Immunological, antioxidative, and morphological response in combined treatment of ofloxacin and Lactobacillus fermentum ME-3 probiotic in Salmonella Typhimurium murine model.

We aimed to elucidate the immunological (cytokines), biochemical (antioxidative), and patho-morphological responses in the gut and liver evoked by the addition of Lactobacillus fermentum ME-3 to ofloxacin (OFX) treatment in an experimental infection model of Salmonella enterica serovar Typhimurium. After challenge with S. Typhimurium and treatment according to different schemes, either with OFX and/or addition of L. fermentum ME-3, the mice were killed. Blood, liver, spleen, and small intestine samples were plated to detect S. Typhimurium and lactobacilli. Histological slides were prepared from the liver and ileum. The cytokines (IL-10, IFN-γ, and TNF-α), the glutathione peroxidase and reductase, the glutathione ratio, and the lipid peroxides (LPO) in mucosa of the small intestine and liver were estimated. The addition of L. fermentum ME-3 to OFX increased the eradication of S. Typhimurium from tested sites because of antagonistic and antioxidative properties, reduced the presence of typhoid nodules in the liver, and decreased the values of LPO. The immunological response included the reduction of pro-inflammatory cytokines interferon-γ and tumour necrosis factor-α and the increase in anti-inflammatory cytokine interleukin-10 in the livers of mice without typhoid nodules.

Epidemiology of typhoid and paratyphoid fever in India.

Enteric fever (typhoid and paratyphoid fever) is a major human bacterial infection. Although the disease is not common in industrialised countries, it remains an important and persistent health problem in developing nations. Hospital-based studies and outbreak reports from India indicate that enteric fever is a major public health problem in this country, with Salmonella enterica serovar Typhi (S. Typhi) the most common aetiologic agent but with an apparently increasing number of cases due to S. Paratyphi A (SPA). Because risk factors such as poor sanitation, lack of a safe drinking water supply and low socio economic conditions in resource-poor countries are amplified by the evolution of multidrug resistant salmonellae with reduced susceptibility to fluoroquinolone, treatment failure cases have been reported in India, which is associated with increased mortality and morbidity. Vaccination, which requires strict planning and proper targeting of the vulnerable age groups, is considered to be an effective tool in controlling this disease in endemic areas, given there is development of a conjugate vaccine against both serovars (S. Typhi and S. Para A).

Vertical transmission of Salmonella paratyphi A.

Neonatal enteric fever is a rare but life-threatening illness. Patients may present with varying severity, Salmonella enterica serotype Typhi causing more severe illness than Salmonella enterica serotype Paratyphi A. Salmonella enterica serotype Paratyphi A is considered to cause milder infection with fewer complications. We report a rare case of vertical transmission of Salmonella enterica serotype Paratyphi A with severe complications and high mortality. Even though there are case reports of vertical transmission of Salmonella enterica serotype Typhi, to our knowledge, this is the first case report of vertical transmission of Salmonella enterica serotype ParatyphiA. The role of blood culture in accurate diagnosis and treatment is also discussed.

[Imported fever. A diagnostic challenge]. / Importfeber. En diagnostisk utfordring.

Fevers without distinguishing symptoms in persons who have visited tropical or subtropical areas is an increasing health problem in most western countries. The condition may be caused by several different microbes, but among cases diagnosed in Norway five infections dominate: falciparum malaria, vivax malaria, typhoid fever, paratyphoid fever and dengue fever. Primary measures should be taken against immediate life-threatening diseases e.g. typhoid fever and falciparum malaria.

Fiebre paratífica: estudio de 107 pacientes / Paratyphoid fever: study of 107 patients

Se presenta un estudio en 107 pacientes con diagnóstico de fiebre paratífica, internados en el Hospital Central de la Sanidad de la Policía Nacional del Perú (HCSPNP) entre setiembre de 1988 y agosto de 1993. Noventa y siete pacientes (91 por ciento) tuvieron hemocultivo positivo, de los cuales el 95 por ciento (92 pacientes) correspondió a S. paratyphi A y el 5 por ciento a S. paratyphi B. El 76 por ciento (82 pacientes) se encontraban entre los 15 y 35 años de edad. El tiempo promedio de enfermedad al ingreso fue de 8 días. El 100 por ciento presentó fiebre, hepatomegalia 45 por ciento, esplenomegalia 36 por ciento, sensibilidad abdominal 38 por ciento y alrededor de 35 por ciento presentó diarrea o estreñimiento. Presentaron leucopenia el 50 por ciento y desviación izquierda el 73 por ciento. La TGO se elevó en el 58 por ciento y la TGP en el 65 por ciento. El examen de aglutinaciones fue positivo (>1/80) en sólo 34 por ciento de casos. Dentro de nuestros criterios de inclusión, ningún diagnóstico se basó en el hallazgo aislado de aglutinaciones positivas. El tratamiento de la mayoría de pacientes (78:73 por ciento) fue con cloramfenicol (sensibilidad antibiótica del 98 por ciento en los cultivos), seguido del cotrimazo (sensibilidad 89 por ciento) y de ampicilina (sensibilidad 53 por ciento). Con el inicio de la terapéutica la caída de la fiebre ocurrió en un promedio de 4,9 días y sólo se presentó recaída en 7 pacientes (6.5 por ciento); la mortalidad fue de cero. En conclusión la fiebre paratífica requiere para el diagnóstico de sospecha una buena historia clínica, el auxilio de un hemograma y el dosaje de transaminasas. El hemocultivo mantiene su importancia para el diagnóstico de certeza. El cloramfenicol y el cotrimoxazol aún son agentes de primera línea para su tratamiento.

[Focal infections caused by non-typhi Salmonella: a review of our case series and comparison with other series]. / Infecciones focales por Salmonella no typhi: revisión de nuestra casuística y comparación con otras series.

Nine cases of local infection due to non typhi Salmonella enterica, some of them of unusual localization, in 8 patients (mean age 64.9 +/- 12.4 years) attended in Zamora's Virgen de la Concha Hospital over a period of five years, are described. Focal salmonellosis represented 1.5% of non-typhi salmonellosis cases in that period (9 out of 606 detected cases). 6 of the 8 patients (75%) showed a predisposing disease. In two patients the previous existence of gastroenteritis due to Salmonella was assessed and only in one of them concomitant bacteremia was detected. Soft-tissue infections were the more frequent clinical feature: plantar abscess, two abdominal wall abscesses--one of them after cholecystectomy--post-pericardiotomy thoracic wall abscess and perianal abscess. Three soft-tissue infections were due to group B serotypes. 4 out of five soft-tissue infections evolved favorably with surgical treatment. The rest of the series is formed by two cases with acute cholecystitis in patients with previous cholelithiasis (one of whom relapsed originating an abdominal wall abscess), a recurrent pleural empyema and a purulent pericarditis. The pericarditis was produced by S. enteritidis. Patient showed signs of cardiac tamponade, his condition improving after pericardial drainage and parenteral and intrapericardial administration of ciprofloxacin. Epidemiologic and clinic characteristic of our series are compared with other series of focal salmonellosis.

Typhoid and paratyphoid fever: a retrospective study.

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.

Paratyphoid fever presenting with renal failure and nephrotic syndrome.

A previously healthy 39-year-old woman had a short, febrile illness that culminated in severe, acute renal failure in association with features of the nephrotic syndrome. Salmonella paratyphi B was isolated from her blood and stool. Treatment with chloramphenicol, dialysis, heparin and steroids was followed by gradual but complete recovery. Paratyphoid is usually more benign than typhoid fever, but is not without danger and may be complicated by potentially fatal renal disease.

Primary osteomyelitis of the sternum due to Salmonella hirschfeldii.

The case of a 71 year-old man with primary osteomyelitis of the sternum caused by Salmonella hirschfeldii is reported. The diagnosis was confirmed by culture, the bony defect was curetted to remove all dead bone and the patient was successfully treated with 6 weeks of high-dose ampicillin (2 g q6h). The treatment is particularly important because inadequate treatment may result in death and overtreatment may cause deformity and instability of the chest wall. Primary osteomyelitis of the sternum is a rare entity and this is apparently the first such case to be reported in the English literature.