[Unusual complications of typhoid. Typhoid meningitis and neuropsychological typhoid manifestations].
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Humans↗
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Typhoid gamma G, gamma M and gamma A antibodies in persons with different relation to the typhoid infection.
A study has been made of the differences in specific antibodies in three classes of immunoglobulins in sera of persons with different relation to the typhoid infection. The amount of specific antibodies was calculated from the differences in the levels of serum IgG, IgM and IgA before and after absorption with purified O, Vi and H antigens. The concentration of each immunoglobulin class was determined by means of single radial immunodiffusion. The results showed a significant decrease of IgA in the sera of typhoid carriers and IgM in the sera of patients with typhoid fever and persons with typhoid history after the absorption with the above mentioned antigens. The amount of eliminated antibodies in IgA class of the sera from typhoid carriers was 2.4 time higher as compared with the sera of non-carriers with typhoid history. The level of gamma M antibodies was 2.2 time higher in the sera of patients with typhoid fever and 2.8 time higher in the sera of persons with typhoid history than in the sera of typhoid carriers. In the IgG class no significant differences were observed.
Absorption↗
Immunological study of typhoid: immunoglobulins, C3, antibodies, and leukocyte migration inhibition in patients with typhoid fever and TAB-vaccinated individuals.
The development of humoral and cell-mediated immune responses to Salmonella typhi antigens and immunoglobulin and C(3) levels were determined in patients suffering from typhoid fever, TAB-vaccinated individuals, and appropriate controls. In 45 patients with typhoid, a significant elevation of immunoglobulin M (IgM) level was noted from the first week of illness onwards. Eighteen TAB-vaccinated persons also showed a significant elevation of IgM levels. In typhoid sera, the anti-O and anti-H antibodies were mostly 2-mercaptoethanol (2-ME) sensitive. The rise of IgM level correlated well with the 2-ME-sensitive anti-O and anti-H antibodies seen in typhoid patients. The anti-O antibodies in the TAB-vaccinated group were almost entirely 2-ME sensitive, but both 2-ME-sensitive and -resistant anti-H antibodies were detected in the TAB group. A marked increas in C(3) level was also noted in patients with typhoid. The cell-mediated immunity (CMI), as measured by leukocyte migration inhibition tests, was demonstrable in 15 of 22 patients with typhoid. On the other hand, only 8 of the 20 normal subjects, 5 of the 16 fever control cases, and 6 of the 18 TAB-vaccinated individuals gave a positive CMI. The latter three groups were comparable with each other but were significantly different from the typhoid patients. It was concluded that TAB-vaccination did not induce CMI even though it induced the development of antibodies, the latter being comparable with those of the patients with typhoid. The significance of these findings is discussed.
Agglutination Tests↗
Prevalence of typhoid fever in febrile patients with symptoms clinically compatible with typhoid fever in Cameroon.
Typhoid fever is difficult to differentiate from other causes of infection such as malaria because their signs and symptoms often overlap. There has been an unprecedented increase in the number of typhoid fever cases diagnosed in Cameroon. Febrile patients are often treated for malaria and typhoid fever simultaneously. This cross-sectional study was carried out to determine the prevalence of typhoid fever in 200 consecutive patients with fever and symptoms clinically compatible with typhoid fever to verify recent estimates of a high prevalence of typhoid fever in Cameroon. Patients were enrolled in three of the 10 provinces of Cameroon. Blood culture, thick and thin blood smears and Widal tests using acute sera were performed in all cases; stool culture for 120 patients. Typhoid fever was confirmed in only 2.5% as evidenced either by culture (four cases) or high salmonella antibody titres (one case); malaria was diagnosed in 94 (47%) patients. Typhoid fever is not as endemic in Cameroon as recently feared.
Adolescent↗
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↗
Immunological studies in typhoid fever. II. Cell-mediated immune responses and lymphocyte subpopulations in patients with typhoid fever.
The development of the cell-mediated immune response (CMIR) to antigens prepared from Salmonella typhi was investigated in patients suffering from typhoid fever and in normal healthy subjects. The leucocyte migration inhibition test, blast transformation of lymphocytes and active rosette-forming cells were used for detecting CMIR. Peripheral blood lymphocytes were analysed for the numbers and proportions of B lymphocytes, T lymphocytes and their subpopulations with receptors for IgM (T micro) or IgG (T gamma) and cells with Fc receptors for IgG. These parameters were correlated with the duration and the severity of illness. The uncomplicated cases of typhoid fever were found to have an intact CMIR as compared to the complicated cases. The ratio of T lymphocyte subpopulations was grossly imbalanced in typhoid patients, the numbers of T lymphocytes and their subpopulations were further altered in he complicated cases as compared to uncomplicated cases. The present study demonstrates a depressed state of CMIR in complicated patients with typhoid fever. CMIR may thus emerge as the cardinal point for recovery in typhoid fever rather than the specific antibodies. The study further demonstrates that imbalance within the subsets of T lymphocytes may be responsible for the depressed state of CMIR in complicated cases of typhoid fever.
Adolescent↗
Studies on infection and immunity in experimental typhoid fever. I. Typhoid fever in chimpanzees orally infected with Salmonella typhosa.
A disease resembling human typhoid fever has been induced by feeding live cultures of Salmonella typhosa to young chimpanzees, thus confirming the classical reports of Grünbaum and of Metchnikoff and Besredka. Detailed clinical observations, results of stool and blood cultures, and serological studies have confirmed the impression that the disease produced in chimpanzees closely resembles the mild form of human typhoid fever frequently seen in childhood. Gross and histologic examination of intestines, mesenteric lymph nodes, liver, spleen, and other organs of orally infected chimpanzees has demonstrated that the pathological findings are essentially indistinguishable from those seen in mild typhoid fever in man. The clinical spectrum of disease seen in chimpanzees ranged from moderately severe illness, through transitory illness, to afebrile infection with or without bacteriemia (but invariably with an antibody response), occasionally leading to the development of persisting biliary infection and the carrier state. Thus the range of illness observed in chimpanzees resembled that seen in man, except that the severe and complicated forms of typhoid fever were not observed in the chimpanzee. A reason for this difference is proposed and discussed. In contrast to the limitations imposed upon the interpretation of human epidemiologic observations, it has been possible to demonstrate in the chimpanzee that clinical variation in disease pattern from animal to animal may occur despite the administration of the same dose of the same bacterial strain simultaneously to an entire group of animals under study; in other words, variation in clinical pattern is dependent on inherent, non-specific host factors as well as on dose, strain or preceding state of immunity. Variation in dose and in challenge strain of S. typhosa employed also appeared to have an effect upon the likelihood of producing febrile as against afebrile infection in chimpanzees. The dose required to produce clinical disease, even with the more virulent strain, was excessively large compared to what is believed to be the dose required to produce illness in man; the limitations of this assumption, and suggested explanations for the findings, are discussed. The production of the spectrum of typhoid fever in the chimpanzee has made possible the study of basic problems in this disease which are not amenable to definitive study through the use of prevailing laboratory techniques.
Animals↗
[Blood groups of the ABO system of chronic carriers of typhoid bacteria and typhoid patients in Uzbekistan].
Blood groups of the ABO system were studied in 186 chronic carriers of typhoid bacilli and in 392 patients with typhoid fever from various districts of the Uzbek SSR. In comparison with control (healthy persons), carriers displayed a higher percentage of persons with A (II) blood group (50.88 and 42.64 against 37.51 and 32.13 in control) and a lesser percentage of persons with the O (I) blood group (21.05 and 22.48 against 32.93 and 32.07 in control). These data demonstrated that predisposition of persons with the A (II) blood group to chronic typhoid carrier state was characteristic of the Asian part of the country. In comparison with control, there were significantly less persons with the O (I) blood group and more with the AB (IV) blood group. Possible correlative mechanisms between the blood group and the typhoid infection and the development of chronic typhoid carrier state is discussed.
ABO Blood-Group System↗
[Comparative evaluation of the dynamics of physico-chemically different serum O- and K-antibodies in typhoid and chronic typhoid carriers].
The character of immune response to different S. typhi antigens in typhoid fever and chronic typhoid carriership was studied. The comparative evaluation of the functional activity of different classes of immunoglobulins was carried out by means of the indirect immunofluorescent method. 34 typhoid patients and 34 chronic carriers were examined. The speed of change-over from the production of IgM to that of IgG was found to be linked-with the nature of antigenic stimulation. In the dynamics of typhoid infection the changeover from the production of IgM to that of IgG specific to S. typhi O-antigen was observed. At a later period of typhoid fever the spectrum of O-antibodies was similar in their physico-chemical characteristics to that in chronic carriers. K-antibodies in chronic carriers were represented by highly active IgG.
Antibodies, Bacterial↗
An outbreak of typhoid fever, Xing-An County, People's Republic of China, 1999: estimation of the field effectiveness of Vi polysaccharide typhoid vaccine.
To evaluate the effectiveness of Vi polysaccharide vaccine (Vi vaccine) in preventing typhoid fever, an analysis was done of an outbreak of typhoid fever among students attending a middle school in the People's Republic of China, where Vi vaccine is licensed for use. Vi vaccine effectiveness was analyzed by using Cox proportional hazards modeling to account for the time-dependent nature of vaccination and illness status during the outbreak. Among 1260 students who had been immunized before the outbreak, receipt of Vi vaccine was associated with 73% (95% confidence interval [CI], 32%-89%) protection. Among the additional 441 students immunized during the outbreak, receipt of Vi vaccine was associated with 71% (95% CI, -9% to 92%) protection. These results provide the first evidence about the effectiveness of Vi vaccine when deployed routinely in a typhoid-endemic area and support the use of Vi vaccine as a public health tool to control typhoid fever.
Adolescent↗
Cell surface determinants on typhoid-specific B cells isolated from peripheral blood after oral Ty21a typhoid vaccination in humans.
Antigen specific B cells (ASC) that circulate after oral immunization with the typhoid vaccine Ty21a display cell surface determinants which are potentially involved in B cell differentiation and homing to mucosal sites. These ASC were isolated from peripheral blood after oral Ty21a, and dual labelled for binding of typhoid antigen and expression of various cell surface determinants: alpha 4 integrin (CD49d), CD45RO, CD45RA, L-selectin, CD44 and CD11a. Of particular interest was the finding of CD45RO expression on ASC. A comparison of cell surface determinants on typhoid-specific cells was also made following binding to high endothelial venules on peripheral and mesenteric lymph nodes, and venules in the lamina propria of the small intestine. Generally more typhoid ASC bound to mesenteric compared with peripheral lymph node. More ASC expressing CD45RO and alpha 4 integrin (CD49d) were bound to mesenteric lymph node and small intestine than to peripheral lymph node. When expressed as a fraction of total ASC, the difference was statistically significant only for CD45RO binding to small intestine versus peripheral lymph node. No differences in expression of other homing markers on bound ASC were seen.
Administration, Oral↗
A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Center Typhoid Study Group.
BACKGROUND: Despite concerns about safety in children, fluoroquinolone antibiotics have become the treatment of choice in patients with multidrug-resistant typhoid fever in Vietnam. However, quinolone-resistant strains of Salmonella typhi have recently been reported from Vietnam; and if quinolone resistance becomes established, alternative oral treatment options will be needed. OBJECTIVE: Cefixime, an orally administered third generation cephalosporin, was compared with ofloxacin for the treatment of uncomplicated typhoid fever in children. METHODS: In an open trial children with suspected typhoid fever were randomized to receive either ofloxacin (10 mg/kg/day in two divided doses) for 5 days or cefixime (20 mg/kg/day in two divided doses) for 7 days. RESULTS: S. typhi was isolated from 82 patients (44 in the cefixime group, 38 in the ofloxacin group) and 70 (85%) of the isolates were multidrug-resistant. Median (95% confidence interval, range) fever clearance times were 4.4 (4 to 5.2, 0.2 to 9.9) days for ofloxacin recipients and 8.5 (4.2 to 9, 1.8 to 15.2) days for cefixime-treated patients (P < 0.0001). There were 11 treatment failures (10 acute and one relapse) in the cefixime group and 1 acute treatment failure in the ofloxacin group (mean difference, 22%; 95% confidence interval, 9 to 36%). CONCLUSION: Short course treatment with cefixime may provide a useful alternative treatment in cases of uncomplicated typhoid fever in children, but it is less effective than short course treatment with ofloxacin.
Adolescent↗
Crossed immunoelectrophoretic analysis of anti-Salmonella typhi antibodies in sera of typhoid patients and carriers: demonstration of the presence of typhoid-specific antibodies to a non-O, non-H, non-Vi antigen.
A veronal buffer extract of Salmonella typhi was used as the reference antigen and its corresponding rabbit antiserum as the reference antibody in crossed immunoelectrophoresis to analyze antibodies in sera obtained from typhoid patients and carriers. Four precipitating antibodies were regularly detected. Three were against antigens common to other gram-negative bacteria and one appeared to be typhoid specific. Of the three common antigens, one (antigen no. 7) formed a precipitin resembling in mobility and morphology the lipopolysaccharide antigen seen in crossed immunoelectrophoresis analysis of other gram-negative bacteria. The other (antigen no. 19) was heat labile and antigenically similar to the reported common antigen of Pseudomonas aeruginosa. The third (antigen no. 14), also heat labile, was present in members of the family Enterobacteriaceae but not the family Pseudomonas. The typhoid-specific precipitating antibody present in sera of most typhoid patients and carriers but not patients infected with nontyphoid salmonella was directed to a heat-labile, non-O, non-H, and non-Vi antigen (antigen no. 28), probably protein in nature.
Adolescent↗
Cellular immunity in typhoid fever, Legionnaires' disease, amebiasis: role of transfer factor and Levamisole in typhoid fever.
Typhoid fever is an infectious disease commonly seen in the tropics, with multisystem involvement and a high morbidity and mortality rate. Legionnaires' disease: a newly described acute respiratory infection by unusual aerobic gram-negative micro-organisms namely Legionella pneumophila. Cellular immunity: in vitro and in vivo evaluations of cellular immunity using E-rosette formation (E) and 2.4-Dinitrochlorobenzene (D) reaction were made in typhoid fever, amebiasis and Legionnaires' disease. Results will be presented. Three patients with relapsing typhoid fever were given transfer factor and another group with typhoid fever were given Levamisole with sulfamethoxazole-trimethoprim. Up to 90% of the cases receiving immunopotentiating factors/agents improved faster in both general condition, fever and cellular immunity.
Adult↗
Immunological studies in typhoid fever. I. Immunoglobulins, C3, antibodies, rheumatoid factor and circulating immune complexes in patients with typhoid fever.
The development of O, H and Vi antibodies to Salmonella typhi antigens, immunoglobulins and C3 levels, and the presence of rheumatoid factor and circulating immune complexes were determined in the sera of patients with typhoid fever and appropriate age and sex-matched controls. IgM, and both O and H antibodies were raised in typhoid patients. Rheumatoid factor, a possible indicator of persistent circulating immune complexes, was also present in these patients. Immune complexes were more often present in patients with typhoid fever than in controls, their presence was much more marked in complicated cases of typhoid fever. A high ratio of alpha 1-antitrypsin to C3 was found in these patients suggesting complement consumption.
Adolescent↗
Antibody response to the protein antigens of "Salmonella typhi" during typhoid infection and following vaccination with a live oral typhoid vaccine Ty21a.
Two protein antigens, named as S1Da and S1Db, common to many gram-negative bacteria, were prepared from an extract of Salmonella typhi cells. Antisera to S. typhi, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, prepared by immunizing rabbits with acetone-treated cells of the corresponding bacterial species, all reacted against S1Da and S1Db as shown both by counterimmunoelectrophoresis (CIE) and by enzyme-linked immunosorbent assay (ELISA). Forty nine (98%) of the 50 tested sera obtained from typhoid patients while only 4 (8%) of the 50 sera obtained from febrile non-typhoid patients showed antibodies to S1Da and S1Db with ELISA titres above 1.000. S1Da and S1Db were then tested against 80 sera collected from 24 volunteers who had received a live typhoid vaccine Ty21a. Those vaccinees, who had antibodies to the LPS antigens of S. typhi following Ty21a vaccination, also developed antibodies to both the S1Da and S1Db antigens. Antigenically, S1Da and S1Db were different from each other and from the LPS antigens of S. typhi. S1Da and S1Db were basically protein in nature, the reactivity of these antigens against a positive control antiserum was destroyed by pronase, i.e., the addition of pronase after coating the MICROELISA plates with S1Da or S1Db reduced the ELISA titre to a minimum. Treatment with pronase, however, did not affect the ELISA titre when plates coated with the LPS antigens of S. typhi were used as the solid-phase antigen.
Antibodies, Bacterial↗
Typhoid, hepatitis E, or typhoid and hepatitis E: the cause of fulminant hepatic failure--a diagnostic dilemma.
OBJECTIVE: To report a case of hepatitis E-induced fulminant hepatic failure associated with typhoid fever, diagnosed with the Widal test. DESIGN: Case report. SETTING: Eight-bed medical/surgical intensive care unit of a university hospital. PATIENT: A 15-yr-old, 50-kg male with grade IV hepatic encephalopathy was admitted to the intensive care unit for ventilatory support. On admission to the intensive care unit he had had fever associated with loss of appetite and nausea for 15 days, jaundice for 4 days, and altered sensorium for 2 days. INTERVENTION: He was intubated and kept on elective ventilation. Tracheal aspirate, blood, urine, and stool were sterile. Anti-coma measures were instituted in the form of 20 degrees head elevation; mannitol, lactulose, and ampicillin through a nasogastric tube; and bowel wash. The mainstay of fluid therapy was 20% dextrose. Viral marker was positive for hepatitis E. He showed a favorable recovery but continued to have high-grade fever (39-40 degrees C). On investigation, peripheral blood smear was negative for malarial parasite, and Widal was positive. Fever responded to treatment with Ceftazidime. RESULT: The patient recovered with anti-coma and anti-typhoid therapy. CONCLUSION: In viral hepatitis, fever is usually present in the prodromal phase but subsides before appearance of the icteric phase. In endemic areas, if fever is present in the icteric phase of hepatitis, typhoid also should be considered in the differential diagnosis of fever, even in the absence of positive cultures for Salmonella typhi. The Widal test may be helpful in reaching a diagnosis.
Adolescent↗
FIELD and laboratory studies with typhoid vaccines: a preliminary report: Yugoslav Typhoid Commission.
In 1953 the Yugoslav Typhoid Commission organized the first strictly controlled field trial of two types of anti-typhoid vaccine-alcoholized and phenolized-in an attempt to determine the relative and absolute effectiveness of each. They were tested against a phenolized control vaccine prepared from strains of Shigella flexneri, type II.This preliminary report gives the basic information on the conditions of the trial, in which 35 508 persons completed the course of two injections, and shows the results obtained.The phenolized vaccine proved the more effective of the two, giving protection in about 70% of the vaccinated, but the Commission points out that the results do not necessarily mean that the same degree of protection would be obtained with other batches of either vaccine. Laboratory work done with the field trial showed that the existing laboratory tests cannot at present be correlated with the protection afforded to man.
Humans↗