A simple prognostic scoring system for typhoid ileal perforation peritonitis.

The increasing awareness of the worse than expected outcome after typhoid ileal perforation (TIP) prompted us to prospectively prognosticate patients with the help of the Jabalpur prognostic score (JPS), a simplified scoring system for peptic perforation peritonitis (PPP). Eighty-two consecutive patients with TIP were studied from May 2005 to August 2008 in the Department of Surgery, NSCB Government Medical College, Jabalpur (MP), India. Six parameters used in the JPS were recorded: age, heart rate, mean blood pressure, serum creatinine, any co-morbid illness and perforation-operation interval. JPS correlated with morbidity and mortality in TIP patients and, as the score increased, so did the morbidity and mortality. Survivors had a significantly lower mean score (3.86 ± 2.23) than non-survivors (7.94 ± 3.6; P < 0.001). Expectedly, TIP patients had worse outcome, stage by stage, than PPP patients. JPS can be easily modified for TIP (JPS-TIP) and can be easily used for its prognostication.

Clonal diversity of Salmonella enterica serotype Typhi isolated from patients with typhoid fever in Tehran.

In this study, antimicrobial susceptibility test and genetic typing were used to characterize 15 Salmonella enterica serotype Typhi (S. Typhi) isolates recovered from sporadic cases of typhoid fever in Tehran, Iran during 2004. Antimicrobial susceptibility test showed that all isolates were susceptible to 20 antimicrobials examined in this study. Analysis of insertion elements showed that 2 IS200 types with 10 and 11 copies were present. 11 of the 15 isolates were found to possess 10 IS200 elements residing on fragments from 23 to 2.3 kb. Comparison of the RiboPrinter (automated ribotyping) patterns of S. Typhi showed that 60% (9/15) of the isolates belonged to a single ribotype. PCR based random amplified polymorphic DNA analysis (RAPD) and enterobacterial repetitive intergenic consensus (ERIC) and pulsed-field gel electrophresis (PFGE) were also performed. ERIC and RAPD-PCR method showed 2 and 3 genotyping patterns amongst the isolates, respectively. The PFGE typing was carried out by using XbaI restriction enzyme, and 7 restriction patterns were observed. Overall, the molecular typing methods applied in this study showed that the isolated S. Typhi populations were highly polyclonal as shown by PFGE.

Infecting dose and severity of typhoid: analysis of volunteer data and examination of the influence of the definition of illness used.

Data from volunteers challenged with Salmonella typhi were reanalysed to explore the relationship between challenge dose and severity of disease. Among 120 ill volunteers who received between 10(5) and 10(9) organisms, dose was weakly correlated with peak temperature (r = 0.22, 95% CI 0.04-0.39), duration of temperature above 103 degrees F (39.4 degrees C: r = 0.13, 95% CI - 0.03 to 0.55) and symptom score (r = 0.27, 95% CI 0.09-0.43). The association with symptom score was lost after adjusting for year, and the findings depended on the definition of illness used: with stricter definitions the associations with temperature were also lost. The study shows the need for caution in interpreting the relationship between dose and severity of disease.

Perforación intestinal por fiebre tifoidea (1988-1993). Hospital de Niños Alejandro Mann, de la ciudad de Guayaquil

Se realizó un estudio retrospectivo de 309 casos condiagnóstico de fiebre tifoidea, en pacientes hospitalizados desde 1988-1993 en el Hospital de niños Alejandro Mann de la ciudad de Guayaquil. Se seleccionaron 32 casos en los que la perforación intestinal se presentó como complicación de la enfermedad. Todos fueron intervenidos quirúrgicamente y se encontró que la relación de edad y sexo fue de dos a uno (masculina /femenino) con mayor afectación en edades entre los 4 y los 7 años. El cuadro clínico característico fue de abdomen agudo perforativo; entre los síntomas más importantes se observó náusea (81.20 por ciento) y el signo de la scudida ded los rectos positivo (90.6). La Salmonella tiphi tiene una localización preferencial a nivel del ileon (11 a 20 cm de distancia de la válvula ileo cecal, 50 por ciento) el tipo de perforación fue única en el 68.7 por ciento, durante la segunda semana de evolución de la fiebre tifoidea se presentó el 53.1 por ciento de las perforaciones. Para corroborar el diagnóstico de los casos de perforación intestinal por salmonella thiphi se analizaron ciertos datos de laboratorio, radiológicos e histopatológicos...

Vacunación contra la fiebre tifoidea / Vaccination against typhoid fever

La fiebre tifoidea es una enfermedad infecciosa aguda y febril causada por Salmonella typhi. La infección se adquiere por medio de la ingestión de alimentos o agua masivamente contaminados con la bacteria. Debido a que este microorganismo afecta sólo al ser humano y no hay reservorios animales, el elemento más importante en la cadena de transmisión son los individuos que no presentan sintomatología clínica pero son portadores y excretores activos del agente (portadores asintomáticos). En México, la enfermedad tiene características endémico-epidémicas relacionadas con deficiencias en el saneamiento ambiental y el aprovisionamiento de agua potable. La tasa de letalidad es de alrededor del 1 por ciento, sin embargo en los casos complicados puede ascender hasta el 30 por ciento. La vacuna que se utiliza más ampliamente en la actualidad es la inactivada por calor y fenol, la cual tiene efectos colaterales debido al LPS que siempre lo contamina. Además, confiere protección parcial y de corta duración, por lo tanto su empleo se ha limitado a grupos considerados como de alto riesgo y no está indicada en niños. La vacuna de Germanier -mutante avirulenta de Salmonella que se administra por vía oral- proteje hasta un 95 por ciento, siempre y cuando antes de administrarse se neutralice el jugo gástrico, aunque su utilización general en Salud Pública es impráctica. Ya que las porinas son buenos inmunógenos en modelos animales, la obtención de un conjugado antígenico Vi-porinas puede ser una excelente opción como vacuna contra la fiebre tifoidea

A preliminary survey of the occurrence of typhoid vi-phage types and biochemical types in the British Caribbean territories: with special reference to Jamaica

Typhoid cultures isolated during 1950-54 in Jamaica were phage typed and only 4 types have been found. Type E1 is the most common and Type T the next most frequent strain. The types prevalent here are among those most common in North America, Africa, Europe and it is likely that their origin here may be from the movement of population to and from those countries, mainly the United States of America, together with the transfer of population from Africa here during the past two centuries. Classification of typhoid strains by their biochemical types has also been done and it is put forward as a possible temporary epidemiological method for use in areas where laboratory facilities for phage typing are not readily available. The biochemical classification recommended by Kristensen was used. Our results have been compared with Kristensen's report and it could be shown that the percentage of these three sub-types found by him is different from that found in Jamaica (AU)