On the Pathogenesis of Typhoid Fever

Abstract

E fever in this century, typhoid fever was common in the United States and interest in it was great. As its incidence decreased as a result of safe water supplies and improved sewage disposal, knowledge of the disease has ceased to be of general concern. Indeed, many physicians are no longer familiar with the clinical presentations of patients with typhoid fever. Butler and co-workers in this issue of theArchives(p 407) present a study of patients with typhoid fever in Vietnam where the disease is still common. Their study aims to resolve some of the unknown fundamental information on the pathogenesis of the symptoms and signs of typhoid fever. The authors attempt to identify whether circulating endotoxin exists in this disease; if so, is it the basis of the prolonged fever? In addition, as Butler and his colleagues demonstrate, this Gram-negative rod infection produces a coagulopathy that fortunately causes