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PubMed1992

Role of ciprofloxacin in typhoid fever.

A study was conducted to investigate the effects of ciprofloxacin in typhoid fever and to compare its efficacy with chloramphenicol. Eighty patients between 20-45 years with positive blood culture were included in the study. Seventy five percent patients treated with ciprofloxacin became afebrile within 72 hours while with chloramphenicol it took upto 120-144 hours for the same percentage of patients to become afebrile. Four patients resistant to chloramphenicol, cotrimoxazole and ampicillin/amoxycillin, also responded to ciprofloxacin. There were no significant adverse effects indicating that ciprofloxacin is safe and effective drug for resistant and nonresistant cases of typhoid fever.

Adult↗
PubMed2004

[Contribution of phage typing and ribotyping in investigating a typhoid fever outbreak in Tunisia].

A study was carried out to investigate an outbreak of typhoid fever that occurred in Sousse city and in the vicinity of Sousse (Tunisia) during summer 1999. Twenty four isolates of Salmonella enterica serotype Typhi were isolated in hospitalized patients with a typhoid fever in two hospitals (Farhat Hached Sousse and M'saken) and were studied with the help of two molecular typing methods: phage typing and automated ribotyping. Twenty one isolates with the Vi antigen had profile DVS (Degraded Vi Strain), one isolate with the Vi antigen belonged to phage type A and two isolates were non phage typable (no Vi antigen). The same ribotype was found in 22 out of 24 isolates. The results suggested that ribotyping is more discriminative than phage typing in this case in distinguishing strains and the strains shared the same source of the contamination. Unfortunately the precise source of the contamination could not be determined.

Adolescent↗
PubMedDate not supplied

[Typhoid fever. Clinical and therapeutic study in 70 patients].

OBJECTIVE: Present clinical features of typhoid fever in Lebanon. METHODS: Retrospective study of 70 patients admitted to a university hospital center between 1995 and 2002. The criteria for inclusion were a positive Salmonella typhi or paratyphi hemoculture and/or a Widal serodiagnosis > or = 1/160 for O agglutinin, in the presence of evocative symptoms. RESULTS: Among the 70 patients, 25 pediatric cases were noted. The patients were aged a mean of 28+/-22 years. Average duration of symptoms before the diagnosis was 10+/-7 days. Fever were observed in 97% of cases and the other predominant symptoms were abdominal pain (41%), diarrhoea (36%), chills (31%) and headache (29%). Febrile gastroenteritis was a frequent manifestation in children (52%). Complications were noted in 31% of cases and were predominantly digestive. Leucopenia was not a helpful diagnostic marker. S. typhi was the most frequent (87%) serotype identified. Resistance to ampicilline was 10%, to cotrimoxazole and chloramphenicol 7% for each and to ofloxacine 2%. One death was reported (1%) of an immunosuppressed patient. CONCLUSION: Typhoid fever is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, febrile gastroenteritis and/or headache. The appearance of bacteria resistant to antibiotics makes ceftriaxone or ciprofloxacine the empirical treatment of choice.

Adolescent↗
PubMed2005

[Typhoid and paratyphoid fever in children].

BACKGROUND: Febrile illness without focal symptoms in a child who has visited tropical or sub-tropical areas is an increasing health problem in western countries. In the department of paediatrics at Ullevaal University Hospital, malaria, typhoid and paratyphoid fever are the most frequent infectious diseases acquired in tropical or sub-tropical areas. MATERIALS AND METHODS: We describe all 31 children under 16 admitted between 1998 and 2003 who had blood cultures positive for Salmonella typhi or Salmonella paratyphi A or B. RESULTS: Nearly all the children were second or third generation immigrants from the Indian subcontinent. Fever was the main symptom at onset. Out of 31 salmonella strains, 8 showed reduced sensitivity to quinolones, which are the drugs of choice. Clinical poor response to treatment is associated with reduced sensitivity to nalidixic acid in vitro. CONCLUSION: Blood cultures prior to administration of antibiotics are important in providing correct diagnosis and appropriate treatment. Before visiting endemic areas, groups at risk should be informed that there are vaccines available against typhoid fever.

Adolescent↗
PubMedDate not supplied

[Pathomorphology and morphogenesis of myocarditis in typhoid fever].

Archives specimens of the heart, autopsy protocols and disease histories of 16 soldiers and officers of Soviet army who died in Afghanistan of typhoid fever were studied. It is concluded on the basis of morphology and statistics that interstitial myocarditis and sometimes pancarditis develop on the 2nd week of the basic disease. Characteristic features of typhoid fever myocarditis are inflammation of the heart intramural vessels, microcirculatory disturbances, edema and lymphocytic-macrophogeal infiltration of the stroma, sometimes with formation of granulomas, dystrophic and necrotic changes of cardiomyocytes.

Adolescent↗
PubMedDate not supplied

[Typhoid fever in north Lebanon: a 8-year study (1992-1999) using the Widal test].

We evaluated the frequency of typhoid fever in north Lebanon over an 8-year period (1992-1999) in patients admitted with fever to the Islami de Bienfaisance Hospital in Tripoli. We analysed 7391 serum samples for Salmonella typhi infection using the Widal and Felix tests. The cut-off value for infection was an agglutinin O titre > or = 1/160 (a value validated in an earlier study in the same region). Of the 7391 samples, 1131 (15.3%) had an agglutinin O titre > or = 1/160. The 8-year surveillance showed there was a progressive decrease in the frequency of the disease. However with over 100 cases annually, typhoid is endemic in the area and could cause major outbreaks. The monthly analysis shows that we have an increase in summer, whilst a decrease is observed in winter.

Agglutination Tests↗
PubMed2005

Effects of pefloxacin in multi drug resistant typhoid Fever.

In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at CMH, Rawalpindi in 2003, first 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 excluding the first drug. A second failure of therapy was taken as an indication to use pefloxacin singly. Finally, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Pefloxacin was used in 10 (35.7%) cases. The failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4% with co-trimoxazole 75% and 0% with pefloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical indicator to diagnosis. along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis that responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases of which 5 (72%) were multi drug resistant S. typhi.

Amoxicillin↗
PubMed2006

Acute acalculous cholecystitis: a rare complication of typhoid fever.

Acute acalculous cholecystitis is a very rare complication of typhoid fever, and may be due to multi-drug resistant and virulent forms of Salmonella infection. It is particularly rare in adults. A 21-year-old woman, presenting with fever, vomiting, diarrhoea and abdominal pain, was found to have acute acalculous cholecystitis due to typhoid fever on basis of ultrasonographical findings and a positive Widal's test for Salmonella typhi. She was treated with antibiotics and made a full recovery.

Acalculous Cholecystitis↗
PubMedDate not supplied

[Morbidity and mortality risk factors in patients with ileal typhoid perforation].

OBJECTIVES: To determine the risk factors, morbidity and mortality rates and the types of postoperative complications in patients undergoing surgery for ileal typhoid perforation. MATERIAL AND METHODS: This retrospective study evaluated 126 patients with anatomohistological diagnosis of ileal typhoid perforation treated at the Belen Hospital, Trujillo, Peru between 1966 and 2000. RESULTS: The average age of the total series was of 21.39 + 13.4 years (range 1 to 57 years); of which, 97 (76.98%) were male and 29 (23.02%) women (proportion M:F, 3.3:1). By means of univariate analysis, the morbidity was related with the absence of previous medical treatment (p = 0.035). The mortality was associated to time of perforation exceeding 48 hours (p = 00001); digestive hemorrhages (p = 0.003), leukocyte count (p = 0.021) fecaloid peritoneal secretion (p = 0.007) number of perforations (p = 0.001) and the surgical technique, that presented major mortality was the resection and ileostomy (48.3%; p = 0.001). The group of patients that presented post-surgical complications was 80.16%, of which 19.8% of them died. The most frequent complications were wound infections (67.3%) and sepsis (27.7%). In the multivariate analysis two parameters were evidenced in relation to morbidity: previous medical treatment (p < 0.05; OR = 2.9) and number of perforations (p = 0.01; OR = 6.4). With regard to mortality the significant statistical parameters were: low digestive hemorrhages (p = 0.02; OR = 11.4) leukocyte count (p < 0.008; OR = 7.9) type of operation (p = 0.03; OR = 1.8) peritoneal secretion (p < 0.04; OR = 3.02) and number of perforations (p = 0.008; OR = 4.6). CONCLUSIONS: The risk factors identified in the present series can be useful to elaborate a risk scale to predict a small, moderate or greater probability of complications and postoperative mortality.

Adolescent↗
PubMed2005

Antibiotic sensitivity profiles of salmonella organisms isolated from presumptive typhoid patients in Zaria, northern Nigeria.

A hundred and ten Salmonella organisms (comprising 38 Salm. typhi, 13 Salm. paratyphi and 59 non-typhi Salmonella spp.) isolated from blood of patients diagnosed of typhoid fever in Zaria, Northern, Nigeria were evaluated for their in-vitro susceptibility to eighteen antibiotics. A high percentage of the Salmonella spp. exhibited resistance to the various test antibiotics. While ceftriaxone, ciprofloxacin and the aminoglycosides exhibited the greatest in-vitro activity against the isolates (82.7-96.4% of the isolates were susceptible), chloramphenicol and the aminopenicilins were considerably less effective (only 54.5% of isolates were sensitive). Multiple antibiotic resistance (MAR) indexing showed that 90.9% of the isolates had multiple drug resistance (MAR) index >0.2. Eighteen of these isolates were resistant to at least 12 of the 18 antibiotics; susceptible only to ceftriaxone, ciprofloxacin and the aminoglycosides. The percentage degree of resistance and MAR indices of the isolates to the antibiotic agents were irrespective of age and gender of the patients. The high prevalence of multiple drug resistant bacteria in this region is of epidemiological concern, as this will restrict the choices of antibiotics in the treatment of typhoid fever to a few compounds.

Adult↗
PubMedDate not supplied

Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan.

We analysed the record of blood cultures carried out at the Armed Forces Institute of Pathology, Rawalpindi between 1996 and 2003. We isolated 477 Salmonella typhi and 410 S. paratyphi A from blood of patients suffering from typhoid fever. We observed a significant shift in the distribution and antimicrobial susceptibility of typhoid salmonellae. The isolation rate of S. typhi fell significantly while S. paratyphi A is emerging as a major pathogen. Resistance to conventional antityphoid drugs in S. typhi decreased dramatically from 80% to 14%, while in S. paratyphi A resistance increased from 14% to 44%. Susceptibility to the fluoroquinolones decreased in both. No resistance to third generation cephalosporins was detected.

Anti-Infective Agents↗
PubMed1999

Comparative study on different recent diagnostic and therapeutic regimens in acute typhoid fever.

Forty five positive blood culture acute typhoid cases were studied during a 2 years period (1997-1999) in Abbassia Fever hospital, Cairo, Egypt. Their ages ranged between 4-23 (12 +/- 2.5) years. Male: Female ratio was 1:1. Three of the 4 classical signs namely: toxic look (84%), bronchitic chest (47%), tumid tympanitic abdomen (84%) and just palpable receding spleen (69%) were found in almost all cases and offer a good bed side clinical diagnostic test. Blood picture revealed anaemia, within normal white blood count and thrombocytopenia. Liver function tests showed within normal total serum bilirubin, two or more folds increase of ALT and within normal serum alkaline phosphatase. Comparing the 3 tests, namely significant Widal titre (56%), modified Widal test (89%) and bright spleen (78%), it was found that modified Widal test is the most sensitive serological test. Ultrasonographic finding of bright spleen is an easy, safe, noninvasive and sensitive technique which is relatively cheap. Each of the 3 drugs in our study namely chloramphenicol, quinolones and ceftriaxone resulted in improvement of general condition, drop of fever, increase in haemoglobin, white blood count and platelet count. Also, there was a significant improvement of liver function tests by either of the 3 drugs. Ceftriaxone is the best drug from the clinical and laboratory points of view followed by quinolones in multidrug resistant (MDR) acute typhoid cases. Chloramphenicol is still the drug of choice in chloramphenicol sensitive salmonellae.

Acute Disease↗
PubMed1996

Chloramphenicol drug failure in typhoid fever.

Two hundred positive blood culture typhoid patients admitted to Embaba Fever Hospital, Giza province, were subjected to: 1) Careful history and thorough clinical examination. 2) Complete blood picture. 3) Widal agglutination test. 4) Urine and stool cultures for Salmonellae. 5) To the isolates of the cultures, disk diffusion chloramphenicol susceptibility test, minimum inhibitory concentrations and chloramphenicol acetyl transferase test were performed. The dose of chloramphenicol was restricted to 50 mg per Kg body weight daily, whatever the route used; whether oral, rectal or intravenous. When fever did not drop up to 5 days or the patient presented with typhoid complications or the blood culture revealed resistant Salmonellae, quinolones or third generation, cephalosporins were administered. Measurement of the level of chloramphenicol in the blood was performed for every patient. Fifty (25%) patients were found to be resistant in vitro and in vivo to chloramphenicol. All their Salmonellae isolates were resistant to chloramphenicol, the mean zone size was 10 mm, the mean inhibitory concentration was 64 microgram per ml. and all were positive for chloramphenicol acetyl transferase. There was no significant difference in the serum level of chloramphenicol between susceptible and resistant groups to the drug. Results were interpreted and discussed.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Short-term ceftriaxone treatment of typhoid fever in children].

Ten children, diagnosed as having typhoid fever, were enrolled in this study between April and September, 1989. Ceftriaxone was administered intravenously, in two dosages adding to 50-100 mg/kg/day over as short a period as five days. The mean period of defervescence was 3.2 days. No adverse reactions to the drug occurred; all those fulfilling the prescribed course were cured. To date, no relapse has been reported nor has any patient become a chronic carrier. Shortterm use of Ceftriaxone had the advantages of rapid response, abscence of serious side effects, and low failure rate in treating children with typhoid fever.

Adolescent↗
PubMed1991

The liver in typhoid fever: always affected, not just a complication.

The course of liver involvement during the first three weeks of typhoid fever was studied in 20 patients. Previous studies of liver involvement in typhoid fever have not considered the time course of changes. In this study, hepatomegaly was found during the 2nd or 3rd wk more often than in the 1st wk (36% vs. 11%), whereas jaundice was detectable in 9% of patients after the 1st wk, but never before. Alkaline phosphatase, AST, and ALT were raised in 100%, 100%, and 91% of cases, respectively, during the 2nd and 3rd wk but during the 1st wk, only 11%, 89%, and 56% had mild increases. This study shows that, although the clinical picture of hepatitis is unusual, liver involvement is invariably present after the 1st wk, and should not be considered as a complication, but as a feature of the disease.

Adolescent↗
PubMed1991

Association between the acquired immunodeficiency syndrome and infection with Salmonella typhi or Salmonella paratyphi in an endemic typhoid area.

Eight cases of typhoid and paratyphoid fever were identified during a 4-year period in a cohort of 117 patients who were positive for human immunodeficiency virus in Lima, Peru. Asymptomatic patients with human immunodeficiency virus infection and patients with the lymphadenopathy syndrome had a typical clinical presentation and response to therapy. Patients with the acquired immunodeficiency syndrome who were culture positive for Salmonella typhi or Salmonella paratyphi presented with fulminant diarrhea and/or colitis; the two patients for whom at least 2 months of follow-up were available relapsed. In our cohort there were 0.06 cases of typhoid or paratyphoid per patient year of observation; this rate is approximately 60 times that in the general population in Lima, and 25 times that in the 15- to 35-year-old age group. Our data indicate that patients who are positive for human immunodeficiency virus are at significantly increased risk for infection with S typhi and S paratyphi, and suggest that the clinical presentation of these diseases in patients with the acquired immunodeficiency syndrome differs from that seen immunocompetent hosts.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Chloramphenicol therapy of typhoid fever.

In a prospective study we compared two different dosage regimens of IV chloramphenicol succinate (100 mg/kg/day and 75 mg/kg/day) in children with culture proven typhoid. Trough and peak blood samples, obtained at 48 hrs, were analysed for free chloramphenicol by high pressure liquid chromatography (HPLC). Although the mean trough (8.8 +/- 7.7 versus 5.4 +/- 2.6 mcg/ml) and peak (19.9 +/- 12.2 versus 15.4 +/- 6.1 mcg/ml) chloramphenicol concentrations were comparable in both groups, a significantly wider range was found in the group receiving 100 mg/kg/day. Potentially toxic levels (greater than 30 mcg/ml) developed in two patients with liver dysfunction. Chloramphenicol in a dosage of 75 mg/kg/day is adequate and safe for the treatment of paediatric typhoid.

Adolescent↗
PubMed1991

The problem of emerging chloramphenicol resistance in typhoid fever--a preliminary report.

Drug sensitivity of Salmonella typhi isolated from 25 blood culture positive cases of typhoid fever who presented between May and July 1990 was tested to determine their in vitro susceptibility to various antimicrobials. Twenty-one of them (84%) showed resistance to chloramphenicol and 24 (96%) to cotrimoxazole. All the 25 cases were sensitive to norfloxacin, gentamicin and cephalexin. Sixteen of 21 chloramphenicol resistant typhoid cases in whom chloramphenicol was initially started failed to respond to this drug even after 5 to 7 days, thereby indicating that in vivo response matched with the in vitro sensitivity. Clinical response to norfloxacin, whether given initially or following chloramphenicol failure, was prompt and satisfactory. Norfloxacin thus appears to be a good choice in such cases.

Chloramphenicol↗