Drug resistant typhoid fever

BACKGROUND: Malignant schwannomas are rare malignant mesenchymal tumors often associated with neurofibromatosis. They occur less frequently in the head and neck than in other regions. PATIENT: A case history of a primary malignant schwannoma of the head and neck area in a 27-year-old man is reported. The tumor was located in the left submandibular region. The patient did not have any functional deficits. The tumor was totally removed. There have been no signs of either recurrence or metastasis within the two years following diagnosis and surgery. DISCUSSION: The microscopic and immunohistochemical findings are presented, and the importance and therapy of this very rare malignant tumor of the head and neck area are discussed. CONCLUSION: Malignant schwannoma in the head and neck region is rare. Radical resection is the treatment of choice.     

Septic shock with coma revealing typhoid fever

BACKGROUND: Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases. CASE REPORT: A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock. Vomiting and abdominal pain were followed by headache, prostration, fever and diarrhea. Leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis and hepatitis were present. Clotting tests were normal. The thick peripheral blood film was negative. Salmonella typhi was isolated from 6 blood cultures. Treatment associated ceftriaxone 4 g per day for 5 days, colloid and crystalloid fluids and dopamine. The patient was discharged 2 weeks later. DISCUSSION: Typhoid fever should be considered as a diagnosis in patients with sepsis who come from endemic zones. Abdominal symptoms, prolonged fever, coma and delayed headache are particularly contributive signs. Specific treatment should be instituted.     

Spondylitis in typhoid fever (author''s transl)

Obstructing esophageal food impaction was successfully relieved in 3 patients by the administration of intravenous glucagon. Since proteolytic enzyme digestion of bolus impaction carries a clear risk of fatal esophageal perforation, early therapeutic administration of glucagon during initial esophagography affords a safe and effective acute-care radiologic adjunct. Advantages include immediate diagnosis and therapy, effectiveness in meat and vegetable impactions, and safety for repeated doses. A glucagon-papain combination is suggested as a routine regimen during standard efforts at enzymatic disimpaction.     

Concurrent dengue hemorrhagic fever and typhoid fever infection in adult: case report

In Indonesia as well as in many developing countries both typhoid fever and dengue hemorrhagic fever (DHF) are still endemic and prevalent. In Indonesia the incidence of DHF in 1994 was 9.72/100,000 population with CFR of 2.5% and each year about 640,000-1,500,000 cases of typhoid fever were reported with mortality of 1.6-3%. The concurrent infection of both diseases may occur in one patient.     

Clinical and laboratory studies with typhoid fever 178 patients

One hundred and seventy-eight cases of typhoid patients were studied on clinical and bacteriological aspects. The main clinical findings were as follows: (1) Most of the cases had sustained fever (66.3%). (2) Gastroenterial symptoms developed as the disesase progressed. (3) Rose spots were found in 32.6% of them. (4) Liver and spleen were enlarged in 69.5% of the cases. (5) Blood eosinophil disappeared in most of the patients and leukopenia was noted in 94.3%. (6) There were toxic hepatitis (47.1%), toxic myocarditis (22.4%) and intestinal hemorrhage (19.7%) as complications. In the drug sensitivity test, the number of ampicillin-resistant and chloramphenicol-resistant strains of salmonella typhi was increased more than that seen 5 years ago (P < 0.05), however 100% of the strains were sensitive to amikacin, tobramycin, norflexacin, oflexacin and the third generation of the cephalosporin. For the time being, norflexacin and oflexacin were good and suitable drugs for the treatment of typhoid fever.     

Current biological aspects of typhoid fever (author's transl)

The biological signs of typhoid fever are studied on the basis of 90 cases collected over a period of 5 years. Average neutrophil granulocyte count before treatment was 5000 with extremes ranging from 1400 to 12180. The development of granulocytopaenia during treatment may be seen not only in patients treated with phenicols but also in those treated with ampicillin or the combination trimethoprim-sulphamethoxazole. It was possible to isolate the organism in 88 per cent of cases, either by blood culture (79%) or by stool culture (23%). Antibodies (O and H agglutinins) were found in only 86 per cent of cases, and for H agglutinins only there was a significant and transient increase in antibodies. This underlines the importance of the combined examination of three biological criteria - blood culture, stool culture and serology - in reaching the diagnosis of typhoid, the relatively asymptomatic forms of which are becoming increasingly frequent.     

Evaluation of the Widal test for diagnosing typhoid fever in Lebanon

BACKGROUND: We performed an experiment to assess whether in ciliary processes adrenergic-receptor agents can modulate the production of nitrite, an oxidized metabolite of nitric oxide (NO). METHODS: The porcine ciliary processes and the iris were dissected and stored at -20 degrees C. Later, tissues were thawed, and nitrite measured by Griess reaction, before and 2 h after exposure to various drugs. RESULTS: In the ciliary processes, but not in the iris, the alpha-, beta-adrenergic receptor agonist, norepinephrine (0.01-10 microM), increased nitrite production (95 +/- 12%, P < 0.01). The norepinephrine-induced (0.1 microM) nitrite production was inhibited by the inhibitor of NO synthase, N omega-nitro-L-arginine methyl ester (0.5 mM; P < 0.05) and by the non-selective beta-adrenergic receptor antagonist, propranolol (10 microM; P < 0.01), but not by the non-selective alpha-adrenergic receptor antagonist, phentolamine (10 microM). CONCLUSION: In isolated porcine ciliary processes, beta-adrenergic receptor stimulation increases NO production.     

Therapy of multidrug-resistant typhoid fever with oral cefixime vs. intravenous ceftriaxone

We randomly allocated 80 children with suspected multidrug-resistant tyhpoid fever to therapy with either cefixime or ceftriaxone. Of these, an alternative diagnosis was subsequently made in 10 children and another 10 were excluded because cultures were negative. In 9 cases the typhoidal organisms isolated were susceptible to first-line drugs. In all, 50 children were randomly allocated to receive therapy with either intravenous ceftriaxone (65 mg/kg/day once daily, Group A, n = 25) or oral cefixime (10 mg/kg/day divided every 12 hours, Group B, n = 25) for 14 days. The two groups were comparable in their clinical characteristics, duration and severity of illness at the time of admission. The time to defervescence was comparable in both groups (8.3 +/- 3.7 vs. 8.0 +/- 4.1 days, P = not significant). An equal number (3 in each group) failed to respond and underwent a change in therapy. Three children in Group A and one in Group B relapsed. No adverse effects were seen in either group during the course of therapy. Our data suggest that oral cefixime can be used as effectively as parenterally administered ceftriaxone for management of typhoid fever in children.     

A comparative study of cefixime and chloramphenicol in children with typhoid fever

We compared cefixime with chloramphenicol in a randomized trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally and twenty received chloramphenicol 50 mg/kg/day orally. On entry in the study, the clinical characteristics of the two groups were comparable. Duration of therapy was 14 days. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenical. Out of the 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all of them were cured. Over all 28 cases out of 30 (93.3%) P = 0.0049 were cured by cefixime.     

Epidemiology of an unusually prolonged outbreak of typhoid fever in Terrassa, Spain

An unusually prolonged outbreak of typhoid fever, from 1988 to 1994, in Terrassa (Barcelona, Spain), was caused by a casual food handler who was a carrier. The pattern of this outbreak suggested intermittent low-level exposure to Salmonella typhi. We found 70 patients with S. typhi infections, 52 of whom were available for study. Medical records were reviewed and patients were interviewed with use of a standard questionnaire. Phage typing and pulsed-field gel electrophoresis (PFGE) for strain subtyping were used to confirm the epidemiological data. The 27 outbreak strains shared the same phage type and the same PFGE pattern. Four sporadic strains shared the same phage type as the outbreak strain. PFGE was found to be useful for differentiating strains for epidemiological purposes.     

Giant cell arteritis manifesting as chronic cough and fever of unknown origin

A 57-year-old white man sought medical attention because of chronic cough and fever of unknown origin. An extensive work-up over 4 weeks, including repeated blood cultures, chest roentgenograms, a gallium scan, and computed tomographic scans of the sinuses, chest, and abdomen, was nondiagnostic. The patient was referred to our institution for bronchoscopy. Further analysis of his history revealed that he had a headache in conjunction with the cough and an episode of a flashing color design in his left eye 1 week before assessment. The erythrocyte sedimentation rate was 115 mm in 1 hour. A biopsy of the temporal artery showed granulomatous inflammation of the vessel wall with multinucleated giant cells, histiocytes, lymphocytes, plasma cells, and few eosinophils. The multinucleated giant cells were closely related to the fragmented elastic lamina. Corticosteroid therapy resulted in prompt resolution of the chronic cough and fever. Giant cell arteritis should be considered in the differential diagnosis of chronic cough.     

Slide coagglutination for Salmonella typhi antigens in broths inoculated with feces from typhoid fever patients

Salmonella typhi antigens D, Vi and d were readily detected, by slide coagglutination, in mannitol selenite (MSB) and dulcitol selenite (DSB), Salmonella enrichment broths 4 hours after inoculation with feces from 60 patients with bacteriologically confirmed typhoid fever. Positive coagglutination also occurred using MSB and DSB inoculated with fecal specimens obtained from 16 patients from whom S. typhi was not cultured. Twelve of these later seroconverted to Salmonella O antigen. None of the MSB or DSB inoculated with feces from 50 healthy control subjects, gave a positive coagglutination test. The coagglutination method appears to have potential as a rapid test for the detection of antigens of S. typhi in MSB and DSB broths inoculated with feces from patients with suspected typhoid fever.     

The functional status of the body and work capacity of convalescent patients after typhoid fever

Convalescents (168 patients) who went through typhoid and 48 sound men (control group) were examined in order to study their clinical and physiological indices, mental and performance capabilities. At the end of inpatient treatment the complete normalization of functional state was marked only in group 1 (convalescents after abortive typhoid). In 96% of patients who went through slight form of disease (group 2) and middle-severe form (group 3) different disorders of functional state of organism were marked. One week after medical rehabilitation the number of convalescents who needed the continuation of rehabilitation treatment has decreased 50% in the 2nd group, after 2 weeks--up to 35%, after 3 weeks there were no changes. In the 3rd group at the end of the 1st week functional disorders were marked in 85% of patients, after 2 weeks--in 35%, after 3 weeks--in 13.8%, after 4 weeks--in 2.5%.