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PubMed1994

Value of single Widal test in the diagnosis of typhoid fever.

The usefulness of single Widal test in the diagnosis of typhoid fever was investigated. The test was done on 50 normal children, 50 children with non typhoidal fevers and 30 culture proved typhoid cases. Twenty one (70%) and nine (30%) of thirty typhoid fever cases had 'O' and 'H' agglutinin titer levels of more than or equal to 1:160, respectively as compared to only 3 (3%) and to 1 (1%) among controls. These differences were significant (p < 0.001). Twenty two (73.3%) out of thirty typhoid fever cases had either an 'O' or 'H' agglutinin titer of more than or equal to 1:160 as compared to only 3 (3%) among controls. An 'O' agglutinin titer of 1:160 had a specificity of 97%, a sensitivity of 70% and an accuracy of 90%. An 'H' agglutinin in titer of 1:160 was had a specificity of 97%, a sensitivity of 30% and an accuracy of 83.1%. Based on the above analysis, 'O' or 'H' titers of 1:160 or more were indicative of typhoid fever. Similarly, when the 2 titers were considered together, either 'O' or 'H' titers of 1:160 or more were suggestive.

Agglutination Tests↗
PubMed2006

Population-based surveillance of typhoid fever in Egypt.

Credible measures of disease incidence are necessary to guide typhoid fever control efforts. In Egypt, incidence estimates have been derived from hospital-based syndromic surveillance, which may not represent the population with typhoid fever. To determine the population-based incidence of typhoid fever in Fayoum Governorate (pop. 2,240,000), we established laboratory-based surveillance at five tiers of health care. Incidence estimates were adjusted for sampling and test sensitivity. Of 1,815 patients evaluated, cultures yielded 90 (5%) Salmonella Typhi isolates. The estimated incidence of typhoid fever was 59/100,000 persons/year. We estimate 71% of typhoid fever patients are managed by primary care providers. Multidrug-resistant (MDR) Salmonella Typhi (resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) was isolated from 26 (29%) patients. Population-based surveillance indicates moderate typhoid fever incidence in Fayoum, and a concerning prevalence of MDR typhoid. The majority of patients are evaluated at the primary care level and would not have been detected by hospital-based surveillance.

Adolescent↗
PubMed1991

Oral immunisation against typhoid fever in Indonesia with Ty21a vaccine.

When tested under conditions of moderate transmission of typhoid fever, a liquid formulation of the oral typhoid fever vaccine Ty21a had a protective efficacy of 96% in Egypt, and an enteric coated capsule formulation had an efficacy of 67% in Chile. We compared the two formulations under conditions of intense transmission of typhoid fever in Indonesia in a randomised, double-blind trial. 20,543 subjects (age range 3-44 years) received either three doses of enteric coated capsules containing placebo or live Ty21a, or three doses of lyophilised placebo or live Ty21a reconstituted with phosphate buffer. During 30 months of follow-up, the rate of blood-culture-positive typhoid fever among controls was 810/100,000 per year. Rates of typhoid fever were 379/100,000 per year for subjects who received the liquid formulation of vaccine and 468/100,000 per year for subjects who received enteric coated capsules. The protective efficacies of the liquid and enteric coated formulations were 53% and 42%, respectively. Neither formulation protected against infection with Salmonella paratyphi A. No major side-effects were noted, but the overall incidence of side-effects was greater in the vaccine groups. Under conditions of intense transmission, Ty21a protected against typhoid fever; however, because Ty21a will not protect all individuals, there is a need for additional approaches to prevent the disease.

Administration, Oral↗
PubMed1989

Neuropsychiatric manifestations of typhoid fever.

Neuropsychiatric manifestations of typhoid fever are not uncommon, occurring in 18 of 40 consecutive patients at the University Hospital of the West Indies. The clinical presentation ranges from a confusional state to hallucinations or meningism, and the diagnosis may be missed or unduly delayed unless there is a strong index of suspicion.

Adolescent↗
PubMed1993

[An epidemic of typhoid fever].

An outbreak of typhoid fever was observed in a group of students and accompanying teachers during a journey to Haiti in summer 1991. All (6) infected persons were symptomatic and rapidly cured by antibiotics. The Salmonella typhi strains isolated from blood cultures were all identical by ribotyping. All the participants had a medical checkup and stool cultures were obtained; asymptomatic carriers could be excluded. Secondarily infected persons were not observed. The infectious source has not been identified, but various hypotheses are considered. Oral vaccination does not appear to modify the risk of infection in exposed persons.

Adolescent↗
PubMed1993

The death of Albert Prince Consort: the case against typhoid fever.

The case against typhoid fever as the cause of the Prince's death rests partly on some uncharacteristic clinical features during the terminal 22 days of his illness, and partly on other aspects of his temperament and emotionally threatening life events, which tend to favour ulcerative colitis or Crohn's disease. That he had been intermittently unwell with abdominal symptoms for several months before the terminal stage of his illness, only 9 days after this sensitive and vulnerable man was confronted by an intensely personal insult, lends further support to a diagnosis of inflammatory bowel disease. His many admirable qualities unfortunately did not include those needed to surmount deeply injured feelings at his son's behaviour, notably flexibility, sufficient sense of humour and tolerance of human frailty. Had he been able to swear or laugh at his son's foolishness, it might have saved him, and so might adequate psychological management. Some patients with fulminating inflammatory bowel disease, if that is what the Prince had, decline such help, preferring to brood rather than speak, and take their bottled-up feelings of resentment to the grave.

Colitis, Ulcerative↗
PubMed2004

Colonoscopic manifestations of typhoid fever with lower gastrointestinal bleeding.

BACKGROUND: Intestinal bleeding in patients with typhoid fever usually occurs in the ileum. However, endoscopic findings in such patients are not well established. We examined the colonoscopic manifestations of intestinal lesions with bleeding in patients with typhoid fever. PATIENTS AND METHODS: The colonoscopic findings of seven patients who presented with haematochezia due to typhoid fever were reviewed retrospectively. Typhoid fever was diagnosed when the Salmonella typhi was isolated or when the Widal test showed strongly positive reactions. RESULTS: Clinical data and colonoscopic findings were reviewed in seven patients (four men and three women with an average age of 42 years). The most commonly involved area was the terminal ileum (100%), followed by the ileocecal valve (57%), the ascending colon (43%), and the transverse colon (29%). Left colon was intact in all cases. The most common colonoscopic finding was multiple variable-sized punched-out ulcers with slightly elevated margin, as found in five patients. In two patients, only several oedematous hyperaemic mucosal patches with haemorrhagic spots or shallow erosions were seen. Active bleeding was noticed only in one patient, who received endoscopic haemostasis twice. The remaining six patients were treated by conservative treatment including antibiotic therapy. There was no complication during or after the colonoscopic examination. CONCLUSIONS: Intestinal bleeding in typhoid fever usually occurs from the ulcers in the ileum or proximal colon, and the most common colonoscopic manifestations are multiple variable-sized punched-out ulcerations.

Adult↗
PubMed1993

Value of a single Widal test in the diagnosis of typhoid fever.

Results of a single Widal test in patients with bacteriologically confirmed typhoid fever (116), clinically suggestive but culture negative fever (170) and non-typhoidal febrile illness (98) and in normal control children (54) were analysed. Positive Widal test (antibody titre against S. typhi O antigen of 1:160) was recorded in 61.2 per cent of patients with bacteriologically confirmed typhoid fever and in 58.8 per cent with culture negative but clinically suggestive typhoid fever. In contrast, the same titre was observed in 10.2 per cent patients with other febrile illnesses of known etiology and in 1.8 per cent of normal children. Differences in the positivity of Widal test in patients with bacteriologically confirmed typhoid fever and clinically suggestive but culture negative fever were highly significant (P < 0.000001) when compared to that of patients with non-typhoidal febrile illnesses and normal controls. High specificity and positive predictive value in 1:160 dilution makes the Widal test acceptable as a diagnostic tool.

Antibodies, Bacterial↗
PubMedDate not supplied

[Adenosine deaminase in typhoid fever and other febrile diseases].

The contribution of serum adenosine deaminase (ADA) activity to the diagnosis of typhoid fever was assessed in 246 children and in 46 adults, by Giusti's original technique. Children included otherwise healthy patients admitted for elective surgical conditions or under follow up for epilepsy which were considered to be a control group (n: 81), presumptive viral diseases (n: 31), miscellaneous febrile diseases except for typhoid fever (n: 41), different kinds of bacteremia (n: 6), diarrhea due to Salmonella typhimurium (n: 14), viral hepatitis (n: 24), and culture proven typhoid fever (n: 49). Adult's group included 39 healthy controls and 7 patients with culture proven typhoid fever. Among children mean ADA activity was as follows: control group 28 +/- 7.8, viral disease 35.3 +/- 13.1, miscellaneous febrile disease 36.1 +/- 15.6, bacteremia group: 30.3 +/- 10.3, salmonellosis group 51.6 +/- 9, hepatitis group 68.3 +/- 34.5, typhoid fever group 124.4 +/- 40.8 U/I 37 degrees C. Among adults, values were 18.4 +/- 7.5 for controls and 112.8 +/- 19.2 U/I 37 degrees C in typhoid fever patients. In both adults and children ADA activity was significantly higher in the typhoid fever group (p < 0.0001). Untreated typhoid fever patients had their higher ADA activity between 10th and 15th day of illness. When ADA cut point was set at 80 U/I, sensitivity of the test was 91.8% and specificity was 91.4% as a preliminary clue to the recognition of typhoid fever.

Adenosine Deaminase↗
PubMed1978

Diagnostic value of the Widal test in areas endemic for typhoid fever.

The usefulness of a single Widal test to diagnose typhoid fever in endemic areas was investigated. Reciprocal Salmonella typhi O and H titers greater than or equal to 40 and greater than or equal to 80, respectively, occurred in approximately 90% of 42 Mexican patients with bacteriologically-confirmed typhoid fever at the time of presentation to hospital and, by day 4 to 5 of clinical illness, in 70% of U.S. adult volunteers who developed typhoid fever in the course of vaccine efficacy trials but in only 0.7% (O) to 3% (H) of 275 healthy individuals from a non-endemic area. Healthy Peruvians from areas endemic for typhoid fever commonly had antibody which was age-related. Peak prevalence was found in 15- to 19-yr-olds in whom 29% had O titers greater than or equal to 40 and 76% had H titers greater than or equal to 80. A single Widal test in an unvaccinated individual showing elevated O and H titers is strongly suggestive of typhoid fever if the person comes from a non-endemic area or is a child less than 10 yr of age in an endemic area. Because of the high prevalence of antibody amongst healthy invididuals over 10 yr of age in endemic, areas, a single Widal test offers virtually no diagnostic assistance in adolescents and adults.

Adolescent↗
PubMed1978

Plasma kallikrein activation and inhibition during typhoid fever.

As an ancillary part of a typhoid fever vaccine study, 10 healthy adult male volunteers (nonimmunized controls) were serially bled 6 days before to 30 days after ingesting 10(5)Salmonella typhi organisms. Five persons developed typhoid fever 6-10 days after challenge, while five remained well. During the febrile illness, significant changes (P < 0.05) in the following hematological parameters were measured: a rise in alpha(1)-antitrypsin antigen concentration and high molecular weight kininogen clotting activity; a progressive decrease of platelet count (to 60% of the predisease state), functional prekallikrein (55%) and kallikrein inhibitor (47%) with a nadir reached on day 5 of the fever and a subsequent overshoot during convalescence. Despite the drop in functional prekallikrein and kallikrein inhibitor, there was no change in factor XII clotting activity or antigenic concentrations of prekallikrein and the kallikrein inhibitors, C1 esterase inhibitor (C1-INH) and alpha(2)-macroglobulin. Plasma from febrile patients subjected to immunoelectrophoresis and crossed immunoelectrophoresis contained a new complex displaying antigenic characteristics of both prekallikrein and C1-INH; the alpha(2)-macroglobulin, antithrombin III, and alpha(1)-antitrypsin immunoprecipitates were unchanged. Plasma drawn from infected-well subjects showed no significant change in these components of the kinin generating system. The finding of a reduction in functional prekallikrein and kallikrein inhibitor (C1-INH) and the formation of a kallikrein C1-INH complex is consistent with prekallikrein activation in typhoid fever. The correlation of these changes with the drop in platelet count suggests that a common mechanism may be responsible.

Adult↗
PubMed2000

Typhoid fever, ciprofloxacin and growth in young children.

Typhoid fever remains a significant public health problem in Southern Asia, particularly with the emergence of multi-resistant strains of Salmonella typhi in the late 1980s. Use of ciprofloxacin in children, although discouraged, is increasing and we aimed to assess whether its use affects growth or the prevalence of joint symptomology. Children under 6 years of age diagnosed as typhoid fever on the basis of a positive Widal test were recruited in the outpatient department of a paediatric teaching hospital after treatment had been initiated. During 6 months follow-up, prevalences of arthritis/arthralgia and ponderal, linear and knemometric growth were recorded. Seventy-five children were recruited (mean age 32 months, mean weight-for-height Z-score--1.3, mean height-for-age Z-score 1.4) and 29 (39%) of them received ciprofloxacin. No significant adverse effects on ponderal, linear or knemometric growth, or on the incidence of arthritis/arthralgia were found to be associated with the use of ciprofloxacin. Knemometric and ponderal catch-up growth was demonstrable 30 days after diagnosis but linear growth was still declining 3 months after diagnosis with catch-up growth demonstrable only after 6 months. We conclude that ciprofloxacin is commonly used in typhoid fever and has no adverse effects on growth or joint symptomology.

Anti-Infective Agents↗
PubMed1992

Diagnostic value of the Widal test for typhoid fever in Singapore.

A study was conducted to assess the diagnostic value of the Widal test in patients with bacteraemic typhoid fever. The Widal test was carried out on 25 bacteriologically proven cases of typhoid fever and 50 patients with non-typhoid fever. All the patients with non-typhoid fever had an O agglutinin titre of less than 1:40, while 82% had an H agglutinin titre of less than 1:40. In the patients with typhoid fever, 56% had an O agglutinin titre of greater than or equal to 1:40 and 72% had an H agglutinin titre of greater than or equal to 1:40. Typhoid patients with titres greater than or equal to 1:40 for O and H antigens of Salmonella typhi were significantly different (P less than 0.01) from those with non-typhoid fever. The O agglutinin was highly specific (100%) in the diagnosis of the disease. The study shows that a single Widal test is useful in the diagnosis of typhoid fever in Singapore.

Adolescent↗
PubMed2001

Blood culture confirmed typhoid fever in a provincial hospital in the Philippines.

Epidemiological features of blood culture confirmed typhoid fever and antibiotic sensitivity of isolated Salmonella typhi strains were investigated in Bohol Province in Central Philippines from where no earlier information of these was avialable. Typhoid fever is endemic elsewhere in the Philippines (eg Metropolitan Manila and surroundings) where also multidrug resistant S. typhi strains have been detected. A laboratory for surveillance of invasive bacterial infections was established in a tertiary care government hospital, in Bohol, Central Philippines, in 1994. Patients with suspected typhoid fever or other serious infection were managed and blood cultures from them were taken according to clinicians' judgment. Blood cultures were processed and the isolated bacteria identified using generally accepted methods. S. typhi and other Salmonella isolates were identified using commercial antisera. Patient data were collected from hospital records. Of a total of 4,699 blood cultures done during a period of 3 3/4 years, 1,530 (32%) were requested for suspected typhoid fever. S. typhi was the most common pathogen isolated from 422 patients (8.9%), followed by S. paratyphi A from 55 patients (1%). Most patients were young adults (43%) and school age children (28%). Male:female ratio was 1.5:1. Among the 422 patients, there were 9 (2%) deaths due to typhoid fever, all with complications. All S. typhi isolates were sensitive to chloramphenicol, cotrimoxazole, and ampicillin. Our observation on blood culture confirmed typhoid fever demonstrates its importance as a major infectious disease in Bohol and gives a sound basis for treatment of typhoid patients and for further clinical and epidemiologic studies of typhoid fever and for following antibiotic sensitivity of S. typhi in Bohol and elsewhere in the Philippines.

Adolescent↗