FIVE CASES OF TYPHOID FEVER THAT HAVE BROKEN OUT LATELY

Abstract

In Japan the outbreak of typhoid fever has rapidly become scarce after World War II and it is now disregarded as the “disease of the past” in our clinical sphere. We have lately come across five cases of typhoid fever on which clinical and epidemiological studies were made. The five cases broke out from August 1976 through November 1979. Patients were four females (20, 19 and 52 years old respectively) and one male (26 years old). Suspected places of their contraction of the disease were Korea for two patients and Kagoshima and Ibusuki cities, Japan for the others. Phage types of causa-tive bacilli were E, 53 and A degraded (found in patients infected in Kagoshima and Ibusuki cities, Japan) and 53 and A degraded were detected in patients who had visited Korea. Initial symptoms developed with the patients were chill, headache and high fever (39.7 C-40.6 C). One of the patients suffered from diarrhea. On the contrary, three of them complained of constipation. Deep red-colored papules appeared on the chest-abdomen region of a patient. There was splenomegaly in two patients while hepatomegaly was found in another patient. Increased LDH level and slight liver function deficiency were seen in all five patients. White blood cell counts varied in the course of the disease. There was leukopenia in all cases ranging from 1, 600/mm3 to 5, 000/mm3. Positive urine protein was noticed in four patients, which turned negative afterwards. Diazo reaction test was performed on two patients who were found to be negative. Intestinal fluoroscopy was done on one patient. An irregular longitudinal niche along a long axis of the intestinal tract and convergence of the intestinal folds were found by press technique. A nodular picture was also seen around the niche. Clinical diagnosis of septicemia was made in four patients and severe infection in one patient. Definite diagnosis was confirmed as a result of arterial blood culture. Periods elapsed from onset of initial symptoms until the time when definite diagnosis was made were 14, 17, 18, 28 and 37 days in each case. The bacilli detected were sensitive to most of the antibiotics tested. Especially, almost all the bacilli detected were sensitive to chloramphenicol. A patient who was supposed to be infected with the bacilli in Korea had joined a Korean tour group from August 4, 1976 through August 11, 1976. Two of 75 tourists on the group contracted the disease. Concurrently, it was reported that 21 patients in a group and six in the other (51 and 73 tourists on each group), both of which tourist groups had traveled Tokyo and Osaka area, contracted typhoid fever. Those facts showed that we should bear imported cases of typhoid fever in mind. However, three of the five patients had never visited any foreign countries and the other three patients were strongly suspected of being infected with Salmonella typhi in Kagoshima and Ibusuki cities, Japan. The fact should carefully be paid attntion to.