Abceso esplénico, rara presentación de salmonela typhi / Splenic abscess, rare presentation of salmonella typhi

Absceso esplénico es una rara complicación de fiebre tifoidea. La incidencia es de 0.2 a 0.7 por ciento en estudios basados en autopsias. Existen menos de 500 casos reportados en la literatura mundial. La presentación clínica es inespecífica y es potencialmente un problema quirúrgico asociado a alta mortalidad. El tratamiento se basa en una combinación de esplenectomía total o drenaje percutáneo mas una terapia antibiótica adecuada (1,2) El absceso esplénico puede ocurrir secundario a infección del tracto urinario, apendicitis, trauma, endocarditis, neoplasia, fiebre tifoidea, embolias sépticas. Entre los microorganismos causantes más frecuentes encontramos Streptococcus, Staphylococcus, Enterobacterias. Nosotros reportamos un caso de absceso esplénico con documentación microbiológica de Salmonella typhi como agente causal.

Typhoid fever & vaccine development: a partially answered question.

Typhoid fever is a systemic disease caused by the human specific Gram-negative pathogen Salmonella enterica serovar Typhi (S. Typhi). The extra-intestinal infections caused by Salmonella are very fatal. The incidence of typhoid fever remains very high in impoverished areas and the emergence of multidrug resistance has made the situation worse. To combat and to reduce the morbidity and mortality caused by typhoid fever, many preventive measures and strategies have been employed, the most important being vaccination. In recent years, many Salmonella vaccines have been developed including live attenuated as well as DNA vaccines and their clinical trials have shown encouraging results. But with the increasing antibiotic resistance, the development of potent vaccine candidate for typhoid fever is a need of the hour. This review discusses the latest trends in the typhoid vaccine development and the clinical trials which are underway.

imported enteric fever caused by a quinolone-resistant Salmonella typhi

Recent reports indicate that nalidixic acid susceptibility correlates well with the clinical outcome of patients with Salmonella Typhi infection treated with quinolones. We report a case of enteric fever caused by S Typhi in which the isolate was resistant to nalidixic acid, but showed in vitro susceptibility to ciprofloxacin. Following treatment with ciprofloxacin, the clinical outcome was not satisfactory and the patient had a relapse. However, after using a higher dose of ciprofloxacin, the patient was cured. We recommend that all Salmonella systemic infections resistant to nalidixic acid with in vitro but decreased susceptibility to fluoroquinolones be treated with other antibiotics like third-generation cephalosporins or azithromycin. These patients should be closely followed up and observed for further relapse

Salmonella as a causative organism of various infections in patients with sickle cell disease

Patients with sickle cell disease [SCD] are susceptible to a variety of bacterial infections, including infections caused by Salmonella species. We sought to identify the most common infections caused by Salmonella spp. in SCD patients at our hospital, and to determine their mortality rates and susceptibility to commonly used antimicrobial agents. Patients and We conducted a retrospective review of all Salmonella infections in SCD patients admitted to Qatif Central Hospital during the last 11 years. During the 11 years of the study, 331 episodes of Salmonella infection occurred in 319 patients. The incidence of Salmonella infection in SCD patients was 11.5% compared to only 0.65% in the general hospital population. The commonest sites of Salmonella infection were blood [42% of isolates], followed by gastrointestinal tract [23.5%] and the skeletal system [22.5%]. Salmonella infection was commonly seen in patients less than 15 years of age. The case fatality rate in patients with Salmonella sepsis was 2.2% [3/139], but there were no deaths associated with other types of Salmonella infections. Ampicillin and cotrimoxazole resistance occurred in 29% and 24% of the isolates, respectively, but only 0.6% were resistant to ceftriaxone and 1.8% had intermediate resistance to ciprofloxacin. Conclusions: Salmonella is a common cause of sepsis and osteomyelitis in patients with SCD in our locality. Empirical antimicrobial therapy should cover the likely pathogens, including Salmonella species

Rhabdomyolysis and Salmonella typhi infection case report and review of the literature

Typhoid fever is endemic in Lebanon. Usual presentation includes fever, headache, abdominal pain and constipation or diarrhea, extra-intestinal manifestations are not uncommon and involve variety oforgan systems. Rhabdomyolysis is rare and has been reported in various Salmonella infections. we present a case of rhabdomyolysis and renal failure that was successfully treated with imipenem/ cilastatin and hemodialysis

Anaerobiosis induced virulence of Salmonella typhi.

BACKGROUND & OBJECTIVES: Anaerobic conditions are frequently encountered by pathogens invading the gastrointestinal tract due to low/limiting oxygen conditions prevalent in the small intestine. This anaerobic stress has been suggested to enhance the virulence of gut pathogens. In the present study, we examined the effect of anaerobiosis on the virulence of Salmonella Typhi, a Gram negative bacteria which invades through the gut mucosa and is responsible for typhoid fever. METHODS: Salmonella Typhi (ty2) was cultured in aerobic and anaerobic conditions to compare its virulence by rabbit ileal loop assay, hydrophobicity assay, expression of outer membrane proteins (OMPs) and antioxidant enzymes assay. RESULTS: Anaerobically grown S. Typhi showed significantly higher cell surface hydrophobicity as compared to aerobic bacteria. In vivo toxin production by rabbit ileal loop assay also showed significantly higher fluid accumulation with anaerobic S. Typhi. Expression of OMPs in anaerobic S. Typhi showed a distinct induction of five outer membrane proteins. We observed that exposure of anaerobic S. Typhi to aerobic conditions induced significantly higher level of antioxidant enzymes like superoxide dismutase (SOD) and catalase. INTERPRETATION & CONCLUSION: Our results suggest that exposure of S. Typhi to anaerobic conditions enhances its virulence.

Cambios epidemiológicos de las salmonelosis en Chile: desde salmonella typhi a salmonella enteritidis / Changes in epidemiological patterns of salmonellosis in Chile: since salmonella typhi to salmonella enteritidis

Chile ha experimentado un cambio epidemiológico en la última década con la desaparición progresiva de la fiebre tifoidea causada mayoritariamente por Salmonella typhi y la emergencia epidémica de Salmonella enteritidis, un agente de diarrea sin tratamiento específico eficaz y ligado estrechamente a productos avícolas contaminados e inadecuadamente preparados. La fiebre tifoidea ha disminuido su importancia debido al desarrollo humano experimentado en Chile que ha significado un alto grado de cobertura de agua potable y de manejo de excretas, en conjunto con un mayor nivel de educación, factores que limitan la contaminación del ambiente por este agente y la adquisición de él por huéspedes susceptibles. A pesar de este notable avance, un nuevo serotipo de salmonela ha irrumpido en Chile, denominado enteritidis, que ha logrado aprovechar el nuevo escenario logrado con la industrialización avícola donde miles de aves ahora conviven en pequeños espacios facilitando la infección cruzada entre ellas. La contaminación intermitente de huevos por vía transovárica o superficial permite la llegada de este agente en forma errática pero persistente al ser humano. Este nuevo escenario y la ausencia de un tratamiento antimicrobiano eficaz para este agente, obligan a que nuestro país adopte nuevas estrategias de prevención que involucran a productores, distribuidores y consumidores de productos avícolas

Tratamiento de la fiebre tifoidea: evaluación de la terapia antibiótica clásica y el uso de ciprofloxacino / Treatment of typhoid fever: evaluation of classic antibiotic therapy and use of ciprofloxacin

La fiebre tifoidea es una infección sistémica aguda de carácter endémico en Chile, cuya mortalidad disminuyó drásticamente con el advenimiento de la terapia antibiótica (cloramfenicol, cotrimoxazol y ampicilina). Aún cuando esto provocó un cambio significativo en el pronóstico de la enfermedad, aún persiste un porcentaje de complicaciones cercano al 10 por ciento. Se ha descrito cepas resistentes a estos antibióticos en todo el mundo, observándose tasas que llegan a no más del 0,4 por ciento en nuestro país. En pacientes que se tratan con cloramfenicol existe un porcentaje de recaída de la enfermedad que llega hasta un 25 por ciento y una tasa de portadores crónicos que llega al 6 por ciento; atribuídos ambos hechos a su acción bacteriostática. En Chile se señala una tasa de portadores crónicos de 694 por 100,000 habitantes, cifra que mantiene las características endémicas de esta enfermedad. En los últimos años se ha propuesto el uso de ciprofloxacino como antibiótico eficaz en el tratamiento de la fiebre tifoidea, sin evidencias de resistencia y que disminuye en forma significativa tanto las recaídas como la portación crónica

study of typhoid bowel preformation in balochistan

A prospective study was carried out for two years in Surgical Unit II of Civil Hospital, Quetta on 57 patients with typhoid perforation. Of these 47 were males and 10 females. The peak incidence was in the second and third decade of life. Abdominal pain, fever, vomiting, constipation and loose motions were the major presenting symptoms. Abdominal distension, tenderness, rigidity, and absent gut sounds were the main signs observed. Wide differences were observed in haemoglobin, total leucocyte count, urea, creatinine and electrolytes. Specific diagnostic tools were Widal test and radiography. All patients underwent emergency surgical procedures like wedge resection, resection and end to end anastomosis, ileostomy and right hemicolectomy with an overall mortality of 33%. Major causes of mortality were shock, septicaemia, renal failure and postoperative respiratory tract infection

Are new antibiotics essential in the treatment of Salmonella typhi enteric fever? a comparison between enteric fever due to sensitive and resistant Salmonella in Ras Al-Kaimah, United Arab Emirates

Document the magnitude of the problem of multiresistant Salmonella typhi in the Emirates and to try to predict clinically if enteric fever patients are harbouring S.typhi sensitive or are resistant to conventional antibiotics. The Medical Department of the Seif Bin Ghubash Hospital. Ras Al-Khaimah, United Arab Emirates. Material and methods: A total of 51 culture proven enteric fever inpatients were studied to see the antibiotic susceptibility pattern. They were grouped into resistant or sensitive S.typhi according to the organism's susceptibility to conventional antibiotics. Twenty four clinical events were compared in both groups. Organisms were statistically significantly resistant to chloramphenicol, co-trimoxozole and ampicillin [conventional antibiotics]. All isolates were 100% sensitive to aminoglycosides, ceftazidime and aztreonam. Twenty six patients were grouped resistant and 25 sensitive. Statistically the duration of fever before presentation was 8.52 +/- 5.23 and 13.04 +/- 8.35 days which was significantly different in the sensitive and resistant, respectively [p<0.03]. The defervescence was shorter in patients treated with conventional antibiotics 5.72 +/- 2.48 days compared to 10.69 +/- 5.08 days in the resistant group [p<0.0001] Multiresistant S.typhi is common in the area ranging between 40% to 60% of S.typhi isolates. A new policy of efficient non-costly parenteral and oral antibiotics should be adopted and the use of quinolones should be encouraged for the time being. The longer the duration of fever before presentation the more likely S.typhi isolates will be resistant to conventional antibiotics

Salmonella typhi meningitis

Salmonella typhi is commonly isolated from the blood of febrile patients, but meningeal involvement and its isolation from cerebrospinal fluid is a rare occurence. We report here a case of Salmonella typhi meningitis in an infant eight months old. Although the meningitis was treated appropriately but the outcome was an infarct in the left cerebral hemisphere leading to right sided hemiperesis

Outbreak and management of enteric fever

An outbreak of enteric fever occurred in the PCSIR campus colony, Karachi during the months of January-February, 1995 due to contamination of drinking water with sewage water. Forty-four [23.28%] cases out of 189 residents of the colony clinically diagnosed as enteric fever, were followed up. Twenty-eight [63.64%] cases were bacteriologically confirmed as typhoid fever because of the isolation of salmonella typhi from their blood or bone marrow. Culture and sensitivity tests showed that all strains were resistant to amoxycillin, cotrimoxazole, chloramphenicol, augmentin, and fosfomycin but sensitive to quinolones and third generation cephalospoirns. Almost all the adult cases were treated with quinolones for 10-14 days with excellent results. However, children were initially treated with amoxycillin, and then changed over to cefixime and ceftriaxone, due to failure of treatment with amoxycillin. They responded satisfactorily to these drugs. As immediate protective measures. Residents were advised to boil the water before drinking. Chlorination of the water in the underground storage tanks was regularly undertaken. Leakages in the piped supply line were fixed on an emergency basis. These measures helped to avert another typhoid epidemic on the campus

Typhoid fever presenting with cervical lymphadenopathy

Typhoid fever is an acute systemic febrile infection caused by the gram-negative bacillus Salmonella typhi. It is endemic in many parts of the world where there is inadequate water supply and poor hygiene. We report an uncommon presentation where typhoid fever presented with cervical lymphadenopathy

Características clínicas, diagnóstico y tratamiento de pacientes internados con el diagnóstico de fiebre tifoidea, entre los años 1990-1994 / Clinical characteristics diagnosis and treatment of patients with thypoid fever between 1990-1994

Se trata de un estudio retrospectivo desde Enero de 1990 a Diciembre de 1994, tiempo en el que fueron internados 52 pacientes con el diagnóstico de fiebre tifodea. Se analizan los criterios clínicos, laboratoriales (hemograma, Widal, hemocultivos), tratamiento y complicaciones en estos pacientes. Se encontro un predominio del sexo masculino 63.4 por ciento, frente a un 43.3 por ciento del sexo femenino: la procedencia en su mayoría era urbana en un 51 por ciento. El promedio de edad fue de 8 años con una distribución mayor en el grupo de edad de 4 a 9 años (46 por ciento). La mayor parte de los pacientes acudieron en la primera semana de la enfermedad (32.5 por ciento) solo se encontro antecedentes de contactos en 3 pacientes (5.7 por ciento) de los 52 pacientes solo se los realizo hemocultivo a 41 de los cuales solo 5 fueron positivos (12.1 por ciento) que hace solo un 9.6 por ciento de los pacientes estudiados. El motivo principal de consulta fue la fiebre (98 por ciento) seguido del decaimiento general en un 84 por ciento, vómitos (75 por ciento), cefalea y dolor abdominal (53.8 por ciento). Al examen físico la fiebre, solo se presento en un 80.7 por ciento de los pacientes en el momento del ingreso, lengua saburral en 78.8 por ciento dolor abdominal 59.6 por ciento faringe congestiva 42 por ciento alteración de la conciencia un 40 por ciento. No se encontraron variaciones significativas en los pacientes con hemocultivo positivo siendo estos los mas constantes, la alteración de la conciencia (80 por ciento). De los examenes de laboratorio utilizados el hemograma mostro valores normales en su mayoria (46.1 por ciento), la mayoria con neutrofilia (58 por ciento). La reacción de Widal se efectuó solo en 46 pacientes de los cuales fue positivo en un (91.3 por ciento). En la mayoria de los pacientes habia recibido antibióticos en forma previa (61.5 por ciento) siendo el mas utilizado el cloranfenicol. No se registro mortalidad, las complicaciones fueron en un 17 por ciento. El tratamiento que se efectuo fue principalmente en base a cloranfenicol, con buena respuesta. U)

Infección de tejidos blandos por salmonella typhi y paratyphi / Soft tissue infection by salmonella typhi and paratyphi

Between 1979 and 1989 patients presented with soft tissue infections caused by salmonella typhi or paratyphi B, at the Infectious Diseases Hospital Dr. Lucio Cordova, Santiago, Chile. These complications appeared during or after the clinical course of an enteric fever, or without any antecedent illness. The patients were predominantly young and females. The lesions were mainly located in the lower extremities. 50 percent of the patients presented with a concommitant deep bone or joint infection. 11 patients were treated with cloramphenicol (average 22,8 days), 3 with TMP-SMX (average 23 days) and 4 whith a combination of drugs. 13 patients required surgical drainage. This unusual complication extended hospital stay convelescence, but all our patients had a complete recovery