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PubMed2006

Acute acalculous cholecystitis: A rare presentation of typhoid fever in adults.

Adult typhoidal acute acalculous cholecystitis is rare with only 2 cases having been reported in the English literature. We present the case of a previously healthy 36-y-old female who suffered fever, chills, epigastralgia and progressive jaundice for 3 d, with acute acalculous cholecystitis subsequently diagnosed. In addition to antibiotic therapy with ceftriaxone, open cholecystectomy was performed. However, bile and blood culture both showed Salmonella typhi growth unexpectedly, and ileocolitis was revealed by colonoscopy. Careful tracing of the history of the patient recalled a history of travel to Indonesia. In adults without common risk factors for acalculous cholecystitis, a detailed history including travel to endemic areas and high index of suspicion for typhoidal acute acalculous cholecystitis are important, and appropriate antimicrobial therapy for covering Salmonella typhi should be considered.

Acute Disease↗
PubMed1981

Increased lymphocyte adenosine deaminase in typhoid fever.

Adenosine deaminase in the peripheral lymphocytes (L-ADA) was determined in 27 patients with typhoid fever and in 15 normal controls. Increased values of enzymatic activity were found in the typhoid fever patients compared with the controls. The increase was prolonged and not correlated to treatment. L-ADA levels could be related to the immune response.

Adenosine Deaminase↗
PubMed1981

Problems in the clinical diagnosis of typhoid fever in children in the tropics.

Between January 1976 and December 1978, the Microbiology Department of University College Hospital (UCH) Ibadan, isolated Salmonella typhi from the blood cultures of 93 children aged 0-14 years, who were admitted to the paediatric wards. Clinical case notes were retrieved and reviewed in 64 (68.8%) of them. Fifteen (23%) of the 64 children were less than one year of age while 22 (34%) were under the age of five years. The commonest presenting symptoms were fever, anorexia, diarrhoea and vomiting. A febrile convulsion was the presenting symptom in 13 (20%) of the patients, all of whom were under the age of five years. Hepatomegaly was almost twice as frequently observed as splenomegaly. Intestinal perforation was present in five of the patients. There was a high proportion of SS children who presented with fever, pallor, jaundice, generalized aches and pains and other clinical features of sickle cell disease and it is possible that such children are specially susceptible to typhoid fever. A clinical diagnosis of typhoid fever on admission was made in only 14 of the 64 children. Reasons are given for the low index of suspicion and it is suggested that any child with unremitting fever after adequate anti-malarial chemotherapy should be treated for enteric fever.

Child↗
PubMed1986

Serological diagnosis of typhoid fever by enzyme-linked immunosorbent assay (ELISA).

Serum sample from 22 bacteriologically proved cases of typhoid fever, 41 febrile cases who were culture negative and 70 sick and healthy age-matched controls were tested for enzyme-linked immunosorbent assay (ELISA) IgG and IgM antibodies using Salmonella typhi LPS antigen. IgG and IgM antibodies were present in 72.7% and 81.8% respectively as against Widal test which was positive in 40.9% in proved cases. In febrile controls IgG and IgM ELISA antibodies were present in 80.4% and 60.9% respectively as against 53.6% by Widal test. This difference between the two tests was statistically significant P less than 0.001. ELISA test was more sensitive than the Widal test and hence it may be useful in rapid serodiagnosis of typhoid fever and also in circumstances where bacteriological techniques are not available.

Enzyme-Linked Immunosorbent Assay↗
PubMed1959

Inactivation of endotoxin by a humoral component. IV. Alteration in the immunological properties of typhoid endotoxin.

The immunological properties of typhoid endotoxin were investigated after incubating it with serum under conditions in which EDC (endotoxin-detoxifying component) was operative. Brief interaction of endotoxin in vitro with this system in serum (human, rabbit, mouse) abolished its antigenicity for rabbits. Suitable modification of the host permitted separate elicitation of toxic and antigenic responses to typhoid endotoxin. Endotoxin altered by EDC was still capable of precipitating specific antibody; moreover, it did so in a manner which resembled that of the haptenic polysaccharide.

Animals↗
PubMed1999

A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.

From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.

Case-Control Studies↗
PubMed2004

Short-course azithromycin for the treatment of uncomplicated typhoid fever in children and adolescents.

We studied 149 children and adolescents 3-17 years of age with clinical typhoid fever who were treated with either oral azithromycin (20 mg/kg per day; maximum dose, 1000 mg/day) or intravenous ceftriaxone (75 mg/day; maximum dose, 2.5 g/day) daily for 5 days. Blood and stool specimens were obtained for culture before the initiation of therapy and were repeated on days 4 and 8 of treatment. Isolation of Salmonella enterica serovar Typhi or S. enterica serovar Paratyphi from the initial culture was required for inclusion in the final analysis. S. Typhi was isolated from 68 patients, 32 of whom were receiving azithromycin. Cure was achieved in 30 (94%) of 32 patients in the azithromycin group and in 35 (97%) of 36 patients in the ceftriaxone group (P=NS). Mean time to clearance of bacteremia was longer in the azithromycin group than in the ceftriaxone group. No patient who received azithromycin had a relapse, compared with 6 patients who received ceftriaxone. A 5-day course of azithromycin was found to be an effective treatment for uncomplicated typhoid fever in children and adolescents.

Adolescent↗
PubMed2004

A clinical, microbiological, and pathological study of intestinal perforation associated with typhoid fever.

One of the most serious complications of typhoid fever is intestinal perforation. Of 27 patients admitted to a provincial hospital in the Mekong Delta region of Vietnam who had gastrointestinal perforation secondary to suspected typhoid fever, 67% were male, with a median age of 23 years and a median duration of illness of 10 days. Salmonella enterica subspecies enterica serotype Typhi (S. Typhi) was isolated from 11 (41%) of 27 patients; of 27 patients, only 4 (15%) had positive cultures from gut biopsies. S. Typhi DNA was detected by polymerase chain reaction for all perforation biopsy samples. Detailed histological examination of the gastrointestinal mucosa at the site of perforation in all cases showed a combination of discrete acute and chronic inflammation. Acute inflammation at the serosal surface indicated additional tissue damage after perforation. Immunohistochemical results showed that the predominant infiltrating cell types at the site of perforation were CD68+ leukocytes (macrophages) or CD3+ leukocytes (T lymphocytes).

Adult↗
PubMed2005

Typhoid fever: a massive, single-point source, multidrug-resistant outbreak in Nepal.

BACKGROUND: In the summer of 2002, a total of 5963 cases of typhoid fever were recorded in Bharatpur, Nepal (population, 92,214) during a 7-week period. A team from the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand, and the CIWEC Travel Medicine Clinic (Kathmandu, Nepal) assisted the Nepal National Public Health Laboratory (Kathmandu, Nepal) in the further investigation of this large, explosive febrile disease outbreak. METHODS: Investigators conducted a thorough epidemiologic and laboratory investigation to assess the size and scope of the outbreak. In addition to subculturing of previously collected samples, blood samples were obtained from 100 febrile patients, and culture and susceptibility testing were done by standard laboratory methods. Pulsed field gel electrophoresis (PFGE) and plasmid analysis were done. RESULTS: The majority of the isolates, including 1 from the municipal water supply, were multidrug resistant. The minimum inhibitory concentrations (MICs) of ciprofloxacin ranged from 0.19 microg/mL to 0.125 microg/mL. With use of PFGE, all isolates, including isolates from the water supply, showed an analytical similarity of 96%-100%. Multidrug-resistant isolates had a plasmid encoding for resistance, and those with resistance to nalidixic acid had a single-point mutation. CONCLUSIONS: To the best of our knowledge, this outbreak is the largest single-point source outbreak of multidrug-resistant typhoid fever yet reported, and it was molecularly traced to the city's single municipal water supply. Isolates were uniformly resistant to nalidixic acid, there was a decrease in their susceptibility as measured by MIC of fluoroquinolones, and 90% of isolates obtained were resistant to >1 antibiotic.

Adult↗
PubMedDate not supplied

Antimicrobial therapy for enteric infections and typhoid fever: state of the art.

Increasing antimicrobial resistance of enteric pathogens represents a significant barrier to therapy for bacterial enteritis and, to a lesser extent, typhoid fever. Poor study design limits the value of many of the clinical trials that suggest drug efficacy. Studies are often not placebo-controlled, randomized, or blind comparative trials; clinical criteria for response are frequently not stated; and the numbers of subjects are small. Among the known therapeutic principles for choosing drugs for enteric infections is that the agent be active in vitro against the isolate, that for treating infections due to invasive pathogens both lumenal and tissue levels be adequate, that drugs with good enterohepatic circulation may be especially well suited for the treatment of infections due to noninvasive pathogens, and that drugs active intracellularly may have particular value in therapy for typhoid, especially in reducing the relapse rate. The new 4-quinolones are not only highly active in vitro against a broad range of enteric pathogens but generally also exhibit most of the other properties desirable for the treatment of these infections. Although further clinical trials are necessary to assess the comparative efficacy of the quinolones, the present clinical data already indicate that they will be of great utility, and particularly important in the treatment of drug-resistant shigellosis, which is currently a major problem in many developing nations in Asia and Africa.

Anti-Bacterial Agents↗
PubMedDate not supplied

Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea.

Features of typhoid fever were correlated with age and gender through a review of the charts of 552 hospitalized culture-positive patients with diarrhea in Bangladesh. Seizures occurred more frequently in children from birth through 10 years of age (5%-11%) and pneumonia more frequently in children from birth through 5 years of age (8%-15%) than in older age groups (P less than .05), whereas intestinal perforation occurred more frequently in patients greater than or equal to 11 years of age (5%-25%) than in younger age groups (P less than .005). Compared with older age groups, children from birth through 10 years of age were more anemic, those from birth through 5 years of age had a higher mean white blood cell count, and those from birth through 1 year of age had a lower mean blood carbon dioxide content (all P less than .05). Female patients were more severely anemic than male patients (P less than .05). The case-fatality rate was 4.3% overall, with the highest rates for children from birth through 1 year of age (11%) and adults greater than or equal to 31 years of age (10%). Female patients had a higher case-fatality rate (6%) than male patients (3%), although the difference was not significant (P greater than .05). Death was independently associated with seizures, intestinal perforation, pneumonia, and delirium or coma. These results indicated that the patients with typhoid fever who were at highest risk of complications and death were children from birth through 1 year of age and adults greater than or equal to 31 years of age.

Adolescent↗
PubMedDate not supplied

Multidrug-resistant typhoid in children: presentation and clinical features.

Typhoid accounts for 8% of pediatric admissions to the Aga Khan University Hospital in Karachi, Pakistan. Over a 4-year period (1986-1989), 355 children had typhoid documented by culture of blood or bone marrow. Strains of Salmonella, resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole accounted for 20% of these cases. Compared with children infected by drug-susceptible strains of Salmonella, children with multiresistant infection were generally sicker at presentation and were more likely to be assessed as appearing "toxic" (P less than .001), as having disseminated intravascular coagulation (P less than .01), and as exhibiting hepatomegaly (P less than .01). The mortality was 4.2% among children with multiresistant infection and 1.4% among those infected with strains susceptible to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; the higher mortality in the former group was probably due to a longer duration of illness (P less than .05) and to ineffectual oral antimicrobial therapy before hospitalization.

Ampicillin Resistance↗
PubMed1995

Evaluation of the response of human humoral antibodies to Salmonella typhi lipopolysaccharide in an area of endemic typhoid fever.

Because of the limited value of Widal's test in the diagnosis of typhoid fever in areas of endemicity, individual serum levels of IgM, IgA, IgG, and IgG subclass antibodies to Salmonella typhi lipopolysaccharide were evaluated in samples collected in Egypt. The study involved 106 febrile patients, including 40 patients for whom cultures were positive for S. typhi and 66 patients for whom diseases other than typhoid were diagnosed. Multivariate regression modeling revealed that detection of the combination of IgA, IgG, and IgG2 correlated best, although not perfectly (adjusted r(2) = 68), with a positive culture; the sensitivity and specificity of testing for IgA, IgG, and IgG2 (i.e., all three tests positive vs. all three tests negative) were 91.7% and 98.1%, respectively. These results suggested that testing for IgA, IgG, and IgG2 in combination is of diagnostic value for S. typhi infection.

Adult↗
PubMedDate not supplied

Treatment of typhoid fever and other systemic salmonelloses with cefotaxime, ceftriaxone, cefoperazone, and other newer cephalosporins.

Third-generation cephalosporins have been considered for the treatment of systemic salmonelloses because of emerging resistance among Salmonella species to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Twelve patients with typhoid/paratyphoid fever, nine with nontyphoid salmonella bacteremia, and two with Salmonella meningitis were treated with cefotaxime; one leukemic patient with Salmonella dublin bacteremia received ceftizoxime. All infections were cured except for one in a patient with sickle cell anemia; this patient's illness recurred but was cured with a second course of cefotaxime followed by ceftriaxone. A review of the literature documented cures with cefotaxime in 50 of 61 patients with typhoid/paratyphoid fever, all of four with salmonella osteomyelitis, 12 of 14 with salmonella meningitis, and 44 of 49 with non-typhoid salmonella bacteremia. Ceftriaxone and cefoperazone cured, respectively, 23 of 25 and 32 of 33 patients with typhoid/paratyphoid fever. The relapse rates of typhoid fever treated with cefotaxime, ceftriaxone, and cefoperazone were 6%, 4%, and 0%, respectively. Cefotaxime, ceftriaxone, and cefoperazone are acceptable alternative antibiotics for the treatment of salmonelloses caused by multiresistant organisms.

Adolescent↗
PubMed1983

Investigation report of an epidemic of typhoid fever.

An explosive common-source epidemic of typhoid fever, probably the world's biggest, occurred in Sangli Town (Maharashtra State), India, between December 1975 and February 1976 when, with the incidence rate of 6.59% over this 12-week period, probably more than 9000 cases occurred in a population of about 135 000. Faecal contamination of municipal water supply, which was receiving unsatisfactory and inadequate chlorine treatment, was responsible for the epidemic. Contamination at suitable intervals resulted in a heavy build-up of S. typhi in the population. Massive central contamination of the ill-maintained municipal water-supply system with faecally-contaminated waste-water from a population of about 37 000, in which there were thought to be over 250 typhoid cases, ultimately resulted in the explosive epidemic. The episode underlines the importance of proper maintenance of water supply and excreta disposal systems.

Adolescent↗
PubMed1975

Isolation and characterization of Gal E mutant Ty 21a of Salmonella typhi: a candidate strain for a live, oral typhoid vaccine.

A gal E mutant of Salmonella typhi was isolated; results obtained with Salmonella typhimurium and the mouse as a model for human typhoid fever indicated that this mutant has the potential for use as a live, oral typhoid vaccine. The mutant, Ty 21a, took up galactose from exogenous sources and accumulated sufficient quantities of galactose-1-phosphate and uridine diphosphate galactose to cause lysis of the cells, an event that resulted in the avirulence of the strain. Galactose was incorporated sufficiently into the cell wall of Ty 21a to allow the synthesis of smooth-type lipopolysaccharides, which are necessary for the proper immunogenicity. Cells of strain Ty 21a, when given intraperitoneally, protected mice against lethal challenge with strain Ty 2 of S. typhi.

Animals↗
PubMed1975

Comparison of trimethoprim-sulfamethoxazole and amoxicillin in therapy of chloramphenicol-resistant and chloramphenicol-sensitive typhoid fever.

The efficacy of orally administered trimethoprim-sulfamethoxazole was compared with that of oral amoxicillin in therapy of typhoid fever due to both epidemic chloramphenicol-resistant and endemic chloramphenicol-sensitive Salmonella typhi. Both drug regimens were effective and of comparable value in treatment of chloramphenicol-resistant infections, as measured by duration of fever (124 hr and 115 hr, respectively) and duration of bacteremia (1.0 and 0.4 days, respectively). Trimethoprim-sulfamethoxazole therapy of infections due to chloramphenicol-sensitive S. typhi resulted in more rapid lysis of fever than did amoxicillin therapy. Trimethoprim and sulfamethoxazole were not synergistic in vitro against the chloramphenicol-resistant strain of S. typhi, and the role of sulfamethoxazole in treatment of such infections appears to be minimal. Oral administration of trimethoprim-sulfamethoxazole is effective therapy of chloramphenicol-resistant, and probably of ampicillin-amoxicillin-resistant, typhoid fever.

Adolescent↗
PubMed1984

Typhoid fever in San Antonio, Texas: an outbreak traced to a continuing source.

Eighty cases of typhoid fever occurred in San Antonio, Texas, with dates of onset from August 18, 1981, to October 26, 1981. Preliminary epidemiological investigations of the first 24 cases suggested a Mexican food takeout restaurant as the common source. A case-control study confirmed this association (P less than or equal to .001). Barbacoa , a mixture of muscle, lips, ears, tongue, and eyes from steamed bovine heads, was identified as the source of Salmonella typhi (P = .03). S typhi was cultured from the stool of one of 31 restaurant employees. Closure of the restaurant resulted in termination of the outbreak within a single incubation period. The restaurant was allowed to reopen after the remaining employees had demonstrated lack of excretion of S typhi in stools. This outbreak represents the largest restaurant-associated typhoid fever outbreak reported in the United States in greater than 50 years.

Adolescent↗