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PubMed1977

Development of immune response during typhoid fever in man.

The development of both humoral and cell-mediated immune responses (CMIR) to antigens prepared from Salmonella typhi was investigated in patients suffering from typhoid fever. The antibodies were determined by the standard Widal test while the leucocyte migration test was used for CMIR. These immunological parameters were correlated with the duration of illness, the duration of chloramphenicol therapy and the severity of the illness. It was found that CMIR appeared after the first week of illness in uncomplicated cases of typhoid fever, where as it remained negative in the patients who had complications. The antibody titres were similar in the two groups. On further follow up of complicated cases, the clinical recovery coincided with the development of CMIR. It may be concluded that for recovery in typhoid fever CMIR is more important than antibodies.

Adult↗
PubMed1977

Reassessment of the Widal test in the diagnosis of typhoid.

The Widal test was done in 100 nontyphoidal febrile pients, 53 patients with proven typhoid, and in 61 patients with immunological disturbances in an are where typhoid is endemic. Salmonella typhi H or O agglutinin titers of 1:160 or more were seen in only 1% of nontyphoidal fevers. Using these criteria, the Widal test was of diagnostic value in 50 of 53 (94.3%) of patients with typhoid. The Widal test was positive in 85.7% of patients even in the first week of the illness, possibly owing to the hyperimmune state of the patients. A false-positive test was found in 11.5% of patients with major immunological disturbances in whom the Widal test must therefore be interpreted with caution.

Agglutination Tests↗
PubMed1995

Plasma endotoxin in typhoid fever.

Plasma endotoxin contents of the patients with sepsis or typhoid fever were measured by two sophisticated chromogenic limulus tests; Endospecy and Toxicolor tests. Endospecy test is the endotoxin-specific test and Toxicolor is responsible for both endotoxin and (1,3)-beta-D-glucan. Plasma was pretreated by our new PCA method which resolved the problem as to the detection of a lesser amount of plasma endotoxin when pretreated by the conventional PCA method. Although Toxicolor values have been reported to exceed more than the Endospecy value, under complicated pathophysiological situations, almost all specimens of these patients had a similar value, except in one expired septic shock case. In 18 typhoid fever cases, Salmonella typhi was isolated only from the bile in 5 cases, however endotoxemia occurred in 11 cases (61.1%). Within the first 4 days, the incidence of endotoxemia was higher (10/14, 71.4%). These results suggest that endotoxin assay seemed to be a useful tool for the diagnosis of typhoid fever.

Bacteremia↗
PubMed1997

Comparison of three operations for typhoid perforation.

BACKGROUND: Typhoid fever is a public health problem in the developing world and gut perforation remains the major complication with a high associated mortality rate. Even though most surgeons agree that elimination of peritoneal soilage and endotoxaemia by surgery offers the best hope of survival, the extent of surgery remains controversial. This prospective study compared the results of three operations for this condition. METHODS: A total of 64 patients with clinical suspicion of typhoid perforation were treated by one of three operations (simple closure, wedge excision and anastomosis or segmental resection and anastomosis) at this hospital. The management protocol was the same for the three groups. The risk of reperforation, mortality rate and duration of hospital stay were compared. RESULTS: The risk of reperforation and mortality rate were highest (two and 13 of 21 respectively) in patients who had wedge excision and lowest (zero and nine of 25 respectively) in those who had segmental resection. The risk of reperforation and mortality rate were zero and nine of 18 respectively in the simple closure group. CONCLUSION: Segmental resection seems to be the best treatment for typhoid perforation and is recommended for surgeons practising in a similar environment.

Adolescent↗
PubMedDate not supplied

An analysis of children with typhoid fever admitted in 1991.

In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at KEM Hospital, Bombay in 1991, initially one of the three recommended drugs (viz. chloramphenicol, amoxycillin or co-trimoxazole) was given for 7 days for defervescence to occur. In those who failed to respond, a second trial of therapy with one of the other two drugs was initiated, after omitting the first drug. A second failure of therapy was taken as an indication to use ciprofloxacin singly. Eventually, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Ciprofloxacin was used in 19(35.7%) cases. the failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4%, with co-trimoxazole 75% and 0% with ciprofloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical pointer to diagnosis, along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis who responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases, of which 5 (72%) were multidrug resistant S. typhi. There were no characteristic clinical features to identify multi-drug resistant typhoid fever.

Amoxicillin↗
PubMed1997

Typhoid perforation of small bowel: a study of 72 cases.

Typhoid perforation, a serious complication of typhoid fever, is still common in Third World countries and has a mortality rate between 1 and 39.3% according to various reports. There are different approaches to the treatment of typhoid perforation. Early surgical intervention with simple closure of the perforation in two layers has good results and negligible mortality. It is easy to perform and can be carried out, even by a trainee surgeon.

Adult↗
PubMed1976

[A comparative study of serum H-antibodies in typhoid patients and bacteria carriers].

A study was made of the dynamics of serum H-antibodies in typhoid patients depending on the period of the disease and the severity of its course; the blood sera of chronic carriers were examined as well. H-antibodies were determined in the indirect hemagglutination test with the use of erythrocyte H-dignoasticum. Antibodies of different physico-chemical nature (of IgG and IgM classes) were obtained by fractionation in columns with DEAE-cellulose. Results of the investigations showed that the titres of sum total serum H-antibodies failed to depend on the severity of the course of the disease. The maximum value of the mean geometrical titre of H-antibodies in the blood serum was determined on the 3rd-4th week from the onset of the disease. In chronic carriers the sum total H-antibody titres were greater than in typhoid patients. The serum H-antibody titres increased on account of IgG-globulins both in the typhoid patients and in carriers.

Adolescent↗
PubMed1997

The prognostic factors in typhoid ileal perforation: a prospective study of 50 patients.

To determine the prognostic factors in typhoid ileal perforation, a prospective study was carried out in 50 patients with typhoid ileal perforation confirmed at operation. Attention was paid to pre-operative and post-operative factors. The sex ratio was 4:1 in favour of male, with an age range of 7-42 years and a mean of 19.5 years. The age and sex had no effect on the prognosis. Late presentation, delay in operation, multiple perforations, and drainage of copious quantities of pus and faecal material from the peritoneal cavity adversely affected the incidence of faecal fistula and the mortality rate. The development of faecal fistula significantly affected the mortality rate. Early presentation, single perforation and moderate amounts of pus/faecal matter draining from the peritoneal cavity enhanced the development of wound infection, wound dehiscence and residual intra-abdominal abscess. Fourteen patients (28%) died, 50% of these within the first 5 post-operative days. Seventy-one per cent of the 14 died within 10 days. Thus, surviving for more than 10 post-operative days tends to give a better chance of recovery. In conclusion, this study has attempted to outline those factors with a strong effect on the progression and outcome of typhoid ileal perforation in Nigerian patients.

Adolescent↗
PubMed1998

[Evaluation of the Widal test for diagnosing typhoid fever in Lebanon].

Typhoid fever is a major public health problem in developing countries. In Lebanon, where the sanitary infrastructure was severely damaged during the civil war, the high prevalence of typhoid fever creates a pressing need for a rapid and reliable diagnostic tool. To evaluate the diagnostic usefulness of the Widal test, patients with a positive blood culture for Salmonella typhi (n = 78) were compared to controls with fever due to another infection (n = 65) and with blood donors (n = 96). Discrimination between the patient group and the two control groups was best when an agglutinin O titer of 1/160 or more was used. With this cutoff, sensitivity was 67.9%; specificity was 93.8% versus the febrile controls and 100% versus the blood donors. These results suggest that despite its well-known limitations the Widal test remains a valuable tool for typhoid fever control in many developing countries.

Antigens, Bacterial↗
PubMed1964

SEROLOGICAL RESPONSES OF MAN TO TYPHOID VACCINES.

Study of the serological responses in man to typhoid vaccines tested in several WHO-sponsored controlled field trials in British Guiana, Poland and Yugoslavia has not indicated any correlation between the level of Vi and O antibodies elicited and the effectiveness of the vaccines. Instead, the more effective vaccines have elicited significantly greater H-antibody responses; but a variety of factors suggests that it may in fact not be the antibody that confers immunity to the disease. The phagocytic test does not appear promising as a technique for determining the effectiveness of a typhoid vaccine, but passive protection of the chick-embryo may warrant further investigation.

Antibodies↗
PubMed1950

Chloramphenicol in the treatment of typhoid fever.

Six patients with typhoid fever were treated with chloramphenicol. The excellent clinical response in four cases suggests that chloramphenicol is the drug of choice in the treatment of this disease. In one case in which clinical relapse occurred, there was good response to re-treatment. One patient, critically ill, in a typhoid state, and treated late in the course of the disease, died without beneficial effect from chloramphenicol, but the patient had been unable to retain the drug because of vomiting.

Chloramphenicol↗
PubMed2002

Perforation of toxic megacolon in non-typhoid Salmonella enterocolitis spares young infants and is immune-mediated.

Intestinal perforation, a life-threatening complication of toxic megacolon (TM) following non-typhoid Salmonella infection, is relatively uncommon in infants less than 1 year of age. The situation, also found in typhoid fever, appears to be cytokine-mediated. This finding may justify immunotherapy for older children with TM associated with non-typhoid Salmonella infection in order to prevent this complication.

Age Factors↗
PubMed1999

In vitro evaluation of intracellular activity of antibiotics against non-typhoid Salmonella.

Non-typhoid salmonellae are the most common causative organisms of bacterial enteritis in children. Clinical studies have failed to show any influence of various antibiotics on the natural course of acute salmonella enteritis. Poor penetration of antibiotics into phagocytic cells that contain intracellular Salmonella spp., and possible intracellular antibiotic inactivation have been considered as possible reasons for this. In this study, we used an in vitro model to assess the intracellular activity of antibiotics against non-typhoid salmonellae. The survival of intracellular Salmonella spp. in P388D1 cells, a mouse macrophage cell line was measured in the presence of various antibiotics. Except for gentamicin, which entered phagocytes poorly, ofloxacin, azithromycin, chloramphenicol and three beta-lactam antibiotics, ampicillin, cefixime and ceftriaxone, exhibited bacteriostatic activity against susceptible intracellular Salmonella spp. at an extracellular concentration equal to the minimal inhibitory concentration (MIC). At a concentration of 10 x MIC, neither chloramphenicol nor the three beta-lactam antibiotics produced a bactericidal response; however, both ofloxacin and azithromycin were bactericidal after 8-24 h of incubation. The results showed that fluoroquinolones and new macrolides were more efficient than the other antibiotics in eradicating intracellular salmonella and might be useful agents for the treatment of non-typhoid salmonella enteritis in children. Clinical trials should be considered.

Animals↗
PubMed2005

Risk factors for bacteraemia and endovascular infection due to non-typhoid salmonella: a reappraisal.

BACKGROUND: Endovascular infections are rare complications of non-typhoid salmonellosis. The diagnosis is frequently not established until the infection is advanced. It is important to identify high-risk patients and treat them as early as possible. AIM: To identify risk factors for bacteraemia and endovascular infection in patients with non-typhoid salmonellosis. DESIGN: Retrospective study. SETTING: A single tertiary-care hospital in Taiwan. METHODS: Data were collected by retrospective chart review. Log-logistic regression modelling was used to identify independent risk factors for bacteraemia and endovascular infection. We analysed the characteristics of patients with gastroenteritis vs. those with bacteraemia, and of bacteraemic patients with vs. without endovascular infection. RESULTS: Between 1984 and 2004, there were 373 adult cases of non-typhoid salmonellosis. There were 76 intestinal Salmonella infections, 290 bloodstream infections (including 47 endovascular infections), and 7 extra-intestinal non-bacteraemic infections. The independent positive predictors of bacteraemia were systemic lupus erythematosus, liver cirrhosis, HIV infection, and solid organ cancers. The only independent positive predictor of endovascular infection was atherosclerosis. The independent negative predictors of endovascular infection were solid organ cancers and immunodeficiency. DISCUSSION: Risk factors for atherosclerosis predisposed our patients with bacteraemia to endovascular infection. Although immunodeficiency predisposed patients to bacteraemia, it was associated with a low incidence of endovascular infection.

Adult↗
PubMed1987

Contribution of Salmonella gallinarum large plasmid toward virulence in fowl typhoid.

Four strains of Salmonella gallinarum isolated from independent cases of fowl typhoid all possessed both an 85-kilobase and a 2.5-kilobase plasmid. Each plasmid was eliminated in turn from one of the strains by transposon labeling and curing at 42 degrees C. Elimination of the small plasmid had no effect on the high virulence of the strain for newly hatched and 2-week-old chickens. Whereas oral inoculation of 2-week-old chickens with the parent strain produced 90% mortality with characteristic signs of fowl typhoid, inoculation of the large-plasmid-minus strain produced 0% mortality. A corresponding increase in the 50% lethal dose from log10 1.1 to greater than log10 7.3 was seen with the large-plasmid-minus strain after intramuscular inoculation. Reintroduction of the large plasmid completely restored virulence. A role for the plasmid-linked virulence genes in both invasion and growth in the reticuloendothelial system is suggested by the failure of the large-plasmid-minus strain to penetrate to the liver and spleen after oral inoculation and by its increased clearance from the reticuloendothelial system after intravenous inoculation. These results clearly demonstrate that the large plasmid of S. gallinarum contributes toward virulence in fowl typhoid of chickens.

Animals↗
PubMedDate not supplied

Predictors for extraintestinal infection of non-typhoidal Salmonella in patients without AIDS.

To identify the risks and predictors for extraintestinal infection (EII) in patients with non-typhoidal salmonellosis, we undertook a study of 398 patients with cultures positive for non-typhoidal Salmonella seen at Chang Gung Memorial Hospital and Chang Gung Children's Hospital between November 1993 and October 1994. Salmonella choleraesuis was the most invasive serotype observed. S. panama, S. typhimurium and S. schwarzengrund were the commonest causes of EII among those serotypes usually causing gastroenteritis. Pre-existing underlying disease, particularly immunosuppressive disease, was the most important risk factor that may have predisposed adult patients to have EII. Old age (> or = 60 years) and isolation of invasive serotypes were also frequently associated with EII in adult patients. The characteristics of paediatric patients with a high probability of having EII were: < 3 years of age, abnormal blood test results (a leucocyte count > or = 15,000/mm3 or < 5000/mm3, immature leucocytes > or = 10% of total leucocytes, and a C-reactive protein concentration > or = 50 mg/l); and isolation of invasive serotypes. This information can be an aid to early diagnosis and treatment of EII caused by non-typhoidal Salmonella.

Adolescent↗
PubMed1975

[Possibility of the occurrence of the Shwartzman phenomenon during administration of a reacting dose of typhoid antigen through the respiratory tracts].

This work is devoted to the study of possible vaccinal complications of Schwartzmann's phenomenon type following subcutaneous injection to rabbits, sensitized by typhoid antigen, of a reacting dose of the same antigen through the respiratory tracts. The reacting dose of the antigen of 0.5; 1.0, 1.5 ml was injected to the rabbits in the form of a dry and liquid aerosol intratracheally intrapulmonary and subcutaneously. Animals to which the reacting dose of the same antigen (0.1; 0.25; 0.5; 1.0 mg) was injected intravenously served as control. Local Schwartzmann's phenomenon was reproduced after administration of all the reacting doses of typhoid antigen tested by intravenous method only. Administration of the reacting dose of the same antigen through the respiratory tracts failed to produce local Schwartzmann's phenomenon, this pointing to the difference in the reaction of rabbit organism sensitized with typhoid antigen to the administration of a reacting dose of the same antigen through the respiratory tracts, in comparison with the intravenous method.

Aerosols↗
PubMedDate not supplied

Study of outer membrane proteins (OMPS) and their role in co-modulation of resistance in non typhoidic Salmonella strains isolated in Iaşi.

OBJECTIVES: To characterize the OMP profile and to study the possible interference with other resistance determinants. MATERIAL AND METHODS: 16 non-typhoidic Salmonella strains, isolated in 1999 from stools of pediatric patients, were selected according to their resistance phenotype: resistance to Ampicillin (AMP), Amoxycillin/Clavulanic Acid (AMC), and third generation cephalosporins: Ceftriaxone (CRO) and Ceftazidime (CAZ). Identification and sensitivity testing were done by DADE MicroScan System. beta-Lactamases were characterized by isoelectric focusing (IEF) with preformed minigelss. OMPs were studied on membrane preparations on SDS-urea gels. RESULTS: Isoelectric points: Majority of the isolates had the association 5.4 +/- 7.6 (3/16) or 5.4 + 8.2 (6/16). The second beta-lactamase has the capacity to hydrolyse CAZ. We found three different patterns of OMPs: I: 30, 29 and 25 kDa; II: 30, 26 and 24 kDa; III: 30 and 25 kDa. We couldn't find any correlation between the OMPs profile and resistance phenotype, showing that the beta-lactamase production is the only resistant determinant. CONCLUSIONS: The study shows the high frequency of extended-spectrum beta-lactamases (ES beta LA) amongst the non-typhoidic Salmonella; association of TEM type and ES beta LA enzymes diminishes considerably the therapeutic resources: inhibitor associated combinations are non effective. In non-typhoidic Salmonella, porins seems to have no influence in co-modulation of resistance.

Anti-Bacterial Agents↗