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PubMed1985

Coagglutination and counter immunoelectrophoresis in the rapid diagnosis of typhoid fever.

The efficacy of two methods--coagglutination (COAG) and counter immunoelectrophoresis (CIE)--in the rapid diagnosis of typhoid fever was studied in parallel with blood and clot cultures on 114 clinically suspected cases. Retrospective analysis showed that only 58 eventually were discharged and had typhoid fever. Antigen detection on their sera was done by both methods, concomitant with antigen detection on culture supernates by CIE. Sera from 50 controls were subjected to both tests. Agglutinating anti-serum being unsatisfactory in the CIE system, anti-serum to the LPS fraction of Salmonella typhi "O" 901 was used in both tests after absorption with Escherichia coli and Salmonella paratyphi A. Analysis of data with reference to retrospectively confirmed typhoid cases show that S. typhi was isolated in 58.6% and 58.3% of blood and clot cultures; antigen detection by CIE in their supernates was 81.1% and 79.2%, respectively. This correlated closely with serum COAG (81.0%) in contrast to serum CIE (5.7%). Thus, COAG was superior to CIE for serology. However, CIE done on culture supernates precludes such tedious procedures as absorption of staphylococcal agglutinins and the confirmatory blocking test.

Agglutination Tests↗
PubMed1993

Typhoid fever in Ethiopian immigrants to Israel and native-born Israelis: a comparative study.

Typhoid fever remains a major cause of mortality in developing countries, with a case-fatality rate (CFR) of 12%-32%, whereas in developed countries this rate has successfully been reduced to < 2%. The cause of this high CFR in developing countries was investigated by studying two populations of patients who had typhoid fever during the years 1984-1985: Ethiopian Jews who were infected in Africa (a region with a high CFR) and treated in Israel (a region with a low CFR) and native-born Israelis. The causative organisms were of similar phage types. Among 121 Ethiopian Jews there were two fatalities (CFR, 1.65%), and among 204 native-born Israelis there were three fatalities (CFR, 1.47%). Findings of the clinical course and treatment were similar for 15 Ethiopian Jews and 14 native-born Israelis and consistent with those of reports from developed countries. We conclude that the high CFR for typhoid fever in Africa is due to delayed hospitalization and treatment rather than to differences in host factors or in the virulence of the pathogen and that mortality can be reduced by hastening hospitalization and treatment.

Adolescent↗
PubMed1994

Rapid serodiagnosis of typhoid fever by dot enzyme immunoassay in an endemic area.

A dot enzyme immunoassay (EIA) using 50-kD outer-membrane proteins (OMPs) of Salmonella typhi was compared with the Widal test for the serodiagnosis of typhoid fever in 109 febrile children admitted to a hospital in an endemic area. In the culture-positive typhoid group, the initial dot EIA was positive in 40 of 42 cases and the initial Widal test was positive in 41. In the culture-negative clinical typhoid group, both the dot EIA and the Widal test were positive in 17 of 18 cases. In the nontyphoidal fever group, the dot EIA was negative in all of 49 cases and the Widal test was negative in 44. With culture used as the gold standard, the dot EIA is as sensitive as the Widal test (95% vs. 98%), has a similar high negative predictive value (96% vs. 98%), and is more specific (75% vs. 67%). In addition, the dot EIA offers the advantages of simplicity, speed, early diagnosis, economy, and flexibility (i.e., other diagnostic tests can be conducted simultaneously).

Antigens, Bacterial↗
PubMed1997

Characteristics of typhoid fever in children and adolescents in a major metropolitan area in the United States.

To examine the epidemiology of typhoid fever in children in an area that was not endemic, we analyzed 55 cases of typhoid fever in children and adolescents who were < or = 18 years and whose cases were reported to the Chicago and suburban Cook County Health Departments over 7 years. Cases had positive blood and/or stool cultures for Salmonella typhi. The ethnic distribution of the patients was as follows: 25% Asian, 22% Hispanic, 15% African American, 9% Caucasian, 18% other, and 11% unknown. Of the 55 cases, 35% were aged 0-5 years, 25% were aged 6-10 years, 31% were aged 11-15 years, and 9% were aged 16-18 years. Twelve patients did not have a history of travel. All patients recovered; none became carriers. Symptoms in 41 patients whose charts were available for review included fever (100%), diarrhea (77%), vomiting (50%), and dehydration (30%). Bacteremia was documented in 27 (66%) of 41 cases. In 17 of 41 cases, the household contacts were food handlers or health care workers. Eight (31%) of 26 isolates were resistant to both ampicillin and trimethoprim-sulfamethoxazole. The findings in our study were as follows: typhoid fever occurred frequently in children aged 0-5 years (in contrast with reports from areas of endemicity), approximately 20% of patients did not have a history of travel, and multidrug-resistant strains were prevalent.

Adolescent↗
PubMedDate not supplied

Selective primary health care: strategies for control of disease in the developing world. XX. Typhoid fever.

The incidence of typhoid fever remains unacceptably high in developing countries. Because Salmonella typhi is disseminated by carriers, there is an urgent need to increase the rate of detection of carriers and to decrease the risk they pose to their communities. In urban areas where sewage disposal is lacking or inadequate, public water supplies are contaminated and typhoid fever is common. The contamination of food by carriers is the second commonest route of infection. Water purification processes lead to a rapid decline in the incidence of the disease; thus, many developing countries hope to develop pure water supplies for all citizens by the end of this century. Until this important public health goal is achieved, the use of vaccine, especially in children, could cause a significant decrease in the incidence of typhoid fever. A new oral attenuated vaccine promises to be effective and safe.

Age Factors↗
PubMed1977

Typhoid fever in the United States associated with the 1972-1973 epidemic in Mexico.

In 1972 and 1973 a nationwide outbreak of typhoid fever occurred in Mexico. The responsible strain of Salmonella typhi had a characteristic pattern of phage lysis, resembling the type A pattern, referred to as degraded Vi(A), and was resistant to chloramphenicol and other antimicrobial agents in vitro and in vivo. Eighty cases of infection with strains of S. typhi that were related to the Mexican epidemic strain were reported in the United States. The epidemic in Mexico subsided in mid-1973, and no further cases of typhoid fever due to chloramphenicol-resistant organisms were reported in the United States. Infections with chloramphenicol-sensitive strains of S. typhi with the phage lysis pattern of degraded (Vi(A) occurred in association with travel in Mexico before and after the height of the epidemic in Mexico. Although typhoid fever due to chloramphenicol-resistant organisms has not been reported in the United States since the subsidence of the Mexican epidemic, testing of isolates of S. typhi for antibiotic sensitivity is recommended because of the continued existence of resistant strains elsewhere.

Adolescent↗
PubMed1991

Three-day treatment of typhoid fever with two different doses of ceftriaxone, compared to 14-day therapy with chloramphenicol: a randomized trial.

Fifty-nine adult Filipino patients suffering from typhoid fever documented by blood culture were randomly allocated to one of three different drug regimens. Nineteen patients received 3 g ceftriaxone iv once daily for three days. Twenty patients received 4 g ceftriaxone iv once daily for three days and 20 patients received oral chloramphenicol 3 g daily in divided doses for two days followed by 2 g daily for 12 days. Eighteen patients were cured (95%) with 3 g of ceftriaxone for three days. All patients receiving 4 g ceftriaxone per day for three days or chloramphenicol for 14 days were cured. In the ceftriaxone groups two patients developed typhoid fever 30 and 45 days respectively after completion of treatment and one further patient had evidence of reinfection. Three patients relapsed within 15 to 17 days in the chloramphenicol group. Fever subsided in most patients between six and eight days, with three patients having a prolonged and moderate fever for 11 days in the ceftriaxone groups. This study suggests that a short treatment of three days of typhoid fever with ceftriaxone (3 or 4 g once daily) is adequate and not hazardous as far as relapses are concerned.

Adolescent↗
PubMed1986

The Widal slide agglutination test, a valuable rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital of Jakarta.

The Widal slide agglutination test was evaluated as a rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital, Jakarta, Indonesia from 1980-1982. The results of the test can be available within 45 minutes of patient admission. The study showed that, among 229 patients with Salmonella typhi-positive typhoid fever and 179 control fever patients, when the Widal O antibody titer was greater than or equal to 1:20 the sensitivity was 53%, the specificity 98%, the positive predictive value 96%, and the negative predictive value 68%. A negative Widal test (O antibody titer less than 1:20) does not provide useful information, but when the O antibody titer is greater than or equal to 1:20 the clinician at the Infectious Diseases Hospital of Jakarta can be 96% certain that the patient has typhoid fever.

Adolescent↗
PubMed2001

Typhoid fever: pathogenesis and disease.

Typhoid fever is an infectious disease of global distribution. Although there is a wealth of data on Salmonella typhimurium infection in the mouse and the interaction of this serovar with human cell lines in vitro, there is a relatively small amount of data on S. typhi and the pathogenesis of typhoid fever. In this review we focus on three areas: adherence to and invasion of gut epithelial cells, dissemination to systemic sites, and survival and replication within host cells. In addition, we attempt to put current salmonella research into the context of typhoid fever.

Bacterial Adhesion↗
PubMed1979

Typhoid fever in children: a forgotten disease?

All indexed cases of typhoid fever occurring in children over a ten-year period in Jacksonville, Fla, were studied retrospectively. This review revealed that anorexia was the most common gastrointestinal complaint and that neurologic symptoms and signs were nearly as common as gastrointestinal signs. There was a significant delay in diagnosis in most cases because typhoid fever was not included in the differential diagnosis upon admission. This is probably due to the decline in the incidence of typhoid fever in the United States and the resultant lowering of the index of suspicion for the disease on the part of physicians in general. Representative cases are presented in detail.

Adolescent↗
PubMed1997

Chronic typhoid carriage and carcinoma of the gallbladder.

Chronic microbial infections and/or their carrier state have been reported to be associated with particular cancers. Since typhoid infections and carcinoma of the gallbladder (the site where salmonella usually persists) are endemic in northern India, it was considered important to explore the relationship between the two. In the present study, a total of 1001 bile specimens collected from cases of carcinoma of the gallbladder (28), cholelithiasis (56) and individuals without biliary pathology (17) were subjected to aerobic cultures that had been enriched for salmonella. Salmonella typhi and S. paratyphi-A could be detected in a significantly higher (P < 0.05) number in patients with carcinoma of the gallbladder as compared with cholelithiasis and control groups. The existence of such an association indicates that detection and eradication of typhoid carriers may lead to a decrease in the incidence of carcinoma of the gallbladder along with typhoid fever.

Bile↗
PubMed2004

Validation of a PCR for diagnosis of typhoid fever and salmonellosis by amplification of the hilA gene in clinical samples from Colombian patients.

Validation of a PCR test to detect hilA gene sequences of Salmonella spp. was performed in blood and faeces samples from typhoid fever and salmonellosis patients. Sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the PCR in blood samples were performed by testing: 37 patients with clinical diagnosis of typhoid fever, 34 of them confirmed by isolation of S. Typhi from blood cultures; 35 patients infected with other pathogens corroborated by blood culture (Klebsiella pneumoniae, 9; Serratia marcescens, 5; Escherichia coli, 4; Pseudomonas aeruginosa, 9; Providencia alcalifaciens, 4 and Enterobacter cloacae, 4) and blood samples from 150 healthy volunteers. To evaluate S, SP, PPV and NPV of the PCR in faeces samples we studied: 34 patients with enteritis due Salmonella spp. (S. Typhimurium, 21; S. Enteritidis, 9; S. Choleraesuis, 3 and S. Agona, 1); faeces samples from 35 patients with enteric infection due to Shigella sonnei (8), Shigella flexneri (10), enteropathogenic E. coli (12), Aeromonas hydrophila (5) and faeces samples from 150 healthy volunteers. The S, SP, PPV and NPV of the PCR in blood samples were all 100 %. PCR detected three patients with clinical diagnosis of typhoid fever and negative blood cultures. In faeces samples, S was 97 %, SP 100 %, PPV 100 % and NPV 99 %. The lowest number of c.f.u. ml(-1) detected by PCR in blood samples was 1 x 10(1) and in faeces samples 4 x 10(2).

Bacterial Proteins↗
PubMed2005

Epidemiology of typhoid carriers among blood donors and patients with biliary, gastrointestinal and other related diseases.

Enteric fever due to Salmonella Typhi is a major public health problem. Typhoid carriers have high titres of Vi agglutinins in their sera. We worked out the baseline data for Vi agglutinins from 705 healthy blood donors (controls) by ELISA and compared it with 446 patients with biliary, gastrointestinal and other related diseases (cases). The samples were divided into five groups based on the disease condition of the patients from whom they were collected. Group A (n=196) consisted of patients with stones in the gall bladder/common bile duct and Group B (n=27) with gall bladder carcinoma. Group C (n=33) comprised patients with carcinoma of the pancreas/ampulla, obstructive jaundice and/or cholangiocarcinoma. Group D (n=112) had patients with acute/chronic pancreatitis, abdominal pain, intestinal obstruction, peritonitis, carcinoma oesophagus, chronic diarrhoea, gastrointestinal bleeding and dyspepsia. Group E (n=78) included patients with miscellaneous diseases. The mean absorbance value obtained for healthy subjects +3 standard deviations was taken as the cut-off value for a positive typhoid carrier. In Group A, 10.2% samples were positive; in Group B, 7.4%; in Group C, 12.0%; in Group D, 9.8% and in Group E, 9.0%. There was a highly significant (P <0.001) increase in the presence of Vi agglutinins in the cases compared to the controls. High prevalence of typhoid carriers occurs in patients with biliary, gastrointestinal and other related diseases. Vi serology employing highly purified Vi antigen offers a practical and cost-effective way of screening for S. Typhi carriers.

Adolescent↗
PubMed1992

Determination by Widal agglutination of the baseline titre for the diagnosis of typhoid fever in two Nigerian states.

This study was carried out in Borno and Plateau States of Nigeria to determine the baseline titre for the diagnosis of typhoid fever using a single Widal test. Of 172 patients with symptoms and signs of typhoid fever, 92.4% and 90.7% had reciprocal O and H antibody titres respectively of 160 or above. On the other hand, 95.3% and 66.3% of the 937 healthy control subjects had reciprocal O and H antibody titres respectively of 80 or less. The results of this study suggest that in Borno and Plateau States of Nigeria a reciprocal O antibody titre of 160 and above in persons with illness whose symptoms and signs are compatible with typhoid fever could be considered diagnostic using the single Widal test.

Adolescent↗
PubMed1993

Usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas.

Data are presented for 2382 children investigated for fever in a Malaysian hospital between 1984 and 1987 when Widal tests and blood cultures were a routine part of every fever screen. There were 145 children who were culture positive (TYP-CP) for Salmonella typhi, while 166 were culture negative but were diagnosed as having typhoid (TYP-CN). Analyses of the sensitivity and specificity of combinations of initial Widal titres in predicting a positive S. typhi culture in a febrile child (culture positive vs the rest) showed the best model to be an O- and/or H-titre of > or = 1 in 40 (sensitivity 89%; specificity 89%). While the negative predictive value of the model was high (99.2%) the positive predictive value remained below 50% even for very high titres of O and H (> 1 in 640), at which point the specificity was 98.5%, supporting the clinical view that a high proportion of the TYP-CN patients really were typhoid but were missed by culture. The TYP-CN patients showed a very similar clinical and age profile to TYP-CP patients. The length of history of fever did not affect the initial Widal titre in culture positive cases. The Widal test in children remains a sensitive and specific 'fever screen' for typhoid although it will not identify all cases. In children, lower cut-off points for O- and H-titres should be used than are generally recommended.

Agglutinins↗
PubMed1997

Typhoid enteric perforation.

BACKGROUND: Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery in managing these patients needs to be assessed. METHODS: The records of 110 cases of typhoid enteric perforation treated at JLN Hospital, Ajmer between 1990 and 1995 were reviewed. RESULTS: A total of 42.7% of the patients were in the 21-30-year age group, and 83.6% were male. All patients presented with the classic features of typhoid enteric perforation. A total of 83.6% were operated on within 36 h of perforation. Surgical management consisted of primary closure of the perforation (74.5%), closure with omental graft (14.5%), resection and anastomosis (3.6%), and only drainage (7.3%). A total of 79.1% of patients developed wound infection and 10% of patients developed faecal fistula. The overall mortality rate was 16.4%. Increasing the time interval between perforation and operation significantly increased the mortality (P < 0.05). The mortality was least with early primary closure of the perforation. Patients with postoperative faecal fistula had higher mortality rates (P < 0.001). CONCLUSIONS: Early limited surgery with thorough peritoneal lavage provides optimal results, faecal fistula is a grave complication, and the use of the McBurney incision may provide better results in terms of subsequent wound healing.

Adolescent↗
PubMed2001

[Two cases of typhoid fever with reduced susceptibility to fluoroquinolones].

Two separate febrile Indian patients who reside in Japan and had recently returned from their country were diagnosed as suffering from typhoid fever. Fluoroquinolone therapy was clinically ineffective and the addition of a third-generation cephalosporin was required in each case. Each strain of Salmonella Typhi was resistant to nalidixic acid in vitro and also showed higher minimal inhibitory concentration to other quinolones than usual susceptible strains. Similar cases of typhoid fever responding poorly to quinolone treatment have been observed in the Indian subcontinent, south-east Asia and central Asia since the early 1990s, and potential spread by travelers into Japan is of serious concern. Although quinolones still remain the drugs of choice for treatment of typhoid fever, physicians should be aware of the possibility and implications of clinical treatment failure.

Adult↗
PubMed2006

Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever.

Isolates of Salmonella enterica serovar Typhi that are multidrug resistant (MDR, resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) and have reduced susceptibility to fluoroquinolones (nalidixic acid resistant, Na(r)) are common in Asia. The optimum treatment for infections caused by such isolates is not established. This study compared different antimicrobial regimens for the treatment of MDR/Na(r) typhoid fever. Vietnamese children and adults with uncomplicated typhoid fever were entered into an open randomized controlled trial. Ofloxacin (20 mg/kg of body weight/day for 7 days), azithromycin (10 mg/kg/day for 7 days), and ofloxacin (15 mg/kg/day for 7 days) combined with azithromycin (10 mg/kg/day for the first 3 days) were compared. Of the 241 enrolled patients, 187 were eligible for analysis (186 S. enterica serovar Typhi, 1 Salmonella enterica serovar Paratyphi A). Eighty-seven percent (163/187) of the patients were children; of the S. enterica serovar Typhi isolates, 88% (165/187) were MDR and 93% (173/187) were Na(r). The clinical cure rate was 64% (40/63) with ofloxacin, 76% (47/62) with ofloxacin-azithromycin, and 82% (51/62) with azithromycin (P = 0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with ofloxacin-azithromycin (7.1 days [6.2 to 8.1 days]) and ofloxacin (8.2 days [7.2 to 9.2 days]) (P < 0.001). Positive fecal carriage immediately posttreatment was detected in 19.4% (12/62) of patients treated with ofloxacin, 6.5% (4/62) of those treated with the combination, and 1.6% (1/62) of those treated with azithromycin (P = 0.006). Both antibiotics were well tolerated. Uncomplicated typhoid fever due to isolates of MDR S. enterica serovar Typhi with reduced susceptibility to fluoroquinolones (Na(r)) can be successfully treated with a 7-day course of azithromycin.

Adolescent↗