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We describe a case of relapsed paratyphoid fever in which the isolate had reduced susceptibility to ciprofloxacin due to a rare mutation within the gyrA gene. 18fluorodeoxyglucose positron emission tomography scanning identified deep-seated infection including unsuspected aortitis and highlights the utility of novel imaging techniques to improve our understanding and treatment of this disease.
From 1977 to 1984, Salmonella typhi was isolated from 85% and Salmonella paratyphl A was isolated from 15% of 192 Thai children with enteric fever at Children's Hospital, Bangkok. Children with enteric fever presented with sudden onset of fever and gastrointestinal symptoms. of fever presented with sudden onset Diarrhea occurred in 62% of children with paratyphoid fever and 36% of children with typhoid fever. Rose spots were seen in 15% of patients with typhoid and 7% of patients with paratyphoid fever. There were no deaths. Bronchitis and pneumonia occurring in 11% of patients were the most common complications. Acute hemolysis occurred in 3% of the patients with typhoid fever who had thalassemia or glucose-6-phosphate dehydrogenase deficiency. Chloramphenicol-resistant S typhi, which accounted for 70% of the isolates in 1977, has since 1982 accounted for less than 2% of isolates.
We carried out a retrospective study of 150 files of patients suffering from typhoid or paratyphoid fever, confirmed bacteriologically, between January 1992 and December 1996 at Libreville. Young adults were the most frequently affected. These infections were associated with unstable living conditions and lack of cleanliness. Neurological (17%), digestive (12%) and cardiovascular (3%) complications were the principal factors aggravating the disease. The following serotypes were identified: Salmonella typhi (47%), S. paratyphi B (25%), S. paratyphi C (20%) and S. paratyphi A (8%). Salmonellosis was associated with schistosomiasis (13%), nematodiasis (2.3%), sickle-cell anemia (7%) and HIV infection (8%). The mortality rate was 3.3%. Fluoroquinolones are the molecules of choice for treating typhoid and paratyphoid fevers.
A retrospective survey of all notified cases of typhoid and paratyphoid fever in Denmark 1986-1990 was carried out by extracting epidemiological data from the mandatory notification forms; laboratory results of diagnostic and follow-up bacteriological investigations of the patients were also obtained. A total of 161 patients were identified, corresponding to a mean incidence of 0.6 per 100,000 inhabitants per year. Salmonella typhi was isolated in 107 cases and S. paratyphi A and S. paratyphi B in 27 cases each. Median age was 21 years, range 2 months to 74 years. All but six patients probably contracted the infection abroad, most often in Pakistan or other Asian countries. Of six cases with no travel history, two were laboratory associated and two had had relevant foreign contacts. Forty percent of the patients were immigrants now resident in Denmark but infected while visiting their home countries. Only one third of the patients strictly fulfilled the recommendations for follow-up laboratory screenings. It is concluded that the incidence of typhoid and paratyphoid fever is low in Denmark and that nearly all cases are imported; secondary cases are uncommon. There is a need for simplification and modernization of the present recommendations for follow-up laboratory screenings, which date from 1943.
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Sixty-eight proved cases of typhoid and paratyphoid fever were reviewed in a retrospective study covering 5 years (1986-1990). Patients within the age range of 10 to 39 years constituted 82.3 per cent of cases and there was equal incidence in both sexes. The mean duration of illness before presentation was 9.67 days. The major clinical features were fever (97%), abdominal tenderness (-9.4%), headache and abdominal pain (70.58%) each). Intestinal perforation was the commonest complication (27.9%) with a male preponderance (M:F-3:1). Perforation occurred after the first week of illness in 73.7 per cent of cases. Fourteen out of the nineteen patients who perforated were not on therapy at the time of perforation and they constituted 80 per cent of those cases of mortality in which perforation played a role. Surgical management of perforation gave better results than conservative management (mortality rates of 16.7% and 40% respectively). Salmonella was sensitive to Chloramphenicol in all the cases where the organism was grown. There were 10 recorded deaths (14.9%) of whom 60 per cent (i. e. 6 patients) presented after two weeks of illness.
A modified method of isolating hemocultures in pyoseptic processes is proposed. It consists in combined use of two known methods: inoculation of the blood by in-depth method and preliminary hemolysis of the blood, and use of commercial medium for assessing the sterility as the nutrient base. High efficacy of the proposed method has been demonstrated in experiments with 17 reference strains of microorganisms. The new approach helped improve the isolation rate of opportunistic enterobacteria, nonfermenting gram-negative bacteria, staphylococci, highly demanding streptococci, and other microorganisms similar in nutrient requirements, as well as the agents of typhoid and paratyphoid fever. This permits unifying the methods of investigation of hemocultures in pyoseptic diseases and typhoid-paratyphoid fevers'.
BACKGROUND: Fluoroquinolones are recommended as first-line therapy for typhoid and paratyphoid fever, but how they compare with other cheaper antibiotics and different fluoroquinolones is unclear. OBJECTIVES: To evaluate fluoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, different fluoroquinolones, and different treatment durations of the same fluoroquinolone. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (August 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1974 to August 2004), LILACS (1982 to August 2004), conference proceedings, reference lists, and contacted researchers. SELECTION CRITERIA: Randomized controlled trials of fluoroquinolones in people with blood or bone marrow culture-confirmed enteric fever. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality of trials and extracted data. We calculated the odds ratio (OR) for dichotomous data with 95% confidence intervals. We analysed norfloxacin separately. MAIN RESULTS: Thirty-three trials met the inclusion criteria; 22 had unclear allocation concealment, and 29 were not blinded. Three trials exclusively included children, and two studied outpatients. The main analysis examined clinical failure, microbiological failure, and relapse. Compared with chloramphenicol, fluoroquinolones were not statistically significantly different for clinical (544 participants) or microbiological failure (378 participants) in adults; they reduced clinically diagnosed relapse in adults (OR 0.14, 0.04 to 0.50; 467 participants, 6 trials), but this was not statistically significant in participants with blood culture-confirmed relapse (121 participants, 2 trials). Compared with co-trimoxazole, we detected no statistically significant difference (82 participants, 2 trials). Among adults, fluoroquinolones reduced clinical failure compared with ceftriaxone (OR 0.08, 0.01 to 0.45; 120 participants, 3 trials), but showed no difference for microbiological failure or relapse. We detected no statistically significant difference between fluoroquinolones and cefixime (80 participants, 1 trial) or azithromycin (152 participants, 2 trials). In trials of hospitalized children, fluoroquinolones were not statistically significantly different from ceftriaxone (60 participants, 1 trial, involving norfloxacin) or cefixime (82 participants, 1 trial). Norfloxacin had more clinical failures than other fluoroquinolones (417 participants, 5 trials). Trials comparing different durations of fluoroquinolone treatment showed no statistically significant differences (693 participants, 8 trials). AUTHORS' CONCLUSIONS: Many trials were small, and methodological quality varied widely. Although enteric fever most commonly affects children, trials in this group were particularly sparse. Insufficient data in all comparisons preclude any firm conclusions to be made regarding superiority of fluoroquinolones over first-line antibiotics in children and adults.
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The authors reviewed 210 children with typhoid and paratyphoid fevers; 191 were infected with S. typhi, 13 with S. paratyphi A and 6 with S. paratyphi B. The proportion was higher in school children. Fever, headache, tongue furred, stupor, and hepatomegaly were the most important clinical findings. Salmonella was cultured from the blood of 42% patients, the Widal reaction was negative only in one case, and faeces culture was positive in 25%. All patients received chloramphenicol.
We report a case of imported paratyphoid fever associated with Giardia lamblia and Isospora belli infection. The patient was a 23-year-old Japanese female with complaints of high grade fever and diarrhea after 10 days traveling to Nepal. Salmonella Paratyphi A was isolated from the blood and fecal cultures on admission and Ciprofloxacin of 200 mg tid was administered for 14 days. Fecal examination revealed cysts of G. lamblia at the same time and metronidazole of 250 mg tid for 7 days was effective for their eradication. During the follow-up studies oocysts of I. belli were found and cotrimoxazole of 960 mg bid for 10 days was effective for their eradication. Fecal examinations on parasites which is rare in Japan such as I. belli are recommended to the cases returning from tropical areas.
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.
A retrospective epidemiological study was conducted in connection with an outbreak of paratyphoid fever at a Peruvian naval installation in Callao. The study sought to determine the magnitude of the outbreak, the source of infection, the attack rates, the persistence of bacilli excretion, and the clinical picture of the disease. The source of Salmonella paratyphi B infection had been a meal of chicken and rice served to around 400 members of the naval police. Over a period of three weeks, 21 persons were hospitalized and 52 received outpatient treatment at the naval hospital. In addition, through a questionnaire it was revealed that 86 unreported cases of diarrhea related to the outbreak had occurred. The most common clinical manifestations were fever, headache, weakness, anorexia, abdominal pain, and diarrhea. The general attack rate was 39.8%. In a follow-up survey carried out 37 days after exposure, fecal cultures indicated that 8.5% of the persons affected continued to excrete the microorganism. The high rates of attack and transmission of S. paratyphi B in this outbreak point up the considerable pathogenicity and virulence of some strains of the microorganism and their impact on public health. It is suggested that preventive measures be taken at naval and other similar installations, including the education of workers who handle and prepare food, in order to ensure proper hygiene.
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Previous descriptions of paratyphoid fever (PTF) are of limited value to the clinician who has had no experience with Salmonella enteric fevers. Sixty-two cases of PTF occurred in a healthy, homogeneous population. Findings supported by the literature included a seasonal incidence, initially seen symptoms of gastroenteritis and spiking fevers, and a high percentage of positive blood cultures. Unusual findings included the rarity of rose spots, patients with fever as their only symptom, two patients with transient papilledema, and two others with peripheral blood smears suggestive of acute leukemia. The findings of this study are compared with previous reports. Likely causes for divergent and contradictory information are inclusion of data from non-PTF states and study of populations with altered states of health.
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