Cases reported "Typhoid Fever"

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1/220. typhoid fever and hiv infection: a rare disease association in industrialized countries.

    typhoid fever is still a global health problem, mainly in tropical and subtropical areas of the world and in developing countries, where relatively elevated morbidity and mortality rates still are present, mostly because of persisting poor hygienic conditions. In the majority of Mediterranean regions, including italy, the disease is constantly present, though with a low prevalence rate, as a result of an endemic persistence of salmonella typhi infection.1-4 On the other hand, in industrialized countries, most cases of S. typhi infection are related to foreign travel or prior residence in endemic countries.4-6 In the united states, 2445 cases of typhoid fever have been reported in the decade 1985 to 1994, and the annual number of cases remained relatively stable over time: over 70% of episodes were acquired in endemic countries (mostly mexico and india).6 The persisting morbidity of S. typhi also may be supported by the increasing resistance rate of this pathogen against a number of commonly used antimicrobial compounds. For instance, 6% of 331 evaluable S. typhi strains were resistant to ampicillin, chloramphenicol, and cotrimoxazole, and 22% of isolates were resistant to at least one of these three agents in a recent survey performed in the united states.6 The spread of antibiotic resistance among S. typhi isolates is emerging in many countries, and multidrug-resistant strains have been isolated, as well as isolates with poor susceptibility to fluoroquinolones,3-5,7-9 so that in vitro susceptibility should be determined for all cultured strains, and antimicrobial treatment should be adjusted accordingly. Nevertheless, fluoroquinolones (e.g., ciprofloxacin and pefloxacin) or third-generation cephalosporins, still represent the best choice for empirical treatment,2,4,6-8,10 and mortality remains rare in Western countries (less than 1% of episodes), although it is expected to be greater in developing areas of the world. The aim of this report is to describe two cases of typhoid fever that occurred in patients with human immunodeficiency virus (hiv) infection, a rarely reported disease association in industrialized countries. ( info)

2/220. Systemic lupus erythematosus-associated catastrophic antiphospholipid syndrome occurring after typhoid fever: a possible role of Salmonella lipopolysaccharide in the occurrence of diffuse vasculopathy-coagulopathy.

    We report a case of well-documented typhoid fever in a 30-year-old woman with inactive systemic lupus erythematosus with asymptomatic lupus anticoagulant and high-titer anticardiolipin antibody (aCL). Despite prompt eradication of the salmonella typhi obtained with appropriate antibiotic therapy, multiple organ system dysfunction occurred. The central nervous system was involved, with ischemic infarcts in the occipital lobes. High-dose corticosteroid therapy failed to improve the neurologic manifestations, which responded to repeated plasmapheresis. A sharp fall in aCL and anti-beta2-glycoprotein I antibody titers was recorded before the start of plasmapheresis. At the same time, IgM and IgG antibodies to Salmonella group O:9 lipopolysaccharide became detectable; the IgM antibodies disappeared within 4 months, whereas the IgG antibodies remained detectable during the next 13 months. Despite treatment with high-dose corticosteroids and cyclophosphamide, rapidly progressive glomerulonephritis developed, leading to chronic renal failure. There is convincing evidence of a link between the S. typhi infection and the ensuing catastrophic syndrome in this patient, probably precipitated by bacterial antigens. ( info)

3/220. typhoid fever due to Salmonella Kapemba infection in an otherwise healthy middle-aged man.

    We report the case of a patient with a Salmonella Kapemba infection, who suffered, 3 weeks after a holiday in israel, occurrences of high fever and lower back pain for 10 days and icterus for 2 days before admission. Laboratory findings revealed a slight cholestasis and elevation of acute phase protein levels. In the blood culture a Salmonella Kapemba-type organism was cultured. The patient was afebrile for 10 days after hospitalization and then suddenly developed a temperature of 40 degrees C again. At the same time leukopenia, thrombocytopenia, and a rise of D-dimer levels were detected. The patient was admitted to the intensive care unit for a few days, because a disseminated intravascular coagulation was suspected. With magnetic resonance imaging and bone scintigraphy no osteomyelitis or abscess formation could be found. A transesophageal ultrasonography of the heart revealed no signs of endocarditis. In multiple stool cultures no salmonellas could be detected. After antibiotic treatment with ciprofloxacin the fever and lower back pain subsided, and the patient was discharged a fortnight later. This is the first reported case of typhoid fever due to the bacterium Salmonella Kapemba. ( info)

4/220. Histopathology of typhoid enteritis: morphologic and immunophenotypic findings.

    Enteric fever is a systemic illness caused by Salmonella infection, with S. typhi, S. paratyphi, and S. enteritidis being the most common serotypes. humans are the only reservoir for S. typhi, and its predilection for the ileum is due to the fact that organisms enter the body by translocation across specialized Peyer's patch epithelium and then proliferate in the mucosal macrophages. The lesions in bowel and mesenteric lymph nodes are distinctive and mimic Kikuchi-Fujimoto disease and Rosai-Dorfman disease as well as infections caused by some non-salmonella bacteria. The four cases presented in this report, two culture-confirmed, all exhibited ileal mucosal hypertrophy caused by a neutrophil-poor monocyte/macrophage-rich hyperplasia. Though diffuse areas were present, much of the lesional proliferation was nodular, representing macrophage infiltration and colonization by the monocytes and macrophages. Immunophenotypic studies, which showed a CD68 , lysozyme , UCHL-1 , OPD4-, CD4-, s100- profile, were helpful in distinguishing these lesions from other processes, including Kikuchi-Fujimoto disease and Rosai-Dorfman disease. Although rare in developed countries, enteric fever should be considered in any patient with recent travel to endemic areas and in the context of illness thought to be related to contaminated foods. ( info)

5/220. Skip colonic ulceration in typhoid ileo-colitis.

    Colonic skip lesions are typically described in Crohn's colitis, but this phenomenon has been recognized in ulcerative colitis (skipped appendiceal involvement), Behcet's colitis, cytomegaloviral colitis, and even in aeromonas hydrophilia and histoplasma capsulatum infection. However, skip lesions in typhoid ileo-colitis have not been reported in the English-language literature. We report herein a patient with skip ulcers due to typhoid fever. ( info)

6/220. Chronic chest wall sinus: an unusual presentation of typhoid.

    A chronic discharging sinus of the chest wall is described in a 59-year-old Maori woman investigated as a typhoid contact. A heavy growth of salmonella typhi organisms was cultured from the sinus, which had first appeared 13 years previously. ( info)

7/220. Acute respiratory distress syndrome complicating typhoid fever.

    We report a case of a young female patient with typhoid fever whose clinical course was complicated by hypotension, thrombocytopenia, encephalopathy and acute respiratory distress syndrome (ARDS). She recovered with prompt mechanical ventilatory support. ARDS in typhoid fever has generally proved to be fatal in reported cases. ( info)

8/220. Reactive arthritis associated with typhoid vaccination in travelers: report of two cases with negative HLA-B27.

    As international travel to developing countries increases, more people seek medical advice concerning food and water-borne diseases, including typhoid fever. Prevention of typhoid fever in high-risk groups (travelers to endemic areas, laboratory workers and household contacts of typhoid carriers) should rely primarily on prevention of exposure. However, immunization is an important adjunct. The decision to immunize against typhoid fever should be individualized, taking into account the benefits versus the risk of possible adverse reactions. Cases of reactive arthritis have been associated with the heat-phenol inactivated 'whole cell' parenteral vaccine, but to our knowledge reactive arthritis has not been previously reported with the oral form (Ty21a). This is a report of HLA-B27 negative reactive arthritis occurring in two travelers after the administration of oral Ty21a typhoid vaccine. ( info)

9/220. intestinal perforation secondary to salmonella typhi: case report and review of the literature.

    The case of a young woman presenting with fever, abdominal distention, and diarrhea is presented. While hospitalized, she developed peritonitis, and a laparotomy was performed emergently. Intraoperative and pathologic examinations are highly suggestive of salmonella typhi as an etiology for her symptoms and eventual perforation. Salmonella enteritis can be a difficult diagnosis to make, but in most cases it is a self-limited disease process. In a minority of cases, multidrug antibiotic therapy may be required secondary to an increasing prevalence of resistant strains. patients who perforate require prompt operation to limit morbidity and mortality. Outcome is significantly improved in those patients by directed resection of the affected segment of bowel and by aggressive perioperative care. ( info)

10/220. Multiple brain abscesses caused by salmonella typhi: case report.

    BACKGROUND: Focal intracranial infections caused by Salmonella species are uncommon. The authors report a case of multiple brain abscesses caused by salmonella typhi. CASE DESCRIPTION: A 2-month-old girl was admitted to the hospital because of diarrhea, vomiting, fever, and poor feeding. Neurological examination revealed cervical hyperextension and absence of sucking and Moro reflexes. During the next 20 hours she developed complex partial seizures with secondary generalization and alternated irritability with drowsiness. Investigation showed hemoglobin 6.3 g/dl; white blood cell count of 19500/mm3 with a marked shift to the left. The analysis of the cerebrospinal fluid revealed white cell count of 1695/mm3, lymphocytes 61%, protein 300 mg/dl and glucose 6 mg/dl. The patient was treated for acute gastroenterocolitis, sepsis, and meningitis. Blood culture taken on the day of admission showed gram-negative bacilli, later identified as S. typhi. Computed tomography scan demonstrated a lesion in the right parietal lobe compatible with a brain abscess. Follow-up computed tomography after 7 days showed several other lesions with the same features. Surgical drainage of the right parietal lesion was performed on the 13th day, through a burr hole. The patient was discharged 5 weeks after admission without neurological deficit. CONCLUSION: bacteremia, sepsis, and meningitis are relatively common in children with Salmonella infection but intracranial abscesses are very rare. Surgical drainage combined with prolonged antibiotic therapy (drug of choice: chloramphenicol) is the best treatment for Salmonella brain abscesses. The possibility of intracranial infection should be considered in patients with Salmonellosis and neurological dysfunction. ( info)
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