Current trends in typhoid fever

Abstract

Typhoid fever, a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality. Endemic cases in the United States are unusual, with most following foreign travel to the Indian subcontinent, Africa, Asia, or Latin America. The classic findings of typhoid fever include rose spots, relative bradycardia, and stepwise fevers, but unfortunately these signs are frequently absent. Gastrointestinal manifestations may include diffuse abdominal pain, bleeding, perforation, cholecystitis, and cholangitis. The diagnosis should be suspected after collection of the appropriate clinical and travel history with confirmation by blood or bone marrow culture. Novel methods are in development to establish the diagnosis when cultures are negative or unavailable. Multidrug resistance has increased worldwide, and decisions on antimicrobial therapy must take such resistance into account. The empiric treatment of choice is a fluoroquinolone drug; ceftriaxone and azithromycin are alternatives. Preventive strategies include good sanitation and food handling practices along with vaccination of selected groups.

ChronicSalmonella entericaSerovar Typhimurium-Induced Colitis and Cholangitis in Streptomycin-PretreatedNramp1+/+Mice

“…Cholangitis has been observed in patients chronically infected with Salmonella enterica serovar Typhi and is thought to be attributable to secondary responses primed by the massive granulomatous disease in the liver parenchyma (10,30). Furthermore, cholangitis is observed in patients suffering from inflammatory bowel disease.…”

“…Therefore, we speculate that cholangitis occurs as a consequence of chronic colitis and that mere systemic colonization by serovar Typhimurium might not be sufficient. Cholangitis has also been observed in humans: 2 to 4% of all patients suffering from chronic colitis develop primary sclerosing cholangitis (10,30,36). This is of considerable interest, because cholangitis may represent a significant risk factor for cholangio-and colorectal carcinoma (22).…”

Dissemination of Persistent Intestinal Bacteria via the Mesenteric Lymph Nodes Causes Typhoid Relapse

“…Ciprofloxacin is a fluoroquinolone antibiotic that is commonly used to treat human typhoid (9). Enrofloxacin is a veterinary fluoroquinolone derivative that can resolve murine typhoid in highly susceptible C57BL/6 mice if it is administered in drinking water for 35 days (17).…”

Molecular evaluation of drug resistance in clinical isolates of Salmonella enterica serovar Typhi from Pakistan

“…As a result, quinolones/fluoroquinolones and third-generation cephalosporins have emerged as current front-line drugs against typhoid. However, resistance against nalidixic acid has emerged rapidly in recent years [2].…”