Typhoid Bacilli Research Articles

False sero-positivity of Salmonella typhi Specific Antibody in Dengue and Corona Virus Infected Patients: An Observational Study

Typhoid fever is a major concern in developing nations. People living in endemic area may frequently get exposed to the typhoid bacilli and can carry some amount of antibody in their circulations which can easily lead to misdiagnosis during other febrile illness. To assess the frequency of false sero-positivity of Salmonella specific antibody in Dengue and COVID-19 patients. An observational case control study was conducted in a multispecialty teaching hospital in north India. A total of 110 serum samples which included dengue IgM positive patients (N= 40), COVID-19 RT-PCR positive patients (N=40) and control subjects (N=30) without any febrile illness were studied. All the samples were tested for Salmonella specific antibody by Widal test and by immune chromatography strip test (ICT). Patient’s detail were documented in a structured Performa. Out of 110 samples 63(57%) were male and 47(43%) were female with age mean age ±45 years. Among the dengue IgM positive patients 8(20%) patients sample showed significant O and H titre of Salmonella typhi (O:80; H:160) in Widal test. Similarly in SARS-CoV-2 RT-PCR positive patients sample 8(20%) patients serum sample showed significant titre of O and H antigen. In control group population significant O antigen along with H antigen of Salmonella typhi were observed in 2(6.6%) sample. False positivity in the serological test should be reported with caution and repeated test should be performed until the etiological agents were not confirmed, in this way we can minimize the misdiagnosis and can prevent the morbidity and mortality as well.

A case of intrauterine infection of the fetus with typhoid bacilli

A typhoid patient had a miscarriage of twins, dead.

Non Typhoidal Salmonella Suppuration of Ovarian Cyst with Sclerosing Peritonitis: An old disease, A New Face

Invasive non-typhoidal Salmonella is an emerging problem in developing regions like Africa and Asia. Infection of ovarian cysts by typhoid bacilli is a complication dating to the 1800s and is rare in the postantibiotic era. A diabetic, hypertensive post-menopausal lady, our patient presented with a large paraovarian cyst infected the Salmonella group B bacillus. The infection is likely transmitted hematogenously or by the surrounding adherent bowel and omentum. Interestingly, our patient developed sclerosing peritonitis and osseous metaplasia of the rectus sheath as well, possibly a peritoneal inflammation to a disseminated infection. Compounded by her diabetes, the ossified rectus healed poorly, leading to burst abdomen in the post-operative period. Hence, our patient presented with a rare manifestation of an emerging disease. A depressed immune status, influenced by her comorbidities, and the lack of sanitation in pockets of South Asia may have led to a reappearance of these once historic complications of typhoid.

Analysis of Salmonella enterica Serovar Typhi by Outer Membrane Protein (OMP) Profiling, Random Amplification of Polymorphic DNA (RAPD) and Pulsed Field Gel Electrophoresis (PFGE)

A number of countries, including developed countries, still have typhoid fever as a major problem resulting in frequent outbreaks. The importance of controlling spread of typhoid fever is well known and necessitates periodic studies to delineate epidemiological relationships. Although phage typing remains to be the preferred conventional method for characterisation of typhoid bacilli, it is of limited use due to prevalence of few predominant phage types in the country like India. Therefore, an effort has been made to assess three molecular methods [Outer Membrane Protein (OMP) Profiling, Random Amplification of Polymorphic DNA (RAPD) and Pulsed Field Gel Electrophoresis (PFGE)] for typing of Salmonella enterica serovar Typhi. 128 Salmonella enterica serovar Typhi isolates were identified using biotyping and serotyping followed by antimicrobial susceptibility testing. These isolates were further subjected to OMP analysis, RAPD and PFGE. PFGE (114 unique clusters) was found to be the most discriminatory method followed by RAPD (94 unique clusters) and OMP profiling (50 unique clusters). Multidrug resistant strains were well discriminated by all three methods used in the study. PFGE still remains the most preferred method for detailed epidemiological investigations. However, random amplification of polymorphic DNA and outer membrane protein profiling can also be considered for molecular discrimination of the isolates in the laboratories lacking high-end facilities.

A Study of Molecular Characterization of the Trimethoprim Resistant Salmonella typhi Strains Prevalent in Himachal Pradesh

Typhoid is a major public health problem in tropical and subtropical countries including India. Salmonella typhi, the causative agent of typhoid fever, is a gram-negative, motile, rod shaped, facultative anaerobe. It is solely a human pathogen and there is no animal reservoir. Antibiotic therapy is the mainstay for the treatment of typhoid fever and the complications associated with it. Nowadays, emerging multidrug resistance among Salmonella typhi strains has become a major public health problem. Present research work was carried out for the identification and molecular characterization of Trimethoprim resistant Salmonella enterica serovar typhi strains from individuals suffering with typhoid fever by means of various techniques i.e.; biochemicals, phenotypical and drug resistant gene specific polymerase chain reaction (PCR). A total of 14 blood specimen of infected patients were collected from Solan district of Himachal Pradesh with varying age groups and were processed via broth enrichment methods for primary isolation and identification of typhoid bacilli. Microbiological and biochemical investigations revealed the presence of S. typhi in all 14 specimens. The antibiotic susceptibility assay was carried out for 11 antimicrobial to study the MDR pattern of the identified bacilli. It was observed that 14/14 S. typhi strains were 100% resistance to Trimethoprim, Co-trimoxazole, Sulfanilamide, Penicillin, Ampicillin, Oxacillin, Tetracycline and Erythromycin, and 70-100% susceptible to Levofloxacin, Amikacin and Amoxicillin. The PCR analysis of these MDR strains showed the presence of dhfr a7 (365 bp) gene in only 10/14 isolates. This study confirmed that Trimethoprim resistance in these strains were due to the presence of dhfr a7 gene and also that PCR based diagnosis could be very useful for the rapid detection of drug resistant S. typhi strains. Present study emphasize that Trimethoprim drug is no longer useful for the treatment of typhoid fever as its MIC optimization was very high (750μg/ml). This study may further help the researchers in selecting the appropriate therapeutic approaches targeting Trimethoprim resistant Salmonella typhi strains.

Antimicrobial resistance pattern of Salmonella enterica servars in Southern Delhi

Background: Enteric fever is predominantly caused by serovars Typhi and Paratyphi of Salmonella enterica . Recently upsurge in multidrug resistant typhoid fever has become a major public health concern in developing countries. This study was conducted to determine the sensitivity pattern of S. Typhi and S. Paratyphi in Southern Delhi. Methods: A total of 98 Salmonella species were isolated over a period of two years between March 2012 – March 2014. Diagnosis of patients was based on clinical features, blood culture and serology. Blood samples were collected and incubated in BacT alert 3D system. Identification was done and antibiotic susceptibility was done by conventional methods and cross checked by Vitek 2 compact system. Results: Of the 98 isolates 87 (88.7 %) were S. Typhi and 11 (11.22%) were S. Paratyphi. Out of 87 samples from which S. Typhi was isolated (68) 78% were male and (19) 21.8% were female patients and they belonged to all age groups. Fever was present in all patients. In this study high resistance was found for both S. Typhi and S. Paratyphi respectively for third generation cephalosporins ( 35.6%, 54.5%), good sensitivity for macrolides (90.8% & 100%) and average sensitivity for ofloxacin (81.6% & 63.7%). Ampicillin and chloramphenicol shows lesser resistance i.e. (11.5% & 18.1%) and (12.6% and 27.2%). 3.5% and 0% resistance was found for imipinem and tigecycline was found 100% sensitive for both S. Typhi and S. Paratyphi, used rarely in treatment of typhoid fever. None of the strains were found sensitive to all drugs. Conclusion: Typhoid bacilli keeps changing its antimicrobial susceptibility pattern. Currently newer drugs like tigecyclline, imipenem and macrolide are showing great response. Primary drugs are showing less resistance may be due to their infrequent usage whereas cephalosporins are showing high resistance towards typhoid bacilli. For better treatment it is important to know the recent susceptibility trend of the area.

Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital

Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia. Blood sample received from the patient attending Nepal Medical College and Teaching Hospital from March, 2012 - August, 2012 were subjected to culture. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method. Out of the total 2,766 blood samples, 368 (13.3%) showed bacterial growth. The percentage of neonatal septicemia was 368 (13.3%). Staphylococcus aureus (28%) was the most common isolates followed by Salmonella enterica Serotype Typhi (22%), Coagulase negative Staphylococci (9.5%), Salmonella enterica Serotype Paratyphi ((7.6%) and Klebsiella pneumoniae (7.6%). 26.3% of the isolates of Staphylococcus aureus were oxacillin resistant. Most of the gram positive organisms were susceptible to amikacin and vancomycin and showed high level resistance to cefuroxime and cotrimoxazole. Out of 109 isolates of typhoid bacilli, 95.3% were resistant to nalidixic acid,79% to ciprofloxacin and 60.5% to ofloxacin. More than 50% of the isolates of Klebsiella pneumoniae and Escherichia coli showed resistance to cephalosporins and cotrimoxazole. Acinetobacter sp. showed high resistance (more than 60%) to ceftriaxone and ofloxacin. More than 20% of the isolates of Pseudomonas aeruginosa were resistant to ciprofloxacin and amikacin. Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread.

An epidemiological surveillance of asymptomatic typhoid carriers associated in respect to socioeconomic status in India

The term ‘enteric fever’ was coined to embrace both typhoid and paratyphoid. It was known as a generalized infection of the reticuloendothelial system and intestinal lymphoid tissue accompanied by sustained fever and bacteraemia. Typhoid has remained a major public health issue in many tropical countries and the highest burden of the disease is in Asia (Pang et al. 1998). The global burden of typhoid was estimated as 16,000,000 cases and 600,000 deaths per year (Pang and Puthucheary 1983; Pang and Bhutta 1995). Currently global pandemics are being caused by the less common serovar of S. typhi (Miko et al. 2002). The asymptomatic carrier state in humans has had serious consequences on public health and the exclusive source for typhoid bacillus was asymptomatic typhoid carriers. An individual could asymptomatically carry the typhoid bacilli for days to years without any symptoms of typhoid fever (Bigelow and Anderson 1933: White and Parry 1996; Senthilkumar and Prabakaran 2005). They usually excrete as many as 10 virulent typhoid bacilli per gram of faeces. These organisms reside in the scarred foci of the biliary tract, migrate through the bile ducts and over the vast surface area of intestinal epithelium; however, they did not cause typhoid fever in the carrier (Hornick et al. 1970). S. typhi usually possesses a polysaccharide Vi (virulence) surface antigen that was associated with enhanced capacity to invade the host. Vi antigen of S. typhi and its relation with high serum titres of S. typhi carrier state, reports about the usefulness of Vi serology in the detection of the carrier state (Felix and Pitt 1934; Felix 1938; Lanata et al. 1983) and establishes a chronic asymptomatic infection in the gall bladder (Kauffmann 1954; Prouty et al. 2002). Asymptomatic typhoid carriers were deficient in IgM and anatomical alterations in the biliary tract lead to prolong bacterial persistence (Cheronokhvostova et al. 1969). The carrier state occurred disproportionately often following infection not only in women but also in older patients, with biliary carriage rather than the urinary carriage (Hornick 1985). Identification of asymptomatic typhoid carriers as the source of an outbreak usually required multiple cultures for several weeks (Engleberg et al. 1983). Positive asymptomatic carriers from food handlers significantly contributed to the spread of S. typhi, S. paratyphi A and S. paratyphi B. Therefore, a periodic assay of Salmonella spp in foodstuffs and food handlers could help in the control of food borne diseases (Sasikumar et al. 2005).

Daring Experiment of a Physician on Himself with Typhoid Bacilli

Daring Experiment of a Physician on Himself with Typhoid Bacilli

Antimicrobial susceptibilities of salmonellae isolated from food handlers and cattle in Lagos, Nigeria

Purpose: Food handlers play an important role in the transmission of typhoid bacilli and other Salmonella spp. This study was conducted to determine the prevalence and antimicrobial resistance patterns of Salmonella spp. from food handlers and cattle and compare the patterns with specimens from patients. Methods: A total of 206 stool samples from apparently healthy food handlers from bukkas (cafeteria) and 100 stool samples from cattle were collected in Lagos Metropolis between June 2006 and June 2007. The prevalence and susceptibility patterns of the S. typhi isolates from the samples and those obtained from the stool samples of 27 patients were determined. Results: Salmonella species isolated from the stool samples collected from food handlers were S. typhi, S. enteritidis, S. choleraesuis, S. paratyphi A and S. arizona with prevalence of 6.8%, 5.3%, 2.9%, 1.5% and 0.5%, respectively. S. enteritidis and S. typhimurium were isolated from 100 faecal cattle samples with prevalence of 12% and 3%, respectively. Nearly all the isolates (including the clinical isolates) were sensitive to nitrofurantoin, nalidixic acid, and ofloxacin, while all were sensitive to ciprofloxacin. Conclusion: Food handlers working in bukkas (cafeteria) and cattle are possible reservoirs of Salmonalle species in Lagos. Other than fluoroquinolones, Salmonalle species exhibit high levels of resistance to most antibiotics. Keywords: Salmonella species; Food handlers; Cattle, Antibiotic resistance; Lagos.

Karl Landsteiner, MD

Karl Landsteiner (1868–1943) Karl Landsteiner, born June 14, 1868, in Vienna, Austria, was the only child of Fanny Hess and Leopold Landsteiner. Even as a child, Dr. Landsteiner displayed an extraordinary aptitude for academics. Dr. Landsteiner completed primary school and the first part of secondary school before attending the Staatsgymnasium in Linz in 1880 as an honors student. Here he developed his burgeoning interest in mathematics and the natural sciences.1 He subsequently attended the University of Vienna, starting in 1885, where he studied under several of the prominent scientists in the fields of anatomy, zoology, hematological chemistry, and organic chemistry. His early experimental work in chemistry foretold of his subsequent interest and achievement in the field of serology. In 1891, Dr. Landsteiner completed his medical degree and began his work in the laboratory of the medical clinic where he studied multiple myeloma (cancer of the cells secreting antibodies). He spent the next 5 years in the laboratories of Hantzsch at Zurich, Emil Fischer at Wurzburg, and E. Bamberger at Munich, publishing on a number of topics investigating the interface between chemistry and biology by focusing on antigen–antibody reactions.2,3,4 In 1896, Dr. Landsteiner returned to Vienna to resume his studies at the Vienna General Hospital as assistant to Dr. Max von Gruber at the Institute of Hygiene at Vienna. Dr. Gruber was known for his discovery of the serological test for typhoid. Dr. Landsteiner was fascinated by the Gruber-Widal reaction, which provided evidence for the serological differentiation between typhoid and non-typhoid bacilli. He believed this differentiation reflected particular chemical differences between the bacilli recognized by antibodies. Under Dr. Gruber, Dr. Landsteiner’s interest in the mechanisms of immunity and in the nature of antibodies intensified, and Dr. Landsteiner published his first papers on agglutination and immunology. …

Highly Susceptible Strains of Typhoid Bacilli Encountered in Jamaica

Background: Unlike reports of multidrug-resistant Salmonella enterica serovar typhi (S. typhi) in countries around the world, strains encountered in Jamaica have been uniformly susceptible to all the anti-typhoid drugs and also to other antibiotics by disc method. We have been maintaining these isolates on Dorset-egg medium over the years. In this report, we examine the MICs of 4 front-line antibiotics against 41 unduplicated isolates(one from a patient) encountered in consecutive 17 years between 1984 and 2000 at the University Hospital in Kingston, Jamaica. Methods: The MICs were determined by E test(AB Biodisk, Solna, Sweden) using E. coli ATCC 25922 as control. Manufacturers’ instructions in regard to media, inoculum density and incubation parameters were followed strictly. Our observation of extremely low MICs (see results below) made us to do the tests repeatedly and read the results independently by each of us (NCB and OH) and repeat again if we differed in reading by more than one E test dilution. Results: The MICs( g/ml) of the four antibiotics were Chloramphenicol MIC range 2—4, MIC50 3 and MIC90 3; Ampicillin MIC range 0.125—1, MIC50 0.25 and MIC90 0.5; Trimethprim/Sulpha MIC range 0.023—0.064, MIC50 0.032 and MIC90 0.047; Ceftriaxone MIC range 0.023—0.047, MIC50 0.032 and MIC90 0.047. All isolates were susceptible. MICs were extremely low, fell in a narrow range and far below the standard susceptible(CLSI) Breakpoint MICs of the antibiotics. We have not seen any report of such a highly susceptible strains of typhoid bacilli from anywhere in the world. Conclusion: Considering the growing increase of multidrug-resistant typhoid in countries around the world and reports of isolation of strains with MICs of front-line antibiotics of more than 256 g/ml(Hirose K et al Antimicrob Ag Chemother 45:956—958,2001), the highly susceptible nature of strains encountered in Jamaica is noteworthy. These unique strains which we call ‘Jamaica strains’ have been persisting in this island country throughout the years.

Ascaris lumbricoides and perforation of the ileum: A critical review

Ileal perforation due to typhoid bacilli is the commonest cause of peritonitis in the Tropics. Perforation due to Ascaris lumbricoides is rare. Three cases of ileal perforation believed to be due to A. lumbricoides are presented and the evidence critically reviewed. It is suggested that signs of heavy infestation with A. lumbricoides make a diagnosis of intestinal perforation more likely in a patient with an acute abdomen.

Surveillance for typhoid fever in Matsuyama city during 1974-1981 and detection of Salmonella typhi in sewage and river waters.

Eighty-two cases of typhoid fever were found in Matsuyama city in the period from 1974 to 1981. Seventy-six cases were found to be infected with Salmonella typhi other three with Salmonella paratyphi A, and the remaining three were diagnosed only clinically. The strains of S. typhi isolated from these patients showed such a variety of Vi-phage types as D1, D2, E1, M1, 53 and degraded Vi-positive strain (DVS). The concurrent survey of the city sewage and river waters for typhoid bacilli was conducted with total 578 samples taken therefrom. S. typhi was isolated from 120 of those samples. The Vi-phage types of the isolates were closely related with those of the isolates from the patients. The periodical examinations of the city sewage and the draining river may serve as a useful means for the controlling typhoid fever epidemics.

Ergebnisse der Lysotypie von Salmonella typhi und Salmonella paratyphi-B in den Jahren 1974–1978, erhoben in der Bundesrepublik Deutschland und Berlin (West)

In the period between 1.1.1974 and 31.12.1978 phage typing of 2058 strains of S. typhi and 1672 strains of S. paratyphi-B was carried out. 45 S. typhi phage types were found, 11 of these occurred in a frequency of more than 1% (relevant to foci). These were E1 a (21.6%), A (17.7%), F1 (5.8%), D1 (5.5%), C1 (4.6%), E1b (4.1%), D2 (2.5%), 40 (1.5%), 29 (1.3%), B2 (1.0%), 46 (1.0%). Among S. paratyphi-B strains 23 phage types or varieties were observed, 11 of these occurred in a frequency more than 1% (relevant to foci): Taunton (46.9%), 1 m.c. (7.8%), 3aI m.c. (7.7%), B.A.O.R. (6.5%), 3aI var. 1 (5.5%), Dundee (4.4%), 3a m.c. (3.0%), 3b m.c. (2.2%), Beccles m.c. (1.9%), Jersey (1.5%), 1 var. 1 (1.4%). In the year 1974 two epidemics of typhoid fever occurred, one with 417 cases (phage type A, subtype Tananarive) and the other with 41 cases (phage type E1a). In the year 1977 there was an outbreak of paratyphoid B fever with 53 cases (phage type 3aI var. 1). The increasing number of imported cases of typhoid and paratyphoid fever from other countries is remarkable. The age distribution of typhoid and paratyphoid bacilli carriers shows that persons who are older than 60 years represent the age group in which carriers occur most frequently.

Contemporary Plagues and Social Progress

For this address at the opening session of the First Mexican National Congress of Infectious Diseases in Children (ler, Congreso National de Infectologia Pediatrica), I have chosen as my title "Contemporary Plagues and Social Progress." While in medicine the term plague usually refers to diseases caused by Pasteurella pestis, the word has broader meanings and usages. It describes that which smites or troubles, can refer to an afflictive evil or anything troublesome or vexatious, or can be applied to any malignant disease, especially those that are contagious. It can be used as an expression of annoyance, as a mild oath, or with the implication of harassment. Thus, today we are concerned with the plague of plagues, the afflictive evils of the cumulative insults of infectious disease. Additionally, we might be tempted to cast a plague on the system of medical education and on the political process that neither conveys the continuing importance of infectious diseases nor funds the mechanisms for their containment. Or, should the shoe be on the other foot? Should not society cast a plague on us? As experts in the field of infectious disease, have we not failed to publicize that, on a global basis, the combination of diarrheal disease and malnutrition is the leading cause of death in infants and children? Has not our successful use of antibiotics induced unjustified public complacency regarding the problems of infectious disease? Why have our low-keyed reports of resistant typhoid bacilli, or pneumococci or of gonococci failed to dispel the prevalent mystique that science has controlled infectious agents, leaving cancer and heart disease in the public eye as the major unconquered problems in the health field?

Salmonellen-Übertragung von der Mutter auf das Neugeborene

Two newborn infants were infected with Salmonella originating from their mothers. After infection of a newborn infant with Salmonella typhi from a mother, known for a long time to be a chronic carrier, no pathological findings were observed but the child continued to secrete typhoid bacilli for three years. The infection of the second child with S. panama, from a mother recognized as a carrier post-partum, caused a fulminating diarrhoea accompanied by septicaemia which had a fetal outcome.

Microbial development of drug resistance: mechanisms and clinical significance.

Bacteria have demonstrated a disconcerting ability to develop resistance to antimicrobial agents nearly as quickly as new compounds become available. During the past two decades the molecular bases of several types of resistance have been elucidated. Mechanisms of resistance include the transference of genetic material either through conjugation (involving direct contact between microorganisms), or indirectly through transduction (involving bacteriophages). In addition to this "infectious" drug resistance, genetic mutations which permit the utilization of new metabolic pathways, and the production of enzymes which can inactivate the antimicrobic have been described. One particularly complex problem has been the ability of many Enterobacteriaceae to develop resistance to multiple antimicrobials simultaneously. The possible effect of such an occurrence is illustrated by the recent epidemic of multiply resistant Salmonella typhi in Mexico. Because the typhoid bacilli shared an identical resistance pattern to an epidemic Shigella dysenteriae type 1 the in vivo interspecies transmission of resistance has been postulated. Understanding the various mechanisms of resistance development should allow more rational use of antimicrobial agents.

Aberdeen's Typhoid Bacillus

Aberdeen's Typhoid Bacillus

Further study of strontium selenite and selenite F broths for the isolation of Salmonella typhi.

The efficiency of strontium selenite and selenite F broths in the isolation of S. typhi from 625 clinical stool specimens were compared. A total of 126 strains of S. typhi were detected. Of these, 96 (76%) were isolated with selenite F broth and 118 (94%) were isolated with strontium selenite broth. At the same time, the number of false positive isolates accruing to strontium selenite broth was less than that accruing to selenite F broth. The superiority of strontium selenite broth over selenite F broth was more obvious when relatively few typhoid bacilli were present in faeces, eg, after antibiotic therapy, or when stools had been left for prolonged periods at room termperature. In the isolation of S. typhi with strontium selenite broth, salmonella-shigella agar was found to be a better plating medium than xylose lysine desoxycholate agar.