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BACKGROUND: Antipyretics reduce the prolonged, high fever characteristic of typhoid fever. The benefits of nonsteroidal drugs in this role have not been quantified. There have been concerns about the safety of antipyretics in typhoid. METHODS: In a double blind randomized study, 80 Vietnamese children with uncomplicated typhoid fever were randomized to receive identical syrup preparations of ibuprofen (10 mg/kg) or paracetamol (12 mg/kg) every 6 h until 36 h after defervescence. Children with a nalidixic acid-susceptible (Na) isolate of Salmonella typhi were treated with ofloxacin (15 mg/kg/day) for 3 days and those with a nalidixic acid-resistant (Na) isolate were treated for 7 days. RESULTS: S. typhi was isolated from 36 of 40 children randomized to ibuprofen (11 isolates Na) and 37 of 40 randomized to paracetamol (13 isolates Na). The median (range) fever clearance time (hours) was shorter in the ibuprofen group than the paracetamol group (68, 4 to 260 vs. 104, 12 to 404; P = 0.055) as was the area under the temperature time curve above 37 degree C (74, 0 to 237 vs. 127, 0 to 573; P = 0.013). The differences occurred predominantly in the children infected with a NaS. typhi whose infections responded more slowly to antibiotic treatment. There were no major side effects associated with the use of either drug. There were no differences between the two treatment arms in the concentrations of circulating interleukin-6 and tumor necrosis factor alpha during the course of treatment. CONCLUSION: The antipyretic effect of ibuprofen is superior to that of paracetamol in children with typhoid fever, particularly those with prolonged fever. Both antipyretics appeared to be safe.
Typhoid fever is always endemic in Ivory Coast. Among the various visceral injuries able to arrive during the course of the illness, a study of hepatic manifestations realized in 279 patients show, by the realization of systematic LBP, that, beside clinically and/or biologically certain forms, an hepatic injury is histologically constant. Aetiological, clinical, biological, diagnostic and therapeutic particularities connected with the hepatic localizations are considered and compared with findings of other authors. To remark, in Ivory Coast, on one hand the great predominance of Eberth bacillus aetiology, on the other hand the lack of statistically significative relation with drepanocytary waste. The pathogenic signification of the constancy of the hepatic injury and its peculiar histological pattern of non specific reactive hepatitis is discussed.
Diarrhoea and typhoid fever are two important diseases in the developing world, particularly the Asian countries. The management of these conditions is becoming increasingly difficult in the face of emerging pathogen resistance. The new fluoroquinolones demonstrate good in vitro activity against the causative pathogens involved, including those that are multidrug resistant. These agents have been shown to be very effective in the treatment of diarrhoea and typhoid in clinical trials, achieving results equal to, or better than, standard drugs. Importantly, fluoroquinolones also considerably shorten the duration of illness, thereby offering rapid relief to the patient.
Typhoid fever is an uncommon disease in the Netherlands. Acquisition occurs mainly during holidays in an endemic area. The history of three children, admitted in the summer of 1985, will be discussed, in one of them the disease had a complicated course. A short review of the literature is given, especially regarding pathogenesis, diagnosis and treatment. Cultures of blood, faeces and bone-marrow are essential for diagnosis. Bone marrow culture remains the most effective method for recovery of the causative agent, especially in children who previously were treated with antibiotics. Chloramphenicol still is the drug of choice in treatment. Vaccination with the oral typhoid vaccine of children who intend to visit an endemic area is recommended.
Typhoid fever has been a problem for military personnel throughout history. A cost-effectiveness analysis of typhoid fever vaccines from the perspective of the US military was performed. Currently 3 vaccine preparations are available in the US: an oral live Type 21A whole cell vaccine; a single-dose parenteral, cell subunit vaccine; and a 2-dose parenteral heat-phenol killed, whole cell vaccine. This analysis assumed all vaccinees were US military personnel. Two pharmacoeconomic models were developed, one for personnel who have not yet been deployed, and the other for personnel who are deployed to an area endemic for typhoid fever. Drug acquisition, administration, adverse effect and lost work costs, as well as the costs associated with typhoid fever, were included in this analysis. Unique military issues, typhoid fever attack rates, vaccine efficacy, and compliance with each vaccine's dosage regimen were included in this analysis. A sensitivity analysis was performed to test the robustness of the models. Typhoid fever immunisation is not cost-effective for US military personnel unless they are considered imminently deployable or are deployed. The most cost-effective vaccine for US military personnel is the single-dose, cell subunit parenteral vaccine.
Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical procedures utilized in the management of these patients are reviewed.
Typhoid fever is diagnosed on the basis of isolation of Salmonella typhi from blood, bone marrow, or bile. S. typhi found in stool or urine may reflect chronic asymptomatic carriage. Although antimicrobial therapy may not eliminate carriage, it is effective for the treatment of clinically evident acute disease. Among the drugs currently available, chloramphenicol is the most widely used. Chloramphenicol is effective and inexpensive, but it is associated with a 3% rate of chronic carriage, a high relapse rate, and, in rare cases, aplastic anemia. For these reasons, and because of the emergence of chloramphenicol-resistant strains of S. typhi, alternative drugs need to be considered. Dysentery is characterized by the passage of unformed stools that commonly contain blood and mucus and in which large numbers of leukocytes can be detected on microscopic examination. Invasion of the intestinal epithelium is the distinguishing characteristic, and Shigella sp are the most frequent cause. Although oral rehydration is useful in dehydrated patients, dehydration is not a common problem in acute dysentery, and antimicrobial treatment is indicated for this disease. An antimicrobial agent should be selected on the basis of knowledge of the susceptibility patterns of locally isolated Shigella strains.
Cutaneous lesions in typhoid fever are uncommon. We report cutaneous ulcers in two children (aged 10 years and 3 years) with typhoid fever.
The diagnosis of typhoid fever requires clinical alertness and ready laboratory support, blood cultures being most important. Chloramphenicol remains the standard drug specific for acute typhoid fever while cotrimoxazole is a useful alternative. Both of these are also useful in the treatment of relapses. The importance of supportive treatment cannot be over-emphasized. The treatment of intestinal complication is mainly conservative. Steroid is useful in the toxic delirious state. The management of chronic typhoid carriers is still an unsolved problem. To exclude the chronic carriers from handling food and to give advice on meticulous attention to personal hygiene is still the best way of public health control.
A case of typhoid fever with neuropsychiatric features is described. These comprised confusion and delirium, meningism, a single major convulsion and bilateral athetoic movements. Athetosis has not previously been described in typhoid fever and must now be added to the long list of neuropsychiatric manifestations of this disease.
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.
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BACKGROUND & OBJECTIVES: As typhoid fever is endemic in India, there is a continuing search for a simple test which can be carried out in small laboratories for an early and rapid diagnosis. We have evaluated the Typhidot test for this purpose. METHODS: The Typhidot test was carried out on coded sera according to the manufacturer's instructions. The test was performed on 30 Widal positive sera, 30 sera from blood culture positive patients, 60 Widal negative sera and 30 samples from patients whose blood culture grew Gram negative bacilli (GNB) other than Salmonella Typhi. RESULTS: Typhidot test was positive for both IgG and IgM in 39 samples, IgM alone in 24 and IgG alone in 2. Of the 30 culture positive samples, 27 were positive by Typhidot. The Typhidot test gave a sensitivity of 100 per cent and specificity of 80 per cent when bacteraemic patients were analysed. INTERPRETATION & CONCLUSION: The Typhidot is easy to perform, and requires no special equipment or training of staff for interpretation of results. It will be a useful complementary test to blood culture and the Widal test in the diagnosis of typhoid fever.
Antimicrobial-resistant typhoid fever in Saigon was studied by examining in vitro antimicrobial susceptibilities of Salmonella typhi strains and conducting a randomized clinical trial of ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ). Isolates of S. typhi were obtained from blood or stool cultures of 90 patients. Of 87 isolates tested for antimicrobial susceptibility, 65 (75%) were resistant (R) to chloramphenicol, streptomycin, sulfonamide, and tetracycline, and 22 (25%) were susceptible (S). The drug resistance was transferable to Escherichia coli and was found in 11 different Vi-phage types. All isolates were susceptible to ampicillin and to TMP-SMZ. Agar dilution studies of TMP and SMZ showed synergistic inhibition of growth in all 18 S isolates and in 12 of 48 R isolates tested. The clinical trial of ampicillin and TMP-SMZ showed that both drugs were equally effective. Treatment failure with both drugs was more frequent in patients with S isolates than in patients with R isolates. Therefore, in an area where antimicrobial-resistant typhoid fever exists, patients with R isolates should receive either ampicillin or TMP-SMZ, but patients with S isolates should be treated with chloramphenicol.
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