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Typhoid perforation of the ileum in children.

Since 1974, 59 children with typhoid perforation of the ileum were studied prospectively using two protocols. In the first 36 cases a temporary total bypass of the terminal ileum was done (end-to-side ileotransverse colostomy) and several weeks later the intestinal continuity was restored (end-to-end ileoileostomy). The second protocol consisted, in 23 cases, of a partial bypass of the terminal ileum (one stage lateral tube ileostomy). Of the first group 10 died (27.7%). There was no reperforations or fistulae in this group. Of the 26 lateral tube ileostomies 8 died (34.8%). There was one reperforation and 4 fistula in this group. The combined mortality was 30.5%. Complications are presented as well as different methods of treatment. The author believes that a bypass operation with good medical supportive treatment, including total parenteral alimentation, will improve results.

Child↗

Surgical treatment of typhoid perforation.

The treatment of perforation of the ileum in 50 cases of typhoid fever is reviewed. Because of the risk of reperforation after surgical closure of a perforation, wedge excision of the ulcer if there is a single area of diseases bowel or segmental resection of the ileum if the ileum is more extensively affected are recommended.

Adolescent↗

Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever.

The recovery of Salmonella typhi from blood, rectal swab, urine, bone-marrow, and rose spots was compared in 62 patients with typhoid fever, most of whom had received some antibiotic therapy before presentation. S. typhi was isolated from culture of bone-marrow in 56 patients (90%); in contrast, S. typhi was recovered from blood in only 25 (40%), from stool in 23 (37%), and urine in 4 (7%). S. typhi was isolated from 24 (63%) of 38 patients who had rose-spot cultures. If culture sites had been limited to blood, stool, and urine, the bacteriological diagnosis would have been missed in 24 patients.

Bacteriuria↗

Comparative efficacy of chloramphenicol, ampicillin, and co-trimoxazole in the treatment of typhoid fever.

Two clinical trials were conducted to compare the efficacy of 3 antimicrobial agents often recommended for the treatment of typhoid fever. Chloramphenicol was more effective than parenteral ampicillin or oral co-trimoxazole (trimethaprim/sulphamethoxazole) in reducing the duration of fever. Oral chloramphenicol was more effective than parenteral chloramphenicol probably because oral doses resulted in higher blood concentrations of the drug. However, parenteral chloramphenicol was given during the initial period of acute illness, without loss of efficacy.

Administration, Oral↗

Assessment of antimicrobial treatment of acute typhoid and paratyphoid fevers in Britain and The Netherlands 1971-1980.

The response of 310 patients with typhoid or paratyphoid fevers to current antibiotic therapy was studied retrospectively. Most patients were of Asian or European origin, thus reflecting the areas in which they were infected. Of the 244 patients with well-recorded therapy 63% were treated with chloramphenicol, 22% with co-trimoxazole and the remainder with various penicillins. There was little difference in response in terms of resolution of fever. Symptoms persisted in only two of 153 (1.3%) patients given chloramphenicol but side-effects led to a change of treatment in nine of these patients. Co-trimoxazole was not significantly inferior and amoxycillin performed well, but the small number of cases treated with ampicillin or mecillinam did not respond as well as those treated with the other drugs.

Acute Disease↗

The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles?

The plague of Athens raged for 4 years and resulted in the defeat of Athens. The cause of the plague of Athens continues to be debated. Infectious diseases most often cited as causes of the plague include influenza, epidemic typhus, typhoid fever, bubonic plague, smallpox, and measles. Thucydides provides the only available description of the plague of Athens. Given the nuances of the translation, bubonic plague, smallpox, and measles are the most likely causes of the plague. In my view, measles is the most likely cause of the plague of Athens.

Communicable Diseases↗

The molecular mechanisms of severe typhoid fever.

Salmonella typhi continues to cause severe disease in many parts of the world, its most feared complication being perforation of ulcerated Peyer's patches within the small intestine, leading to peritonitis with associated mortality. The pathogenesis of this process is not well understood. In this article, we present a theoretical mechanism as to how bacterial factors and host immunological mediators within infected tissue might contribute to the observed intestinal pathology, and propose that necrosis of the Peyer's patches observed in typhoid is caused by a mechanism similar to the Shwartzman and Koch reactions.

Enterotoxins↗

"Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention.

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

Carrier State↗

Typhoid and paratyphoid fever in travellers.

Enteric fever--a more inclusive term for typhoid fever and paratyphoid fever--is a systemic infection caused by Salmonella enterica, including S enterica serotype Typhi (S typhi) and serotype Paratyphi (S paratyphi). In developed countries there have been two major changes in the pattern of the disease: a marked decline in its incidence and its characterisation as a predominantly travel-associated disease. The risk to travellers appears to vary by geographic region visited, with travel to the Indian subcontinent accounting for the greatest travel risk. Although the most common cause of enteric fever is S typhi, the incidence of disease caused by S paratyphi among travellers may be more important, since the available vaccines only protect against S typhi. Descriptions of the clinical presentation in travellers are scarce but severe complications and death are rare, probably due to rapid access to readily available medical care. Drug resistance reflects the situation in endemic countries, and shows a steady increase in multidrug-resistance patterns. Currently, the recommendation for first-line therapy is ceftriaxone and, where isolates have been found to be quinolone sensitive, fluoroquinolones can still be given. Preventive measures are educating travellers about hygiene precautions and vaccination. With an increase in multidrug-resistant strains, a more effective vaccine for S typhi and S paratyphi is urgently needed.

Developing Countries↗

Water-borne typhoid fever caused by an unusual Vi-phage type in Edinburgh.

Investigation of a small series of cases of typhoid fever infected in a river between 1963 and 1970 revealed that all were caused by a single source, a carrier of a rare phage type of Salmonella typhi. The contamination of the river resulted from an incorrect sewage connexion with a surface water drain outfall into the river.

Adolescent↗

Intradermal versus subcutaneous immunization with typhoid vaccine.

Swedish nationals about to travel abroard were immunized against typhoid with a monovalent heat-inactivated vaccine which was administered intra- or subcutaneously. No major differences in serum antibody response were noted in the two groups of vaccinees as determined with direct agglutination and indirect hemagglutination techniques. As the intracutaneous route caused fewer adverse reactions this way of administration seems to be preferable.

Agglutination Tests↗

Antibiotics and the Aberdeen typhoid outbreak in 1964.

This paper gives an abbreviated account of part of a research programme which followed the Aberdeen typhoid outbreak in 1964. Chloramphenicol, the main antibiotic used in treatment, was shown to have a minimum inhibitory concentration (MIC) of between 5 and 2-5 mug./ml. for the S. typhi phage type 34 of the outbreak. The MIC for methacycline was between 5 and 2-5 and 2 mug./ml. Whereas the deep and shallow broth techniques used gave similar results with these antibiotics, the MIC for ampicillin, and also cephaloridine, was less in the deep than in the shallow broths. Serum assays in patients given ampicillin or cephaloridine yielded abnormally high concentrations of both antiboitics when S. typhi phage type 34 was the test organism whereas, with other test organisms, the concentrations were within expectation. These abnormally high values fell within expected values when the sera under investigation had first been heated to 56 degrees C. for 30 min. before assay against the S. typhi of the outbreak. The findings with ampicillin suggested that dosages given were satisfactory. With cephaloridine the concentrations found in patients' sera seemed to show that twice daily doses of 0-5 g. fell short of adequacy.

Adult↗

Typhoid fever from water desalinized using reverse osmosis.

In May 1992, 81 bacteriologically confirmed cases of typhoid fever (TF) were identified in all districts of Tabuk City in northwestern Saudi Arabia. Attack rates (AR) in residential districts ranged from 0.9-10.3 per 10,000. Confirmed cases included 9 workers in the city's referral hospital, King Khalid Hospital (AR 140/10,000), 2 in families of medical staff, 57 in the community (AR 4.4/10,000) and 13 in a local military cantonment (AR 0.8/10,000). The outbreak began with the onset of TF in the three areas within 5 days, continued for 7 weeks, and ended 2 weeks after chlorination began. Among water sources, the odds ratio (OR) was highest (2.6; 95% confidence interval [CI] 1.25-5.39) for water purchased from reverse osmosis (RO) plants, especially RO plants supplied by one well (ASUW) (OR = 7.05; 95% CI 2.51-20.7). The aquifer for ASUW lay partially beneath a depression where city sewage collected. Unchlorinated water samples from ASUW 1 month after the outbreak ended yielded coliforms. ASUW probably became contaminated with Salmonella typhi when KKH demand overtaxed the aquifer and drew in surface water. Membranes in RO plants using this unchlorinated well water could then become fouled with S. typhi. RO plants, which are common throughout Saudi Arabia, need close monitoring. Water for RO must be prechlorinated to prevent microbiologic fouling of the membranes.

Adolescent↗

Does chloramphenicol remain the drug of choice for typhoid?

Of 2356 strains of Salmonella typhi isolated in Britain in the 8-year period 1978-85, 2345 (99.53%) were sensitive to all antibiotics tested and 11 (0.47%) were chloramphenicol-resistant; chloramphenicol resistance was plasmid-mediated in 6 strains. It is concluded that chloramphenicol remains a satisfactory first-line choice of drug for typhoid fever in Britain.

Chloramphenicol↗

Antigen-specific B cells in tissues after oral typhoid vaccination.

Six human subjects who were to receive elective bowel surgery for a variety of diseases were vaccinated with the oral typhoid vaccine, Ty21a. Intestinal tissue (ileum in two, large intestine in four) removed 7-26 days after the first dose of vaccine was examined for the presence and distribution of antigen-specific B cells. This was compared with intestinal tissue derived from two unvaccinated controls. A number of B cell differentiation antigens were also assessed on these cells by immunofluorescence using dual-labelling. Antigen-specific cells were found randomly distributed in the lamina propria of all the vaccinated subjects in low frequency (6 +/- 0.5 to 37 +/- 31 [mean +/- s.e.m.] antigen specific cells/10 mm2 of tissue). The lymphocyte differentiation antigens CD45RA, CD45RO, L-selectin, CD-11a CD-38, CD-44 and VLA-4 were all found on antigen-specific cells, but no particular pattern was recognizable in this small series of six subjects with different disease processes affecting the intestine.

Administration, Oral↗

Unusual presentation of typhoid fever: cutaneous vasculitis, pancreatitis, and splenic abscess.

We report a case of typhoid fever with an unusual presentation: prolonged fever with cutaneous vasculitis, pancreatitis, and splenic abscess. This is the first case of cutaneous leukocytoclastic vasculitis associated with Salmonella typhi. The diagnosis was made upon isolation of S. typhi in blood cultures, and after ruling out other causes of leukocytoclastic vasculitis. The outcome was favourable with antibiotics alone without surgery.

Abscess↗