Changing pattern of typhoid fever

      This paper is only available as a PDF. To read, Please Download here.


      A prospective clinical and microbiologic study was carried out in ninety-eight cases of typhoid fever over a period of eighteen months. The diagnosis was made by positive blood culture or rising Widal agglutination titers. Eighty-two per cent of patients presented with insidious onset of fever accompanied by constitutional symptoms in the first or second week; in the remaining 18 per cent the illness started abruptly with atypical features such as acute gastroenteritis, hemiplegia and hematuria. Clinical features included moderate to high continuous or remittent pyrexia in 54 per cent, intermittent pyrexia in 46 per cent, bronchitic chest signs in 50 per cent, encephalopathy in 44 per cent and splenic enlargement in 38 per cent. Rose spots and relative bradycardia were either absent or rare. Complications developed in forty-one patients, notably circulatory failure (61 per cent) and encephalopathy (35 per cent); thirteen patients died of these. Widal agglutination titers (TO and TH) more than Math Eq were noted in twenty-two of fifty-seven patients admitted in the first week, twenty-three of twenty-eight patients in the second week and eleven of thirteen patients in the third week. Blood culture was positive in forty-six cases (twenty-nine in the first week, twelve in the second week and five in the third week of illness).
      Improvement occurred with chloramphenicol. Fever and toxemia settled within three to five days; encephalopathic manifestations persisted in six patients for two to four weeks. Agglutination titers were raised or remained the same in the majority of patients. The effect of chloramphenicol on agglutination titers was variable, corticosteroids usually depressed the titers. The blood culture became sterile in all but one resistant case.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Huckstep R.L.
        Typhoid Fever and other Salmonella Infections.
        in: E. & S. Livingstone, Ltd, London1962: 4
        • Woodward T.E.
        • Smadel T.E.
        • Leg H.L.
        • Gren R.
        • Mankikar D.S.
        Preliminary report on the beneficial effect of chloromycetin on the treatment of typhoid fever.
        Ann. Int. Med. 1948; 29: 131
        • Stuart A.
        • Pullen L.R.
        Typhoid fever; clinical analysis of three hundred and sixty cases.
        Arch. Int. Med. 1946; 78: 629
        • Osler W.
        Principles and Practice of Medicine.
        in: 8th ed. D. Appleton & Co, New York and London1912: 1
        • El-Ramli A.H.
        Chloramphenicol in typhoid and paratyphoid fevers.
        Lancet. 1953; 1: 927
        • Dreyer G.
        • Imman A.C.
        The agglutination test and its importance in the diagnosis of typhoid and paratyphoid fever in occulated persons.
        Lancet. 1917; 1: 365
        • Singh B.
        Agglutination reaction in the diagnosis of enteric fever.
        J. Indian M. A. 1951; 20: 248
        • Blasi R.D.
        Boll, Ist. Sievoter, Milan. 1950; 29: 11
        • Blasi R.D.
        (Cited by Wilson and Miles)5th ed. Principles of Bacteriology and Immunity. vol. 11. Edward Arnold & Co, London1964: 1847
        • Subramanyam P.
        Action of chloromycetin on the production of antibodies in typhoid fever.
        J. Indian M. A. 1952; 22: 99
        • El-Rooby A.
        • Gohar A.A.
        Effect of chloramphenicol on the agglutinin titre in enteric fevers.
        J. Trop. Med. 1956; 59: 57
        • Wilson G.S.
        • Miles A.A.
        5th ed. Principles of Bacteriology and Immunity. vol. 11. Edward Arnold & Co, London1964: 1847
        • Hammond S.
        • Harris T.N.
        Relation of adrenal cortical steroids to antibody release.
        in: 5th ed. Proc. Soc. Exper. Biol. & Med.74. 1950: 155
        • Fischel E.E.
        • Stoerck H.C.
        • Bjornboe M.
        Failure of cortisone to affect rate of disappearance of antibody protein.
        in: 5th ed. Proc. Soc. Exper. Biol. & Med.77. 1967: 111
        • Main R.G.
        Treatment of chronic alimentary enteria carriers.
        Brit. M. J. 1961; 1: 328
        • Perkins J.C.
        • Devetski R.L.
        • Dowling H.F.
        Ampicillin in the treatment of salmonella carriers.
        Arch. Int. Med. 1966; 118: 528