Results for Typhoid  
Title: Typhoid hepatitis in children
Abstract:
Liver involvement is commonly observed in patients with typhoid fever. However, a hepatitis-like picture with fever and jaundice is unusual and infrequently reported in the paediatric literature. Our aim was to characterize the clinical picture, biochemical features, and prognosis of typhoid hepatitis. One hundred cases of typhoid fever (age 0 to 12 years), proven by positive blood cultures to Salmonella typhi, were studied with special reference to hepatic dysfunction. Of these, eight patients were found to have hepatitis during the course of their illness. All had high fever, tender hepatomegaly, elevated serum bilirubin (in the range of 2.5-5.8 mg/dl), and elevated serum alanine transaminase levels (in the range 100-620 IU/l). All the eight patients showed complete clinical and biochemical recovery in response to appropriate antibiotics. The clinical picture of typhoid hepatitis frequently mimics acute viral hepatitis. In tropical areas, the differential diagnosis of a child presenting with fever and jaundice should include typhoid hepatitis.

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid perforation: An analysis
Abstract:
Objective: To describe the clinical features of typhoid perforations and the treatment outcomes. Methods: This study was a retrospective analysis of the cases of typhoid perforation at two hospitals in Manipur treated by different surgeons during 1998 and 2000. All the cases of intestinal perforation, which were due to typhoid fever, were included in this study. Records were abstracted for the clinical features and mode of treatment of the cases. Results: There were 82 patients in the age group of 8 to 63 years. There were 67 males and 15 females. The site of perforation was in the terminal ileum in all the cases except in one case in which the perforation was in the transverse colon. In 85% of the cases there was a single perforation. In 16% of the cases perforation was associated with worm infestation. Typhoid perforation most commonly occurred in the third week of illness (43%). The average time from perforation to admission in the hospital was 48-72 hours. Fever, abdominal pain, abdominal distension and obstipation were the commonest mode of presentations. All were treated surgically, either by simple closure or wedge excision and closure. Mortality was influenced by the duration of illness, the time of presentation to hospital after perforation, the presence of shock on presentation, fecal peritonitis and worm infestation found at operation. Conclusion: There was no significant difference in the mortality between the two modalities of treatment. Higher mortality rate in the group treated by simple closure of the perforation could be due to the larger number of cases with longer duration of illness and late presentation (more than 48 hours after perforation).

Sources: Mendeley
Keywords: perforation,typhoid,
Title: Typhoid fever
Abstract:
Typhoid fever is one of the most common febrile illnesses encountered by the physicians in Bangladesh. Diagnosis is not difficult but has lately become a challenge due to changed clinical pattern of the disease, lack of adequate facilities for blood, stool, urine culture, excessive reliance on nonspecific Widal test and non availability of any reliable rapid diagnostic tests. Further, the indiscriminate and injudicious use of antibiotics for treating fever in undiagnosed febrile illnesses early has created problems to the physicians to reach to a diagnosis later on. This has also led to the emergence of high level resistance to many of the commonly used antibiotics in our country. Ciprofloxacin is often used empirically for treating the disease though there is already a high level resistance. In case the organism is in-vitro sensitive to ciprofloxacin but resistant to nalidixic acid, a much higher dose of drug is required to maintain the MIC which is 10 times higher than usual. Third generation cephalosporins (ceftriaxone and cefixime) are still the effective drugs for treating typhoid fever. The drug needs to be used in proper dose and duration to prevent emergence of resistance. Azithromycin though advocated by many as an alternative to ciprofloxacin in resistant cases, has recently lost its credibility due to emergence of resistance. We should not rely on Widal test in diagnosing typhoid fever. In a suspected case, the patient should not be prescribed any antibiotic without sending blood sample for culture sensitivity.

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever and pregnancy
Abstract:
Typhoid fever is rare in Europe, but well-recognized endemic disease in tropical zones. We report our findings in a series of 25 cases of typhoid fever during pregnancy observed in French Guiana and reviewed the literature on clinical signs, diagnosis and treatment. Salmonellea typhi causes septicemia of digestive origin that can cross the placenta resulting in chorioamniotitis. Maternal-fetal infection with S. typhi can lead to miscarriage, fetal death, neonatal infection, as well as diverse maternal complications. In order to avoid maternal complications and possible fetal transmission, treatment with ceftriaxone should be initiated as early as possible.

Sources: Mendeley
Keywords: typhoid,
Title: Epidemiology of typhoid fever
Abstract:
Typhoid fever remains an important public health problem in the world especially in the impoverished population from developing countries. Globally, the disease is estimated to cause 220,000 deaths and 22 million illnesses per year, predominantly in children of school-age or younger. Typhoid fever is one of the most common etiological sources of bacteraemia in many developing countries. Within the countries, the disease burden is often heterogeneously distributed with the areas with poor hygiene and sanitation suffering the most. Studies from urban slums in India and Bangladesh reported very high incidence rate of typhoid fever in young children. A retrospective analysis of laboratory data from an urban hospital in Nepal identified typhoid infection to be one of the most leading causes of bacteraemia. Though these data are indication of high typhoid burden, utilizing different methods makes direct comparison impossible. The DOMI programme conducted a prospective, populationbased surveillance in five Asian countries - China, India, Indonesia, Pakistan, and Vietnam - using standardized surveillance, clinical, and microbiological methods to comparatively assess the burden of typhoid fever in the region. The incidence rate of typhoid fever ranged from 15.3 cases per 100,000 persons 5 to 60 years old in China to 451.7 cases per 100,000 persons 2 to 15 years old in Pakistan. In the 5 to 15 year old age group, the incidence rate ranged from 24.2 cases per 100,000 persons in Vietnam to 493.5 cases per 100,000 persons in India. For sites where surveillance was additionally undertaken in preschool children (2 to 5 years of age), the incidence rate was found to be comparable to older children. Multidrug resistance (resistant to chloramphenicol, ampicillin and TMP-SMX) was observed from 85/127 S. Typhi isolates from Pakistan, 4/18 from Vietnam, and 8/113 from India. The finding highlights the considerable, but geographically heterogeneous, burden of typhoid fever in endemic areas of Asia, and underscores the importance of evidence on disease burden in making policy decisions about interventions to control this disease

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever
Abstract:
Typhoid fever, the enteric fever caused by Salmonella typhi, is a major public health problem. Transmission is by the faecal-oral route, and incidence peaks among school-age children (5-19 years). Since multi-drug resistant S. typhi is increasing and typhoid fever causes significant morbidity, immunization may prove relevant for epidemic control. Currently three classes of typhoid vaccine are available: inactivated whole-cell, oral attenuated (TY21a) and virulence (Vi) polysaccharide vaccines. Because they have fewer side-effects, the latter 2 vaccines are recommended by the World Health Organization. The immune response to immunization comprises secretory intestinal antibodies, circulating antibodies and cell-mediated immunity. Populations at high risk of developing typhoid fever, and hence likely to benefit from vaccination, include military personnel, travellers and school-age children in endemic areas, and clinical microbiology technicians. Several studies on novel genetically engineered oral vaccines are in progress; one dose of these vaccines elicits a satisfactory immune response. The incorporation of typhoid vaccine into a country's immunization programme should be based on local epidemiology, including incidence,by age group and in high-risk subpopulations, as well as a cost-benefit analysis of the particular vaccine. © 2001 Adis International Limited.

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Keywords: typhoid,
Title: Chloramphenicol resistant typhoid fever
Abstract:
We report a patient with typhoid fever caused by a strain of Salmonella typhi which was resistant to chloramphenicol. This is the first documentation of chloramphenicol resistant Salmonella typhi in Sri Lanka.

Sources: Mendeley
Keywords: chloramphenicol,typhoid,
Title: Typhoid vaccination: the Asian experience.
Abstract:
The WHO has recently issued updated recommendations for the programmatic use of new-generation typhoid vaccines in high-risk areas of countries where typhoid fever is still endemic. Countries have subsequently been instructed to discuss how these recommendations can be implemented and to develop plans for targeted typhoid vaccination. These plans can be informed by the experiences with typhoid vaccination that several Asian countries have had. This article reviews past and current typhoid vaccination programs that have taken place in Thailand (using the old whole-cell vaccine) and in China, Vietnam and India (using the new-generation injectable Vi polysaccharide vaccine). This review also describes recent typhoid Vi vaccine demonstration projects that were conducted in five Asian countries.

Sources: Mendeley
Keywords: typhoid,
Title: Oral typhoid vaccine.
Abstract:
This article and the editorial in the same issue (p. 509) discuss the new hope of a live oral vaccine against typhoid which has resulted from the development of a genetically crippled strain of Salmonella typhi (Ty21a) by Germanier in Berne as a stable double mutant of the wild type Ty2. When swallowed it undergoes 4 or 5 cell divisions, infects and penetrates the intestinal wall, but then "self-destructs". Vaccinees have had no adverse reactions, the vaccine strain has seldom been isolated from their stools, and as yet there is no evidence of reversion to virulence.

In Egypt the vaccine or placebo has been given to over 30 000 children aged 6-7 years in 3 doses, each preceded with a tablet to be chewed of bicarbonate. Comparison with the placebo controls over a 3-year period has shown an efficacy of 96% in the prevention of typhoid fever confirmed with positive blood culture. A larger trial is now in progress in Chile, using only 1 or 2 doses in enteric coated capsules.

Other avirulent oral vaccines have been tried in the past, with little success-perhaps because they have not colonized the gut. If the initial promise with this new typhoid vaccine is maintained, it may lead to similar success against other diseases such as shigellosis and cholera, or even rotavirus infection, possibly by incorporating into this strain of typhoid bacillus the genes that specify other antigens. The technology for this exists, whether or not the product would immunize. N.W. Preston

See also abst. 2617.


Sources: Mendeley
Keywords: typhoid,
Title: Typhoid
Abstract:
Typhoid fever is a severe systemic infection caused by the human-adapted Salmonella enterica serovar Typhi (S. Typhi). Paratyphoid fever is indistinguishable from typhoid fever in its clinical presentation but is associated with other typhoidal Salmonella serovars, including the human-adapted S. enterica serovars Paratyphi A, Paratyphi B, Paratyphi C, or Sendai. Although eradicated in most developed countries, these illnesses continue to be a major contributor to morbidity and mortality worldwide, and the emergence of antibiotic resistance is beginning to limit treatment options. Sanitation of drinking water is effective in reducing transmission of typhoid and paratyphoid fever, but eradication of these diseases also requires management of human carriers. Typhoidal Salmonella serovars are closely related genetically to nontyphoidal Salmonella serovars, which are associated with a localized gastroenteritis in humans. Recent studies suggest that differences in the clinical presentation of typhoid fever and gastroenteritis can be attributed to virulence mechanisms that enable typhoidal Salmonella serovars to evade innate immunity but that are absent from nontyphoidal Salmonella serovars. One such factor is the virulence capsular polysaccharide (Vi antigen) of S. Typhi and S. Paratyphi C. Studies on immunity to typhoid fever have resulted in licensing of a killed whole-cell parenteral typhoid vaccine, a live-attenuated oral typhoid vaccine, and a parenteral vaccine consisting of purified Vi antigen. Our entry will review basic and applied research on this enigmatic human disease. © 2013 Springer-Verlag Berlin Heidelberg. All rights are reserved.

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever: Current concepts
Abstract:
Infectious diseases account for most of the 10 million annual deaths globally in children younger than 5 years. In recent years, data indicating that typhoid fever is a major cause of morbidity among the urban and periurban populations and the single most important cause of febrile bacteremia in febrile children has emerged. In several community-based studies from south Asia, the incidence rate seems to be especially high among young children, with rates exceeding 500 to 1000 cases per 100,000 population. In contrast, nontyphoidal salmonella infections in Africa seem to be an important cause of community-acquired bacteremia, especially among HIV-infected populations.Although isolated cases of chloramphenicol resistance in Salmonella typhi have been known for a long time, the mid 1980s saw the emergence of strains of S. typhi resistant to all the 3 primary oral antibiotics. In recent years, there has also been a marked increase in quinolone-resistant isolates. Although the exact determinants and factors associated with endemic disease and outbreaks of drug-resistant cases of typhoid are uncertain, there does seem to be an association with crowding, lack of sanitation and hygiene, and access to street foods.The appropriate and rapid diagnosis of typhoid remains a challenge with a variety of serological diagnostic tests and polymerase chain reaction-based techniques. Given the limited resources available for case management, appropriate antimicrobial therapy of multidrug- and quinolone-resistant typhoid poses particular problems in developing countries, especially because of the rapid emergence of resistant strains in recent years. Therefore, it is imperative that the focus clearly remain on preventive strategies for typhoid, including safe water, hygiene, and appropriate vaccination strategies. Copyright © 2006 by Lippincott Williams & Wilkins.

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever: Current concepts
Abstract:
Infectious diseases account for most of the 10 million annual deaths globally in children younger than 5 years. In recent years, data indicating that typhoid fever is a major cause of morbidity among the urban and periurban populations and the single most important cause of febrile bacteremia in febrile children has emerged. In several community-based studies from south Asia, the incidence rate seems to be especially high among young children, with rates exceeding 500 to 1000 cases per 100,000 population. In contrast, nontyphoidal salmonella infections in Africa seem to be an important cause of community-acquired bacteremia, especially among HIV-infected populations.Although isolated cases of chloramphenicol resistance in Salmonella typhi have been known for a long time, the mid 1980s saw the emergence of strains of S. typhi resistant to all the 3 primary oral antibiotics. In recent years, there has also been a marked increase in quinolone-resistant isolates. Although the exact determinants and factors associated with endemic disease and outbreaks of drug-resistant cases of typhoid are uncertain, there does seem to be an association with crowding, lack of sanitation and hygiene, and access to street foods.The appropriate and rapid diagnosis of typhoid remains a challenge with a variety of serological diagnostic tests and polymerase chain reaction-based techniques. Given the limited resources available for case management, appropriate antimicrobial therapy of multidrug- and quinolone-resistant typhoid poses particular problems in developing countries, especially because of the rapid emergence of resistant strains in recent years. Therefore, it is imperative that the focus clearly remain on preventive strategies for typhoid, including safe water, hygiene, and appropriate vaccination strategies. Copyright (copyright) 2006 by Lippincott Williams & Wilkins.

Sources: Mendeley
Keywords: typhoid,
Title: Power, Medical Knowledge, and the Rhetorical Invention of “Typhoid Mary”
Abstract:
This essay examines the interrelationship between legal, medical, and public knowledge in the case of Mary Mallon. The author argues that although Mallon was never convicted of any crime, she was under the constant surveillance of medical authorities because of her characterization as a recalcitrant “typhoid carrier.” Mallon's physical body became a contested site of controversy as various medical and legal communities fought for the legitimization of their own bodies of knowledge. Modern health care theorists and practitioners still use a plethora of “Typhoid Mary” narratives in their discussions of the relationship between jurisprudence, ethics, and medicine.

Sources: Mendeley
Keywords: typhoid,
Title: Changing spectrum of typhoid
Abstract:
To assess the changing spectrum of typhoid fever, a study was conducted of 204 cases of typhoid fever (130 males, 74 females, aged 5-20 years), admitted in 1989-92 to medical units of Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Peak incidence (in 1991) was in May and June with 14% and 16% of cases, respectively. The classical `Stepladder fever' and `relative bradycardia' were not often seen. Presentation as hepatitis, psychosis, meningism, myocarditis, polyneuropathy and diarrhoea were encountered in a small number of patients. Reversible proximal myopathy occurred in 4 patients and all of them recovered completely over 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. In conclusion, the clinical spectrum of typhoid has changed, efficacy of blood cultures is low and drug resistance is increasing.

Sources: Mendeley
Keywords: typhoid,
Title: Solving the typhoid diagnostics conundrum
Abstract:
Typhoid fever is serious bacterial infection caused by the bacterium Salmonella Typhi and other related invasive Salmonella. In endemic areas, diagnostic tests are needed to diagnose acute cases for clinical management, to detect convalescent and chronic fecal carriage and for contact tracing. However, the diagnostic tests that are currently used are poor. Blood culture is the currently mainstay of typhoid diagnostics, yet is insufficiently sensitive and technically demanding, and bone marrow culture, although more sensitive, is infrequently performed. There is a clear need for a novel approach to typhoid diagnostics. We have made extensive inroads into understanding how the organisms are transmitted and how they interact with the human host. Yet, these new insights into studying disease have not, as yet, let to new approaches for diagnosing typhoid fever. As the result of ameeting held in London in 2010,wehave generated a typhoid fever diagnostics working group. Though a number of collaborations, generated through this group, we have investigated a number of novel techniques aimed at developing the next diagnostic test for typhoid. Here, I discuss the approach of the typhoid diagnostics consortium and I present the preliminary data for several methods which may become the gold standard for typhoid diagnosis in the future. We have a clear blueprint for the next typhoid diagnostic and through the typhoid community we hope to develop some of the these new tests over the coming years, taking the leading method into production.

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Keywords: typhoid,
Title: Mild typhoid fever.
Abstract:
A series of 100 Zimbabwean children aged between 5 months and 13 years with culture positive typhoid fever is presented. The disease was found to be fairly mild with a low prevalence of complications, and no patient in the series died. Possible explanations for the relative mildness of typhoid in this paediatric population are discussed.

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Keywords: typhoid,
Title: Neonatal typhoid fever.
Abstract:
Typhoid fever occurs in children less than 2 years of age but is thought to be a mild, often unrecognized illness. Neonatal typhoid fever is a rare but often life-threatening illness, uniformly fatal in the preantibiotic era. Vertical intrauterine transmission from a typhoid-infected mother is implicated in neonatal typhoid fever. Ten cases at a rural African hospital are presented. Three patients died with two deaths associated with empiric management inappropriate for Salmonella typhi. A second clinical presentation in the neonate is asymptomatic persistent excretion. Infants < or = 3 weeks old may also be infected from an exogenous source and have severe disease. Where typhoid is endemic S. typhi should be considered as a cause of sepsis neonatorum and appropriate antibiotics included in empiric therapy

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever
Abstract:
Purpose: A 29-year-old male farmer presented to Maua Methodist Hospital in Kenya with a one week complaint of malaise, chills and myalgia. Two days prior to admission, he developed nausea and non-bilious vomiting. There was no cough, change in mental status, diarrhea or hematochezia. On the day of admission, he developed mild diffuse abdominal pain and his vomiting worsened, prompting him to seek medical attention. On examination, he was febrile, hypotensive without tachycardia, breathing comfortably. His abdomen was soft with mild diffuse tenderness with no guarding or rebound tenderness. There were no visible rashes. Laboratory showed a leukocytosis of 11, blood smear was negative for malaria parasites, HIV test was negative and Widal test was positive for O antigen with a titer of 1:320. The patient was started on ciprofloxacin with gradual improvement of his abdominal pain. He was discharged within 3 days with a diagnosis of typhoid fever. Discussion: Typhoid fever presents as a febrile illness 1-3 weeks after ingestion of the causative organism (usually Salmonella Typhi and to a lesser degree S. Paratyphi). Outside the United States, it is associated with poor sanitation. Classically, it has been described as a "step-wise" or "undulating" fever in the setting of a normal heart rate (sometimes referred as relative bradycardia) with faint salmon colored macules on the abdomen and trunk. As abdominal pain develops after the first week, the majority of patients recover slowly over weeks. There have been other "classic" findings described in the literature such as confusion, psychosis, rigidity and both constipation and diarrhea in adults. When antibiotics are not instituted, 15%-25% of patients progress to intestinal bleeding and perforation leading to peritonitis, sepsis and eventual death. The clinical presentation has changed due to early widespread use of antibiotics with the subsequent decrease in mortality. The gold standard of diagnosis is a positive culture in the setting of a compatible clinical scenario. However, this can be challenging to obtain due to the lack of availability of culture techniques in endemic areas. Blood cultures may take days before they become positive with yields as low as 40% in some reported case series. The highest reported culture yield has been from the bone marrow, with positive cultures even 5 days after antibiotic commencement. Though not the gold standard, Widal test is a simple, rapidly available test that can offer important diagnostic information. A four-fold rise in O antigen titers or a single titer of 1:320 or more are significant even in endemic areas and highly suggestive of active infection.

Sources: Mendeley
Keywords: typhoid,
Title: Typhoid fever
Abstract:
Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas, especially those in Africa. The main barriers to control are vaccines that are not immunogenic in very young children and the development of multidrug resistance, which threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow surveillance and to implement control measures.

Sources: Mendeley
Keywords: typhoid,
Title: Neonatal typhoid fever
Abstract:
Three infants of Pakistani immigrant mothers developed typhoid fever in the neonatal period. All three survived, but two became chronic excretors of Salmonella typhi. The risk of an outbreak of typhoid fever in a maternity unit or special care baby unit is emphasized.

Sources: Mendeley
Keywords: typhoid,