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PubMed1993

Randomized comparative study of fleroxacin and chloramphenicol in typhoid fever.

This study compared fleroxacin, 400 mg daily for 7 or 14 days, with chloramphenicol, 50 mg/kg per day for 14 days, for the treatment of patients with typhoid fever in a multicenter study. A total of 184 patients were randomly assigned to the three treatment groups. Efficacy was determined by culture of blood and stool, overall clinical response, and time to defervescence. Safety was assessed by occurrence of adverse events and laboratory abnormalities. A total of 97 patients were evaluable for efficacy, 28 in the fleroxacin 7-day group, 35 in the fleroxacin 14-day group, and 34 in the chloramphenicol group. All showed rapid defervescence with high cure rates. Bacteriologic cure rates were 96% in the fleroxacin 7-day group, 97% in the fleroxacin 14-day group, and 85% in the chloramphenicol group. Clinical cure rates were 83-100% with fleroxacin and 82% with chloramphenicol. The time to defervescence was shorter for patients treated with fleroxacin than for those treated with chloramphenicol. All three treatment regimens were well tolerated. Fleroxacin, 400 mg daily for 7 days, appears to be satisfactory for the treatment of typhoid fever and compares favorably with the standard 14-day therapy with chloramphenicol.

Adolescent↗
PubMed1993

[Complications and the proximate causes of death in typhoid].

The article analyses the 65 lethal cases by typhoid in the period 1980-1986 during an outbreak of infection among the servicemen of the 40-th Army. All the deceased had the age of 18-37, 79.8% of them were 18-20 years old. The most frequent complications were: myocarditis (84.6%), pneumonia (75.4%), hemorrhagic syndrome (50.8%), intestinal perforation (49.2%), intestinal ulcer hemorrhage (21.5%), pleuritis (20.0%), purulent complications (11.7%), endotoxic shock (12.3%). The structure of proximate causes of death was as following: perforative peritonitis (30.8%), pneumonia (20.0%), acute heart failure (13.8%), intestinal ulcer hemorrhage (12.3%), suprarenal hemorrhage (7.7%). The results obtained during this study prove the fact that this outbreak of epidemic infection had the features of classical typhoid.

Adolescent↗
PubMed1993

Prognostic factors in typhoid perforation.

A review of 60 patients undergoing surgery of typhoid perforation at the Ahmadu Bello University Teaching Hospital in Northern Nigeria between January 1981 and April 1987 was performed. Solitary perforation of the terminal ileum was found in 45 of 58 (78%) patients. 52 (87%) patients had debridement of the edge of perforation and simple closure. The overall hospital mortality was 57%. Important prognostic factors identified were blood urea level and duration of perforation before admission. In order to improve prognosis in typhoid perforation, patients must present early to hospital where early diagnosis, aggressive resuscitation and prompt surgery should be carried out.

Adolescent↗
PubMed1995

[The functional status of the body and work capacity of convalescent patients after typhoid fever].

Convalescents (168 patients) who went through typhoid and 48 sound men (control group) were examined in order to study their clinical and physiological indices, mental and performance capabilities. At the end of inpatient treatment the complete normalization of functional state was marked only in group 1 (convalescents after abortive typhoid). In 96% of patients who went through slight form of disease (group 2) and middle-severe form (group 3) different disorders of functional state of organism were marked. One week after medical rehabilitation the number of convalescents who needed the continuation of rehabilitation treatment has decreased 50% in the 2nd group, after 2 weeks--up to 35%, after 3 weeks there were no changes. In the 3rd group at the end of the 1st week functional disorders were marked in 85% of patients, after 2 weeks--in 35%, after 3 weeks--in 13.8%, after 4 weeks--in 2.5%.

Adult↗
PubMed1995

[Investigation of an outbreak of water-borne typhoid fever in Catalonia in 1994].

BACKGROUND: Typhoid fever incidence in Spain, and particularly in Catalonia has decreased significantly since 1985. Water borne outbreaks can affect large numbers of people. These two reasons make specially interesting to study all suspected typhoid fever outbreaks, like the one that happened in March 1994 in Bages county (Barcelona). METHODS: Epidemiological questionnaires were conducted to investigate the origin of the outbreak, the presence of related cases in the same area, and the household contacts of cases S. typhi isolates were characterized by serotyping, biotyping, phage-typing, ribotyping and pulsed field gel electrophoresis analysis of DNA. RESULTS: Nine cases were identified. All cases were treated with antibiotics, with clinical success. There were not secondary cases. The possible origin was a drinking fountain. All the strains had the same epidemiological marker patterns. CONCLUSIONS: Breaking of the sewer pipes near to the drinking fountain was probably the origin of the contamination. It can be concluded the importance of keeping a good epidemiological control system to investigate and prevent outbreaks. It is also important to control the drinking fountains to prevent its contamination. Finally it is necessary to highlight the utility of epidemiological markers to fully characterized the involved strains.

Adolescent↗
PubMed1995

[Persistent cerebellar ataxia following typhoid fever].

We report a patient who developed acute cerebellar ataxia, delirium, disseminated intravascular coagulation (DIC), and acute renal failure following typhoid fever. After treatment his general conditions improved except for cerebellar ataxia. Brain magnetic resonance imaging (MRI), before and after intravenous gadolinium administration, showed slight atrophy of the cerebellar vermis. 1-123 iodoamphetamine single photon emission computed tomography (IMP-SPECT) images showed markedly reduced radioisotope (RI) uptake in the cerebellum, and strongly implicated dysfunction of the cerebellum. Our report suggests that severe typhoid fever can produce persistent cerebellar dysfunction.

Adult↗
PubMed1995

Typhoid hepatitis: report of two cases.

Early appearance of clinical jaundice is rare presentation in enteric fever. Although abnormal biochemical tests suggestive of hepatic involvement has already been suggested in 23-60 per cent of cases. The early hepatic changes have been attributed to generalised bacteraemia, persistence of hepatomegaly and hepatic lesion during pyrexial stage. But the typhoid hepatitis has been ignored as a clinical entity. In this report the importance of typhoid hepatitis and its clinical significance for the diagnosis of enteric fever is highlighted, particularly at places where viral hepatitis and hepatic amoebiasis are usually common and enteric fever is endemic.

Adolescent↗
PubMed1977

[Current biological aspects of typhoid fever (author's transl)].

The biological signs of typhoid fever are studied on the basis of 90 cases collected over a period of 5 years. Average neutrophil granulocyte count before treatment was 5000 with extremes ranging from 1400 to 12180. The development of granulocytopaenia during treatment may be seen not only in patients treated with phenicols but also in those treated with ampicillin or the combination trimethoprim-sulphamethoxazole. It was possible to isolate the organism in 88 per cent of cases, either by blood culture (79%) or by stool culture (23%). Antibodies (O and H agglutinins) were found in only 86 per cent of cases, and for H agglutinins only there was a significant and transient increase in antibodies. This underlines the importance of the combined examination of three biological criteria - blood culture, stool culture and serology - in reaching the diagnosis of typhoid, the relatively asymptomatic forms of which are becoming increasingly frequent.

Ampicillin↗
PubMed1996

Changing spectrum of typhoid.

To determine the changing spectrum of typhoid fever, a study was conducted on 240 cases of typhoid fever, admitted over a period of 4 years. The classical 'Stepladder fever' and 'relative bradycardia' were less commonly seen. Presentation as hepatitis, psychosis, meningism, myocarditis, polyneuropathy and diarrhea were encountered in a small number of patients. Reversible proximal myopathy occurred in four patients and all of them recovered completely over a period of 2-3 weeks. The total leukocyte counts were within normal range in most of the cases. Bone marrow cultures were positive in all untreated and partially treated patients. All strains of Salmonella typhi in this study were sensitive to ofloxacin ceftriaxone and ciprofloxacin.

Adolescent↗
PubMedDate not supplied

[Modified method of inoculation of hemocultures from patients with suppurative-septic diseases and typhoid-paratyphoid fever].

A modified method of isolating hemocultures in pyoseptic processes is proposed. It consists in combined use of two known methods: inoculation of the blood by in-depth method and preliminary hemolysis of the blood, and use of commercial medium for assessing the sterility as the nutrient base. High efficacy of the proposed method has been demonstrated in experiments with 17 reference strains of microorganisms. The new approach helped improve the isolation rate of opportunistic enterobacteria, nonfermenting gram-negative bacteria, staphylococci, highly demanding streptococci, and other microorganisms similar in nutrient requirements, as well as the agents of typhoid and paratyphoid fever. This permits unifying the methods of investigation of hemocultures in pyoseptic diseases and typhoid-paratyphoid fevers'.

Bacteria↗
PubMed1996

Gm and Km allotypes and typhoid fever.

Gm and Km allotypes of immunoglobulins were determined in children with typhoid fever (Cases), in children without infectious diseases (Con-1), and in children with fever but no Salmonella in their blood or bone marrow (Con-2). Children were sampled from the urban population of Santiago; and they belonged to the low and low-middle socioeconomic strata. Cases had a higher frequency of [f;(-);b1,b3 or 3;(-);5,13] G1m, G2m, G3m haplotype than Con-1 and Con-2. Con-1 and Con-2 did not differ in their Gm haplotype or Km allele frequencies, but they differed in phenotype distribution. Con-1 deviated from Hardy-Weinberg equilibrium for Km due to a lack of Km 1-1 homozygotes. The relationship among these results, the ethnic origin of Chileans, and the differential susceptibility to typhoid fever are discussed.

Adolescent↗
PubMed1976

[Effect of prednisone and typhoid vaccine on the size of systemic neutrophil granulocyte pool].

Changes of total granulocyte pool in the organism were evaluated after administration of prednisone or typhoid vaccine. For this purpose the unsaturated capacity of serum vitamin B12 binding was determined. After administration of prednisone the rise of granulocytes in peripheral blood was associated with a rise in the unsaturated capacity of vitamin B12 binding by the serum which was not observed after administration of typhoid vaccine. This observation confirmed the suggestions that corticosteroids not only mobilize the bone marrow reserve of granulocytes but prolong also their survival in the organism.

Humans↗
PubMed1976

[The quantity of immunoglobulins (A, G, M) in different forms of typhoid fever].

Results of determination of the quantitative content of immunoglobulins (IgA, IgG and IgM) demonstrated chronic typhoid carrier state to be a dynamic process characterized by high IgA and IgG indices which began to form as early as the acute period. A complex of clinico-laboratory indices permitted to detect the latent phase of the carrier state among the persons who sustained typhoid fever within the range of 30%; this confirmed the statement of a number of investigators put forward earlier that the true number of carriers was much greater than that recorded.

Acute Disease↗
PubMed1996

Typhoid ileal perforation: the value of delayed primary closure of abdominal wounds.

Twenty-four patients with typhoid perforation of the terminal ileum operated on over a period of 1 year were studied to evaluate delayed primary closure of abdominal wounds. Twenty patients with the same diagnosis had primary wound closure to serve as control. Over 80% of the patients were between 1st and 3rd decades of life. The male:female ratio was 3:1 to 4:1. Mean duration of symptoms was 9.83 and 11.25 days while that of peritonitis was 2.87 and 2.50 days for the study and control groups, respectively. Terminal ileal perforations were confirmed in all and mean volume of pus and faeculent peritoneal fluid were 529 ml and 482 ml, respectively. Wound infection occurred in 70.8% and 70% of the study and control groups, respectively. Other complications such as wound dehiscence occurred in 37.5% and 35%, residual intraabdominal abscess in 8.3% and 10%, and faecal fistula in 8.3% and 10% of the study and control groups, respectively. Mortality was in 25% and 20%, respectively. The above results suggest that delayed primary closure has no value in preventing abdominal wound infection in typhoid perforation.

Adolescent↗
PubMed1997

Complications of typhoid perforation of the ileum in children after surgery.

Sixty six consecutive cases of typhoid perforation of the ileum in children between the ages of four and 14 years were analysed. 62.1% of the children were boys and 37.9% girls, a boy/girl ratio of 1.6:1.0. Postoperative complications included: wound infection, gaped wounds, intestinal obstruction secondary to adhesions, wound dehiscence and pneumonia. The most serious complication was enterocutaneous fistula and the most frequent was wound infection. These postoperative complications adversely affected the morbidity and mortality rates of these severely ill and debilitated patients with typhoid perforation of the ileum--a serious complication of enteric fever.

Adolescent↗
PubMed1997

Multi-drug resistant typhoid fever with diarrhea.

OBJECTIVE: To provide information about the characteristics of diarrheal stool in multi-drug resistant typhoid fever and observe the clinical course after treatment with furazolidone or ciprofloxacin. SETTING: Hospital based. SUBJECTS AND METHODS: Twenty one male children who were positive for multi-drug resistant S. typhi by blood and stool cultures, having diarrhea at the time of hospitalization comprised the subjects. Serum and stool electrolytes were estimated. Stool samples were also processed to detect established enteropathogens, leukocytes and red blood cells. Children were treated either with furazolidone or ciprofloxacin and evaluated till recovery. RESULTS: Mean (+/- SD) pre-admission duration of fever and diarrhea of these cases were 19.1 (+/- 5.6) and 15.8 (+/- 4.6) days, respectively. Stool character in 81% of the patients was watery with mean (+/- SD) volume of stool 51.4 (+/- 25.1) ml per kg body weight in the first 24 hours of observation. Leukocyte count varied between 20-49 per high power field in 66.7% stool samples. Occult blood was present in only 19% cases. Fecal red blood cells in high power field were detected in 52.4% cases. Mean fecal electrolytes (mmol/liter) were as follows: sodium-53.8, potassium-51.4, chloride-41.6 and total CO2-24.3. Most of the children (71.4%) had no dehydration and had normal serum electrolytes. The isolated strains of S. typhi were multi-drug resistant. These children were treated successfully either with furazolidone or ciprofloxacin. CONCLUSION: The stools of multi-drug resistant typhoid fever patients were watery with little blood. Their electrolyte contents were more similar to the diarrheal stool seen in shigellosis rather than cholera. Uncontrolled observations revealed that children recovered with furazolidone or ciprofloxacin therapy.

Anti-Infective Agents↗
PubMed1998

[Septic shock with coma revealing typhoid fever].

BACKGROUND: Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases. CASE REPORT: A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock. Vomiting and abdominal pain were followed by headache, prostration, fever and diarrhea. Leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis and hepatitis were present. Clotting tests were normal. The thick peripheral blood film was negative. Salmonella typhi was isolated from 6 blood cultures. Treatment associated ceftriaxone 4 g per day for 5 days, colloid and crystalloid fluids and dopamine. The patient was discharged 2 weeks later. DISCUSSION: Typhoid fever should be considered as a diagnosis in patients with sepsis who come from endemic zones. Abdominal symptoms, prolonged fever, coma and delayed headache are particularly contributive signs. Specific treatment should be instituted.

Adult↗
PubMed1997

[Observation of 212 cases of typhoid fever treated with FQNS].

OBJECTIVES: To treat 212 cases of typhoid fever with Seven kinds of fluoroquinolones (FQNS) and to evaluate their clinical efficacy, bacterial susceptibility and adverse drug reaction (ADR). METHODS: All the cases were hospitalized and uniantibiotic treated in which NFX group (n = 43) was compared with CP group (n = 28). RESULTS: 204/212 (96.23%) cases were positively cultured. All except 9 (S. paratyphi) were S. typhi. Of the 212 clinically isolated strains, 194(91.51%) were susceptible to FQNS with K-B assay. The MIC except 1 (6.25 mg/L) were all < or = 4 mg/L. The results of MIC detection with 20 strains of clinically isolated bacteria in 1994 and 1995 showed that FQNS were apparently superior to other antityphoid fever antibiotics as chloramphenicol and cefoperazone. When FQNS were used the overall clinical cure rate was 98.11%, the bacterial clear rate was 99.51%, and the rate of ADR was 11.3%. No difference was found between the NFX group and CP group in defervescent days and the cure rates and bacterial carrier state in recovery. The rate of recurrence and ADR in the NFX group was lower than that in the CP group. With the improvement of pharmacokinetics, new FQNS can be administered once or twice a day, and the therapy course shortened from 14 to 7 days. It is considered that FQNS are currently the first choice of antibacterials in treating typhoid fever.

Adult↗