Typhoid Carrier State Research Articles

The Many Hidden Faces of Gallbladder Carcinoma on CT and MRI Imaging-From A to Z.

Gallbladder carcinoma represents the most aggressive biliary tract cancer and the sixth most common gastrointestinal malignancy. The diagnosis is a challenging clinical task due to its clinical presentation, which is often non-specific, mimicking a heterogeneous group of diseases, as well as benign processes such as complicated cholecystitis, xanthogranulomatous cholecystitis, adenomyomatosis, porcelain gallbladder or metastasis to the gallbladder (most frequently derived from melanoma, renal cell carcinoma). Risk factors include gallstones, carcinogen exposure, porcelain gallbladder, typhoid carrier state, gallbladder polyps and abnormal pancreaticobiliary ductal junction. Typical imaging features on CT or MRI reveal three major patterns: asymmetric focal or diffuse wall-thickening of the gallbladder, a solid mass that replaces the gallbladder and invades the adjacent organs or as an intraluminal enhancement mass arising predominantly from the gallbladder fundus. The tumor can spread to the liver, the adjacent internal organs and lymph nodes. Depending on the disease stage, surgical resection is the curative treatment option in early stages and adjuvant combination chemotherapy at advanced stages. The purpose of this scientific paper is to fully illustrate and evaluate, through multimodality imaging findings (CT and MRI), different presentations and imaging scenarios of gallbladder cancer in six patients and thoroughly analyze the risk factors, patterns of spread and differential diagnosis regarding each particular case.

Case-control investigation of invasive Salmonella disease in Malawi reveals no evidence of environmental or animal transmission of invasive strains, and supports human to human transmission.

Invasive Salmonella infections cause significant morbidity and mortality in Sub-Saharan Africa. However, the routes of transmission are uncertain. We conducted a case-control study of index-case and geographically-matched control households in Blantyre, Malawi, sampling Salmonella isolates from index cases, healthy people, animals, and the household environment. Sixty index cases of human invasive Salmonella infection were recruited (March 2015-Oct 2016). Twenty-eight invasive Non-Typhoidal Salmonella (iNTS) disease and 32 typhoid patients consented to household sampling. Each index-case household was geographically matched to a control household. Extensive microbiological sampling included stool sampling from healthy household members, stool or rectal swabs from household-associated animals and boot-sock sampling of the household environment. 1203 samples from 120 households, yielded 43 non-Typhoidal Salmonella (NTS) isolates from 25 households (overall sample positivity 3.6%). In the 28 iNTS patients, disease was caused by 3 STs of Salmonella Typhimurium, mainly ST313. In contrast, the isolates from households spanned 15 sequence types (STs). Two S. Typhimurium isolates from index cases closely matched isolates from their respective asymptomatic household members (2 and 3 SNP differences respectively). Despite the recovery of a diverse range of NTS, there was no overlap between the STs causing iNTS disease with any environmental or animal isolates. The finding of NTS strains from index cases that matched household members, coupled with lack of related animal or environmental isolates, supports a hypothesis of human to human transmission of iNTS infections in the household. The breadth of NTS strains found in animals and the household environment demonstrated the robustness of NTS sampling and culture methodology, and suggests a diverse ecology of Salmonella in this setting. Healthy typhoid (S. Typhi) carrier state was not detected. The lack of S. Typhi isolates from the household environment suggests that further methodological development is needed to culture S. Typhi from the environment.

English

BACKGROUND Gallbladder cancer and breast cancer are two common malignancies seen along the Ganges River and the Indo-Gangetic plains of northern India, especially in the states of Uttar Pradesh and Bihar. Some of the postulated aetiologies include cholelithiasis (gallstones), typhoid carrier state, dietary factors, genetic predisposition and chemical carcinogens. Studies have also linked gallbladder cancer and breast cancer to carcinogens in polluted rivers. We undertook this study to investigate as to whether these conditions and gallstones were more prevalent in populations living close to polluted rivers. We also wanted to investigate as to whether there is any association between gallbladder cancer, gallstones and breast cancer with river pollution. METHODS This was a case-control study carried out in the Department of Oncology of a tertiary level defence hospital between 2018 and 2020. Patients who were diagnosed as having gallbladder cancer, gallstones or breast cancer in this tertiary institute, and were permanent residents of Uttar Pradesh or Bihar were included in the study. RESULTS In this study, we found that patients with gallbladder cancer, gallstones and breast cancer had their home closer to the river at a distance of around 53.9, 54 and 39.1 Kms. respectively compared to controls whose homes were at a distance of 76.7 Kms. CONCLUSIONS This study suggests that proximity to polluted rivers is one more factor in the aetiology of aforementioned diseases. Governmental agencies must consider monitoring and controlling the release of pollutants from the industries into the local nearby rivers. KEYWORDS Gallbladder Neoplasms, Drinking Water, Gallstones, Public Health

Is Salmonella enterica serovar Typhi associated with carcinoma gall bladder?

Introduction: Gallbladder carcinoma is a common hepatobiliary malignancy with poor prognosis. It is 3rd commonest malignancy in north India. Salmonella typhi is one of risk factor for gallbladder cancer. India is high endemic area for typhoid in the world. Various authors reported association between the two but without doing testing for typhoid carrier, association cannot be proven. Aim: The present study was designed to explore the association of the chronic typhoid carrier state and carcinoma gall bladder by detecting Salmonella typhi in specimens of gallbladder from patients with malignant and benign gallbladder diseases using a Nested PCR. Methods and material: In this prospective case control study, we have got 39 samples from Carcinoma Gall Bladder (GBC) patients as cases and 75 samples from benign Gall Bladder Diseases (GBD) patients as controls in two years duration. We have done Indirect haemagglutination test for typhoid carrier from five milliliters of blood which was collected from each patient before surgery. Nested PCR was done from gall bladder tissue, which was taken at operation, from both GBC and GBD patients. Result: Nested PCR showed 59% positivity for Salmonella typhi in the GBC and 56% in GBD, so association of Salmonella typhi with GBC was not statistically significant. Vi antibody was present 33% in GBC and 37% in GBD by IHA. It is also not statistically significant. Conclusion: A large number of sample size is require for proving association between carcinoma gall bladder and Salmonella typhi by using definite marker for Vi antibodies.

Transcriptomic study of Salmonella enterica subspecies enterica serovar Typhi biofilm

BackgroundTyphoid fever is an acute systemic infection of humans caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi). In chronic carriers, the bacteria survive the harsh environment of the gallbladder by producing biofilm. The phenotype of S. Typhi biofilm cells is significantly different from the free-swimming planktonic cells, and studies have shown that they are associated with antibiotic resistance, immune system evasion, and bacterial persistence. However, the mechanism of this transition and the events leading to biofilm formation are unknown. High throughput sequencing was performed to identify the genes involved in biofilm formation and to postulate the mechanism of action.ResultsPlanktonic S. Typhi cells were cultured using standard nutrient broth whereas biofilm cells were cultured in a stressful environment using high shearing-force and bile to mimic the gallbladder. Sequencing libraries were prepared from S. Typhi planktonic cells and mature biofilm cells using the Illumina HiSeq 2500 platform, and the transcriptome data obtained were processed using Cufflinks bioinformatics suite of programs to investigate differential gene expression between the two phenotypes. A total of 35 up-regulated and 29 down-regulated genes were identified. The identities of the differentially expressed genes were confirmed using NCBI BLAST and their functions were analyzed. The results showed that the genes associated with metabolic processes and biofilm regulations were down-regulated while those associated with the membrane matrix and antibiotic resistance were highly up-regulated.ConclusionsIt is proposed that the biofilm phenotype of S. Typhi allows the bacteria to increase production of the membrane matrix in order to serve as a physical shield and to adhere to surfaces, and enter an energy conservation state in response to the stressful environment. Conversely, the planktonic phenotype allows the bacteria to produce flagella and increase metabolic activity to enable the bacteria to migrate and form new colonies of infection. This data provide a basis for further studies to uncover the mechanism of biofilm formation in S. Typhi and to discover novel genes or pathways associated with the development of the typhoid carrier state.

Analysis of TLR polymorphisms in typhoid patients and asymptomatic typhoid carriers among the schoolchildren

BackgroundToll like receptor (TLR) plays a critical role in recognition and activation of both innate and adaptive immune responses against microbial pathogens. Several studies have implicated the genetic variations (polymorphisms) in TLR genes to influence the host susceptibility to infectious diseases. However, the available literature on TLR polymorphism and susceptibility to typhoid fever is unclear. AimThis study aimed to investigate the polymorphism of TLRs 1, 2, 4 and 5 in typhoid patients and convalescent phase asymptomatic typhoid carriers among the schoolchildren. Subjects and methodsTLR genes were amplified by PCR from peripheral blood leukocytes of schoolchildren with typhoid (n=20) or asymptomatic typhoid carrier (n=30) state, and normal healthy individuals (n=50). The RFLP analyses for TLR1, 2, 4 and 5 genes using restriction enzymes such as AluI, AciI, NcoI and DdeI, respectively, were performed to determine the single nucleotide polymorphism. ResultsTLR1 polymorphism was observed in 5% (1/20) of typhoid patients and 6.6% (2/30) of typhoid carriers. TLR2 polymorphism was observed in 10% (2/20) of typhoid patients and 6.6% (2/30) of carriers. TLR4 polymorphism was not observed in typhoid patients, but 6.6% (2/30) of typhoid carriers exhibited a polymorphism. As well, TLR5 polymorphism was not observed in typhoid patients, while 13.3% (4/30) of typhoid carriers had polymorphism. None of the control healthy individuals had evidence for TLR polymorphisms. ConclusionThe study reports polymorphisms of TLR genes in a lower proportion among the schoolchildren with typhoid or convalescent typhoid carrier state.

Association of carcinoma of the gallbladder with typhoid carriage in a typhoid endemic area using nested PCR

Although well studied the association between chronic typhoid carrier state and carcinoma of the gallbladder (CaGB) remains unproven. The study was performed at a tertiary care medical center in North India and involved 52 patients with CaGB, 223 patients with benign gallbladder diseases, 508 healthy individuals and, 424 corpses. For the detection of Salmonella enterica serovar Typhi, hepatobiliary specimens were subjected to DNA extraction for specific nested- PCR amplification of the S. Typhi flagellin gene. Anti-Vi S. Typhi antibodies were detected in serum samples from patients by indirect haemagglutination. Thirty five of the 52 (67.3%) CaGB patients were PCR-positive for the S. Typhi flagellin gene; significantly higher than for patients with benign gallbladder diseases (95/223, 42.6%; p<0.01) and corpses (35/424, 8.2%; p<0.001). The numbers of individuals that had significant anti-Vi antibody titres (> or = 160) in their serum were 20/52 (38.5%) for CaGB patients, 31/223 (13.9%) for patients with benign gallbladder diseases, and 47/508 (9.2%) for healthy individuals. Specific nested-PCR amplification of the S. Typhi flagellin gene in hepato-biliary specimens was more sensitive for detection of S. Typhi carriage than anti-Vi antibody titres in serum. The results demonstrate an association between typhoid carriage and gallbladder diseases, both CaGB and benign. S. Typhi specific immunosuppression is also suggested in patients with gallbladder diseases.

Primary gallbladder cancer: recognition of risk factors and the role of prophylactic cholecystectomy.

The objective of this article is to review the available literature on the epidemiology, predisposing factors, and conditions associated with primary gallbladder cancer, and to discuss the role of prophylactic cholecystectomy in high-risk patient populations. Gallbladder cancer is a highly malignant tumor with a poor 5-yr-survival rate. It is a tumor of the elderly and has striking genetic, racial, and geographic characteristics, with an extremely high prevalence in Native Americans and Chileans. Cholelithiasis is a well-established risk factor for gallbladder cancer and the risk seems to correlate with stone size. Polyps that are >1 cm, single, sessile, and echopenic are associated with a higher risk of malignancy. Anomalous junction of pancreaticobiliary ducts (AJPBD), especially without choledochal cyst, and porcelain gallbladder are additional factors that predispose to gallbladder cancer. Lesser associations include chronic bacterial infections of the gallbladder, typhoid carrier state, certain occupational and environmental carcinogens, hormonal changes in women, and certain social, dietary, and familial factors. It is important to identify high-risk groups for gallbladder cancer because of the dismal nature of this tumor. In patients with porcelain gallbladder and anomalous junction of the pancreatic and biliary ducts, cholecystectomy is recommended provided that the patient is a good operative candidate. Patients with large solitary polyps or gallstones require close ultrasonic follow-up. With the advent of endoscopic ultrasound it is expected that early changes of malignancy in polyps will be reliably detected, and more patients will potentially be cured with a simple cholecystectomy. Through a MEDLINE/PAPERCHASE search we identified and reviewed articles regarding gallbladder cancer published in English-language journals between 1966 and 1999, using the key words biliary tract and gallbladder diseases, cancer, neoplasms, surgery, cholelithiasis, gallstones, cholecystitis, gallbladder polyps, risk factors, chemical industry, occupational diseases, typhoid, porcelain gallbladder, bacteremia, and precancerous conditions. We also used the bibliography of relevant articles to increase our search. A total of 122 publications were selected using the mentioned data source.

Typhoid carriers among patients with gallstones are at increased risk for carcinoma of the gallbladder.

The aim of this study was to identify risk factors for carcinoma of the gallbladder (CaGB) among patients with gallstones (GS) with special reference to role of chronic Salmonella typhi carrier state. A prospective case-control study was conducted in a tertiary care center in India. Cases were defined as consecutive patients with CaGB and GS, whereas controls were patients with GS alone. All were assessed clinically and their demographic data, diet, and smoking history recorded. Patients were detected to be typhoid carriers on the basis of Vi serology by enzyme linked immunosorbent assay. Cases (n = 37) and controls (n = 80) were compared by univariate and logistic regression analysis. The mean age of the cases and the controls were 53.4 +/- 11 yr and 43.5 +/- 14 yr, respectively. Among the cases, six (16%) patients were detected to be typhoid carriers, in contrast to two (2.5%) among controls (p = 0.01). Compared to controls, cases were more often older (p = 0.0002), of a lower socioeconomic status (p = 0.0005), and smokers (p = 0.0002). Stepwise logistic regression analysis identified typhoid carrier state (OR = 14; CI 2-92), age > or =47 yr (OR = 5; CI 2-14) and smoking (OR = 11; CI 2-71) as the three independent risk factors for development of CaGB among patients with GS. Chronic typhoid carrier state was the most important risk factor among patients with CaGB and gallstones.

Typhoid carriers among patients with gallstones are at increased risk for carcinoma of the gallbladder

OBJECTIVE: The aim of this study was to identify risk factors for carcinoma of the gallbladder (CaGB) among patients with gallstones (GS) with special reference to role of chronic Salmonella typhi carrier state. METHODS: A prospective case-control study was conducted in a tertiary care center in India. Cases were defined as consecutive patients with CaGB and GS, whereas controls were patients with GS alone. All were assessed clinically and their demographic data, diet, and smoking history recorded. Patients were detected to be typhoid carriers on the basis of Vi serology by enzyme linked immunosorbent assay. Cases (n = 37) and controls (n = 80) were compared by univariate and logistic regression analysis. RESULTS: The mean age of the cases and the controls were 53.4 ± 11 yr and 43.5 ± 14 yr, respectively. Among the cases, six (16%) patients were detected to be typhoid carriers, in contrast to two (2.5%) among controls ( p = 0.01). Compared to controls, cases were more often older ( p = 0.0002), of a lower socioeconomic status ( p = 0.0005), and smokers ( p = 0.0002). Stepwise logistic regression analysis identified typhoid carrier state (OR = 14; CI 2–92), age ≥47 yr (OR = 5; CI 2–14) and smoking (OR = 11; CI 2–71) as the three independent risk factors for development of CaGB among patients with GS. CONCLUSION: Chronic typhoid carrier state was the most important risk factor among patients with CaGB and gallstones.

Carcinoma of the gallbladder--is it a sequel of typhoid?

Gallbladder diseases, including carcinoma, are common in the northern part of India and so are Salmonella typhi infection and typhoid carrier state. This study was aimed to find out the association of typhoid carrier state in patients with cholelithiasis, carcinoma of the gallbladder, and controls. The three groups are comparable in age and sex composition. This is the first study of its kind from an area of high endemicity for both typhoid infection and carcinoma of the gallbladder. A case-control study was carried out to detect typhoid carrier state among the patients with biliary diseases and healthy controls, using indirect haemagglutination assay measuring antibodies against highly purified S. typhi Vi polysaccharide antigen. A significantly high Vi positivity was observed in patients with gallbladder carcinoma (29.4%) compared to controls (5%) (chi2 = 6.325, P < 0.004, OR = 7.19) and patients with cholelithiasis (10.7%) (chi2 = 5.066, P < 0.01, OR = 3.86). There is 8.47 times more risk of developing carcinoma of the gallbladder in culture-positive typhoid carriers than the noncarriers. The present study suggests the typhoid carrier state to be one of the possible mechanisms of gallbladder carcinogenesis.

Norfloxacin, the first of a new class of fluoroquinolone antimicrobials, revisited

Norfloxacin is the first in a series of new 4-quinolones that have been introduced into medical practice for the treatment of bacterial infections. This totally synthetic compound is a broad spectrum, bactericidal agent that is much more potent than the earlier analogs, i.e. nalixidic acid, pipemidic acid, cinoxacin, rosoxacin, and flumequine, is less likely to select for resistant mutants. While the compound has been used most widely in the treatment of urinary tract infections including pyelonephritis and prostatitis, utility has also been demonstrated in gastrointestinal and ophthalmological infections, gonorrhea, typhoid fever, the typhoid carrier state, as well as in the prophylaxis of traveler's diarrhea, biliary tract infections prior to surgery, and gram-negative bacillary infections in profoundly neutropenic patients.

ASSOCIATION BETWEEN HEPATOBILIARY CANCER AND TYPHOID CARRIER STATE

A case-control study of deceased typhoid carriers registered by the New York City Health Department between 1922 and 1975 was carried out to test for an association between the typhoid-carrier state and death due to hepatobiliary cancer. 471 carriers were matched with 942 controls for sex, age at death, year of death, borough in which the carrier died, and where they were born. The results show that chronic typhoid carriers die of hepatobiliary cancer six times more often than the matched controls and that this difference is significant (P<0·001) by simple χ 2 test and by the Mantel-Haenszel method of χ 2 for matched triples. Possible mechanisms for this association are discussed.

Typhoid Cholecystitis and Gallbladder Carcinoma After Interval of 67 Years

To the Editor.— A woman who had had typhoid fever at age 13 years had an attack of cholecystitis at age 80 years. At operation, her inflamed gallbladder had a solitary stone, a carcinoma of the fundus, and typhoid bacilli on culture. Her unsuspected and unusually prolonged typhoid carrier state illustrates a potential contagious hazard. Obscure infection in the remote past, decades of apparent good health, and late exacerbation and contagion is a pattern well recognized in tuberculosis and occasionally in other infections as well. Report of a Case.— An 80-year-old white woman, a life-long resident of Massachusetts, was admitted to the Peter Bent Brigham Hospital, Boston, for the first time on Nov 10, 1967, because of 12 hours of pain in the right upper quadrant radiating into the back, associated with a single episode of vomiting of bright-red blood. The patient recalled in detail her case of typhoid fever

QUANTITATIVE BACTERIOLOGY OF THE TYPHOID CARRIER STATE.

Summary Thirteen chronic stool carriers of Salmonella typhosa were studied to determine the number of typhoid bacilli in stool, gastric juice, and duodenal aspirate before and after intravenous injection of Pancreozymin®. The number of salmonella excreted ranged from 106 to 1010 per gram of feces in 42 of 46 specimens from the 13 patients, and only 1 sample was negative for S. typhosa. S. typhosa was recovered from the pre-pancreozymin duodenal aspirates of only 6 of the 13 patients. However, after administration of pancreozymin, S. typhosa in titers of 104 to 108 per ml was recovered from the duodenal aspirate of every patient. In 12 of the 13 patients the number of salmonella in the post-pancreozymin specimen exceeded by at least 10-fold the number in the pre-pancreozymin specimen. The present studies show that chronic typhoid carriers regularly excrete large numbers of S. typhosa in stool. The evidence strongly suggests that the biliary tract is the primary site of multiplication in those patients.

Intracellular infection and the carrier state.

The evidence summarized in this article is sufficient to support conclusions as follows. 1) Antibiotics penetrate rapidly into mammalian cells and inhibit multiplication of susceptible microbes within the cell as promptly and effectively as they inhibit multiplication of such microbes outside the cell. This is consistent with clinical experience. 2) Death of individual organisms inside mammalian cells bathed in medium containing antibiotics continues over several weeks but may not proceed pari passu with time. This observation supports the as yet meager clinical data, which suggest that eradication of the typhoid carrier state may be accomplished through antibiotic therapy, provided (i) the proper antibiotic is selected; (ii) it is administered in amounts sufficient to obtain continuous suppression of growth of intracellular organisms; and (iii) the regimen is maintained for 2 or 3 weeks. 3) The actual cause of death and destruction of intracellular microbes in treated cells remains an enigma. To attribute this to inanition or senescence of the organisms, without describing mechanisms, is to avoid the issue. The hypotheses dealing with inactivation of intracellular microbes by intracellular antimicrobial substances and antibodies deserve to be explored. 4) Evidence from the ward and laboratory suggests that infected cells can clear themselves of invading pathogens and recover. Although antibiotics have played the major role in demonstrating this in the laboratory, it is possible that they do nothing more than hold the intruders in abeyance while natural defense mechanisms of the cell gain the upper hand. Certainly such cellular mechanisms must provide a potent force for survival; otherwise, why would 98 percent of typhoid patients fail to become chronic carriers? 5) The continued study of infections, including the carrier state, with a view to understanding the abnormalities created by the multiplying intracellular microbe and the means by which the cell corrects these and eliminates the intruder, should open new vistas in chemotherapy and immunology.

The detection of the typhoid carrier state

1. The existing procedures recommended for the detection of carriers of enteric pathogens are reviewed.2. The techniques employed in this work at present were re-examined.3. An investigation of the sera of 67 chronic typhoid carriers and 343 normal persons, suggested that titrations for typhoid Vi, O and H agglutinins are useful screening tests for the detection of typhoid carriers. The examination may be usefully extended to the titration of H agglutinins against paratyphoid B and paratyphoid A, the former as a possible indicator of the carriage ofSalm.paratyphid B, the latter as an indicator of previous inoculation with T.A.B. vaccine.4. Inoculation did not appear to increase the proportion of positive reactions with TVi bacterial suspension, which in uninfected persons was about 1%. In contrast, the proportion of positive reactors with TO suspension rose from 8·8% in uninoculated to 25·3% in inoculated persons, at a serum dilution of 50; and with TH suspension the positive figure rose from 2·7% in uninoculated to 71·4% in inoculated persons at a serum dilution of 25. Inoculation thus impairs the value of TO agglutination and destroys that of TH agglutination as indicators of infection.5. The investigation of 29 chronic carriers showed that a single bacteriological examination of excreta for the presence ofSalm. typhiis not a reliable method of carrier detection. Increasing the number of specimens to three greatly raises the probability of detection.6. The findings are discussed and a revised form of paragraph 5 of the Ministry of Health Memorandum on the safeguards recommended for adoption by water undertakings is suggested.The Working Party is grateful to a number of pathologists for the supply of sera from chronic carriers and we should also like to thank Mr F. J. Flyn of the Central Enteric Reference Laboratory for his great technical help.

The chronic typhoid carrier. III. Therapy with antagonistic bacillus, antibiotics and sulfonamides.

Article1 August 1950THE CHRONIC TYPHOID CARRIER. III. THERAPY WITH ANTAGONISTIC BACILLUS, ANTIBIOTICS AND SULFONAMIDESJ. A. VAICHULIS, Ph.D., A. LITTMAN, M.D., A. C. IVY, Ph.D., M.D., F.A.C.P., G. ZUBOWICZ, M.D., R. KAPLAN, M.D.J. A. VAICHULIS, Ph.D.Search for more papers by this author, A. LITTMAN, M.D.Search for more papers by this author, A. C. IVY, Ph.D., M.D., F.A.C.P.Search for more papers by this author, G. ZUBOWICZ, M.D.Search for more papers by this author, R. KAPLAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-33-2-361 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONThe treatment of chronic typhoid carriers is an important public health problem. Hundreds of non-surgical methods of therapy have been tried and found ineffective.While cholecystectomy results in the cure of 70 per cent or more of biliary carriers, there are patients who refuse or who are too ill for this operation. There are also many extra-cholecystic carriers. Although the morbidity and mortality incident to cholecystectomy are low in many surgical clinics, it is undesirable to remove the gall bladder because of an infection which may not have destroyed the functional ability of that organ.It is the purpose...Bibliography1. LittmanVaichulisIvyKaplanBaer AJAACRWH: The chronic typhoid carrier: I. The natural course of the carrier state, Am. J. Pub. Health 38: 1675, 1948. CrossrefGoogle Scholar2. Nissle : Ueber die Grundlagen einer neuen ursachlichen Bekampfung der pathologischen Darmflora, Deutsch. med. Wchnschr. 42: 1181, 1916. CrossrefGoogle Scholar3. Bigger JW: Synergistic action of penicillin and sulphathiazole on B. typhosum , Lancet 1: 81, 1946. CrossrefMedlineGoogle Scholar4. ComerfordRichmondKay CHAWW: Typhoid carriers treated with penicillin and sulfathiazole, Lancet 2: 343, 1946. CrossrefMedlineGoogle Scholar5. KornsTrussell RFRE: Treatment of the typhoid carrier state, J. Lab. and Clin. Med. 33: 1150, 1948. MedlineGoogle Scholar6. BiggerDaly JWRW: The treatment of typhoid carriers with penicillin and sulphathiazole, Lancet 1: 296, 1949. CrossrefMedlineGoogle Scholar7. Hardy AV: Bacteriostatic action of sulfadiazine on E. typhosa in carriers and cases, Pub. Health Rep. 58: 833, 1943. CrossrefGoogle Scholar8. CollerCrabtree FAP: Chronic biliary typhoid carriers, Surgery 12: 426, 1942. Google Scholar9. Vaichulis JA: Unpublished data. Google Scholar10. Sievers JJ: Weekly report, Division of Communicable Disease, Illinois Department of Public Health, Feb. 12, 1949. Google Scholar11. LittmanVaichulisIvy AJAAC: The chronic typhoid carrier: II. The effect of cholecystectomy on the bacteriologic course, J. Lab. and Clin. Med. 34: 549, 1949. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rock Island, Illinois*Received for publication August 12, 1949.From the Manteno State Hospital, Manteno, Illinois, State of Illinois Department of Public Welfare, and the Department of Clinical Science, University of Illinois, Chicago, Illinois.The coöperation of Dr. Alfred Paul Bay, Superintendent, Dr. D. A. Manelli, Assistant Superintendent and Dr. Otto Lohman, Public Health Officer of the Manteno State Hospital is gratefully acknowledged.The cultures of "antagonistic bacilli" used for therapy were prepared by Dr. P. S. Carley and Mr. L. Shermerdiak. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMicro-cells beneath organic lacquers: a study using scanning Kelvin probe and scanning acoustic microscopyDie SalmonellosenTrinkwasserchlorination, Darmflora und Infektionskrankheiten, insbesondere TuberkuloseAntibacterial Agents in Gastrointestinal DiseaseUntersuchungen über die Wirkung des Jodtetragnost auf Bakterien der T.P.E.-GruppeGeneral abstracts 1 August 1950Volume 33, Issue 2Page: 361-370KeywordsAntibioticsBacillusBladderCholecystectomyMorbidityMortalityPrevention, policy, and public healthSulfonamideTyphoid ePublished: 1 December 2008 Issue Published: 1 August 1950 PDF downloadLoading ...

A study of the Vi agglutination test for the detection of typhoid carriers

A total of 1040 individuals has been examined for the typhoid carrier state by the O, H and Vi agglutination tests. Some observations have been made upon the technique of the Vi test.Estimation of the O and H agglutinins proved unsuitable as a preliminary test owing to the high proportion of positive reactors. The Vi test, in contrast, gave a positive result in only a small percentage of those tested and brought the cultural work subsequently required within practical limits. All positive reactors were examined by cultural methods, and in no case were the organisms of enteric fever recovered.The relative merits of the various tests available for the detection of carriers are discussed and certain tentative conclusions are expressed.

Age and Sex as Factors in the Development of the Typhoid Carrier State, and a Method for Estimating Carrier Prevalence

Age and Sex as Factors in the Development of the Typhoid Carrier State, and a Method for Estimating Carrier Prevalence