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PubMed1981

Radial counter-immunoelectrophoresis for rapid sero-diagnosis of typhoid fever.

Serum samples were collected from 24 confirmed cases of typhoid fever and 23 normal healthy controls. Convalescent sera from the patients were obtained, wherever possible, one week after the first sample. In all, 13 paired sera, 11 acute phase only and 23 normal serum samples were tested for ability to elicit precipitins to Salmonella typhi by radial counter-immunoelectrophoresis using cellulose acetate membranes. In addition, conventional counter-immunoelectrophoresis (CIE) was performed using agar-gel layer for comparison. One of 24 acute phase sera gave positive results whereas all 13 convalescent sera were positive by both methods. The radial CIE test may be useful for rapid sero-diagnosis of typhoid fever as it takes only 4 min and can be used to screen large numbers of serum samples from patients suspected of typhoid fever.

Antigens, Bacterial↗
PubMed1984

Methylprednisolone sodium succinate (Solu-Medrol) in the treatment of typhoid perforation (a preliminary report).

It is now universally accepted that treatment of typhoid perforation must be surgical. In spite of this and the use of antibiotics, the mortality rate is still high. Previous observations that some patients with typhoid perforation present with features suggestive of septicaemia and septic shock made us conduct a clinical trial with methylprednisolone sodium succinate (Solu-Medrol) in treating this disease. Our data show that use of this drug in addition to antibiotics and early surgical intervention reduces the mortality rate in typhoid perforation.

Adolescent↗
PubMed1993

Lipopolysaccharide-independent radioimmunoprecipitation and identification of structural and in vivo induced immunogenic surface proteins of Salmonella typhi in typhoid fever.

The humoral response to Salmonella typhi is important for protective immunity against typhoid fever, as indicated by the protection obtained with killed cell vaccines and component vaccines (outer membrane proteins, Vi antigen) in animals and human beings. Nonetheless, analysis and interpretation of host humoral immune response to S. typhi surface antigens have been difficult because of the complex structure of the S. typhi envelope and the lack of purified reagents for detection of immune response to individual surface components. Normal and convalescent human sera from typhoid fever patients were absorbed with S. typhi lipopolysaccharide. These sera were used in radioimmunoprecipitation assays of whole S. typhi cells and S. typhi membranes labelled with either 125I or 35S-methionine. This strategy has permitted the unequivocal identification of a humoral immune response to structural and in vivo induced outer membrane proteins of S. typhi. In this manner, we have identified the porins, lipoprotein, the iron-starvation-induced proteins, and three proteins of 30, 18.5 and 15 kDa as surface-exposed immunogens of S. typhi in patients with typhoid fever. These studies suggest that further experimental work is needed to characterize the relevance of both anti-S. typhi outer membrane protein and antilipopolysaccharide antibodies in recovery from S. typhi infections and protective immunity.

Antibodies, Bacterial↗
PubMed2004

Treatment failure in typhoid fever with ciprofloxacin susceptible Salmonella enterica serotype Typhi.

Fluoroquinolones are considered the most effective drugs for the treatment of typhoid fever and hence are widely used in the empiric treatment of acute undifferentiated febrile illnesses in India. Recent reports of Salmonella enterica serotype Typhi (S. Typhi) strains with increasing minimum inhibitory concentration (MIC) of ciprofloxacin have raised the fear of potential treatment failures. In this case series of 109 consecutive patients hospitalized with typhoid fever (S. Typhi grown from blood), we documented clinical failure (fever persisting >6 days) in 25 of 46 (54.3%) adults who could be evaluated. Among these, eight (17.4%) had microbiological failure (S. Typhi recovered from blood after 6 days of ciprofloxacin therapy) despite adequate serum ciprofloxacin levels, and all required alternative drugs for treatment. These 8 S. Typhi strains, although susceptible to ciprofloxacin (MIC < 1 microg/mL) (NCCLS 2000), had MICs (median MIC 0.5 microg/mL) that were increased 15-fold compared to S. Typhi strains from patients with typhoid fever seen at our center in 1995 (median MIC 0.032 microg/mL), and were nalidixic acid resistant S. Typhi (NARST) (MIC > or =32 microg/mL). The poor treatment outcomes with ciprofloxacin therapy in patients infected with NARST strains that exhibit an increased ciprofloxacin MIC call for a need to revise the ciprofloxacin breakpoints for S. Typhi.

Adolescent↗
PubMedDate not supplied

Fever of unknown origin: subacute thyroiditis versus typhoid fever.

Fever of unknown origin (FUO) is not infrequently a diagnostic dilemma for clinicians. Common infectious causes include endocarditis and abscesses in adults, and noninfectious causes include neoplasms and certain collagen vascular diseases, for example, polymyalgia rheumatica, various vasculitides, and juvenile rheumatoid arthritis (adult Still's disease). Subacute thyroiditis is a rare cause of FUO. Among the infectious causes of FUO, typhoid fever is relatively uncommon. We present a case of FUO in a traveler returning from India whose initial complaints were that of left-sided neck pain and angle of the jaw pain, which initially suggested the diagnosis of subacute thyroiditis. After an extensive FUO workup, when typhoid fever is a likely diagnostic possibility, an empiric trial of anti- Salmonella therapy has diagnostic and therapeutic significance. The presence of relative bradycardia, and response to quinolone therapy, was the basis of the clinical diagnosis of typhoid fever as the explanation for this patients FUO. This case illustrates the diagnostic difficulties in assessing patients with FUO with few diagnostic findings.

Administration, Oral↗
PubMed2005

Quantitative detection of Salmonella enterica serovar Typhi from blood of suspected typhoid fever patients by real-time PCR.

We quantified the gene copies from Salmonella enterica serovar Typhi (S. Typhi) in the blood of patients suspected of having typhoid fever by using TaqMan-based real-time PCR (TaqMan assay) to target the S. Typhi flagellin gene in genomic DNAs isolated from blood samples. Of 55 blood samples taken from suspected typhoid fever patients, eight blood samples with a positive blood culture had S. Typhi loads ranging from 1.01 x 10(3) to 4.35 x 10(4) copies/ml blood, and from 47 blood samples with negative blood culture, there were 40 (85.1%) TaqMan assay-positive samples with loads ranging from 3.9 to 9.9 x 10(2) copies/ml blood. In the present study, the TaqMan assay detected more than 10(3) copies/ml blood of S. Typhi in all of the blood culture-positive samples, whereas less than 10(3) copies/ml blood of S. Typhi were detected in the blood culture-negative samples. Our findings suggest that a TaqMan assay may be useful for assessing S. Typhi loads, especially in cases of suspected typhoid fever with negative results from the standard blood culture test.

Bacteremia↗
PubMed2005

Typhoid fever complicated by multiple organ involvement: report of two cases.

Typhoid fever complicated by multiple organ involvement has been rarely mentioned in the literature. We reported two cases of typhoid fever with several unusual manifestations, including acute renal failure, acute hepatitis, acute pancreatitis, disseminated intravascular coagulation, and lower gastrointestinal bleeding. A renal biopsy in the first case showed no pathological change. Bone marrow biopsy showed focal necrosis of matrix, which might have been due to severe illness. A liver biopsy in the second case showed a predominantly histiocytic proliferation with occasional neutrophilic infiltration in the portal areas and hepatic sinusoids. Focal necrosis, bile duct injury, and multiple eosinophilic bodies were also noted. After appropriate antimicrobial therapy, both patients recovered without any sequelae. The potential of multiple organ involvement is highlighted in typhoid fever, which, on rare occasions, may occur simultaneously in the same patient.

Acute Disease↗
PubMed1976

Lethal complications of typhoid-cholera-vaccination. (Case report and review of the literature).

Simultaneous parenteral vaccination against typhoid and cholera lead to death through either anaphylactic shock or endotoxic shock in a 36-year-old male. At autopsy the charactertic features of shock as well as chronic interstitial myocarditis were noted. Moreover, fresh histiocytic and lymphocytic nodules were found in the liver, heart and meninges. A review of the literature dealing with lethal complications following parenteral tyhoid vaccinations shows an increased risk in debilitated persons (emaciation, stress, cold). Most of the fatalities occurred in persons who had previous disturbances of the cardiovascular system, as in the case reviewed here. Cardiac failure, Landry's paralysis, renal failure and disturbances of skin, joints and intestines may also follow typhoid vaccinations. However, these latter complications are usually not lethal. The patients presented here had many of the conditions which are known to aggravate the situation and to lead to a lethal culmination. The review of this case and the disucussion following it shows that only healthy persons should receive the parenteral typhoid vaccination. Hopefully, the presentation of this material will help prevent fatalities of this type in the future.

Adult↗
PubMed1983

Lyophilized typhoid vaccine for intradermal use.

The prophylaxis of typhoid fever in Romania is usually achieved with fluid heat-killed phenolized vaccine. However the shelf life of this vaccine is only two years. The long term storage of an intradermal typhoid vaccine is made possible by lyophilization. A heat-inactivated bacterial suspension with a high concentration of organisms, at least 25 X 10(9) cells per ml, was freeze-dried at a temperature not higher than 30 degrees C. The final vaccine obtained had a residual moisture content of not more than 5%. Active and passive protection tests in mice, specific agglutinin production in humans and rabbits, the innocuity and the toxicity for mice, and the investigation of post-vaccinal adverse reactions in man, showed that the lyophilized typhoid vaccine could be stored at 4 degrees C for at least five years without loss of potency. Consequently, the vaccine may be stored without risk of deterioration for rapid emergency mass immunization with Jet-injector apparatus.

Animals↗
PubMed1979

Association between hepatobiliary cancer and typhoid carrier state.

A case-control study of deceased typhoid carriers registered by the New York City Health Department between 1922 and 1975 was carried out to test for an association between the typhoid-carrier state and death due to hepatobiliary cancer. 471 carriers were matched with 942 controls for sex, age at death, year of death, borough in which the carrier died, and where they were born. The results show that chronic typhoid carriers die of hepatobiliary cancer six times more often than the matched controls and that this difference is significant (P less than 0.001) by simple chi2 test and by the Mantel-Haenszel method of chi2 for matched triples. Possible mechanisms for this association are discussed.

Adult↗
PubMed1981

Vi serology in the detection of typhoid carriers.

A new haemagglutination assay for Vi antibodies was evaluated in searches for symptom-free carriers of Salmonella typhi associated with sporadic cases of typhoid fever. The assay differs from previous ones in that a purified (instead of crude) Vi antigen from Citrobacter was used to sensitise the red blood cells. In ten sporadic outbreaks of typhoid stool culture identified seven enteric carriers of S. typhi among the patients' families or other close contacts. All seven carriers had Vi antibodies in titres ranging from 1:40 to 1:2560. Moreover, among thirty-seven stool-culture-negative contacts of patients, only one had Vi antibodies, in a titre of 1:10. Thus, the new assay for Vi antibodies was as sensitive and as specific as faecal culture in detecting symptom-free typhoid carriers. It could become a convenient screening test.

Adolescent↗
PubMed1984

Rapid diagnosis of typhoid fever by antigen detection.

Salmonella typhi antigen was demonstrated in the blood of patients with typhoid fever by a passive staphylococcal agglutination test. This test was positive in 10 culture-proven typhoid patients and negative in 10 febrile patients without typhoid.

Agglutination Tests↗
PubMed1994

Cancer mortality in chronic typhoid and paratyphoid carriers.

It has been shown in vitro that bacteria are able to form or release carcinogens, mutagens, or promoters from intestinal secretions such as bile, or from excretions such as urine. It is, therefore, of interest to find out whether chronic infection of the gallbladder is associated with carcinogens, as in chronic infection of the urinary bladder. A study of cancer risk in chronic typhoid and paratyphoid carriers showed a large excess (observed/expected cases) for cancer of the gallbladder (167.0; 95% confidence interval 54.1-389) and also excess risks of cancer of the pancreas (8.1), colorectum (3.0), lung (2.5), and all neoplasms (2.6). There was no similar excess risk in a group of 386 people with typhoid from the 1964 Aberdeen outbreak. This indicates that it is long-term typhoid carriage, not acute infection, which is the risk factor. This has important implications for cancer prevention. Eradication of chronic carriage, by use of antibiotics or elective cholecystectomy, should be re-emphasised, and the need for good documentation of carriers is, therefore, of great importance.

Adult↗
PubMed1985

Typhoid fever among Swedish visitors to Kos in 1983.

Seven cases of confirmed typhoid fever were discovered among 26 Swedish visitors to the Greek island of Kos in 1983. They had all stayed at the same hotel during the last week of June and the first week of July. During the same period 32 British visitors and 16 visitors from other Scandinavian countries who stayed at the implicated hotel also developed typhoid fever. By analysing questionnaires and by personally interviewing the Swedish visitors, a close association with the eating of salad at dinner on the 4th of July was found. As soon as the first Swedish case was discovered, a carrier among the hotel staff was suspected because it was known that one Swedish and one Finnish case of typhoid fever had been reported in 1981 and 1982 respectively, both patients having stayed at the implicated hotel.

Adult↗
PubMed1997

Plasma cytokines in paediatric typhoidal salmonellosis: correlation with clinical course and outcome.

We evaluated the clinical profile, outcome and serial plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) concentrations in 38 consecutive children (aged 6 months-14 years) admitted with culture-proven multidrug-resistant typhoid. All children received therapy for 14 days with either i.v. ceftriaxone or oral cefixime, with comparable outcome. Concentrations of IL-6 and TNF-alpha were significantly elevated in over 50% of the cases and correlated with clinical severity of illness as quantitated by the typhoid morbidity score. Sequential measurements revealed a significant decrease in IL-6 and TNF-alpha concentrations within 7 days of initiation of therapy (P<0.05). While no clear relationship was seen with time-to-defervescence, the failure rate was significantly higher in children with baseline serum IL-6 values >400 pg/ml (P<0.05). Our data suggest that plasma cytokine activity is frequently elevated in children with typhoidal salmonellosis, and IL-6 concentrations show a correlation with clinical severity and recovery from the illness.

Adolescent↗
PubMed1997

Typhoid fever in hospitalized children in Singapore.

A study was conducted to determine the clinical features and severity of typhoid fever in children admitted to the Communicable Disease Centre, Singapore. Over a 5 year period (1990-94), 40 children had documented culture-proven typhoid fever. Nine of the 40 children (22.5%) were below the age of 5 years. The predominant presenting symptoms were fever and diarrhoea. Pneumonia and ileus were the only complications observed. No patient in the series died. Ten Salmonella typhi isolates were multi-drug resistant. The majority of the children were treated with chloramphenicol and ceftriaxone. Typhoid fever appears to be a mild disease in Singapore children.

Child↗
PubMedDate not supplied

Correlates of psychiatric morbidity in typhoid fever in a Nigerian general hospital setting.

This study explored factors associated with psychiatric morbidity in typhoid fever in a Nigerian general hospital. Information such as sociodemographic characteristics, symptom manifestations, results of investigations, neuropsychiatric symptoms, outcome and disposal were obtained from the case files of patients admitted for typhoid fever over a period of six years. The patients with psychiatric morbidity conspicuous enough to be documented by the attending physicians-mostly internists-were compared with those with no documented psychiatric morbidity on sociodemographic and clinical indices. Of the 136 cases, 26 (19.1%) had psychiatric morbidity. This included delirium (73.1%), generalized anxiety disorder (3.8%), depressive episode (3.8%), schizophrenia like disorder (3.8%) and monosymptomatic neuropychiatric manifestations such as apathy, hallucinations and irrelevant talking (15.5%). The clinical and sociodemographic indices that were significantly associated with psychiatric morbidity were diarrhea, blood biochemical imbalance and age (P<.05). Adolescents and young adults were more predisposed to developing psychiatric complications. Some factors potentially associated with psychiatric morbidity in typhoid fever have been identified. There is the need to prospectively assess the burden from psychiatric morbidity and identify interventions that may reduce it.

Adolescent↗
PubMed2000

Emergency department presentations of typhoid fever.

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.

Abdominal Pain↗