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Twenty-seven cases of enteric fever were diagnosed between January 1961 and February 1977 at a medium-sized urban hospital. Nineteen of the patients had recently travelled abroad. Fever was the only constant finding, and four patients noted fever and headache as their only symptoms. Splenomegaly was present in 30% and rose spots in just 11%. Enteric fever was initially suspected in only 63% of cases, and a mean of 4.8 days elapsed after admission before specific therapy was instituted. Salmonella was cultured from blood samples in 19 of 24 patients and from stool specimens in 21 of 27, but was never isolated from the urine. Serum O agglutinins, while eventually present in 54% of the patients tested, did not help in establishing an early diagnosis. No deaths occurred, though two patients sustained relapses. Sporadic enteric fever is unlikely to be suspected unless associated with recent foreign travel, but is easily diagnosed by usual culture methods.
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PMID:Epidemiologic and clinical features of sporadic Salmonella enteric fever. 74 58

An extensive outbreak of waterborne typhoid fever occurred in 1973 at a migrant labor camp in Dade County, Florida. Blood cultures from 105 of the 188 patients with proved or presumptive cases of typhoid fever grew Salmonella typhi. The clinical and laboratory findings in these patients were reviewed. Fever, usually with temperatures above 38.8 degrees C and of the sustained type, was a primary manifestation of disease, although a majority of the patients also complained of headache and gastroenteric symptoms. Hepatic or splenic enlargement was present in 52 per cent and 42 per cent, respectively, whereas rose spots were detected in only 13 per cent. The total leukocyte count was normal in 74 per cent, but serum levels of liver and muscle enzymes were frequently elevated. Gastrointestinal, pulmonary and neurologic complications were infrequent; circulatory failure was not observed. Defervescence in response to antibiotic therapy was variable; however, the median response among 68 patients who received chloramphenicol was two days less than that in 34 patients treated with ampicillin. There was one possible treatment failure with ampicillin. The relapse rate of 10 per cent in chloramphenicol-treated patients was not significantly greater than the 3 per cent rate among those treated with ampicillin. Serologic studies for typhoid fever were of limited diagnostic value since the titer of agglutinins was 1:160 or higher in 49 per cent of the serums obtained before treatment, and a fourfold rise in titer occurred in only 24 per cent of 57 patients studied. The serologic response to chloramphenicol treatment did not differ from that to ampicillin.
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PMID:Waterborne typhoid fever in Dade County, Florida. Clinical and therapeutic evaluation of 105 bacteremic patients. 116 56

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.
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PMID:Typhoid and paratyphoid fever: a retrospective study. 141

Most cases of typhoid fever in the United States occur in international travelers, with the greatest risk associated with travel to Peru, India, Pakistan, and Chile. Laboratory workers and household contacts of long-term carriers are also at greater risk than the general population. Decisions to the use typhoid vaccine involve weighing the risk of illness against the risk of vaccine reactions. Until recently, the only typhoid vaccine commercially available to US civilians was a heat-phenol-inactivated parenteral product that is 51% to 77% effective in preventing typhoid fever but frequently produces local pain and swelling, fever, headache, and malaise. A new orally administered, live-attenuated vaccine, made from the Ty21a strain of Salmonella typhi, has been recently licensed in the United States. This vaccine provides equivalent protection with a much lower incidence of adverse reactions. It is administered in a four-dose series given over 7 days. Since neither vaccine offers total protection, the most important elements in prevention of typhoid fever remain sound biosafety precautions in laboratory workers and care in selecting food and beverages by those traveling to areas where typhoid fever is endemic.
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PMID:A new look at typhoid vaccination. Information for the practicing physician. 173 24

Due to mass tourism and the exodus of refugees from Africa and Asia, typhoid fever, common in the tropics, has reappeared in the more temperate climates. The clinical signs of prolonged fever, headache, general malaise, anorexia and abdominal pain are not specific enough to allow diagnosis and only a blood culture will prove the presence of the disease. Unless there is resistance, which is in fact rare in Southeast Asia, chloramphenicol, an effective, well tolerated and cheap antibiotic, remains the treatment of choice for typhoid. In the search for an alternative treatment a cephalosporin, ceftriaxone (Rocephin) seems promising. It has a low MIC of 0.05 micrograms/ml for S. typhi and a high level of biliary excretion which destroys S. typhi in the bile and thus prevents relapse. In Southeast Asia three consecutive studies, of which two were randomised and comparative with chloramphenicol given for 14 days, showed that treatment for two or three days, 3 or 4 g per day of ceftriaxone was as effective as chloramphenicol and was not followed by relapse. In 46 adults there was one failure with ceftriaxone (in an immunocompromised patient) and none in the 30 patients treated with chloramphenicol, three of which, however, relapsed in the 15 days after completion of treatment. Defervescence was a little more rapid with chloramphenicol (six to seven days) than with ceftriaxone (seven to ten days) even though blood, urine and stool cultures were all negative from the third or fourth day of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of typhoid fever for three days with ceftriaxone]. 228

The case of a 22-year-old patient is described, who developed a clinical picture of pseudotumor cerebri in the course of typhoid fever, an association not previously described. The patient progressed favorably after treatment with amoxicillin. The etiopathogenesis of pseudotumor cerebri is briefly discussed, as is the need to study the possible existence of this disorder in cases of typhoid fever patients with headaches and/or visual deficits which are not readily explained.
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PMID:Pseudotumor cerebri complicating typhoid fever. 228 13

Ninety-four patients, 61 men and 33 women with a mean age of 54 years, were treated with intravenous ciprofloxacin. Eighty-one patients (86 percent) were in serious or fair condition. Pathogens included Enterobacteriaceae (74 patients), Pseudomonas sp. (23 patients), other gram-negative bacilli (five patients), staphylococci (19 patients), other gram-positive cocci (seven patients), and Rickettsia conorii (five patients). Thirty-eight patients were given parenteral therapy (ciprofloxacin at a mean daily dose of 200 mg every 12 hours, mean duration of therapy, nine days). Fifty-six patients were also given ciprofloxacin orally after initial intravenous therapy at a dose of either 500 or 750 mg every 12 hours (mean duration of therapy, 36 days). Another antibiotic was given concomitantly in 25 cases (27 percent). The overall clinical response was 93 percent and the bacteriologic response rate was 84 percent. There was no difference between patients treated by intravenous ciprofloxacin and those treated by intravenous ciprofloxacin followed by oral ciprofloxacin. Favorable responses (resolution of improvement) were observed in 39 of 42 patients (93 percent) with bacteremia, 28 of 30 (93 percent) with urinary tract infection, 10 of 13 (77 percent) with respiratory tract infection, 11 of 12 (92 percent) with bone and joint infection, three of three (100 percent) with skin and soft-tissue infection, nine of nine (100 percent) with intra-abdominal infection, three of three (100 percent) with typhoid fever, and two of two (100 percent) with meningitis. All five patients with R. conorii infections had a response to therapy. The adverse effects were minor and transient. Seven patients experienced clinical adverse effects: pain at the injection site (three patients), rash (two patients), and headache (2 patients). Serum transaminase levels were increased in 11 patients. Intravenously administered ciprofloxacin or intravenous ciprofloxacin followed by oral ciprofloxacin is a safe and effective therapy for serious infections.
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PMID:Treatment of serious infections with intravenous ciprofloxacin. French Multicenter Study Group. 268 26

Experience with typhoid fever in 111 children over a 5-year period was reviewed. There were 66 boys and 45 girls, ranging in age from 1 to 11.5 years. The symptoms of typhoid fever were quite non-specific. Fever was the most common presenting symptom (in 98.3%). Other common presenting features were diarrhoea (25.7%), constipation (22%), vomiting (21.1%), cough (25%), abdominal pain (27.5%), headache (9.2%), epistaxis, meningism and convulsions. Rose spots were detected in 20% of cases, occurring mainly during the first 2 weeks of illness. Significant Widal reactions were present in 84.7% of cases. Blood and stool cultures were positive in 57% and 44% of cases, respectively. Peripheral blood white cell counts were not found to be of great diagnostic value. Chloramphenicol remained the drug of choice in the treatment of typhoid fever. It was more effective than ampicillin or co-trimoxazole. Complications were uncommon, occurring in only two patients. There were two deaths; both were admitted late and in moribund state. Early diagnosis and treatment is vital in typhoid fever and, as the presenting features are non-specific, a high index of suspicion is required.
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PMID:Typhoid fever in Hong Kong children. 278 7

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.
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PMID:[Typhoid and paratyphoid fevers in childhood. Apropos of 210 cases]. 309 49

The clinical and immunological responses to typhoid vaccination with parenteral (TAB) and oral (Ty21a) vaccines in two groups of 30 adult male subjects were studied. Parameters monitored included specific anti-Salmonella typhi cell-mediated immunity and total and specific antilipopolysaccharide fecal immunoglobulin A (IgA) titers in Ty21a-vaccinated subjects. Peripheral blood lymphocytes antibacterial activity was significantly increased only in Ty21a-vaccinated subjects. Serum arming activity and results of human F(ab')2 anti-IgG and -IgA inhibition tests suggest antibody-dependent cellular cytotoxicity mediated by IgA in those vaccinated with Ty21a. Interestingly enough, the cells of TAB-vaccinated subjects were able to mediate IgG-dependent cellular cytotoxicity, as was observable from the results of blocking experiments. Moreover, total and specific antilipopolysaccharide fecal IgA levels were observed to be significantly increased with Ty21a, up to 8 months post-vaccination schedule. An early-onset, transitory increase in serum IgM rheumatoid factor was also found, exclusively in subjects treated with TAB, and was no longer detectable on day 240. Ty21a was well tolerated and free of side effects, whereas 65% of subjects administered TAB reported fever, headache, malaise, and local tenderness at the injection site. Our data show that the two typhoid vaccines induce different cell-mediated specific immune responses. The role of these responses in protection against Salmonella infection, however, requires further investigation.
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PMID:Comparative analysis of immunological responses to oral (Ty21a) and parenteral (TAB) typhoid vaccines. 341 54


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