[Japanese clinical statistical data of patients with typhoid fever-paratyphoid fever and cholera].
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Altogether 181 patients with typhoid and paratyphoid fever (54 with typhoid fever, 50 with paratyphoid fever type A, and 77 with paratyphoid fever type B) were investigated. Of them 108 (59.7%) patients were examined during the 1st week of disease. Serum specific O-antigens of typhoid and paratyphoid fever agents were determined by enzyme immunoassay (EIA), radioimmunoassay (RIA), and O-aggregate hemagglutination reaction (O-AHA), serum specific O-antibodies were determined by RDHA, EIA, RIA or O-AHA used during the 1st week of disease were twice as effective as RDHA. Combined use of EIA and O-AHA for the detection of serum specific O-antigens made it possible to diagnose typhoid fever in 90.91%, paratyphoid fever type A in 96.15%, and paratyphoid fever type B in 95.55% of cases.
Patients with typhoid or paratyphoid fever, admitted to 14 hospitals for infectious diseases during 1984-1987, were epidemically and clinically studied. Of the total number of 183 typhoid, 49 paratyphoid fever patients, those infected overseas was 44.3% and 71.4% respectively, giving an overall annual decrease, yet marking an increased ratio of overseas infection. Patients aged 20s-30s and males were dominant. One hundred and seventy six cases (96.2%) of typhoid and all the paratyphoid fever cases were bacteriologically diagnosed. The period from the onset to the diagnosis was around 14 days in most cases, but beyond 29 days in over 10% of the cases. We would like to emphasize that enteric fever, focusing on high fever, bradycardia, roseola, hepatosplenomegaly, leukopenia, elevated serum-GOT GPT and LDH, can be easily diagnosed by blood/stool culture before beginning chemotherapy. Intestinal bleeding was recognized in 24 cases (13.1%) of typhoid and 4 (8.2%) of paratyphoid fever, intestinal perforation in 2 (1.1%) and death in 1 (0.5%) of typhoid fever. CP was most commonly used in chemotherapy. Bacteriological relapse was recognized in 7/127 cases (5.5%) of typhoid, 6/48 (13.0%) of paratyphoid fever those followed beyond 3 weeks, though eradication was attained by retreatment. One strain of S. typhi resistant to CP.ABPC.KM.SM was isolated in 1986 from a patient infected overseas. New quinolones seem reliable in our preliminary studies.
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BACKGROUND: Salmonella enterica serovar Paratyphi A (S. Paratyphi A) has emerged as a significant global health concern due to the progressive development of antimicrobial resistance and its broader geographic distribution. In Taiwan, paratyphoid fever was historically rare and predominantly associated with imported cases. Since 2022, however, a marked increase in domestically acquired infections has been observed, prompting investigations into their origin and likely route of introduction. METHODS: We analyzed surveillance data on 223 patients with paratyphoid fever reported in Taiwan between January 2001 and December 2024. Whole-genome sequencing and antimicrobial susceptibility testing were performed on 88 S. Paratyphi A isolates obtained from both imported and domestically acquired infections from 2007 to 2024. Phylogenetic analysis and genotyping were conducted to assess genetic relatedness and to trace potential sources of introduction by comparing them with global isolates. RESULTS: Although 55.2% of paratyphoid fever infections were imported, domestically acquired infections became predominant after 2022. Most isolates (76.1%) were resistant to nalidixic acid and nonsusceptible to ciprofloxacin due to gyrA mutations at codon 83 (S83F or S83Y). The majority of domestic isolates were classified as ST129 and paratype 2.4 and showed close genetic relatedness to strains from Indonesia. Of the 31 domestic isolates collected between 2022 and 2024, 30 clustered with Indonesian strains, and 28 exhibited nearly identical genomic profiles, which suggested a prolonged outbreak likely linked to a common external source, such as contaminated imported food. CONCLUSIONS: The genomic evidence suggests that the recent increase in domestically acquired S. Paratyphi A infections in Taiwan represents a prolonged outbreak rather than a sustained epidemiological shift. These infections were closely related to strains from Indonesia, suggesting a potential epidemiological link between the two countries in the transmission of paratyphoid fever. While 76.1% of isolates were nonsusceptible to ciprofloxacin due to gyrA mutations, susceptibility to traditional first-line agents remained high. The observed decline in case numbers in 2024 may indicate that the outbreak is subsiding. Genomic surveillance played a crucial role in tracing sources of infection and informing targeted public health responses.
A comparative trial of co-trimoxazole and chloramphenicol was carried out on 91 patients, 57 having typhoid fever and 34 cases having paratyphoid fever. Co-trimoxazole is an effective drug in the treatment of enteric fevers with respect to clinical cure, absence of relapses and the mild nature of short term toxic drug effects. Unlike some of the earlier reports, treatment failure or non-responsiveness to the drug occurred in just under 10 per cent of the cases and would constitute a drawback of therapy with co-trimoxazole. This feature was not observed in the patients receiving chloramphenicol. The excretion of Salmonellae after drug therapy was more common with chloramphenicol than with co-trimoxazole, again indicating the value of the latter drug in the treatment of enteric fevers.
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.
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.
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.
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.
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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Forty adult patients with Salmonella typhi and S. paratyphi infections were studied in a randomly assigned prospective study to receive norfloxacin (12 drug-sensitive and 8 drug-resistant cases) or chloramphenicol (20 cases). No complication occurred in either group and no side effect was noted in the norfloxacin-treated group. The results suggest that a 7 d course of twice daily norfloxacin promises to be an alternative to a 14 d course of chloramphenicol for treating chloramphenicol-sensitive and multidrug-resistant typhoid and paratyphoid fevers.
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