Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:


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 January 2003

6372.  Donmez O, Basdemir G. Presentation of a case with Salmonella glomerulonephritis. Turk J Pediatr  2002 Jul-Sep;44(3):267-8


Salmonella infection is frequently encountered in childhood, but it is rarely associated with glomerulonephritis. We present in this report a case with Salmonella glomerulonephritis, which is infrequent in children. His general condition was found moderate, and temperature and blood pressure were 38 degrees C and 150/90 mmHg, respectively. The whole blood counts were as follows: white blood cell count 3,800/mm3, hemoglobin 6.3 g/dl and platelet count 240,000/mm3. Serum urea was 140 mg/dl, albumin 2.5 g/dl and complement (C3) 23.6 mg/dl. Both Salmonella type O and Salmonella typhi H were detected positive (1/800 titer). In view of these findings, the case was considered as Salmonella glomerulonephritis; his clinical and laboratory recovery were achieved by supportive therapy.


6373.  Dutta P, Mitra U, Dutta S, De A, Chatterjee M K, Bhattacharya S K. Ceftriaxone therapy in ciprofloxacin treatment failure typhoid fever in children. Indian J med Res 2001; 113 (June), 210-3 No abstract.

6374.  House D, Chinh NT, Hien TT, Parry CP, Ly NT, Diep TS, Wain J, Dunstan S, White NJ, Dougan G, Farrar JJ. Cytokine release by lipopolysaccharide-stimulated whole blood from patients with typhoid fever. J Infect Dis  2002 Jul 15;186(2):240-5


The ex vivo cytokine response to lipopolysaccharide (LPS) of whole blood from patients with typhoid fever was investigated. Tumor necrosis factor (TNF)-alpha release by LPS-stimulated blood was found to be lower during acute typhoid fever than after a course of antimicrobial therapy (P<or=.001). Ex vivo interleukin (IL)-1beta, but not IL-1 receptor antagonist, release was also depressed during the acute stage of typhoid fever. Low ex vivo production of TNF-alpha was associated with delayed recovery. No association was found between the TNFA-308 promoter polymorphism and LPS-induced TNF-alpha release, either during an active infection or after treatment. In acute typhoid fever, the ability of peripheral blood leukocytes to release proinflammatory cytokines in response to an inflammatory stimulus is depressed, and this may contribute to delayed recovery following antibiotic treatment.


6375.  Ismail TF, Smits H, Wasfy MO, Malone JL, Fadeel MA, Mahoney F. Evaluation of dipstick serologic tests for diagnosis of brucellosis and typhoid Fever in egypt. J Clin Microbiol  2002 Sep;40(9):3509-11.


Two dipstick assays for the detection of Brucella- and typhoid-specific immunoglobulin M, recently developed by the Royal Tropical Institute of The Netherlands, were evaluated by use of 85 plasma samples from Egyptian patients. Both dipsticks were simple and accurate rapid diagnostic assays, and they can be useful adjuncts for the diagnosis of typhoid fever and brucellosis.


6376.  Hindle Z, Chatfield SN, Phillimore J, Bentley M, Johnson J, Cosgrove CA, Ghaem-Maghami M, Sexton A, Khan M, Brennan FR, Everest P, Wu T, Pickard D, Holden DW, Dougan G, Griffin GE, House D, Santangelo JD, Khan SA, Shea JE, Feldman RG, Lewis DJ. Characterization of Salmonella enterica derivatives harboring defined aroC and Salmonella pathogenicity island 2 type III secretion system (ssaV) mutations by immunization of healthy volunteers. Infect Immun  2002 Jul;70(7):3457-67.


The attenuation and immunogenicity of two novel Salmonella vaccine strains, Salmonella enterica serovar Typhi (Ty2 Delta aroC Delta ssaV, designated ZH9) and S. enterica serovar Typhimurium (TML Delta aroC Delta ssaV, designated WT05), were evaluated after their oral administration to volunteers as single escalating doses of 10(7), 10(8), or 10(9) CFU. ZH9 was well tolerated, not detected in blood, nor persistently excreted in stool. Six of nine volunteers elicited anti-serovar Typhi lipopolysaccharide (LPS) immunoglobulin A (IgA) antibody-secreting cell (ASC) responses, with three of three vaccinees receiving 10(8) and two of three receiving 10(9) CFU which elicited high-titer LPS-specific serum IgG. WT05 was also well tolerated with no diarrhea, although the administration of 10(8) and 10(9) CFU resulted in shedding in stools for up to 23 days. Only volunteers immunized with 10(9) CFU of WT05 mounted detectable serovar Typhimurium LPS-specific ASC responses and serum antibody responses were variable. These data indicate that mutations in type III secretion systems may provide a route to the development of live vaccines in humans and highlight significant differences in the potential use of serovars Typhimurium and Typhi.

6377.  Katz DJ, Cruz MA, Trepka MJ, Suarez JA, Fiorella PD, Hammond RM. An outbreak of typhoid Fever in Florida associated with an imported frozen fruit. J Infect Dis  2002 Jul 15;186(2):234-9


An outbreak of typhoid fever in Florida involving at least 16 persons during the winter of 1998-99 was investigated using case-control, environmental, and laboratory methods. The genomic profiles of Salmonella serovar Typhi (Salmonella Typhi) isolates from the 15 confirmed case subjects were identical. Consumption of fruit shakes made with frozen mamey, a tropical fruit, was significantly associated with illness (matched odds ratio, 7.6; 95% confidence interval, 1.4-81.4). Laboratory testing showed that the fruit was heavily contaminated with fecal coliforms; no Salmonella Typhi was isolated. The frozen mamey was prepared in plants in Guatemala and Honduras. No further cases occurred after the frozen product was recalled. As our nation's food sources become increasingly globalized, the risk of outbreaks of exotic diseases linked to contaminated imported food will increase. This outbreak highlights the need for new approaches to ensure the safety of our food supply.


6378.  Salerno-Goncalves R, Pasetti MF, Sztein MB. Characterization of CD8(+) effector T cell responses in volunteers immunized with Salmonella enterica serovar Typhi strain Ty21a typhoid vaccine. J Immunol  2002 Aug 15;169(4):2196-203.


Salmonella enterica serovar Typhi (S. typhi) strain Ty21a remains the only licensed attenuated typhoid vaccine. Despite years of research, the identity of the protective immunological mechanisms elicited by immunization with the Ty21a typhoid vaccine remains elusive. The present study was designed to characterize effector T cell responses in volunteers immunized with S. typhi strain Ty21a typhoid vaccine. We determined whether immunization with Ty21a induced specific CTL able to lyse S. typhi-infected cells and secrete IFN-gamma, a key effector molecule against intracellular pathogens. We measured the functional activity of these CTL by a (51)Cr-release assay using 8-day restimulated PBMC from Ty21a vaccinees as effector cells and S. Typhi-infected autologous PHA-activated PBMC as target cells. Most vaccinees exhibited consistently increased CD8-mediated lysis of targets by postimmunization PBMC when compared with preimmunization levels. We also developed an IFN-gamma ELISPOT assay to quantify the frequency of IFN-gamma spot-forming cells (SFC) in PBMC from Ty21a vaccinees using an ex vivo system. Significant increases in the frequency of IFN-gamma SFC following immunization (mean +/- SD, 393 +/- 172; range 185-548 SFC/10(6) PBMC; p = 0.010), as compared with preimmunization levels, were observed. IFN-gamma was secreted predominantly by CD8(+) T cells. A strong correlation was recorded between the cytolytic activity of CTL lines and the frequency of IFN-gamma SFC (r(2) = 0.910, p < 0.001). In conclusion, this work constitutes the first evidence that immunization of volunteers with Ty21a elicits specific CD8(+) CTL and provides an estimate of the frequency of CD8(+) IFN-gamma-secreting cells induced by vaccination.


6379.  Shankar PS; Dagaonkar SV. K J Somaiya Medical College And Research Centre, Somaiya Ayurvihar Complex, Eastern Express Highway, Sion, Mumbai-400022, India Efficacy and Safety of levofloxacin in the treatment of typhoid fever in hospitalized adults Indian Practitioner. 2002 Mar; 55(3): 139-44.

ABSTRACT: An open, non-comparative prospective study was undertaken to identify the efficacy and safety of levofloxacin 500 mg OD oral/IV in the management of acute uncomplicated typhoid fever in adults. The therapy was monitored for 14 days in 30 adult patients with fever for over 5 days, clinically exhibiting features of typhoid fever. The patients were subjected to Widal's test for further confirmation. Levofloxacin 500 mg OD Oral/IV showed excellent to fair clinical response in 100 percent (28) of the evaluated patients (28). Therapy was not evaluated in 2 patients as they were discharged before completion of therapy. Mild and transient side effects were reported, which were predominantly GI related and were relieved in a day or two. However, the adverse effect-cause relationship was not established in any case. Thus, Levofloxacin was found to be an effective and well tolerated quinolone in the treatment of typhoid fever

6380.  Sharma D, Bhansali M, Saxena A, Raina VK. Treatment of typhoid ileal perforation by resection and temporary ileostomy. Indian J Gastroenterol  2002 Sep-Oct;21(5):205-6.  No abstract.



April 2003



Pathogenesis :

   6957.  Crump JA, Griffin PM, Angulo FJ. Bacterial contamination of animal feed and its relationship to human foodborne illness. Clin Infect Dis  2002 Oct 1;35(7):859-65.

Animal feed is at the beginning of the food safety chain in the "farm-to-fork" model. The emergence of variant Creutzfeldt-Jakob disease has raised awareness of the importance of contaminated animal feed, but less attention has been paid to the role of bacterial contamination of animal feed in human foodborne illness. In the United States, animal feed is frequently contaminated with non-Typhi serotypes of Salmonella enterica and may lead to infection or colonization of food animals. These bacteria can contaminate animal carcasses at slaughter or cross-contaminate other food items, leading to human illness. Although tracing contamination to its ultimate source is difficult, several large outbreaks have been traced back to contaminated animal feed. Improvements in the safety of animal feed should include strengthening the surveillance of animal feed for bacterial contamination and integration of such surveillance with human foodborne disease surveillance systems. A Hazard Analysis and Critical Control Point program should be instituted for the animal feed industry, and a Salmonella-negative policy for feed should be enforced.


              Vaccines :

    6958.  Lundin BS, Johansson C, Svennerholm AM. Oral immunization with a Salmonella enterica serovar typhi vaccine induces specific circulating mucosa-homing CD4(+) and CD8(+) T cells in humans. Infect Immun  2002 Oct;70(10):5622-7

The kinetics and homing characteristics of T-cell responses in humans after mucosal immunizations have not been well characterized. Therefore, we have investigated the magnitude and duration of such responses as well as the homing receptor expression of antigen-specific peripheral blood T cells by using an oral model vaccine, i.e., the live, attenuated Salmonella enterica serovar Typhi vaccine (Ty21a). Eight volunteers were each given three doses of the vaccine 2 days apart, and blood samples, from which CD4(+) and CD8(+) T cells were selected by the use of magnetic beads, were collected before vaccination and at regular intervals thereafter. To purify the potentially antigen- specific gut-homing T cells, CD45RA(-) integrin beta(7)(+) cells were further sorted by flow cytometry. The sorted cells were then stimulated in vitro with the serovar Typhi vaccine strain, and the proliferation of cells and the cytokine production were measured. Following vaccination, there was a large increase in both the proliferation of and the gamma interferon (IFN-gamma) production by blood T cells stimulated with the vaccine strain. The responses were seen among both CD4(+) and CD8(+) T cells, although the CD8(+) cells produced the largest amounts of IFN-gamma. Peak responses were seen 7 to 14 days after the onset of vaccination. Furthermore, most of the IFN-gamma produced by both CD4(+) and CD8(+) cells emanated from cells with the potential to home to mucosal tissues, as the integrin beta(7)-expressing memory T cells produced around 10-fold more IFN-gamma than the remaining populations. In conclusion, we demonstrate that oral vaccination with a live oral bacterial vaccine induces antigen-specific CD4(+) and CD8(+) memory T cells, almost all of which express the gut-homing integrin beta(7).


              Therapy :

   6959.  Shankar PS; Dagaonkar SV. Efficacy and Safety of levofloxacin in the treatment of typhoid fever in hospitalized adults Indian Practitioner. 2002 Mar; 55(3): 139-44.

An open, non-comparative prospective study was undertaken to identify the efficacy and safety of levofloxacin 500 mg OD oral/IV in the management of acute uncomplicated typhoid fever in adults. The therapy was monitored for 14 days in 30 adult patients with fever for over 5 days, clinically exhibiting features of typhoid fever. The patients were subjected to Widal's test for further confirmation. Levofloxacin 500 mg OD Oral/IV showed excellent to fair clinical response in 100 percent (28) of the evaluated patients (28). Therapy was not evaluated in 2 patients as they were discharged before completion of therapy. Mild and transient side effects were reported, which were predominantly GI related and were relieved in a day or two. However, the adverse effect-cause relationship was not established in any case. Thus, Levofloxacin was found to be an effective and well tolerated quinolone in the treatment of typhoid fever.


July 2003 


7555.  Agarwal N K, Agarwal S. Acute reversible cerebellar ataxia in typhoid fever. J Indian Acad Clin Med 2002, 3(1), 96-7. (19635) Vol 38 No 19 Oct 2023

7556.  Ghandage D P, Bai A M. Entreic fever due to Salmonella weltevreden in a four-year old child. Indian J med Sci 2002, 56(6), 273-5. (21867)Vol 38, No. 21, 1 Nov 2023 .

7557.  Joshi S, Wattal C, Sharma A, Prasad K J. Mixed Salmonella infection. Indian J med Microbiol 2002, 20(2), 113-14. (21900)Vol 38, No. 21, 1 Nov 2002.

7558.  Kapil A, Reuka, Das B. Nalidixic acid susceptibility test to screen ciprofloxacin resistance in Samlonella typhi. Indian J med Res 2002, 115(Feb), 49-54.(21906)Vol 38, No. 21, 1 Nov 2002.

7559.  Saha M R, Dutta P, Niyogi S K, Dutta S, Mitra U, Ramamurthy T, Manna B, Bhattacharya S K. Decreasing trend in the occurrence of Salmonella enterica serotype Typhi amoungst hospitalised children in Kolkata, India during 1990-2000. Indian J med Res 2002, 115(Feb). 46-8. (22021)Vol 38, No. 21, 1 Nov 2002.



7560.  Boddicker JD, Knosp BM, Jones BD. Transcription of the Salmonella invasion gene activator, hilA, requires HilD activation in the absence of negative regulators. J Bacteriol  2003 Jan;185(2):525-33

Salmonella enterica serovar Typhimurium causes human gastroenteritis and a systemic typhoid-like infection in mice. Infection is initiated by entry of the bacteria into intestinal epithelial cells and is mediated by a type III secretion system that is encoded by genes in Salmonella pathogenicity island 1. The expression of invasion genes is tightly regulated by environmental conditions such as oxygen and osmolarity, as well as by many bacterial factors. The hilA gene encodes an OmpR/ToxR family transcriptional regulator that activates the expression of invasion genes in response to both environmental and genetic regulatory factors. HilD is an AraC/XylS regulator that has been postulated to act as a derepressor of hilA expression that promotes transcription by interfering with repressor binding at the hilA promoter. Our research group has identified four genes (hilE, hha, pag, and ams) that negatively affect hilA transcription. Since the postulated function of HilD at the hilA promoter is to counteract the effects of repressors, we examined this model by measuring hilA::Tn5lacZY expression in strains containing negative regulator mutations in the presence or absence of functional HilD. Single negative regulator mutations caused significant derepression of hilA expression, and two or more negative regulator mutations led to very high level expression of hilA. However, in all strains tested, the absence of hilD resulted in low-level expression of hilA, suggesting that HilD is required for activation of hilA expression, whether or not negative regulators are present. We also observed that deletion of the HilD binding sites in the chromosomal hilA promoter severely decreased hilA expression. In addition, we found that a single point mutation at leucine 289 in the C-terminal domain of the alpha subunit of RNA polymerase leads to very low levels of hilA::Tn5lacZY expression, suggesting that HilD activates transcription of hilA by contacting and recruiting RNA polymerase to the hilA promoter.

7561.  Mills-Robertson F, Crupper SS, Addy ME, Mensah P. Antibiotic resistance and genotyping of clinical group B Salmonella isolated in Accra, Ghana. J Appl Microbiol  2003;94(2):289-94

AIMS: The purpose of this study was to investigate the antibiotic resistance and clonal lineage of serogroup B Salmonella isolated from patients suspected of suffering from enteric fever in Accra, Ghana. METHODS AND RESULTS: Serogroup B Salmonella were isolated from blood (n=28), cerebral spinal fluid (CSF) (n=1), or urine (n=2), and identified based on standard biochemical testing and agglutinating antisera. Isolates were examined for their susceptibility to ampicillin, chloramphenicol, tetracycline and trimethoprim-sulfamethoxazole. Most of the isolates could be classified as multiple-drug resistant. Furthermore, the genetic location of resistance genes was shown to be on conjugative plasmids. Genetic fingerprinting by plasmid profiling, enterobacterial repetitive intergenic consensus (ERIC)-PCR, and repetitive element (REP)-PCR were performed to determine the diversity among the isolates. Plasmid profiling discriminated five unique groupings, while ERIC-PCR and REP-PCR resulted in two and three groupings, respectively. CONCLUSIONS: A high rate of antibiotic resistance was associated with the Salmonella isolates and the genes responsible for the resistance are located on conjugative plasmids. Also, there appears to be minimal diversity associated with the isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: As a result of the increasing antibiotic resistance among bacteria of all genera, surveys to monitor microbial populations are critical to determine the extent of the problem. The inability to treat many infectious diseases with current antibiotic regimens should prompt the medical community to be more prudent with its antibiotic use.


7562.  Chia S, Ludlam CA, Fox KA, Newby DE.Acute systemic inflammation enhances endothelium-dependent tissue plasminogen activator release in men. J Am Coll Cardiol  2003 Jan 15;41(2):333-9

OBJECTIVES: The purpose of this study was to investigate in vivo the effects of acute systemic inflammation on the endogenous fibrinolytic capacity in men. BACKGROUND: Systemic inflammation and endogenous fibrinolysis play a major role in the pathogenesis of coronary artery disease. Although previous studies have shown impaired endothelium-dependent vasomotor function, the effects of inflammation on the endothelial release of the fibrinolytic factor tissue plasminogen activator (t-PA) are unknown. METHODS: In a double-blind randomized placebo-controlled crossover trial, we administered a mild inflammatory stimulus, Salmonella typhi vaccine, or saline placebo to eight healthy men on  two separate occasions. Six hours after vaccination, blood flow and plasma fibrinolytic variables were measured in both arms during intrabrachial infusions of bradykinin (40 to 1,000 pmol/min), acetylcholine (5 to 20 microg/min), and sodium nitroprusside (2 to 8 microg/min). RESULTS: Compared with placebo, the S. typhi vaccination caused a rise in white cell count (11.1 +/- 0.5 x10(9)/l vs. 7.9 +/- 0.8 x10(9)/l; p = 0.004) and plasma interleukin-6 concentrations (6.9 +/- 1.4 pg/ml vs. 1.6 +/- 0.4 pg/ml; p = 0.01) in addition to a significant augmentation of t-PA antigen (45 +/- 9 ng/100 ml/min at peak dose vs. 24 +/- 8 ng/100 ml/min at peak dose; p = 0.016, analysis of variance) and activity (104 +/- 15 IU/100 ml/min vs. 54 +/- 12 IU/100 ml/min; p = 0.006, analysis of variance) release during bradykinin infusion. Forearm blood flow increased in a dose-dependent manner after bradykinin, acetylcholine and sodium nitroprusside infusions (p < 0.001), but this was unaffected by vaccination. CONCLUSIONS: Our results showed that acute systemic inflammation augmented local forearm t-PA release in men, which suggests that acute inflammation may invoke a protective response by enhancing the acute endogenous fibrinolytic capacity in healthy men. Further studies are needed to clarify whether this response is impaired in patients with cardiovascular disease.



7563.  Basnyat B.Typhoid fever. N Engl J Med  2003 Mar 20;348(12):1182-4 No abstract available.

7564.  Zaidi AK, Hasan R, Bhutta ZA.Typhoid fever. N Engl J Med  2003 Mar 20;348(12):1182-4; No abstract available.


October 2003


8211.  Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, Oun SA, Mahoney FJ. Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerg Infect Dis. 2003 May;9(5):539-44. 


To measure the incidence of typhoid fever and other febrile illnesses in Bilbeis District, Egypt, we conducted a household survey to determine patterns of health seeking among persons with fever. Then we established surveillance for 4 months among a representative sample of health providers who saw febrile patients. Health providers collected epidemiologic information and blood (for culture and serologic testing) from eligible patients. After adjusting for the provider sampling scheme, test sensitivity, and seasonality, we estimated that the incidence of typhoid fever was 13/100,000 persons per year, and the incidence of brucellosis was 18/100,000 persons per year in the district. This surveillance tool could have wide applications for surveillance for febrile illness in developing countries.



8212.  Singh MK, Choudhuri G. Re: Dutta et al.-gallbladder cancer. Am J Gastroenterol. 2003 Apr;98(4):936; author reply 936-7.  No abstract.



8213.  Ajaiyeoba EO, Oladepo O, Fawole OI, Bolaji OM, Akinboye DO, Ogundahunsi OA, Falade CO, Gbotosho GO, Itiola OA, Happi TC, Ebong OO, Ononiwu IM, Osowole OS, Oduola OO, Ashidi JS, Oduola AM. Cultural categorization of febrile illnesses in correlation with herbal remedies used for treatment in Southwestern Nigeria. J Ethnopharmacol. 2003 Apr;85(2-3):179-85. 


The ethnographic study was conducted in two communities in Oyo State in Southwestern Nigeria. The study sites consisted of a rural and an urban local government area located in the tropical rain forest zone of Nigeria. The study was designed to obtain information on febrile illnesses and herbal remedies for treatment with the aim of identifying potential antimalarial drugs. The study revealed that fever is a general term for describing illnesses associated with elevated body temperature. The indigenous Yoruba ethnic population has categorized fever based on symptoms and causes. The present communication is the result of focus group discussion and semi-structured questionnaire administered to traditional healers, herb sellers, elders and mothers. This was on types of fevers, symptoms and causes of febrile illnesses. The investigation also included use of traditional herbs in the prevention and treatment of the illnesses in the two communities.A total of 514 respondents were interviewed. This was made up of 266 (51.8%) from Atiba local government area (LGA), an urban centre while 248 (48.2%) respondents were interviewed from Itesiwaju LGA, a rural community. The LGAs are located in Oyo State of Nigeria. The respondents proffered 12 types of febrile illnesses in a multiple response answering system in Yoruba language. The most common ones (direct translation into English) were: yellow fever (39.1%), typhoid (34.8%), ordinary (28.8%), rainy season (20.8%) and headache (10.5%) fevers, respectively. Perceived causes of each of the febrile illnesses included stress, mosquito bites, unclean water, rains and over exposure to the sun. Methods of fever prevention were mainly with the use of herbal decoctions, powdered herbs, orthodox medications and maintenance of proper hygiene.Of a total of 112 different herbal remedies used in the treatment of the febrile illnesses compiled from the study, 25 recipes are presented. Recipes consisted of 2-7 ingredients. Oral decoctions (84%), oral powders (63%), use as soaps and creams (40%) in a multiple response system, were the most prevalent routes of administration of prepared herbs used in the treatment of the fevers. Boiling in water or alcohol was the most common method used in the preparation of the remedies. The four most frequently mentioned (multiple response system) plants in the Southwest ethnobotany for fevers were Azadirachta indica (87.5%), Mangifera indica (75.0%), Morinda lucida (68.8%) and Citrus medica (68.8%).


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