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PubMed1985

Typhoid enteric perforations.

Forty-five cases of typhoid enteric perforation are presented. The disease was most common in young males. Half of the perforations occurred during the second week of fever. Diagnosis was mainly clinical, supplemented by radiological evidence of pneumoperitoneum and confirmed at laparotomy by the presence of perforations in the terminal ileum. Laboratory investigations including Widal perforations in the terminal ileum. Laboratory investigations including Widal test and blood culture were of little value. All the 45 were managed operatively by simple closure of the perforation(s) and drainage of the peritoneal cavity. Burst abdomen occurred in 9 per cent and fecal fistula in 20 per cent. Overall mortality was 11 per cent--much lower than that reported in the literature in case of management of typhoid enteric perforations.

Adolescent↗
PubMedDate not supplied

Rapid diagnosis of typhoid fever.

A Reverse Passive Haemagglutination Test (RPHA) was designed for the detection of Salmonella typhi antigen and rapid diagnosis of typhoid fever. Two per cent fresh sheep RBC's were coated with 32 micrograms/ml of immunoglobulin. The minimal detectable level of the antigen was 1250 micrograms/ml. Cross reactions were observed with the samples of patients suffering from Salmonella paratyphi A and pseudomonas infections. The RPHA established was used for the detection of S. typhi antigen in culture broths from 100 patients with clinically suspected typhoid fever with culture and/or widal positive, 50 patients with septicemia caused by bacteria other than S. typhi and 50 normal, afebrile healthy controls. It was found that the sensitivity and specificity of this assay was 70% and 92% respectively.

Antigens, Bacterial↗
PubMed1998

Typhoid intestinal perforations in Nigerian children.

This study was a retrospective analysis of 75 children with perforated typhoid enteritis treated at the Baptist Medical Centre in Ogbomoso, Nigeria over a 4-year period. The mean age was 11.4 years. The usual symptoms were fever and abdominal pain, with a mean duration of 10.5 days. The diagnosis of perforation was usually based on the history and physical examination alone. The time interval from hospital presentation to operation was 11 hours, during which intravenous crystalloid and antibiotics were administered. Among the 75 children, 53 (71%) had a single perforation, and 22 had multiple perforations. Débridement and two-layered closure was performed in 71 (95%) and resection with anastomosis in 4 (5%). Ileus resolution was usually not complete until the eighth postoperative day, and the mean time until the surviving children were afebrile was 10 days. Complications other than death occurred in 7 (9%) children, and there were 15 deaths (20% mortality). All deaths were attributed to overwhelming sepsis, and all but one of the deaths occurred during the first 72 postoperative hours. The only factor statistically significant as a predictor of mortality was the duration of abdominal pain. Improvement in perioperative management including intensive care nursing and more effective antibiotics, although expensive, could result in decreased mortality. A significant decrease in mortality can occur only when the prevention of typhoid fever becomes a higher priority than its treatment.

Child↗
PubMed1999

Skip colonic ulceration in typhoid ileo-colitis.

Colonic skip lesions are typically described in Crohn's colitis, but this phenomenon has been recognized in ulcerative colitis (skipped appendiceal involvement), Behcet's colitis, cytomegaloviral colitis, and even in Aeromonas hydrophilia and Histoplasma capsulatum infection. However, skip lesions in typhoid ileo-colitis have not been reported in the English-language literature. We report herein a patient with skip ulcers due to typhoid fever.

Adult↗
PubMed2003

Current trends in typhoid Fever.

Typhoid fever, a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality. Endemic cases in the United States are unusual, with most following foreign travel to the Indian subcontinent, Africa, Asia, or Latin America. The classic findings of typhoid fever include rose spots, relative bradycardia, and stepwise fevers, but unfortunately these signs are frequently absent. Gastrointestinal manifestations may include diffuse abdominal pain, bleeding, perforation, cholecystitis, and cholangitis. The diagnosis should be suspected after collection of the appropriate clinical and travel history with confirmation by blood or bone marrow culture. Novel methods are in development to establish the diagnosis when cultures are negative or unavailable. Multidrug resistance has increased worldwide, and decisions on antimicrobial therapy must take such resistance into account. The empiric treatment of choice is a fluoroquinolone drug; ceftriaxone and azithromycin are alternatives. Preventive strategies include good sanitation and food handling practices along with vaccination of selected groups.

Humans↗
PubMed1989

Perforated typhoid enteritis: operative experience with 108 cases.

A retrospective review of 108 consecutive patients with perforated typhoid enteritis managed operatively over a 4-year period at Baptist Medical Centre, Ogbomoso, Nigeria is presented. There were 75 males and 33 females with an average age of 19.7 years. Presenting symptoms were fever, abdominal pain, vomiting, and either diarrhea or constipation. One hundred patients (93 percent) underwent debridement of the perforation and two-layer bowel closure. Postoperative morbidity included intraabdominal abscess, wound dehiscence, and subsequent bowel perforation. Most of the 35 deaths (32 percent mortality) were attributed to overwhelming sepsis which progressed despite aggressive operative management and antibiotic administration. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.

Adolescent↗
PubMed1988

Haemoglobinuric renal failure and typhoid fever.

Three patients with typhoid fever, initially misdiagnosed, developed intravascular haemolysis, disseminated intravascular coagulation, haemoglobinuria and acute renal failure. 2 of the patients were deficient in erythrocyte glucose-6-phosphate dehydrogenase; Plasmodium falciparum was present in the blood of the third. Among the indigenous population of endemic areas, typhoid fever is the likely diagnosis in any pyrexial illness associated with haemoglobinuric renal failure.

Acute Kidney Injury↗
PubMedDate not supplied

Hydrocortisone in chloramphenicol-treated severe typhoid fever in Papua New Guinea.

We investigated the effect of hydrocortisone on mortality and complications in chloramphenicol-treated severe typhoid fever (STF) in Goroka, Papua New Guinea. Of 374 culture-positive patients, 146 formed a retrospective comparison group, of whom 41 had STF. Of 228 patients in the intervention group, 58 had STF. Patients without STF had low mortality (2.5%) with standard treatment. In the intervention group, hydrocortisone was used in two dosage schedules, 100 mg for 12 doses (23 patients) and 400 mg for 12 doses (23 patients). There was no difference in mortality between steroid-treated and comparison STF patients (44.8% versus 43.9%) or in complications, and we conclude that moderate doses of steroids are not beneficial in severe typhoid fever.

Adult↗
PubMedDate not supplied

Factors reducing mortality in typhoid ileal perforation.

A retrospective study of 42 patients treated surgically for typhoid ileal perforation found the mortality to be 24%. The study suggested that general peritonitis was the main cause of death in typhoid ileal perforation. However, the high mortality was significantly improved by adequate preoperative rehydration. The combination of chloramphenicol/gentamicin/metronidazole was superior to other antibiotic regimes. No mortality was recorded with this triple drug therapy.

Adolescent↗
PubMed1990

Specific immune response in humans following rectal delivery of live typhoid vaccine.

The specific immune responses to the live vaccine Salmonella typhi Ty21a following rectal administration were determined in serum, peripheral blood lymphocytes, saliva and in jejunal fluid of adult human subjects. Following vaccination, all seven subjects had a detectable anti-typhoid IgA antibody response using their peripheral blood lymphocytes (p = 0.009). Significant rises in postvaccination anti-typhoid IgA antibody were observed in the jejunal fluid (p = 0.033), serum (p = 0.010) and saliva (p = 0.050) of these subjects. This study confirms that the normal rectal mucosa is an efficient route of entry to the systemic immune system for microbial agents, and therefore may provide a further possible route of immunization with attenuated bacterial vaccines.

Administration, Rectal↗
PubMed1993

Studies of safety, infectivity and immunogenicity of a new temperature-sensitive (ts) 51-1 strain of Salmonella typhi as a new live oral typhoid fever vaccine candidate.

This report describes the results of a phase 1 study evaluating the safety, infectivity, and immunogenicity of a new live oral Salmonella typhi temperature-sensitive (ts) 51-1 typhoid fever vaccine in the human. Three normal male subjects aged 23-32 years received three oral doses of S. typhi ts 51-1, each dose containing 10(9) organisms. Prior to and following immunization each subject was carefully monitored by clinical and laboratory parameters over a 2 week period during which serial specimens of blood and stool were analysed for the presence of the organism. Blood specimens were also obtained for the determination of serum antibody and cell-mediated immune responses and stool filtrates were analysed for the development of coproantibody. The results of these studies indicate that: (1) the vaccine is well tolerated with no clinical or laboratory evidence of adverse reactions; (2) ts 51-1 was detected in only one stool specimen from one volunteer; the organism recovered displayed characteristics of the ts 51-1 vaccine strain; and (3) although no significant humoral or cell-mediated lymphocytotoxic immune responses were detected in the blood, coproantibody was detected in stool specimens from all of the three immunized subjects and IgA-armed ADCC activity was detected in two of three subjects. These studies indicate that S. typhi ts 51-1 may be a suitable strain for the development of an improved oral typhoid fever vaccine. Studies are in progress to determine optimal methods of vaccine delivery preparatory to large phase 2 studies of efficacy.

Administration, Oral↗
PubMed1989

The Hobart typhoid epidemic of 1887-88.

Typhoid fever records for Hobart during the nineteenth century are examined and the summer of 1887/88 identified as the second year of a 5-year epidemic cycle. Three factors are used to explain the change from endemic to epidemic typhoid in the 1880s. Firstly, there was a sequence of hot, dry summers that affected water quality and the amount of water available for the cleansing of the street gutters. Secondly, there were changes to the system of disposal of excrement from cesspits to poorly organized pail and single-pan schemes which led to the causal disposal of sewage in the street gutters. Thirdly, the population increase of the 1880s followed 25 years of stagnation and led to overcrowding in existing, often deteriorated, buildings and the placement of new dwellings on small internal allotments.

Disease Outbreaks↗
PubMed1984

Sudden, unexpected death following typhoid-cholera vaccination.

A previously healthy 33-year-old Australian male died suddenly and unexpectedly 8 h after a typhoid-cholera vaccination. Such fatalities are extreme rarities and the present case is the first in which postmortem measurement of serum immunoglobulins has been undertaken. The clinical course and necropsy findings suggest that death was the result of a slowly evolving systemic anaphylactic reaction which terminated in hypotension and right heart failure. The deceased was probably atopic. The current recommendations for the vaccination of international travellers against typhoid and cholera are discussed.

Adult↗
PubMed2005

A randomized comparison of oral chloramphenicol versus ofloxacin in the treatment of uncomplicated typhoid fever in Laos.

We conducted a randomized open trial of oral chloramphenicol (50mg/kg/day in four divided doses for 14 days) versus ofloxacin (15 mg/kg/day in two divided doses for 3 days) in 50 adults with culture-confirmed uncomplicated typhoid fever in Vientiane, Laos. Patients had been ill for a median (range) of 8 (2-30) days. All Salmonella enterica serotype typhi isolates were nalidixic acid-sensitive, four (8%) were chloramphenicol-resistant and three (6%) were multidrug-resistant. Median (range) fever clearance times were 90 (24-224) hours in the chloramphenicol group and 54 (6-93) hours in the ofloxacin group (P<0.001). One patient in the chloramphenicol group developed an ileal perforation. Three days ofloxacin was more effective than 14 days chloramphenicol for the in-patient treatment of typhoid fever, irrespective of antibiotic susceptibility, and was of similar cost.

Administration, Oral↗
PubMed2006

Cases of typhoid fever imported into England, Scotland and Wales (2000-2003).

Although typhoid fever is no longer endemic in most of the developed world, it remains a major infectious disease in less developed regions and imported cases continue to occur in returning travellers, immigrants or migrant workers. We analysed all 692 isolates of Salmonella enterica subspecies enterica serovar Typhi from cases in England, Scotland and Wales that were sent to the Laboratory of Enteric Pathogens at the Health Protection Agency, Centre for Infections, London, UK between 2000 and 2003. The country of acquisition was known for 416 isolates (60%), and the majority of these (70%) came from India or Pakistan. Overall, 24 countries were listed, mainly in Asia and Africa. A total of 48 phage types were detected, 41% of which were Vi-phage type E1. Antimicrobial susceptibility testing revealed that 22% of isolates were multidrug resistant (MDR) (defined as resistance to chloramphenicol, ampicillin and co-trimoxazole) and 39% were quinolone resistant. A significant number of isolates (n=49) were sensitive to nalidixic acid by disk test but exhibited low-level ciprofloxacin resistance, suggesting a novel mechanism of resistance and reinforcing the need for minimum inhibitory concentration determination. Overall, 13% of isolates were both MDR and likely to show a poor response to a fluoroquinolone. A third-generation cephalosporin (e.g. ceftriaxone) should be considered as empirical therapy in regions of the Indian subcontinent where resistance is now at high levels as well as in patients returning from these areas. This study helps to describe the epidemiology of antimicrobial drug resistance in typhoid fever.

Anti-Bacterial Agents↗
PubMed2005

Policymakers' views regarding the introduction of new-generation vaccines against typhoid fever, shigellosis and cholera in Asia.

Face-to-face interviews and meetings with more than 160 policymakers and other influential professionals in seven large Asian countries (Bangladesh, China, India, Indonesia, Pakistan, Thailand and Vietnam) were conducted to survey opinions regarding the need for, and potential uses of new-generation vaccines against cholera, typhoid fever and shigellosis. Despite several barriers to their uptake--notably uncertainty of the burden of enteric diseases; preference for water, sanitation and other environmental improvements over vaccination for disease control; and high prices of the current vaccines relative to basic EPI vaccines, and their moderate protection levels--considerable interest was found in the targeted use of Vi typhoid vaccine in most countries, followed by (future) Shigella and oral cholera vaccines. The introduction of these vaccines in Asia could be greatly facilitated by country-specific evidence of disease burden, local or regional vaccine production, field studies demonstrating their safety and efficacy in local populations, evidence of potential economic savings from vaccination, and effective dissemination of research results to all those who make or influence immunization policy.

Administrative Personnel↗
PubMedDate not supplied

The increase in occurrence of typhoid fever in Cameroon: overdiagnosis due to misuse of the Widal test?

This study investigates the cause of an apparent increase in occurrence of typhoid fever in Cameroon. The reasons explored include an overdiagnosis of the illness related to poor performance of the Widal test in laboratories and interpretation by prescribers. Questionnaires were used in 1996 to evaluate the use and interpretation of the Widal test, and checklists were used to assess its laboratory performance in 2 of the 10 provinces in Cameroon. The majority of prescribers from 20 health facilities (an average of 76% of the doctors and 61% of the nurses) could detect patients who truly had positive Widal tests and needed treatment. However, an average of 48% of the doctors and 84% of the nurses would treat patients who did not require treatment based on the Widal test result. Patients may therefore be treated unnecessarily. Most (88%) of the visited laboratories performed the Widal rapid slide agglutination test as opposed to the conventional tube agglutination test. About 14% of the laboratories that performed the rapid slide agglutination test had a score above average for each criterion evaluated. Misdiagnosis of typhoid fever leads to unnecessary expenditure and exposure of patients to the side-effects of antibiotics. In addition, misdiagnosis may result in delayed diagnosis and treatment of malaria, and other acute febrile illness.

Agglutination Tests↗
PubMedDate not supplied

Serum thrombomodulin levels in patients with typhoid fever.

Elevated plasma or serum levels of thrombomodulin (TM) have been reported in some diseases. However, to our knowledge, plasma and serum levels of TM have not been investigated in febrile patients with typhoid fever. Serum TM and creatinine levels were determined in 7 male Japanese febrile patients with typhoid fever and 6 male Japanese healthy controls. The serum TM values of the patients and controls, in arbitrary units/mL, were 5.04 (SD = 1.69) and 2.93 (SD = 0.74), respectively (P < 0.025). The serum creatinine levels of the patients and controls were 0.93 (SD = 0.16) mg/dL and 0.77 (SD = 0.10) mg/dL, respectively, and the lack of any significant difference between them suggests that delayed clearance from the kidneys was not the predominant explanation for the elevated serum TM levels. Although the numbers of patients and controls were small and more studies are needed, we conclude that elevated serum TM levels during the course of a febrile infection with Salmonella serovar typhi may reflect the disease activity.

Adult↗