma were negative in all 21 patients tested. These results indicated that the concentrations of circulating bacteria and endotoxin in typhoid fever are lower than in other Gram-negative bacterial infections and suggested that circulating bacteria and endotoxin do not play a major role in the pathogenesis of typhoid fever.

Antigens↗

PubMed1987

Typhoid and paratyphoid fever in 192 hospitalized children in Thailand.

From 1977 to 1984, Salmonella typhi was isolated from 85% and Salmonella paratyphl A was isolated from 15% of 192 Thai children with enteric fever at Children's Hospital, Bangkok. Children with enteric fever presented with sudden onset of fever and gastrointestinal symptoms. of fever presented with sudden onset Diarrhea occurred in 62% of children with paratyphoid fever and 36% of children with typhoid fever. Rose spots were seen in 15% of patients with typhoid and 7% of patients with paratyphoid fever. There were no deaths. Bronchitis and pneumonia occurring in 11% of patients were the most common complications. Acute hemolysis occurred in 3% of the patients with typhoid fever who had thalassemia or glucose-6-phosphate dehydrogenase deficiency. Chloramphenicol-resistant S typhi, which accounted for 70% of the isolates in 1977, has since 1982 accounted for less than 2% of isolates.

Adolescent↗

PubMed1982

Duodenal intubation as a source of typhoid fever.

Typhoid fever developed in three patients during a period of 13 weeks. Although each of these patients was admitted to a different London hospital, the patients became ill approximately 10 days after undergoing duodenal intubation in one gastroenterology unit. All other patients who had undergone duodenal intubation in the unit during that period of time were investigated. Salmonella typhi was isolated from bile and feces of two out of the 20 other patients (carriers). In each of the three patients who developed typhoid fever, intubation followed within two days of intubation of one of the carriers. After use in each patient, the polyvinyl tubes had been thoroughly washed with disinfectant and detergent. There were no further cases of typhoid fever when a new tube was used for each patient.

Adolescent↗

PubMed1977

Typhoid: clinical picture and response to chloramphenicol. Prospective study in Bombay (1972).

The clinical picture of 78 cases with proven typhoid and 18 cases with proven paratyphoid A fever is presented. The diagnosis was made by isolating the organisms from the blood. The Widal test could not be used as a diagnostic criterion. By means of chemotherapy with chloramphenicol (initial dose 30-40 mg/kg body weight) defervescence was achieved within an average of 4.5 days. The course of the disease was generally mild; one patient with typhoid fever died. The average hospital stay was 19 days. Four patients of the typhoid fever group were readmitted with a relapse. The laboratory examinations included blood clot culture, phage typing, Widal test, haemoglobin, leucocyte count, transaminases, serum bilirubin, and routine examination and culture of stool and urine. Forty-two patients were infected with intestinal parasites and 25 with Shigella organism. The findings are discussed and compared with findings of similar studies of enteric fever.

Adolescent↗

PubMed1987

Presence of endotoxemia and its relationship to liver dysfunction in patients with typhoid fever.

Twenty-one patients with typhoid fever were studied to evaluate the presence of endotoxin in peripheral blood and its relationship to the incidence and features of hepatic dysfunction which may occur during this disease. The limulus test for endotoxin was positive in the plasma samples of all patients prior to treatment. Liver dysfunction, as assessed by fasting and postprandial serum bile acid levels and by standard biochemical tests, occurred in 90% of patients. In seven, the injury was purely cholestatic (elevation of postprandial serum bile acid levels, alone); in 12, it was of mixed cholestatic-hepatocellular type (elevation of both serum bile acids and aminotransferase levels). After recovering, the limulus test was negative and liver function tests returned to normal values in all patients. The results demonstrate that endotoxemia is present in patients with typhoid fever. In addition, since endotoxin can impair bile secretion, our results suggest that endotoxin may have a pathogenetic role in the development of liver injury during typhoid fever.

Adolescent↗

PubMed1986

In vitro activity of ofloxacin against 210 clinical isolates of typhoid salmonellae.

210 clinical isolates of typhoid salmonellae, cultivated from blood of patients with typhoid fever (108 strains of Salmonella typhi, 99 strains of Salmonella paratyphi A and three strains of Salmonella paratyphi B) as well as 266 random clinical isolates of Escherichia coli (n = 152), Klebsiella spp. (n = 51) and Proteus spp. (n = 63) were tested for susceptibility to ofloxacin, using an agar dilution method. All the typhoid salmonellae were found to be highly sensitive to ofloxacin with MICs ranging from 0.03 mg/l to 0.12 mg/l. The sensitivity pattern of enterobacteriaceae was comparable to data published internationally.

Anti-Bacterial Agents↗

PubMed1988

Prospective randomized comparative trial of pefloxacin versus cotrimoxazole in the treatment of typhoid fever in adults.

Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.

Adult↗

PubMed1995

Typhoid fever in the park: epidemiology of an outbreak at a cultural interface.

The number of reported outbreaks of typhoid fever in the United States has recently increased. Only six were reported from 1980-1989, but seven outbreaks were reported in 1990. In August 1990, health officials in Montgomery County, Maryland, were notified of two cases of typhoid fever among persons who had attended both a family picnic attended by 60 persons and a Latin Food Festival attended by 100,000 people. We obtained interviews, blood and stool cultures, and Vi serologies from attendees at and food handlers for the picnic. We defined cases as culture-confirmed or probable. Of the 60 picnic attendees, 24 (40%) had cases, of which 16 were culture confirmed. Those who ate potato salad were at increased risk of disease (17/32 vs. 6/28, relative risk [RR] = 2.5, 95% confidence interval [CI] 1.1-5.4). Picnic attendees who also attended the Latin Food Festival were not at significantly greater risk of disease than those who did not, (11/22 vs. 13/38, RR = 1.5, CI = 0.8-2.7) and we found no evidence of disease among other festival attendees. The potato salad was prepared with intensive handling and without adequate temperature control by a recent immigrant from El Salvador who was asymptomatic, did not attend the picnic, had Salmonella typhi (S. typhi) in her stool, and had elevated Vi antibodies, strongly suggestive of the carrier state. Outbreaks of typhoid fever are a threat for cosmopolitan communities. While currently available control measures are unlikely to prevent all outbreaks, thorough investigation can identify previously unrecognized carriers.

Adolescent↗

PubMed2005

Susceptibility to typhoid fever is associated with a polymorphism in the cystic fibrosis transmembrane conductance regulator (CFTR).

The cystic fibrosis transmembrane conductance regulator (CFTR) is the affected protein in cystic fibrosis (CF). The high rate of CF carriers has led to speculation that there must be, similar to the sickle cell haemoglobin advantage in malaria, a selective advantage for heterozygotes. Such a selective advantage may be conferred through reduced attachment of Salmonella typhi to intestinal mucosa, thus providing resistance to typhoid fever. We tested this hypothesis by genotyping patients and controls in a typhoid endemic area in Indonesia for two highly polymorphic markers in CFTR and the most common CF mutation. We found an association between genotypes in CFTR and susceptibility to typhoid fever (OR=2.6). These analyses suggest that the role CFTR plays in vitro in S. typhi infection is also important for infection in the human population.

Cystic Fibrosis Transmembrane Conductance Regulato↗

PubMed2000

Outbreak of typhoid fever on the French Riviera.

A case-control study was conducted to establish the source of a community outbreak of typhoid fever in Utelle, France, a village located in the Alpes-Maritimes district of the French Riviera. Thirteen confirmed cases of typhoid fever and 41 confirmed community controls were included in the study. Cases and controls did not differ regarding ingestion of water. Multivariate logistic regression analysis identified consumption of pork meats during a village festival as the only statistically significant risk factor for typhoid fever after adjusting for age and sex (odds ratio, 76.0; 95% confidence interval, 3.5-1660). Assessment of food-handling procedures at the inn where the food had been prepared showed that the refrigeration and cooking facilities were inadequate to maintain a proper sanitary environment during the preparation of a meal for 350 people. Although the exact cause of the epidemic could not be confirmed, food contaminated by a chronic typhi carrier is the most plausible hypothesis.

Animals↗

PubMed2003

Rapid diagnosis of typhoid fever by PCR assay using one pair of primers from flagellin gene of Salmonella typhi.

Using the polymerase chain reaction (PCR) assay, we developed a rapid diagnosis method for Salmonella typhi infection in blood specimens from patients with typhoid fever. Primers were designed from the flagellin gene sequence, which would give an amplification product of 367 base pairs. In this study, the specificity of the assay, with no amplification, was seen for the other Salmonella strains with the flagellin gene, and not for non- Salmonella bacteria. For the sensitivity test, the protocol described allowed the detection of two to three copies of the Salmonella typhi genome, as determined by serial dilution of genomic DNA from Salmonella typhi. With the PCR technique, genomic DNA of Salmonella typhi was detected in 46 of 73 blood samples collected from patients with clinically suspected typhoid fever who had fever within 3 days of admission to the General Hospital, Makassar, South Sulawesi, Indonesia, and who had had no prior antibiotic treatment. The PCR results (63% positive cases) were compared with those of blood culture (13.7% positive cases) and the Widal test (35.6% positive cases), using the same samples from each of the 73 patients admitted to the General Hospital in Makassar. The time taken for PCR analysis of each sample was less than 12 h, compared with 3 to 5 days for blood or clot culture. The PCR with one pair of primers can be used as a novel, rapid diagnostic method for typhoid fever, particularly when results of standard culture assays are negative.

Adolescent↗

PubMed1975

Waterborne typhoid fever in Dade County, Florida. Clinical and therapeutic evaluation of 105 bacteremic patients.

An extensive outbreak of waterborne typhoid fever occurred in 1973 at a migrant labor camp in Dade County, Florida. Blood cultures from 105 of the 188 patients with proved or presumptive cases of typhoid fever grew Salmonella typhi. The clinical and laboratory findings in these patients were reviewed. Fever, usually with temperatures above 38.8 degrees C and of the sustained type, was a primary manifestation of disease, although a majority of the patients also complained of headache and gastroenteric symptoms. Hepatic or splenic enlargement was present in 52 per cent and 42 per cent, respectively, whereas rose spots were detected in only 13 per cent. The total leukocyte count was normal in 74 per cent, but serum levels of liver and muscle enzymes were frequently elevated. Gastrointestinal, pulmonary and neurologic complications were infrequent; circulatory failure was not observed. Defervescence in response to antibiotic therapy was variable; however, the median response among 68 patients who received chloramphenicol was two days less than that in 34 patients treated with ampicillin. There was one possible treatment failure with ampicillin. The relapse rate of 10 per cent in chloramphenicol-treated patients was not significantly greater than the 3 per cent rate among those treated with ampicillin. Serologic studies for typhoid fever were of limited diagnostic value since the titer of agglutinins was 1:160 or higher in 49 per cent of the serums obtained before treatment, and a fourfold rise in titer occurred in only 24 per cent of 57 patients studied. The serologic response to chloramphenicol treatment did not differ from that to ampicillin.

Adolescent↗

PubMed1985

The "typhoid state" revisited.

The "typhoid state" occurs classically with typhoid and typhus fevers but is also seen in other infectious diseases. Clinical descriptions of this state as "muttering delirium" or "coma vigil" refer to the peculiar preoccupied nature of the stupor. Picking at the bedclothes and at imaginary objects (carphology and floccillation) are characteristic, as is muscular twitching (subsultus tendinum). There is strong evidence that the death of Falstaff in Shakespeare's Henry V is a vivid description of the typhoid state.

Delirium↗

PubMed1981

A simple bactericidal antibody test for sero-diagnosis of typhoid fever.

Serum samples were collected from 24 confirmed cases of typhoid fever, 15 clinically suspected cases and 23 normal healthy controls. The convalescent sera were obtained in 13 of the 24 confirmed typhoid cases. In all, 13 paired sera, 11 acute phase only, 15 clinically suspected and 23 normal serum samples were tested for eliciting bactericidal antibodies to Salmonella typhi. In addition, the Widal test was also performed for comparison. All the 24 acute phase sera as well as 13 convalescent sera were found to be positive by bactericidal antibody test (titre 1:80 or above). Of 15 clinically suspected cases, 5 were positive whereas one of the 23 normal controls sera gave a false positive reaction. In contrast, the Widal test could detect only one of the 24 cases in the acute stage, but all 13 cases showed antibodies at a diagnostic titre level during the convalescent stage. None of the 15 clinically suspected cases or 23 normal controls were positive by the Widal test. The feasibility of using a bactericidal antibody test in sero-diagnosis of typhoid fever is discussed.

Acute Disease↗