[Hepatopathy in typhoid fever. Study on 80 typhoid patients].
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Adolescent↗
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[Recurrence of typhoid fever in carriers of typhoid bacilli].
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Adult↗
Epidemiology of typhoid fever in Mauritius.
BACKGROUND: The epidemiology of typhoid fever in Mauritius was studied to determine whether there was any need for tourists visiting Mauritius to be vaccinated against the disease, and where Mauritians with typhoid fever had been infected. Data on antibiotic susceptibility of Salmonella typhi isolates from Mauritius were also analyzed. METHODS: Since 1997 every time S. typhi is isolated from blood cultures at our laboratory, an epidemiologic inquiry is conducted to determine the likely origin of the infection and the outcome of treatment, and the information collected is recorded. Results of antibiotic susceptibility testing are also noted. Data recorded on cases between 1997 and 2004 were reviewed and analyzed. RESULTS: S. typhi was isolated on 25 occasions during the 8-year period. The infection was likely to have been acquired in Mauritius in only 6 cases (24%). Another 6 cases (24%) occurred in expatriate workers from the Indian subcontinent. Of the 13 Mauritians (52%) who probably acquired the infection abroad, 11 had a history of recent travel to India. Thirteen of 14 S. typhi isolates from cases acquired in India were resistant to nalidixic acid. Of the 6 cases acquired in Mauritius, 4 occurred in children under 12 years and 1 was caused by a multiply resistant strain. Twenty-two patients made an uneventful recovery. One death was indirectly caused by typhoid fever, and there was 1 case each of intestinal perforation and relapse. CONCLUSIONS: In Mauritius typhoid fever is mainly an imported disease, but indigenous cases of the illness occur rarely and sporadically. Travelers to Mauritius need not be vaccinated against typhoid fever as the risk of acquiring the disease in the country is negligible. Mauritians traveling to India must be made aware of the risk of typhoid fever and of preventive measures. Ceftriaxone should be used as the initial first-line treatment of infection acquired in India.
Adolescent↗
Typhoid fever in an 8-month-old infant.
Typhoid fever occurs both in epidemic and endemic forms and is a public health problem in developing countries. Typhoid fever is rare under 2 years of age. The clinical profile of typhoid fever in an infant is variable and non-specific. The absence of specific symptoms or signs makes the clinical diagnosis of typhoid fever difficult. The problem in diagnosing typhoid fever in a young infant is highlighted with a brief literature review on the subject. A rare case of typhoid fever in an 8 month old infant is reported.
Female↗
Helicobacter pylori infection and typhoid fever in Jakarta, Indonesia.
We evaluated the association between typhoid fever and Helicobacter pylori infection, as the latter microorganism may influence gastric acid secretion and consequently increase susceptibility to Salmonella typhi infection. Anti-H. pylori IgG and IgA antibody titres (ELISA) and gastrin concentration (RIA) were determined in the plasma of 87 blood culture-confirmed typhoid fever cases (collected after clinical recovery) and 232 random healthy controls without a history of typhoid fever, in the Jatinegara district, Jakarta. Patients with typhoid fever more often than controls were seropositive for H. pylori IgG (67% vs. 50%, P<0.008), when antibody titres were dichotomized around median titres observed in controls. H. pylori IgA seropositivity was not associated with typhoid fever. Plasma gastrin concentrations indicative of hypochlorhydria (i.e. gastrin > or =25 or > or =100 ng/l) were not significantly elevated in typhoid fever cases compared to controls (P=0.54 and P=0.27 respectively). In a multivariate analysis, typhoid fever was independently associated with young age (<33 years, median age of the controls) [odds ratio (OR) 7.93, 95% confidence interval (CI) 3.90-16.10], and H. pylori IgG seropositivity (OR 1.93, 95% CI 1.10-3.40). Typhoid fever was independently associated with H. pylori IgG seropositivity, but not with elevated gastrin concentration. Therefore, the association suggests a common risk of environmental exposure to both bacteria, e.g. poor hygiene, rather than a causal relationship via reduced gastric acid production.
Adolescent↗
Atypical manifestations of typhoid fever.
BACKGROUND: High fever, toxaemia, constipation during first week of fever, complicated by encephalopathy and perforation during third week of fever are the typical manifestations of typhoid fever. However, the classical presentation of typhoid fever has considerably changed now. AIM: To study atypical presentations of typhoid fever. SETTING: A teaching unit of a hospital in South India METHOD: All culture-positive adult patients of typhoid fever admitted over a period of seven years were studied RESULTS: Thirty-two adult patients were admitted. Fifteen (46.9%) patients presented with atypical manifestations. Atypical manifestations observed were burning micturition with normal urine examination (n= 5, 15.6%) diarrhoea in first week (6.2%), encephalopathy in first week (3.1%), isolated hepatomegaly (6.2%), pneumonitis (3.1%) and bone marrow depression (6.2%). Out of 32 Salmonella typhi culture positive patients, 10 (31.3%) patients had multidrug resistant (MDR) strain. Patients with MDR strains had atypical manifestations (5/10=50%) not significantly more often than patients having multidrug sensitive strains (10/22=45.5%) (Z <2). All patients responded to treatment. CONCLUSION: It appears atypical manifestations do not necessarily mean a worse prognosis in typhoid fever. Patients having high fever presenting with pneumonia, early encephalopathy, early diarrhoea or bone marrow depression in a typhoid endemic area, should be suspected for this disease.
Adolescent↗
Diagnostic usefulness of Vi-indirect fluorescent antibody test(Vi-IFAT) for typhoid fever--a prospective study.
Although the confirmative diagnosis of typhoid fever is by culture of the causative organism, usually from blood, a serological test is still necessary to provide a more rapid method of diagnosis. The indirect fluorescent antibody test, using a Salmonella typhi Vi antigen and a FITC-conjugated rabbit anti-human polyvalent immunoglobulin, was evaluated for the diagnosis of typhoid fever. Serum specimens were collected from patients with febrile diseases on admission. Of the 32 patients with titers of 1:64 or more, 22 were confirmed to have typhoid fever by blood culture and 7 had fever of undetermined origin that was considered to be typhoid fever clinically. Three patients were diagnosed to have salmonellosis other than typhoid fever. Of the 121 patients with titers of 1:32 or less, 105 patients had non-typhoidal febrile disease, 15 patients had fever of undetermined origin, and one patient was confirmed to have typhoid fever by blood culture. When a Vi antibody titer of 1:64 or more was taken as serological evidence for the diagnosis of typhoid fever, the sensitivity and specificity were 95.7% and 97.2%, respectively. The incidence of positive test results following fever onset was 70.0% within 1 week of fever onset, 88.9% from 1 to 2 weeks, and 100% after 2 weeks. In conclusion, the Vi-indirect fluorescent antibody test(Vi-IFAT) can be employed as a useful serologic test in the diagnosis of typhoid fever.
Antigens, Bacterial↗
Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia.
To identify risk factors for typhoid fever in Semarang city and its surroundings, 75 culture-proven typhoid fever patients discharged 2 weeks earlier from hospital and 75 controls were studied. Control subjects were neighbours of cases with no history of typhoid fever, not family members, randomly selected and matched for gender and age. Both cases and controls were interviewed at home by the same trained interviewer using a standardized questionnaire. A structured observation of their living environment inside and outside the house was performed during the visit and home drinking water samples were tested bacteriologically. Univariate analysis showed the following risk factors for typhoid fever: never or rarely washing hands before eating (OR = 3.28; 95% CI = 1.41-7.65); eating outdoors at least once a week (OR = 3.00; 95% CI = 1.09-8.25); eating outdoors at a street food stall or mobile food vendor (OR = 3.86; 95% CI = 1.30-11.48); consuming ice cubes in beverage in the 2-week period before getting ill (OR = 3.00, 95% CI = 1.09-8.25) and buying ice cubes from a street vendor (OR = 5.82; 95% CI = 1.69-20.12). Water quality and living environment of cases were worse than that of controls, e.g. cases less often used clean water for taking a bath (OR = 6.50; 95% CI = 1.47-28.80), for brushing teeth (OR = 4.33; 95% CI = 1.25-15.20) and for drinking (OR = 3.67; 95% CI = 1.02-13.14). Cases tended to live in houses without water supply from the municipal network (OR=11.00; 95% CI = 1.42-85.2), with open sewers (OR = 2.80; 95% CI = 1.0-7.77) and without tiles in the kitchen (OR = 2.67; 95% CI = 1.04-6.81). Multivariate analysis showed that living in a house without water supply from the municipal network (OR = 29.18; 95% CI = 2.12-400.8) and with open sewers (OR = 7.19; 95% CI = 1.33-38.82) was associated with typhoid fever. Never or rarely washing hands before eating (OR = 3.97; 95% CI = 1.22-12.93) and being unemployed or having a part-time job (OR = 31.3; 95% CI = 3.08-317.4) also were risk factors. In this population typhoid fever was associated with poor housing and inadequate food and personal hygiene.
Adolescent↗
Inefficacy of the commercial live oral Ty 21a vaccine in the prevention of typhoid fever.
The efficacy of the live oral typhoid fever vaccine Ty 21a marketed in Switzerland in 1981 was investigated. Forty-seven Swiss travellers to Third World countries contracted typhoid fever in 1982 and 1983; 20 (43%) of these persons had been vaccinated with Ty 21a. The incidence of typhoid fever in vaccinees was 1.1 per 10,000 doses of Ty 21a vaccine sold, which was similar to the incidence of 0.9 per 10,000 doses for the ineffective killed Ty 2 vaccine. Comparison of the incidence of vaccination in patients with typhoid fever in 1983 and in healthy travellers to India revealed vaccination efficacy rates which were not significantly different from zero. It is suggested that Ty 21a vaccine in the form marketed in Switzerland in 1981-1983 is not sufficiently potent or heat-stable, so that the doses of viable bacteria ingested were too low.
Administration, Oral↗
Risk Factors for Typhoid Fever in Travelers.
Background: The incidence of typhoid fever in the developing world remains high and has been estimated at 540 cases per 100,000 of the population per year. International travelers to such areas are at risk of infection, especially if they travel under low hygienic standards. Methods: In order to identify the risk factors leading to infection in travelers and expatriates, travel histories, anamnestic and clinical features of 31 patients with typhoid fever, who presented to a German travel clinic, were investigated. Results: Compared to the total patient population of the outpatient clinic during the period of investigation (n = 17,029 patients), patients who presented with typhoid fever were older (39 years versus 31 years, p <.001) and traveled longer (58 days versus 19 days, p <.001). While only 19.2% of the total patient population had traveled to the Indian subcontinent prior to referral, 35.4% of the patients with typhoid fever had acquired the infection there (p <.001). Similar results were obtained for South East Asia and Indonesia: twenty percent of the total patient population traveled there in contrast with 32.2% of patients with typhoid fever (p <.001). Latin America was visited by 16.3% of all patients, but only 6.4% of patients with typhoid (p <.001).
Journal Article↗
Multidrug-resistant typhoid fever in Singapore.
A study was conducted to determine the clinical and epidemiological characteristics of multidrug-resistant (MDR) typhoid fever in Singapore. Twenty-one of 121 patients with typhoid fever had MDR typhoid fever after recent travel to the Indian subcontinent. Fifty patients with drug susceptible typhoid fever were also analysed for comparison. Nineteen of the MDR S. typhi isolates had resistance to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole (TMP-SMX) while the remainder had resistance to ampicillin and TMP-SMX. The predominant presenting symptoms were fever and diarrhoea. Eleven patients with MDR typhoid fever were treated with oral ciprofloxacin and nine with intravenous ceftriaxone. The patients with MDR typhoid fever had a longer duration of fever defervescence (8 +/- 5 days) compared to those with drug-susceptible typhoid fever (5.7 +/- 4.16 days) (p < 0.01). Eighteen patients were cured and one patient defaulted treatment. Two patients relapsed within two months of treatment. The study showed that 17.4% of patients with typhoid fever had imported MDR S. typhi after recent travel to the Indian subcontinent where MDR typhoid fever is prevalent.
Adult↗
The need for high index of suspicion in early diagnosis of typhoid fever in young children.
BACKGROUND: The diagnosis of typhoid fever in young children is more difficult than in the adult due to the unusual pattern of presentation. This letter aims to sensitize general physicians and paediatricians on the need for a high index of suspicion in the diagnosis of typhoid fever in children. METHOD: The case records of a child diagnosed with typhoid fever and a review of literature on the subject were used. RESULT: A five year old female misdiagnosed as a case of severe malaria and sepsis was found to have typhoid fever on post mortem examination. CONCLUSION: It is important to make an early diagnosis of typhoid fever in young children in order to prevent mortality from this treatable disease.
Age Factors↗
Control of typhoid fever in Bangkok, Thailand, by annual immunization of schoolchildren with parenteral typhoid vaccine.
The number of cases of typhoid fever in Bangkok, Thailand, began to increase sharply in 1974 and peaked in 1976. In 1977, as part of a national typhoid immunization program, Thai schoolchildren aged seven to 12 years began to receive annually a single 0.25-ml subcutaneous dose (2.5 x 10(8) organisms) of a heat/phenol-inactivated typhoid vaccine. Isolations of Salmonella typhi in Bangkok decreased from 880 (4.6% of all blood cultures) in 1976 to 54 (0.3% of all blood cultures) in 1985. The case ratio of S. typhi to Salmonella paratyphi A infection declined from 4.1:1 before the epidemic (1970-1973) to 0.9:1 after the epidemic (1984-1985), and the proportion of cases of typhoid fever occurring among children aged seven to 12 years significantly decreased from 30% to 10%. During the same periods S. paratyphi A isolation rates did not significantly decrease (in terms of either total number or percentage of cases) in school-aged children. Thus, mass vaccination of schoolchildren in Thailand with the heat-inactivated typhoid vaccine has been closely associated with a sharp decline in typhoid fever in Bangkok during an epidemic and with continuous control after the epidemic.
Child↗
Chloramphenicol in the treatment of typhoid fever.
Six patients with typhoid fever were treated with chloramphenicol. The excellent clinical response in four cases suggests that chloramphenicol is the drug of choice in the treatment of this disease. In one case in which clinical relapse occurred, there was good response to re-treatment. One patient, critically ill, in a typhoid state, and treated late in the course of the disease, died without beneficial effect from chloramphenicol, but the patient had been unable to retain the drug because of vomiting.
Chloramphenicol↗
Typhoid fever in Hong Kong children.
Experience with typhoid fever in 111 children over a 5-year period was reviewed. There were 66 boys and 45 girls, ranging in age from 1 to 11.5 years. The symptoms of typhoid fever were quite non-specific. Fever was the most common presenting symptom (in 98.3%). Other common presenting features were diarrhoea (25.7%), constipation (22%), vomiting (21.1%), cough (25%), abdominal pain (27.5%), headache (9.2%), epistaxis, meningism and convulsions. Rose spots were detected in 20% of cases, occurring mainly during the first 2 weeks of illness. Significant Widal reactions were present in 84.7% of cases. Blood and stool cultures were positive in 57% and 44% of cases, respectively. Peripheral blood white cell counts were not found to be of great diagnostic value. Chloramphenicol remained the drug of choice in the treatment of typhoid fever. It was more effective than ampicillin or co-trimoxazole. Complications were uncommon, occurring in only two patients. There were two deaths; both were admitted late and in moribund state. Early diagnosis and treatment is vital in typhoid fever and, as the presenting features are non-specific, a high index of suspicion is required.
Ampicillin↗
Relative sensitivity of blood and bone marrow cultures in typhoid fever.
In a prospective study of typhoid fever in Ahmadu Bello University Hospital, Zaria, the relative diagnostic sensitivities of blood culture and bone marrow culture were studied. The results in 64 patients with proved diagnosis of typhoid fever (either by recovery of S. typhi from stool, blood and/or bone marrow or by a positive Widal agglutination test) are presented. Forty-four per cent and 59% of the patients yielded S. typhi on blood and bone marrow cultures, respectively. In 31 patients who were investigated by both blood and bone marrow cultures, the yields of S. typhi were 35% and 61% respectively. This difference is statistically significant (P less than 0.05). In this study bone marrow culture proved to be the most sensitive diagnostic test for typhoid fever. A simple technique of bone marrow aspiration is described and its use is recommended for large general teaching hospitals.
Blood↗
Typhoid fever: present and future.
Typhoid fever (TF), a systemic prolonged febrile illness, continues to be a worldwide health problem especially in developing countries where there is poor sanitation and poor standards of personal hygiene. The worldwide incidence of TF is estimated to be approximately 16 million cases annually with 7 million cases occurring annually in SE Asia alone. More than 600,000 people die of the disease annually. The pathogenesis of TF is beginning to be understood. The clinical features and diagnosis of TF are well known. New diagnostic methods have yet to gain universal acceptance. Traditional treatment with the first-line antibiotics (i.e. chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole) though still being used in most developing countries are gradually being replaced with shorter courses of treatment with third generation cephalosporins or fluoroquinolones especially with the growing incidence of multi-drug resistant S typhi strains (MDR-ST). MDR-ST strains are particularly common in the Indian subcontinent; Pakistan and China. The presently available vaccines are far from satisfactory in terms of safety, efficacy and costs. Newer vaccines have been developed and are presently undergoing clinical trials in human volunteers.
Carrier State↗
Presence of endotoxemia and its relationship to liver dysfunction in patients with typhoid fever.
Twenty-one patients with typhoid fever were studied to evaluate the presence of endotoxin in peripheral blood and its relationship to the incidence and features of hepatic dysfunction which may occur during this disease. The limulus test for endotoxin was positive in the plasma samples of all patients prior to treatment. Liver dysfunction, as assessed by fasting and postprandial serum bile acid levels and by standard biochemical tests, occurred in 90% of patients. In seven, the injury was purely cholestatic (elevation of postprandial serum bile acid levels, alone); in 12, it was of mixed cholestatic-hepatocellular type (elevation of both serum bile acids and aminotransferase levels). After recovering, the limulus test was negative and liver function tests returned to normal values in all patients. The results demonstrate that endotoxemia is present in patients with typhoid fever. In addition, since endotoxin can impair bile secretion, our results suggest that endotoxin may have a pathogenetic role in the development of liver injury during typhoid fever.
Adolescent↗